Banner - Hide this banner





Author Topic: Failed microfracture...now what?  (Read 14743 times)

0 Members and 1 Guest are viewing this topic.

Offline bizzybank

  • MINIgeek (20-50 posts)
  • **
  • Posts: 47
  • Liked: 4
Failed microfracture...now what?
« on: March 23, 2016, 09:43:23 AM »
      Well like many of you ive had a myriad of knee issues. Recently have been getting pain in my right knee one of which had a microfracture in the trochlear area two years ago, I decided two months ago I should stop wearing my special insoles in my snow boots. Big mistake. Quads started swelling followed by knee shortly after. Went to Peru a week after, knee felt great because of the weather. Last week I was there quads started to flare up again due to overwalking. Came up with the dumb idea of doing body squats and heel slides to strengthen quads. Knee got worse and haven't been the same since. Ive had this nagging pain in my knee for 6 weeks and it hasn't gone away.
      Went to get an MRI and found out the microfracture in the trochlear area is fully filled in but I might have some wear and tear in the trochlear area and behind the patella causing me pain. I told him this surgery has been a nightmare for me where I'd feel great some days and horrible the next. I also blame myself for pushing it not completely knowing how delicate my knee is now. He's suggesting maybe doing a graft,  possibly denovo because I've been through quite a bit but needs to investigate further to see if I have kissing lesions in my knee now. I'm only 27, I'm quite down right now, just wanna know if there's any others out there like me on the boards.
Attached

Offline willrunagain

  • Regular Poster
  • ***
  • Posts: 111
  • Liked: 55
Re: Failed microfracture...now what?
« Reply #1 on: March 23, 2016, 03:22:57 PM »
Look into Cartiform (cryopreserved allograft cartilage).  Denovo is outdated and Zimmer Orthopedics (the maker) is not publishing success rates because the product is a joke.  There seem to be as many negative stories about denovo as there are positive ones on kneeguru.  An indepedent study by the International Cartilage Repair Society graded cartiform as an 85% match to hyaline cartilage.  Denovo was a dismal 25% match to hyaline cartilage.

I had a cartiform implant on my patella for a 3.5cm lesion 6 months ago.  I am already very happy with the results.  I can squat, lunge, climb stairs, and bike with virtually no pain.  And my doctor stated he will likely clear me for running at 12 months.

Offline bizzybank

  • MINIgeek (20-50 posts)
  • **
  • Posts: 47
  • Liked: 4
Re: Failed microfracture...now what?
« Reply #2 on: March 23, 2016, 04:35:33 PM »
Interesting. I've seen amazing things about Denovo, wasn't aware that its also a coin flip surgery. My surgeon didn't mention anything about Cartiform. I wonder if it's approved in Canada, since everything seems to take longer over here.  I'll definitely have to bring it up. Oh man what id give to be able to squat again ass to grass, I'm so jelly.

Offline willrunagain

  • Regular Poster
  • ***
  • Posts: 111
  • Liked: 55
Re: Failed microfracture...now what?
« Reply #3 on: March 24, 2016, 02:05:27 PM »
Unfortunately cartiform is only available in the US right now.  I heard they were trying to expand in international markets though.  Given your defect is on the trochlea, I think you can have success with Denovo.  I don't mean to scare you.  But you should know that cell based therapies (ACI and Denovo) after failed microfracture increase the failure rate by 25%.  That is something you need to bring up with your surgeon.

http://orthodoc.aaos.org/WilliamFBennettMD/Autologous%20Chondrocyte%20Implantation%20for%20Failed%20Microfracture.pdf

Allograft cartilage straight from a cadaver may be your best choice.  I'd imagine your subchondral bone isn't in the best of shape after your failed microfracture.  Allograft could potentially take care of your bone and cartilage problem.



Offline bizzybank

  • MINIgeek (20-50 posts)
  • **
  • Posts: 47
  • Liked: 4
Re: Failed microfracture...now what?
« Reply #6 on: April 13, 2016, 06:11:14 PM »
Update:

So my doc went over my MRI again and discovered these findings:

7 x 5 mm trochlea .... partial....fibrocartilage exists

medial facet: not full thickness. maybe 5 mm in diameter

both contained

osteophytes medial and lateral tibial surface and back of patella.

He wants me to see him and from his tone it sounds like there are quite a bit of nonop options available to me. I don't know how I feel about this. I've tried cortisone shots and PRP and tbh felt no difference. I also don't want just a quick fix again which will end up failing in a couple years like this stupid microfracture. I'm hoping for more clarity of the situation on my next visit but would appreciate some of your thoughts.   

Offline bizzybank

  • MINIgeek (20-50 posts)
  • **
  • Posts: 47
  • Liked: 4
Re: Failed microfracture...now what?
« Reply #7 on: April 28, 2016, 05:56:41 PM »
So brief update, im going for a scope tomorrow. MRI scans showed both my defects filled up. One of them has a thin layer of cartilage over it so not full thickness. Also there's quite a bit of wear and tear on the cartilage underneath my kneecap. My non operative choices were BMAC which is quite a bit pricey at 3 grand per injection. Also my doc gave me know guarantee that it will fix my knee, just that he's had patients who had positive results with it. Other's were Hyaluronic injections which are worse than the prp's i got before so no point really. Agreed that the best option is to go down there see the quality of my fibrocartilage and whether there is loose debris causing me pain and inflammation. If the cartilage is poor then i might be able to get a denovo graft. This will be my fourth surgery in four years, Im hoping for the best at this point. 

