I took the plunge, Lateral Meniscus Transplant + OATs

[LateralMeniscusIssuesGuy]

Finally the 1 year update!

1 year is reported by many rehab protocols as the time required for a meniscus transplant recovery, so I have been curious this entire time how I would feel on that 1 year anniversary of surgery date.  Would my leg feel pre surgery still, or more like a normal leg.  Would I regret the year of work and money invested as it didn’t yield a knee I felt I could live with?  So many questions swirl when you are thinking of going ahead with a serious surgery.

My current response to all of that is satisfaction and relief.  I am largely ache and pain free, zero ‘visible’ swelling, and getting stronger and more athletic month to month. I don’t have discomfort in the mornings, I can get full flexion at any time on demand without easing into it, in honesty it’s been more successful than I had hoped!

I remarked on pains in and around my knee recently, and in fact throughout the rehab process, all of which have resolved. I suspect the majority if not all of which were brought on by waking up muscle patterns, over training / under training, essentially me not coordinating properly leading to imbalances and so muscles tugging on ligaments and structures to the point when they become painful.  Spending lots of time following the guidance of a man named Trevor Bachmeyer (youtube channel “Smashwerx”), spending upwards of 30 mins a day essentially massaging my muscles, peeling facia layers, gaining ROM in my hips and other joints…and it seems to resolve all onsets of pain.  I’m still trying to shift what I think is some plantar fasciitis, but it’s much better than a fortnight ago.  I think this work may be a vital component of rehab that isn’t addressed by any physios I had access to, I do really recommend his channel.

The unloader brace came in, and it is a great piece of kit.  When wearing it I feel very supported, and have already been pushing myself skating with it, performing skating strides which would have been agony before my surgery without issue.  I think this brace will be excellent for any kind of sport outside of the gym, and won’t be visible under my equipment.  I will report back more on it after more use, but after 10 hours in it, I think its vital for me to responsibly engage in impact, twisting and valgus loaded movements, and so thankfully not £700 wasted.

The scaredy cat in me is concerned that I may just be pain free due to the OATS and actually slowly working through that new articular protection…but that wearing away was previously accompanied by massive swelling which there is zero sign of now, so I’m slowly permissioning myself to not think in such a conservative way. 

The physio sessions have stopped now, I won’t get access to more care, just a final MRI follow up with the surgeon next month to confirm everything looks ok inside my knee.  The end stages of the physio which focused on movement patterns in things like quick squats, hops and quick feet was interesting, challenging, and valuable.  I didn’t realise in so many movements how much I was attempting to protect my lateral compartment, such as walking up stairs my stride was very different on one leg to the other as I climbed and descended (twisting my hips, less knee bend, foot placement not under body…), being made aware of these things seems to have left me more balanced and again addressed some pains I would develop.

Whilst this all sounds good, I must stress I’m still not at the activity level that “fully recovered” probably implies in the mind of most persons when they have hopes of what this surgery can do for them.  I have perhaps been more conservative than most with my progression through to impact activities.  I need to apply myself more with a return to running and jumping, but since those activities aren’t core to my sport I have avoided them.  When I have ran for a train recently, I have been pleasantly surprised by the lack of pain or swelling and the spring in my step.  So someone else might instead be able to report flawless running at my stage of recovery, but while I have probably been guilty of overtraining in some ways, I have been cautious with impact. 

Also, I still get pains, but again, I really do think these are muscular / nervous system related due to improper movement or inadequate body maintenance.  They all resolve with time though sometimes reappear.  I can only assume as my movements become more trained that the maintenance time required will reduce, as I obviously have never had to do this amount of stretching and massage before to keep pain free, and still do very little for my good side.

I’ll update after my MRI, which will be approx a 13.5 month update, by which time I should have progressed my attempts at a return to sport, have more time in the brace, and perhaps even some moderate impact work.

So, again, so far so good, pleased I went ahead, if I could turn back time to my initial injury I would have sought out Tim Spalding to attempt my first meniscus repair, and regardless of whether he managed a repair or had to do a partial removal (as happened with the surgeon I went with), I would have committed to this custom OA unloader brace to participate in sport.  Ah, sweet hindsight!

JT

[AndrewC]

Thanks for the detailed reply. It is great to hear of a success story from this treatment. Im a 42 year old fit male who has always been very active, well until recently. I have a post in the general forum about my current situation but basically, my medial meniscus is torn and extruded from the joint, no articular damage yet according to MRI but it is still very limiting in what I can do at present. Partly through fear, the other part through pain.

NHS said 'cant help' so I will be seeing Tim Spalding and Nick Black and maybe one other opinion depending on choices to see if they can repair it as an attempt to would be the case in America going on my very extensive research. I already had my lateral meniscus repaired in the same knee years ago.... bucket handle tear, and that side is ok thankfully.

I'm a realist though, I know I won't get back to serious running or twisting sports but I served my time doing these, I will be happy to be able to jog after my son and not be in pain so often.

