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Author Topic: Meniscus transplant, second ACL revision  (Read 17780 times)

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Offline ferdiscat

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Re: Meniscus transplant, second ACL revision
« Reply #45 on: August 29, 2016, 04:51:42 AM »
Hello Adam (and Ben and Pilgrim!),

Nice to hear from you all, and I appreciate the kind words. I see I have a lot to catch up on, so I'll give a quick summary of where I am now:

I finished with my course of PT about two weeks ago, after just 15 months of therapy. I had an option to continue on with a return to sport program, but my therapist, my surgeon, and discussed it and decided that focusing on agility training and plyometrics would be too risky right now, and ultimately not of much benefit. I miss PT and the accountability it forced me to have, but it is great to feel like I'm returning to "normal life" again. Adam, like you, I have been going to the gym about once a week, and want to step it up, but classes and work got crazy. I'm glad to be back in school but this semester is going to be a doozy. Silly as it sounds, I signed up for a course of "Fitness Walking" at my school, just to stay a little bit disciplined. I still have pain, swelling, and soreness, but I was told to expect that for at least another year or two. I'm getting used to it at this point. I'm still struggling to get back to a pre-surgery weight, but it's getting easier.

In JOYFULLY EXCITING news, I'm running again! ... Kind of. I started over completely on the Couch to 5K program, and I'm taking it realllly slow. (I'm on week 4).

Adam, congrats on your successes in school! How is everything going? Is that clicking still bothering you? My stitch that pops out of my tibia is still driving me crazy, but I am really not in the mood to go under the knife again.

Ben, so sorry to hear of your troubles. I'm glad to hear though that the surgery went fairly well. Were they able to check on the OATs site? My younger brother had an OATs procedure done a few years back and he's had no problem since, but where he was living at the time it was a hellish experience to get insurance to cover the surgery. I guess that's one of many benefits of the Steadman Clinic! I briefly entertained the notion of traveling out there to have another opinion (both of my brothers live near Copper). My surgeon, by the by, is Dr. Volker Musahl at UPMC (in Pittsburgh), and I recommend him highly, and would be happy to talk to anyone about my experiences with him.

I digress, however! So you're doing PT with a therapist twice a day, or independently? What do they have you working on? Was Dr. Laprade able to repair anything on your lateral meniscus? Is the prognosis generally good for your medial? Even a year out, I'm still having nightmares about doing anything to harm either of my meniscii. Like Adam, I have trouble imagining returning to any sport more high impact than jogging at this point. Are you hoping to return to sport?

Hey Pilgrim,

What kind of surgery are you having to consider?

I can also say that talking to Adam was incredibly helpful to have throughout the year - I really looked forward (and still do!) to our correspondence. I think it's really isolating to go through repeated surgeries, especially when you're used to an active lifestyle. It's so helpful to know that someone is going through a similar experience, and even though I wouldn't wish it on anyone, it was serendipitous that Adam and I were going through the same transplant at roughly the same time. Even just comparing exercises made the very slow progress a little bit more bearable. So Adam, thanks for being there for me! I really appreciate our messages. :)

Then again, I am (as I think I mentioned) trying to get into graduate school for physical therapy, so I can seriously talk about knees ALL DAY (and have, much to my friends' chagrin!).

Anyway, glad to hear that this thread has helped people. I'm always really interested to hear peoples' stories, so thanks for being in touch, all.
 
Left: Dec 02 ACL patellar recon, meniscectomy
Right: Mar 08 ACL allograft recon
Mar 12 ACL allograft revision, meniscus repair
May 15 med + lat meniscectomy
July 15 ACL rev, quad graft, medial meniscal transplant
Dec 15 lateral meniscal transplant

Offline mulberrysdream

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Re: Meniscus transplant, second ACL revision
« Reply #46 on: August 29, 2016, 06:49:08 PM »
I guess I had good timing to hop on the site :) Glad to hear you're doing so well (relatively speaking).

Laprade said the OATs site looked perfect, although the cartilage around it was starting to frey a little...along with most of the cartilage in my knee haha.

PT was 2x a day with a therapist for the first two weeks, and now (4ish weeks out) I try go go 4-5 times a week...but life can certainly get in the way. I've been going to the same PT spot for about 18 months or so consistently.My biggest issues/things to work on have been swelling (always an issue) and muscle spasms, causing my quad to not fire properly. It might seem excessive, but after a day or two off PT I really can feel a difference and need to go back. They have the ability to stretch and move things in a way I can't replicate.