Offline bizzybank

  • MINIgeek (20-50 posts)
  • **
  • Posts: 47
  • Liked: 4
Re: Failed microfracture...now what?
« Reply #8 on: June 21, 2016, 05:03:11 PM »
Just checking in again. So two months ago, went in with a scope and prp of my right knee. My doc found out that one of my defects was like 95 percent filled in(so that was good), my other one in the trochlea area wasn't completely filled in and loose. So he cleaned up the area as best as he could and said if it doesn't get better in two months we're going with something more aggressive. It only got a little bit better, the crepitus pretty much went away and is just left with a small click now but i still get dull stabbing pains from time to time and I can't even picture myself kneeling, squatting or running in my current state. Talked to the doc today and he's gonna convince the hospital to go with a combination of a denovo graft and BMAC injection, he's convinced this is my best bet and should do the trick. I'm hoping this as well too. I'm due for surgery on July 18th so ill check back around then.

Offline Aly0108

  • Regular Poster
  • ***
  • Posts: 130
  • Liked: 10
Re: Failed microfracture...now what?
« Reply #9 on: June 21, 2016, 05:19:32 PM »
Just checking in again. So two months ago, went in with a scope and prp of my right knee. My doc found out that one of my defects was like 95 percent filled in(so that was good), my other one in the trochlea area wasn't completely filled in and loose. So he cleaned up the area as best as he could and said if it doesn't get better in two months we're going with something more aggressive. It only got a little bit better, the crepitus pretty much went away and is just left with a small click now but i still get dull stabbing pains from time to time and I can't even picture myself kneeling, squatting or running in my current state. Talked to the doc today and he's gonna convince the hospital to go with a combination of a denovo graft and BMAC injection, he's convinced this is my best bet and should do the trick. I'm hoping this as well too. I'm due for surgery on July 18th so ill check back around then.

Where do you live?

Did you find Denova and BMAC in Canada?

Offline bizzybank

  • MINIgeek (20-50 posts)
  • **
  • Posts: 47
  • Liked: 4
Re: Failed microfracture...now what?
« Reply #10 on: June 21, 2016, 07:20:09 PM »
Toronto. My surgeon is Dr Chahal at women's college. He's done BMAC on world class athletes with defects similar to mine. From my knowledge, they don't really do Denovo in most hospitals in Canada except for trials, but he says because of what I've been through with my knees there probably gonna make an exception. It's a very costly procedure, both BMAC and Denovo, i don't know if i'd be able to afford it in the states. I'm thankful for our free health care lol.
« Last Edit: June 21, 2016, 07:43:12 PM by bizzybank »

Offline jnestor1299

  • MINIgeek (20-50 posts)
  • **
  • Posts: 33
  • Liked: 0
Re: Failed microfracture...now what?
« Reply #11 on: July 12, 2016, 03:53:53 PM »
If I can make a suggestion. The problem with microfracturing is the drilling is too far apart and not deep enough. I don't know if you can get insurance in the United States. But if you can I would recommend you contain Dr. Broyles in Baton Rouge. The procedure would be around 15k out of pocket with travel. Look even if you have to put it on a credit card...it's your health. Good Luck!

Offline bizzybank

  • MINIgeek (20-50 posts)
  • **
  • Posts: 47
  • Liked: 4
Re: Failed microfracture...now what?
« Reply #12 on: July 19, 2016, 01:06:26 AM »
Thanks for the advice j Nestor, but I'm not sure if I wanna go through another microfracture again. I know saw is one of the best at it, but from what I've read it's not the best to go for another microfracture after a failed one. Also hands down one of the most mentally draining procedures I've had in my life, made my ACL repair look like a picnic. OATS or a graft is usually the best option after a microfracture from what I've heard and read..

 My doc pushed back my surgery for another month to consult with  some other surgeons about my procedure. Maybe looking for a better alternative, I'm hoping cartiform is on the table, since most of you speak so highly of it.

It sucks cause Pokemon go is out and I can't walk for long distances lol. Its so addictive.
« Last Edit: July 19, 2016, 02:13:28 AM by bizzybank »

Offline mulberrysdream

  • Regular Poster
  • ***
  • Posts: 69
  • Liked: 6
Re: Failed microfracture...now what?
« Reply #13 on: July 19, 2016, 06:34:25 AM »
My advice- contact dr Laprade at the Steadman Clinic here in Vail CO. I had an OATs and a Meniscus Transplant with him 11 months ago. My biggest regret is not seeing him sooner. Good luck!!
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 bizzybank

  • MINIgeek (20-50 posts)
  • **
  • Posts: 47
  • Liked: 4
Re: Failed microfracture...now what?
« Reply #14 on: October 18, 2016, 03:47:50 PM »
It's been a while since I last posted. The Canadian health system takes forever... So pretty much my doc did more research on the subject and decided that the results of Denovo are way too mixed at this point to perform on me, he too is hearing about a lot of people rejecting the grafts. He got a BMAC type procedure approved from the hospital board. The basic gist of it is, its an open knee surgery where he's gonna flip over my patella  and fill in the two defects in my trochlea and medial region and fill them with a bmac paste as well as fibrin products to act as a graft. I'm gonna be paying for the bmac at cost for like 900 plus cpm and crutches for 6 weeks. He said again that he can't 100 percent guarantee my surgery will work, but he said this is probably my best option. My surgery is booked Dec 5 so I'll look into maybe posting a post op diary around then.















support