Will see what the consultants say and report back. Please keep the updates coming, it fills me with hope in case this is a route I am offered!! Maybe it won't be and if so, I will have to deal with that.

[Mr. Potato Head]

Lateral Meniscus Guy,

Thanks for all your updated posts will enjoy to continue hearing how your return is to sport and what you decide you can and can't do.  For all of us thinking about this surgery its great information.

Great updates and best wishes for return to active lifestyle!

[LateralMeniscusIssuesGuy]

I'm glad it's even a little useful, even if just an interesting read.

Had my 13 mth MRI performed yesterday, have the report and 'final' meeting with Tim Spalding on Thursday.  I have encountered lots of issues with the knee as I have tried to ramp up the activity level, all seem to have resolved again, but it's a really confusing, worrying, and frustrating time.  I hope that the MRI reveals that everything looks fine internally, and I plan to hire a movement coach, as despite my best efforts, I'm obviously not aware of the haphazard way I move, sit, lay etc.

I have had /still have:

- shin splints
- plantar fasciitis
- IT band syndrome
- foot pain
- hip internal and external rotation issues

Literally my whole architecture has gone through an enormous reset, and its all jumbled up.  I honestly was a very high level amateur athlete, very present, very body aware (compared to the layman), this has been an enormous shock, especially since things were going on schedule, and none of the rehab schedules remarked on these kind of issues, and I literally had them all together.

I hope that things still turn out fine, I am doing really well despite all these complaints that last for a fortnight or more at a time, but I obviously want to be perfect, and far better than my pre-surgery condition.  Maybe in 6 months I will be somewhere I dreamt I would be after surgery, so far I still have a way to go.  What a mountain of a rehab!

Proper update the end of the week

[LateralMeniscusIssuesGuy]

I had my "final" catchup with Tim Spalding at the 13th month post surgery mark, and learnt a bit more about the surgery and the condition of my knee.

First and foremost, I seem to have good thickness articular cartilage everywhere.  The site of he OATS has healed well and has essentially filled the 1cm pothole I had on the posterior lateral head of the femur.  The meniscus transplant is fully infact, no rips or tears, which is as I would hope since I have full range of motion.  He did explain in more detail that of course the rest of the surface of the bone which was not operated on didn't have pristine articular cartilage at the time of surgery, and again went through the pictures to show an almost fluffy texture when it should look like smooth marble, but the thickness is essentially full thickness despite this wear.

I did also have a defect in the posterior lateral tibia head, however he elected to simply place the meniscus over this rather than any kind of oats pug, and it seems I have some kind of full thickness fibrocartilage over that.

The OATS donor site has completely healed with bone, and again seems to have full thickness fibrocartilage.  I remarked that I has a full thickness fissure (essentially a small crack) behind my patella, and that seemed to have disappeared on my last set of MRI, but it is back this time, haha, essentially it was missed in the thickness of the MRI scan slices last time.  It has not developed and as far as he is concerned, is zero issue and the underlying bone is fine.  He doesn't anticipate it progressing and thinks much of the population probably have something similar without ever knowing.

He explained better to me that the reason I have a more pronounced bump in the surgical site is due to the suture technique for the transplant, where he retains a 1mm rim of the meniscus, and then uses sutures to attach the donor to this, then tying the horns down using bone tunnels.  I have been a little anxious that my knees don't look the same, and I keep getting remarks from PTs that my right knee looks puffy, but I think it is this protrusion.

He anticipates the low level swelling I occasionally get is probably due to the OATs donor site continuing to mature, that is a nice mindset for me, and while it was robbing peter to pay paul, it doesn't give me any pain, and means I will be less anxious that I should anticipate swelling as an issue with my lateral compartment.

I will try and upload some pictures of my knee to this post to show some of the progress and where I am at the moment.

So essentially from when I met Tim 18 months ago, I dreamed I would be at this stage.  I have had 3 sessions back at ice hockey, taking it very slowly, without issue so far.  I am performing well at the gym, but want to take things to the next level.  I am hiring a PT, likely for the next year, who I think will really assist with my quality of movement.  I have been doing some work recently on my hip mobility, and that has been a huge step up for my knee function and comfort during exercise and all times really.  So I want to sent that into overdrive, as while I can do that myself slowly using YouTube, I suspect it will take some time to become self aware to the point I will realise all the compensatory habits I have.  His website and YouTube content is really good, have met him, and start training tomorrow, I think it will be a great investment https://movementfirst.co.uk/.  Together with the Smashwerx youtube channel, and movement videos from Dr Spina, I think I am doing things the wrong way around, and that quality of movement should have been sought pre surgery and much earlier in the rehab.  As much as Isokinetic was a good rehab practice, there is a whole other world of quality of movement out there, which would have probably help avoid injury in the first place.

So essentially I am pain and swelling free 95% of the time. I would say a couple of days a week, I have a swelling sensation at some point during the day when I have been sat down for a long period of time, but I can flush it out with a bit of bike work or even just low compression while going through active ROM. The crepitus is reducing, though still that knee is more audible than my other.  I am really excited what I can achieve in the next 6 months.