He cleaned out a tiny bit of freying from my lateral meniscus, but said it was extremely minor. And the cartilage defect on my lateral side wasn't nearly as bad as the MRI made it seem.

I'm now undergoing a series (starting with 4, including one done during surgery) of BMAC injections, with Laprade's full support. Spreading them out 3 weeks apart, I'll have my third next Tuesday. Still a few more weeks of crutches...Hopefully this will save my knee! Hearing from some of the top professionals in the world that you are one of the "worst they've seen"....isn't ideal.

Slow and steady, slow and steady....

Insurance wasn't necesarilly "easy" with the two transplants last year...but we played the game, and they eventually paid up.

I had hoped to return to snowboarding this winter, and had (up until my mri) been planning to hike a 14er (14,000ft elevation mountain) with my PT this month...but that won't be happening. I'd like to think I'll get back to it one day...and hope to hike and bike next summer. But who knows...at this rate I'd just like to make it to 30 being able to walk around without being in constant pain.


I'm just extremely lucky to live where I do, even if it's for all the wrong reasons haha.
Right Knee-
MT Menisectomy, Chondroplasty, 10/16
MT Repair, Chondroplasty, Clean out+ BMAC/PRP7/16
Meniscus Transplant & OATs 8/15
Notchplasty,Osteophyte Removal,Prep for MT/OATs 7/15
loose body removal, menisectomy- 4/15
Menisctomy, loose body removal1/14
Lateral Release08
Meniscus Repar 07

Offline BarefootPilgrim

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Re: Meniscus transplant, second ACL revision
« Reply #47 on: August 30, 2016, 11:08:08 AM »
Hi guys,

thanks for posting updates on your respective progress, glad to hear you're both active and staying positive.

Well I'm still in limbo as it turns out, I injured my left knee (the one that I've had 2 ACL surgeries on) two and a half months ago, and was convinced something had torn, either ACL again or something else. But the MRI showed no damage to the ligaments and both OS were reluctant to operate because there is no clear sign of any damage... however, I know my body and especially my knee and something is not where it should be.

I've been going to the gym at least twice a week for the last 7 weeks, as soon as I could put any sort of weight on my leg, to keep the blood circulating and to strengthen the muscles, but I feel like I've plateaued in terms of progress. There's an instability that wasn't there before the injury and (only occasionally, but still) short pains on the inside of the knee when kicking out or pushing off or getting off a bus/sidewalk.

I haven't felt up to going for a run, which I really miss. I just want to know what the damage is and if I can ever return to sports again, it's making me so miserable having to sit out even stuff like table tennis.

Offline vickster

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Re: Meniscus transplant, second ACL revision
« Reply #48 on: August 30, 2016, 12:30:13 PM »
You may progress better working with a physiotherapist on a tailored exercise programme rather than going it alone in a gym?

What does the OS think is the issue? A lower grade ligament strain and muscle imbalance?

It could be worth getting a further opinion on the MRI, small meniscus tears can be easy to miss for example but be bothersome

Some sort of injection could help with pain from inflammation

How old are you? Small degenerate tears can be common as we get older (ie over 30 the meniscus can start to age)

A Physio could also advise on a support for light sports while you heal.
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline BarefootPilgrim

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Re: Meniscus transplant, second ACL revision
« Reply #49 on: August 31, 2016, 11:36:00 AM »
You may progress better working with a physiotherapist on a tailored exercise programme rather than going it alone in a gym?

What does the OS think is the issue? A lower grade ligament strain and muscle imbalance?

It could be worth getting a further opinion on the MRI, small meniscus tears can be easy to miss for example but be bothersome

Some sort of injection could help with pain from inflammation

How old are you? Small degenerate tears can be common as we get older (ie over 30 the meniscus can start to age)

A Physio could also advise on a support for light sports while you heal.

Hi Vickster,

I got a referral for 6 physio appointments, which I completed the other week. They told me to keep doing what I was doing, but couldn't advise on any longer-term strategy. I didn't feel like it helped a great deal, but that might have something to do with the lack of an actual diagnosis from the OSs - the first one basically told me to wait until everything went back to normal, the second only referred me to the physio after I insisted that I felt like something was wrong.

They did an ultra-sound that didn't show any fluid or swelling, the pains I've been getting are always due to movement (pushing off, landing, even just moving the leg forward).

