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Author Topic: My Cartiform Patella Implant/Cyst Removal Surgery 9/8/15  (Read 23348 times)

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Offline willrunagain

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My Cartiform Patella Implant/Cyst Removal Surgery 9/8/15
« on: September 09, 2015, 10:51:33 PM »
Hi all!

I'm a 26 y/o male. For a little over a year, I have had a chondral defect in my right patella. I was a competitive regional distance runner before the injury. Yesterday (9/8/15), I finally went under the knife and had a cartiform cartilage implant placed in the center of my patella.  I also had a small patella cyst removed and replaced with healthy bone from my femur about the size of two tic tacs.

So far the pain has been very manageable.  I had a nerve block which allowed me to be completely pain free the first 24 hours. Now that the nerve block has worn off, I have a little more pain, but it is very manageable. I got home from the hospital exactly 24 hours after the surgery.  I have even been able to do up to 15 straight leg lifts at a time albeit with a good amount of pain.

For 36 hours post op, I am very happy with my condition.  I can get around in crutches just fine.  I even put about 30-40lbs of weight on the operated leg when locked in my brace.

If anyone has any questions, I'd be glad to answer.  I will try to post my weekly progress.
 

Offline dal_knee

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Re: My Cartiform Patella Implant/Cyst Removal Surgery 9/8/15
« Reply #1 on: September 10, 2015, 11:00:19 PM »

Hi willrun,

Thanks for posting, I hope you are feeling well today.   

Did the doc need to do the bone autograft associated with the chondral defect? 

Was yours an open or arthroscopic-only procedure?
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline willrunagain

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Re: My Cartiform Patella Implant/Cyst Removal Surgery 9/8/15
« Reply #2 on: September 11, 2015, 01:45:52 AM »
Hi dal knee,

Before my doc implanted the cartiform he removed a patella cyst about 3mm in diameter. He plugged it with bone from my femur about the size of 2 tic tacs. The actual cartiform disc was 2cm in diameter. I tried to load a picture but it said the file was too big. The cyst was right in the center. Just picture a pupil within an eye. That's the best way I can describe it.

Unfortunately the procedure was quite invasive. My patella had to be inverted to implant the cartilage disc. At 60 hours post surgery the pain is a little rough. I am managing though. My nurse said these next 24-48 hours will be the toughest.
 

Offline dal_knee

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Re: My Cartiform Patella Implant/Cyst Removal Surgery 9/8/15
« Reply #3 on: September 11, 2015, 04:08:56 PM »

When does PT start for you? 

I understand that with any cartilage restoration, the PT is critical to outcome.  So are you with a specialized PT?   Are you staying around Dr Farr's location for a few weeks to do PT there?
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline willrunagain

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Re: My Cartiform Patella Implant/Cyst Removal Surgery 9/8/15
« Reply #4 on: September 11, 2015, 06:17:21 PM »
Hours before my surgery on Tuesday, I went through all my exercises with one of the PTs. She sent me home with a list of my exercises and the CPM machine.

Starting since the day of surgery, I have been in the CPM machine for 8 hours a day. I just worked up to 40 degrees last night without too much issue. I've also been doing a stim machine at home that stimulates my quads when I flex them. The remaining exercises are pretty basic for the first two weeks. The only exercise I currently have issue with is the straight leg raises. I started having too much pain to perform more than one at a time, but I am able to do side leg lifts.

My follow up with Dr. Farr's PA is on Wednesday. I imagine they will give me more home exercises to do at that point.

Offline dal_knee

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Re: My Cartiform Patella Implant/Cyst Removal Surgery 9/8/15
« Reply #5 on: September 11, 2015, 08:03:46 PM »

8 hours in the CPM machine  :-\ :-\

So are you using it while asleep, if that's possible?    Can you sleep through it? 
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline willrunagain

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Re: My Cartiform Patella Implant/Cyst Removal Surgery 9/8/15
« Reply #6 on: September 11, 2015, 08:56:50 PM »
I actually have no issues falling asleep with the CPM machine on my leg. I think it feels good. Although I may feel differently once I run out of pain meds!   :(.

Last night I slept for 6 hours straight as it was moving my leg without a problem :)

Offline dal_knee

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Re: My Cartiform Patella Implant/Cyst Removal Surgery 9/8/15
« Reply #7 on: September 14, 2015, 05:42:27 PM »
Are you able to take a little less of the pain meds now?
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline willrunagain

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Re: My Cartiform Patella Implant/Cyst Removal Surgery 9/8/15
« Reply #8 on: September 14, 2015, 07:32:05 PM »
Post Op Day 6:

I began working from home today, but not a whole lot has changed.  I still have quite a bit of soreness and swelling in the knee.  Although starting yesterday, I stopped taking pain meds during the day.  I now only take them at night mostly to help with sleep and the pains associated with the CPM machine.

