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Author Topic: Complex meniscus tear and 2 mild arthritis with Dr Broyles  (Read 2062 times)

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Offline Vlad

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Complex meniscus tear and 2 mild arthritis with Dr Broyles
« on: February 02, 2017, 12:45:45 AM »
I just want to present my journey with the knee injury, in the hope some people might find it useful.
Currently I'm 45 years old, male, 5'9 (178cm) and 160 lbs (72 kg), living in Denver, CO, but prior to that I lived for 19 years in Toronto, Canada.

When I post this, I'm 9 days post-surgery, but I'll continue to post my progress.

History of the injury:
-   Jan 2005 (33 years old): hard fall on the right knee cap on hardwood floor while playing indoor soccer. I didn't do any xRay or MRI because at that time my family doctor said something to this extent: "Most likely you damaged the cartilage in the knee cap. There's no point in doing an MRI, because there's no treatment for that"?. And for the most part he was probably right at that time. I used to have pain in the knee, but no swelling, for the next 5 years, but only after really hard workouts. Using road and mountain bikes a lot and avoiding other injury, eventually help the knee recover (or so it seem from outside), and I was pain free for the last 5-6 years as I continued to be very active, road-biking, hiking, playing soccer, etc.
-   Sep 2015 (43 years old): tore the quads while playing outdoor soccer, most likely due to dehydration. Did physiotherapy for at least couple of months, and that helped. Not sure though if the muscles recovered in a tighter size (i.e. shorter) and this lead to the final injury.
-   July - Oct 2016: moved to Denver and hiked up a lot of Colorado Rockies, sometimes in 13 hrs pushes. Almost every weekend we hiked up and down something. Never had an issues with any of the knees (i.e. no pain, no swelling, no clicking)
-   Sat Oct 29, 2016: hiked up another mountain for a total of 6 hours.
-   Sun Oct 30, 2016: short run with the dogs (around half-mile) and hiked around Red Rocks Amphitheatre for couple of hours. No pain or injury felt.
-   Mon Oct 31, 2016 (Halloween Day): woke up with a slight indisposition in the right knee (no real pain). Commuted with the bicycle to work as usual (8 miles/12.5 km one way). Not much worse when I got there. But 2 hrs later right knee starts to swell, hurts and clicks. A lot. Asked my wife to come and pick me up from office as I cannot bike back.
-   Nov 1 - 17, 2016: tried to keep the leg elevated, protected from the effort (no more commuting with the bicycle, no stairs). It progressively got worse (pain, range of motion, clicking). Didn't experience any locking though.
-   Nov 18, 2016: performed MRI and the results were pretty bad: moderate-sized horizontal tear of the medial meniscus posterior horn and body, with fraying of the inner margin and irregularity of the inferior articular surface of the body; mild to moderate thinning of medial patellar facetal cartilage with fibrillation and multiple deep fissures; mild diffuse trochlear cartilage thinning; moderate cartilage thinning at the medial most aspect of the medial compartment with mild subchondral edema in the tibial plateau underlying the torn meniscus.
-   Nov 22 - Dec 12: started to read on KneeGuru. Consulted not less than 7 (magnificent) orthopedic specialists and among them, 2 from Steadman Clinic in Vail, CO (Dr LaPrade and Dr Karli), Harry Adelson from Docere in St Lake City, 3 orthopedic surgeons in Denver, and Dr Broyles in Baton Rouge, LA. After reading quite a bit on KneeGuru and some other sites, and weighing in all the opinions of the docs I consulted, I decided to go for the Dr Broyles AMS procedure, as is the only one that promised to fix the 2 zones with mild arthritis, and the 12 stem cell injections might help heal the complex meniscus tear, after applying sutures to the tear during the surgery.
-   Dec 14, 2016: got a PRP injection in the right knee at one the docs I've seen in Denver to help a little bit with the healing and swelling while waiting for the surgery
-   Jan 20, 2017 (in Baton Rouge): had a 3.0T MRI done on the knee. Plus lots of xRays. And the consultation with Dr Broyles. Got the CPM machine home.
-   Jan 23: the surgery took over 5 hrs, due to a larger than expected area for drilling and due to the sutures on the meniscus. A small corner of the meniscus had to be cut out, but the main tear was sutured. Took the first stem-cells & PRP & HA injection.
-   Jan 23-24: struggled to sleep due to the side-effect from the codeine contained in the painkiller Hydrocodone/Acetaminophen. Didn't remember I had problems with codeine before. Switched to the good stuff (hydromorphone), but only took 1 pill on Jan 24, as the pain was bearable.
-   Jan 25: post-surgery MRI and replacing of the bloody knee wraps.
-   Jan 26: started physiotherapy, but very limited moves possible
-   Jan 27: second injection. It hurt, but not as much as the PRP only, back in Denver. Hammering a syringe in your hip is definitely an interesting feeling. But what hurt the most was the bone-marrow extraction. The assistant used a Hamilton Bell VanGuard V6500 machine for spinning the stem-cells and a Biomet for spinning the PRP. The whole procedure start to finish took exactly 1 hour. Knee was still very swell and Dr Broyles tried to take out some fluid out, but at one point the syringe clogged (with a blood clot) and he just injected the new stuff in.
-   Jan 29: got a little bit of fever (37.5C/99.5F) and got scared it might be an infection. Took 2 Tylenols and fever broke down and didn't came back since.
-   Feb 1 (today): knee still too swollen. Gotta do more exercises at home. CPM & 1 hr of physio in the morning is not enough. My leg muscles are very atrophied from 3 months of no use (Nov, Dec, Jan) and it's very hard to do much. 9 days post-surgery and all I can do on the CPM is 50 degree bend. Tomorrow is the 3rd injection. We'll see if the doc manages to take some more fluid this time, as this will help a lot with range of motion and muscle firing. Right now, until Feb 8th, I'm partial-bearing on the leg with 44 lbs (20 kg).