I'm 29 now. I was very active until up to the injury without any pain whatsoever, then the (v painful) injury happened and now I'm left feeling like half a person  :(

Offline vickster

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Re: Meniscus transplant, second ACL revision
« Reply #50 on: August 31, 2016, 12:19:46 PM »
Can you get a second opinion? Perhaps find a highly experienced 'consultant' Physio (dk what country you are in)

Knee injuries really can often take many months or longer to resolve, unfortunately sometimes they never really do and you may need to adapt your activities if you can't find a solution. Cartilage damage can be the most debilitating
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline mulberrysdream

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Re: Meniscus transplant, second ACL revision
« Reply #51 on: September 01, 2016, 05:30:13 AM »
Get an opinion of a highly trained knee doc....or get an mri and send it to one if you can't locate one near you.

Depending on where you are and your situation...maybe stem cell injections/prp could be an option and alternative to surgery...but again you need to consult with an expert.

Best of luck...knees are miserable.
Right Knee-
MT Menisectomy, Chondroplasty, 10/16
MT Repair, Chondroplasty, Clean out+ BMAC/PRP7/16
Meniscus Transplant & OATs 8/15
Notchplasty,Osteophyte Removal,Prep for MT/OATs 7/15
loose body removal, menisectomy- 4/15
Menisctomy, loose body removal1/14
Lateral Release08
Meniscus Repar 07

Offline ferdiscat

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Re: Meniscus transplant, second ACL revision
« Reply #52 on: October 02, 2016, 09:37:39 PM »
Knees are miserable indeed.

I just had an MRI done to ensure that my transplants are healing smoothly. Got both good news and bad.

The good: my transplants are both holding strong. No observable problems yet.

The bad: my ACL is gone again.

There's no discernable graft, there's PCL buckling and an anterior tibial shift (these are both common indicators of a torn ACL), but there's also no evidence of a rupture, or ANY graft fragment. My surgeon believes that my biology is responsible for somehow breaking down the grafted ACL tissue and reabsorbing it.

For now, there's nothing to be done, except for going back to physical therapy to strengthen some more (I'm still diligent about working out, but now I'm concerned about moving forward without some guidance). It's so, so disappointing. I'm so frustrated and afraid and confused (what if somehow the meniscal grafts get absorbed too? how much are my transplants at risk now? what CAN I do safely?)

I know that many people have lived full and active lives without an ACL, but I'm just so worried about the fragility of my meniscii, and the most paranoid part of me is worried that I'm really just on a crash course for a TKR.

I'm just so sad. I know that I'm better off than I was a year ago, but it's hard to look at the  big picture when I feel like my knee is just falling apart.
Left: Dec 02 ACL patellar recon, meniscectomy
Right: Mar 08 ACL allograft recon
Mar 12 ACL allograft revision, meniscus repair
May 15 med + lat meniscectomy
July 15 ACL rev, quad graft, medial meniscal transplant
Dec 15 lateral meniscal transplant

Offline icarus

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Re: Meniscus transplant, second ACL revision
« Reply #53 on: October 10, 2016, 09:00:32 AM »
Knees are miserable indeed.

I just had an MRI done to ensure that my transplants are healing smoothly. Got both good news and bad.

The good: my transplants are both holding strong. No observable problems yet.

The bad: my ACL is gone again.

There's no discernable graft, there's PCL buckling and an anterior tibial shift (these are both common indicators of a torn ACL), but there's also no evidence of a rupture, or ANY graft fragment. My surgeon believes that my biology is responsible for somehow breaking down the grafted ACL tissue and reabsorbing it.

For now, there's nothing to be done, except for going back to physical therapy to strengthen some more (I'm still diligent about working out, but now I'm concerned about moving forward without some guidance). It's so, so disappointing. I'm so frustrated and afraid and confused (what if somehow the meniscal grafts get absorbed too? how much are my transplants at risk now? what CAN I do safely?)

I know that many people have lived full and active lives without an ACL, but I'm just so worried about the fragility of my meniscii, and the most paranoid part of me is worried that I'm really just on a crash course for a TKR.

I'm just so sad. I know that I'm better off than I was a year ago, but it's hard to look at the  big picture when I feel like my knee is just falling apart.

Hi ferdiscat,

I'm happy for you that your meniscus transplants are healthy.