I attached a picture of my graft from the surgery for those intererested. WARNING: Graphic Content.  DO NOT look at on a full stomach :)

Offline Needcartilage

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Re: My Cartiform Patella Implant/Cyst Removal Surgery 9/8/15
« Reply #9 on: September 18, 2015, 05:57:10 AM »
Hi Willrun,

I hope you are healing nicely. I actually need cartilage surgery on my right patella. My doctor informed me about this procedure yesterday. After doing research this process is very new. Not many testimonials on it. My doctor is stating it can be done arthroscopicly and that I would have my right knee immobilized for two weeks. After that I would start physical therapy. Does this sound like the same limitations you were given? Please keep updating the blog on your progress.

Best,
RL

Offline willrunagain

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Re: My Cartiform Patella Implant/Cyst Removal Surgery 9/8/15
« Reply #10 on: September 18, 2015, 03:46:56 PM »
Hi RL,

I was told to wear my straight leg brace for 4-6 weeks (weight bearing as tolerated).  However, I am allowed to take the brace off for my PT exercises and for the CPM machine.  My real PT sessions start next week which is week 2 in my recovery.

My procedure was not done arthroscopically.  I had to have a 5 inch incision down the center of my knee.  I would be a bit skeptical if a doctor told me they could do this procedure arthroscopically, especially on a patella.  I have spoken with a handful of people who have had cartiform and they were all open procedures.  The surgeon typically uses suture anchors to secure the cartiform and I can't imagine how that would be possible to do on a patella with an arthroscope.  Having said that, I could be wrong through.  I've just never heard of anyone who had it done arthroscopically.

Offline Needcartilage

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Re: My Cartiform Patella Implant/Cyst Removal Surgery 9/8/15
« Reply #11 on: September 21, 2015, 07:33:48 AM »
Hi Willrun,

Thanks for your response.

If you don't mind me asking how you connected with the other people who have gone thru cartiform surgery. I would like to know of those people who went thru it how many had success. My doctor has mentioned two other process as well. Genzyme which is a two step process and Biocartilage. I really want to pick the most successful procedure even tho I know everyone heals different. With this being so now I am a little hesitant.

Best -RL

Offline willrunagain

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Re: My Cartiform Patella Implant/Cyst Removal Surgery 9/8/15
« Reply #12 on: September 21, 2015, 03:04:37 PM »
My surgeon has performed about 10 of the cartiform procedures and he has only had one partial failure.  6 of the patients are more than 9 months out and all are very satisfied with the results.  I personally know one of the other patients.  She is a lady in her 50s who went back to running half marathons after the cartiform.  There was also one other cartiform poster here on knee guru that got back to doing mountain biking and heavy lifting i.e. power cleans, deadlifts, and burpees without any pain.

As far as the most successful procedure, I believe cartiform is the one if you're talking patella.  Biocartilage is also a very good procedure, but I don't think they will do it on a patella.  Biocartilage is usually reserved for the femoral condyles and trochlea.  I strongly advise against Genzyme.  It is a two stage surgery and the histological staining of the cartilage when it heals shows a mix of fibrocartilage and hyaline like cartilage.  Cartiform studies have shown that the repair tissue is upwards of 85% true hyaline cartilage.  That is the most hyaline cartilage you can get from any procedure out there. And the more hyaline cartilage, the better your knee is going to feel and continue to feel for many years to come.

Take a look at this video. Starting at 5:07, they compare cartiform to Denovo which is supposed to be even better than Genzyme.  The staining of the repair tissue shows a score of 91/100 in tissue morphology for cartiform and only 25/100 for Denovo.  The choice is pretty clear to me. Cartiform all the way to the bank.

http://www.arthrex.com/resources/presentation/BY488mDq0U2FywFLmQZS0g/cartiform-cartilage-restoration-using-a-novel-cryopreserved-viable-chondral-graft

Offline dal_knee

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Re: My Cartiform Patella Implant/Cyst Removal Surgery 9/8/15
« Reply #13 on: September 21, 2015, 04:08:52 PM »

needcartilage,

Dr Phil Davidson has done about 20 of these.  Just letting you know in case you are interested. 

2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline willrunagain

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Re: My Cartiform Patella Implant/Cyst Removal Surgery 9/8/15
« Reply #14 on: September 23, 2015, 07:29:00 PM »
Post Op Week 2 Update:

I have made some significant progress over the last few days.  I am able to walk around my house at a shuffling pace without any crutches.  I do this with my straight leg brace on of course.  I also started driving (automatic transmission).  I have found driving to be fairly comfortable as I always been one to just use my ankle when driving anyway.  Straight leg raises have become less painful over the past few days.  I now do 3x10 SLRs per day without much issue.

My knee still has 3.5cm of swelling when compared to my non-operative knee.  I have achieved 95 degrees of flexion compared to 130 degrees of flexion in my good knee.  My PT was very pleased with 95 degrees flexion at only 2 weeks post op.  Once the swelling goes down, she thinks I will have no problem reaching full ROM.  That is all for now.  I will update when I hit another big milestone.  Hopefully within the next few weeks!  Best wishes to everybody out there working towards a better knee! Keep on fighting!