I will continue to update this post as something worth sharing is happening.

Ask questions and I'll try to answer.

I'm posting a couple of pics with my knee 2 days post-surgery and one from the Nov 18th with the meniscus tear. Once I got them (hopefully tomorrow), I will post some pics from the pre and post surgery MRI, and from the surgery itself.
« Last Edit: April 24, 2017, 08:47:05 PM by Vlad »
10/2016 - meniscus tear, mild arthritis right knee

Offline psny

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Re: Complex meniscus tear and 2 mild arthritis with Dr Broyles
« Reply #1 on: February 03, 2017, 09:35:47 PM »
That does not sound too bad, you seem to be making great progress if you are partially bearing weight already. Thanks for posting this on the forums. I wish you a speedy recovery!

Offline Vlad

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Re: Complex meniscus tear and 2 mild arthritis with Dr Broyles
« Reply #2 on: February 10, 2017, 04:49:18 AM »
Received today the email below for Dr Broyles' assistant and I thought I would share it for those interested in his procedure:

Dr. Broyles is happy to announce that the early results of the cartilage regeneration procedure were recently published in the journal Surgical Science. You may download and view a copy of the article titled “Biologic Augmented Microdrilling Surgery for Multiple and Large Full-Thickness Cartilage Lesions in the Knee: Early Clinical and Radiological Results” at the link below. You are welcome to share this link with anyone who may be interested in learning more about the procedure.

https://doi.org/10.4236/ss.2017.82013

10/2016 - meniscus tear, mild arthritis right knee

Offline Vlad

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Re: Complex meniscus tear and 2 mild arthritis with Dr Broyles
« Reply #3 on: February 18, 2017, 06:40:28 PM »
Just an update on the progress: in couple of days I'll be 4 weeks post-op, and my range of motion has increased substantially (I can do a 110° bend on the CPM machine), also I can do straight leg raises for couple of weeks now (which is a big deal) and I started to do static squats at the wall, using a bit the right leg.
I'm running out of PT sessions (I did 15 so far and I have 20 in total per year), so Dr Broyles sent a letter to my insurance, to see if we can convince them that I need more sessions. If not, I will take the protocol and do it at home.
On Wednesday I'll have the 6th injection  (the schedule was a bit compressed, so I can stay here in Baton Rouge and work remotely, and don't have to fly back-and-forth to Denver) and then I'll go back to Denver.
2 weeks and 2 days after surgery, the weight bearing on right leg increased to 66 lbs, and I'm pretty sure next week it will increase again.
The cuts are healing pretty well, but the scars under the skin need to be massaged every day, to try to break them down.

As I said, I'm posting some pictures from the surgery.
« Last Edit: February 18, 2017, 06:44:19 PM by Vlad »
10/2016 - meniscus tear, mild arthritis right knee

Offline psny

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Re: Complex meniscus tear and 2 mild arthritis with Dr Broyles
« Reply #4 on: February 21, 2017, 03:55:24 AM »
Just an update on the progress: in couple of days I'll be 4 weeks post-op, and my range of motion has increased substantially (I can do a 110° bend on the CPM machine), also I can do straight leg raises for couple of weeks now (which is a big deal) and I started to do static squats at the wall, using a bit the right leg.
I'm running out of PT sessions (I did 15 so far and I have 20 in total per year), so Dr Broyles sent a letter to my insurance, to see if we can convince them that I need more sessions. If not, I will take the protocol and do it at home.
On Wednesday I'll have the 6th injection  (the schedule was a bit compressed, so I can stay here in Baton Rouge and work remotely, and don't have to fly back-and-forth to Denver) and then I'll go back to Denver.
2 weeks and 2 days after surgery, the weight bearing on right leg increased to 66 lbs, and I'm pretty sure next week it will increase again.
The cuts are healing pretty well, but the scars under the skin need to be massaged every day, to try to break them down.

As I said, I'm posting some pictures from the surgery.

Awesome it sounds like you are on your way to a full recovery. Are you still walking with crutches, how is it getting around?

