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Author Topic: What's next  (Read 2693 times)

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Offline jg5118

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What's next
« on: January 23, 2017, 02:11:13 PM »
Back in 2010, I had microfracture done on my right knee there was a fissure extending into the articular cartilage at the lateral facet of my patellar

In 2014, I damaged my MCL, and the scan showed a large chondral flap on the lateral facet of the patellar - but I just had physio as it was only a minor injury to the MCL

Just before Xmas 2016, I was twisting my knee to sit on my feet on the sofa and I heard a loud clunk from that knee - it's still painful over a month later.

I saw the consultant last week - he thinks the articular cartilage repair may need re-doing and I may also have a torn meniscus.  MRI scan was done yesterday so waiting for that to be reported and another appointment with the consultant next week

If my articular cartilage needs repairing - what's my best option - especially since there may be the additional problem with the meniscus?

I am in the UK and do have private cover and am seeing one of the consultants from the Royal National Orthopaedic

Thanks



Online Vickster

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Re: What's next
« Reply #1 on: January 23, 2017, 02:27:37 PM »
You need to discuss the options with the Consultant, what they are doing at the RNOH but also what other surgeons may be doing, possibly as part of a clinical trial

For example, someone sent me this for information. A trial being done by a surgeon in Southampton

http://www.goravdatta.com/surgeryinfomation/stem-cell-surgery/

The patella is notoriously hard to repair due to the forces in the knee with lower rates of success, but there could be options

Do NOT assume that your private healthcare will cover any cartilage repair technique especially if being done outside a recognised clinical trial. I went through hideous rigmarole in the past, months of negotiations, letters because the surgery, a MACI, was not approved by NICE. I was referred by my surgeon to one of the RNOH surgeons too as they were doing a trial. In the end they wouldn't do the repair due to the state of the knee and slight malalignment.  Bupa for example apparently no longer fund MACI, but RNOH do offer it on NHS (or did, perhaps they do other things too)

How old are you? This will potentially determine eligibility as well as the state of your meniscus and whether a tear can be repaired with stitches and preserved, or only trimmed  or tidied
« Last Edit: January 23, 2017, 02:31:39 PM by Vickster »
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 jg5118

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Re: What's next
« Reply #2 on: January 23, 2017, 02:33:33 PM »
Thanks Vickster

The consultant was one of the ACTIVE team (was featured on Embarrassing Bodies!)

i'm 51 - that sounds so old when I write it down...

J


Online Vickster

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Re: What's next
« Reply #3 on: January 23, 2017, 02:43:34 PM »
You'll likely find that the meniscus is degenerate and can only be trimmed, the process of deterioration starts from around the age of 30!

ACTIVE finished a couple of years ago. That  was the trial I would have been treated under in 2010 if deemed appropriate. Luckily the knee has been fairly calm until recently, the last MRI wasn't good reading though. I'm 44

Definitely discuss with the surgeon, ask about options elsewhere too if you are prepared to travel. I found going to Bushey from SW London appalling due to traffic on the M25 and am glad my knee specialist is again 10 minutes away!
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 jg5118

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Re: What's next
« Reply #4 on: January 23, 2017, 02:46:42 PM »
I'm really lucky - Bushey is 10 mins away!  Although, I opt to go to Stanmore and use the Private ward there as it gives back some support to the NHS (and you have all the back up)

He removed a plica in that same knee back in 2007 - otherwise the knee was in pristine condition he said - guess I've just been unlucky since then.




Online Vickster

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Re: What's next
« Reply #5 on: January 23, 2017, 02:51:20 PM »
Your age might potentially preclude you from a trial, but certainly explore the options

It seems that once the cartilage damage occurs and the inflammation takes hold, it is a downward slope often. I expect my only option will be a TKR in around 10 years time. In the meantime, I get hyaluronic acid injections to lubricate the joint and calm the inflammation

Good luck, hope all is well with your knee
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 jg5118

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Re: What's next
« Reply #6 on: January 23, 2017, 02:55:36 PM »
I'll update you when I've seen him next week - I know it's most likely to be surgery  :( 

it's just what...

Online Vickster

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Re: What's next
« Reply #7 on: January 23, 2017, 03:29:10 PM »
I'd exhaust all the conservative options first, physio, pain management, injections (HA works well for me, although not for everyone). 
Cartilage repair is so hit and miss - with sometimes seriously long recoveries...I was told by the Bushey surgeon that I'd need at least 3 months off work on crutches in a brace, then a year to feel the same and 2+ years to see any benefit.  I'm actually kind of glad he refused to do it, although I was extremely diappointed at the time after all the hassle with the insurance company!

Also, if possible, meniscus best left in place unless the knee is locked and/or buckling and function majorly impaired and pain unmanageable/unlivable
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