As for the acl, I'm sorry to hear about that and it must feel so frustrating cause it wasn't your fault at all. I think that you always have the option of wearing the brace that's meant to prevent injury during sports.  If you wear this maybe 90 percent of the time, you're basically reducing the likelihood of injuring the meniscu. You can do this at least until you decide that you want a more permanent solution. I know you just had surgery a year ago, so it's understandable that you would want a break from it. Also if you can get alot of quad stability, that may also work well enough to protect your knee in lieu of an acl

Offline ferdiscat

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Re: Meniscus transplant, second ACL revision
« Reply #54 on: October 12, 2016, 12:27:53 AM »
Thanks, icarus. I finally got to meet with my surgeon in person, which in my experience is always helpful. Unfortunately, the next step for me, should I elect to do so, is an osteotomy. I'm going to wait a year or so to see how my stability improves (or degrades) and re-evaluate. I'll report back on PT progress.

You bring up a good point regarding braces: I've heard conflicting opinions as to whether they actually provide much protection to the ACL. I have two sports braces, but I honestly don't use them very often. Anyone here have firsthand recommendations as to whether or not braces actually provide helpful stabilization?
Left: Dec 02 ACL patellar recon, meniscectomy
Right: Mar 08 ACL allograft recon
Mar 12 ACL allograft revision, meniscus repair
May 15 med + lat meniscectomy
July 15 ACL rev, quad graft, medial meniscal transplant
Dec 15 lateral meniscal transplant

Offline Cueson9

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Re: Meniscus transplant, second ACL revision
« Reply #55 on: October 12, 2016, 12:23:23 PM »
Hi Kate,

Shocked to hear about your ACL failing! So what has your surgeon said, does he want to do another ACL reconstruction in the future?

At least the good news is that your meniscus transplant's are fine. I can understand why you're worried as there's a risk damaging the meniscus without a functioning ACL. I remember my surgeon telling me that last year. Surely your surgeon would want to perform another ACL reconstruction at some stage?

You've had some real bad luck, hang in there! It'll get sorted!!
Ruptured ACL and torn lateral and medial meniscus 22/09/2010
ACL reconstruction and medial menisectomy 28/08/2012
First arthroscopic washout due to infection 03/09/2012
Second arthroscopic washout due to infection 11/09/2012
ACL revision & medial meniscus transplant 24/07/15

Offline Catherine88

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Re: Meniscus transplant, second ACL revision
« Reply #56 on: October 17, 2016, 09:42:24 PM »
Allograft ligaments are reputable for high failure rate. The most sólid one is the paltela graft. Also, the muscle responsible for keeping the leg from over-extending is the hamstring, and very often there is a imbalance between guads being too strong in proportion to hams..so this is something to look at. Also all the little stabilisator muscles that are round the knee and that are affecting propioception and balance should be strenghtened.

Offline ferdiscat

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Re: Meniscus transplant, second ACL revision
« Reply #57 on: October 19, 2016, 02:31:20 AM »
Hi Catherine,

Any sources for any of that? I'm actually in the midst of a paper outlining the various pros and cons of common grafts. Having had a failed patellar (in my left), two failed allografts and a failed quad graft in my right, I'm curious to hear any takes. I've read a lot about various pros and cons of patellar versus hamstring grafts, and there's definitely a lot of back and forth about which are best for long term recovery. Can you explain what you mean specifically about an imbalance between quads being too strong in proportion to hams?

As far as stabilizing the smaller muscle groups around the knee, I spent a lot of time doing dynamic exercises designed to increase my balance. My proprioception has definitely suffered as a result of my numerous surgeries, but that is an area that I focus particularly hard on.

Adam,

For now, we don't have any plans to do another ACLr, as this is my second graft failure. There's no evidence of trauma, and frustratingly, there's no real explanation. My surgeon and I have been conjecturing on a few possible reasons, but there's no good way to test for what may have happened. Unfortunately, my surgeon seems to think that my next option for recovery would be an osteotomy. I have a valgus deformity that may be at least in part responsible for the repeated failure of my grafts.

Regardless, we're both in agreement that surgery is not a good option currently. I want to give my knee time to heal, and we're planning to wait and monitor the situation to see how my stability and strength develops without an ACL. I'm returning to PT next week, and I'm hopeful that we can come up with a good plan to recover at least some good function.

Bleh.
Left: Dec 02 ACL patellar recon, meniscectomy
Right: Mar 08 ACL allograft recon
Mar 12 ACL allograft revision, meniscus repair
May 15 med + lat meniscectomy
July 15 ACL rev, quad graft, medial meniscal transplant
Dec 15 lateral meniscal transplant















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