Offline Vlad

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Re: Complex meniscus tear and 2 mild arthritis with Dr Broyles
« Reply #5 on: March 22, 2017, 08:14:19 PM »
Now, I'm over 8 weeks post surgery, and even though the protocol said I should start walking progressively without crutches at the 6 weeks mark, I'm still using them because of few reasons:
- it starts to hurt if I walk too many steps without them
- it's protecting my meniscus, which hopefully is still healing with the help of stem-cell injections
- I'm only putting probably less than 25% body-weight on the crutches, so I still get the benefit of weight-bearing on the joint

I'm hoping that in 2-3 weeks I'll only be using the crutches for longer walks (i.e. walking the dogs) or when I carry my day-pack with something heavy in it.
One of the reasons for such a long recovery for me is because I couldn't use the right leg for almost 3 months before the surgery, so there was a lot of muscle loss, which takes a long time to build back, while still protecting the knee.

The knee is still swollen, but doing the exercises from the physio protocol every day (including free style swimming and aqua jog/walk) and going to a physiotherapist once a week helps a lot. Also I'm taking turmeric powder daily as an anti-inflammatory (I've checked with the doc and he said is OK).

Right now I'm about 130° range-of-motion, which is not great, but it's not that bad either. Stretching and bicycle help a lot with this.

At the end of May I'm going for the next 3 stem-cells injections.
10/2016 - meniscus tear, mild arthritis right knee

Offline Vlad

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Re: Complex meniscus tear and 2 mild arthritis with Dr Broyles
« Reply #6 on: February 23, 2018, 12:40:56 PM »
I haven't posted in a while here, so I'll try to cover what happened since my last posting, almost a year ago.

For the first 6 months I followed the PT protocol pretty strictly, doing even more than minimum required by the protocol. I went to the therapist and to the gym very regularly.

Then at the end of May I went to the 3 injections at the 4 months mark and did of course an MRI and a set of XRays. The MRI showed some healing, but it was too early to say what the final result will be like.

A week after the 3rd injection, I did a bad twist on my knee, heard a small crack sound, and pain ensued. Scared that I damaged the meniscus again, I did another MRI, less than a month from the Dr Broyles' one, but luckily there was no visible difference between the 2 MRIs. After couple of weeks, I slowly resumed the PT protocol and recovered from that incident pretty well.

When I hit the 6 months mark, I was supposed to incorporate gradually some small impact movements, like very light jogging on treadmill, but the knee didn't agree, plus I wanted to allow the meniscus to heal better (which could take up to 2 years accordingly to Dr Broyles).
So I continued my regime of cardio, strength at the gym (mainly bicycle, elliptical, weights, body-weight exercises), some stretching and lots of dog walking and light hiking, the latter using the forearm crutches.

Due to personal circumstances, not related to the knee itself, about mid-November I stopped for the most part going to the gym regularly (I used to go 4-6 times a week) and that continues until today. I will resume going to the gym regularly next week.

Mid Jan I scheduled the one year checkup and injections, but again due to some circumstances, I missed the first injection and ended up doing only 2 of them.
The MRI though wasn't impressive, still showing the surgery scars/holes. It's probably not the worst result Dr Broyles has seen, but it's definitely not the best.

And now the interesting bit: I asked Dr Broyles if I could attempt to hike up Kilimanjaro in Sep 2018. After some consideration, he said I should be able to, since the longest day (the summit one) is only 10 miles in total (up + down) and I will be using the forearm crutches, as my hiking poles.
So, that's my goal now: to be able to hike this summit in 6 months. That's why I'll HAVE to go back to gym (and start light with bicycle and elliptical for the knee) and do some serious hiking before I decide to actually fly to Tanzania.

I don't know if my knee will get much better than it is today (hopefully it will), but I'll look to see if I can do some stem-cell injections here in Europe, where I moved at the end of Jan, and eventually do another MRI at the 2-years mark.

All-in-all, I'm torn to put a definitive conclusion on the decision to do the surgery with Dr Broyles: on one side, I think my meniscus is much better than a year ago, but in the same time, the holes drilled in the kneecap and femur are probably worse than the mild arthritis I had to start with.

I will try to post some more as the year progresses, and let everybody interested know more about the Dr Broyles' procedure.
« Last Edit: February 23, 2018, 12:43:54 PM by Vlad »
10/2016 - meniscus tear, mild arthritis right knee

Offline Brandon123

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Re: Complex meniscus tear and 2 mild arthritis with Dr Broyles
« Reply #7 on: February 23, 2018, 04:21:04 PM »
Many thanks for your update, Vlad.

Can I ask what you mean by "the holes drilled in the kneecap and femur are probably worse than the mild arthritis I had to start with?" Do you have more pain/symptoms from this area than before surgery?
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline dal_knee

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Re: Complex meniscus tear and 2 mild arthritis with Dr Broyles
« Reply #8 on: February 23, 2018, 05:58:21 PM »
Thanks for updating.

What about the level of new cartilage growth at the 1-year MRI?  Can you comment on that?
And will the drill holes heal more? 
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 PuneKnee

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Re: Complex meniscus tear and 2 mild arthritis with Dr Broyles
« Reply #9 on: March 06, 2018, 12:35:54 PM »
Hi Vlad,

Thanks for updating the thread. Please keep is updated about the progress. Dr Saw says that in this procedure cartilage continues to get better till 3 years so still 2/3 more to go.















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