For all the success, Tim was careful to say that this was still salvage from his perspective, I don't have a new knee, just a new to me knee.  That said, I can't believe the typical meniscus transplant patient will be taking all the supplements and dietary considerations I have, and will be working out in the balanced way I have tried, and this new approach to proprioception and movement quality, and no plans to run (which almost everyone else does), so I'm optimistic this salvage will be a very long term fix / project.  He said the hope would be this gives me 5 more years of international level sport, then reduce down to something like cycling, and it should keep going until my 60's (currently 35YO).  So lets see, but I will put all my chips in to get a little bit more out of my prime.

Thanks all for reading.  Tim has also released a website called meniscaltransplant.com which has some other patient stories and information, is a work in progress, but a good resource, which I will contribute to soon.

I'm very open to advice or support or questions and will be as honest as I can.

Warmest regards
JT

[LateralMeniscusIssuesGuy]

15 month update.

For the past month I have committed my rehab towards FRC (Functional Range Conditioning) and that combined with my continued supplement combination, and perhaps more sleep, and just the passage of time, has me in the position of feeling the best I have since surgery.

I have done some light jogs to catch trains without issue, but don't intend on trying anyt serious running, I will try to increase my tolerance for it, but slowly, however I was never a runner.  The FRC identified so many issues with my ROM, both active and passive, its a work in progress over a lifetime but a month of work seems to have got me functional in squat positions and really assisted the control in my hip internal rotation, crucial for my ice hockey goaltending.

I have returned to sport, an adjusted less demanding and less competitive level for now, and haven't had any issues.  I want to have months of training once a week without any consequences before I notch up the intensity.  The custom knee brace is probably also helping protect my compartment when I train.  I'm in a happy place most of the time at the moment.

There are those days when I detect some swelling or discomfort, normally when I have gone off routine, but I can do heavy gardening, plenty of gym, just about anything that is slow and controlled.  Its speed that has me anxious.  I hope to become more comfortable with speed as time goes on.  I am doing work with my FRC which is training my nervous system to unlock active ROM, when that is sufficient across my joints, my trainer is happy for me to start to introduce speed drills, but not before as much responsible slow control is in place that he feels confident.

So overall I'm really happy, 9 months away from a 2yr follow-up MRI with Tim Spalding, after which time I will have lots of hockey under my belt.  Assuming I don't detect an injury during that time, it will be a nerve-wracking moment to see what thinning or damage the MRI shows, if any.  For now I feel I am just about toeing that line between being responsible and living life, everyone will have an opinion, and those closest to you will normally recommend you boas towards caution, no one can say what is right for you such that you will look back at a life well lived, such a conundrum, for now trying to live each day maximally, within reason.  Sorry for the flowery nonsense.

[Catherine88]

15 month update.

For the past month I have committed my rehab towards FRC (Functional Range Conditioning) and that combined with my continued supplement combination, and perhaps more sleep, and just the passage of time, has me in the position of feeling the best I have since surgery.

I have done some light jogs to catch trains without issue, but don't intend on trying anyt serious running, I will try to increase my tolerance for it, but slowly, however I was never a runner.  The FRC identified so many issues with my ROM, both active and passive, its a work in progress over a lifetime but a month of work seems to have got me functional in squat positions and really assisted the control in my hip internal rotation, crucial for my ice hockey goaltending.

I have returned to sport, an adjusted less demanding and less competitive level for now, and haven't had any issues.  I want to have months of training once a week without any consequences before I notch up the intensity.  The custom knee brace is probably also helping protect my compartment when I train.  I'm in a happy place most of the time at the moment.

There are those days when I detect some swelling or discomfort, normally when I have gone off routine, but I can do heavy gardening, plenty of gym, just about anything that is slow and controlled.  Its speed that has me anxious.  I hope to become more comfortable with speed as time goes on.  I am doing work with my FRC which is training my nervous system to unlock active ROM, when that is sufficient across my joints, my trainer is happy for me to start to introduce speed drills, but not before as much responsible slow control is in place that he feels confident.

So overall I'm really happy, 9 months away from a 2yr follow-up MRI with Tim Spalding, after which time I will have lots of hockey under my belt.  Assuming I don't detect an injury during that time, it will be a nerve-wracking moment to see what thinning or damage the MRI shows, if any.  For now I feel I am just about toeing that line between being responsible and living life, everyone will have an opinion, and those closest to you will normally recommend you boas towards caution, no one can say what is right for you such that you will look back at a life well lived, such a conundrum, for now trying to live each day maximally, within reason.  Sorry for the flowery nonsense.

Hi, happy to see you are doing so well, but 15 months??! To feel ok! What changes if any, do you feel you are experiencing from before the surgery, as I assume you are not yet full on the sports you d like to do. I’m asking casue what you are describing I’m experiencing as well, without lateral meniscus, and with thinned cartilage, and a meniscus allograft have crossed my mind, but if it’s to go through another operation plus much recovery To feel OK, i don’t think it’s worth it. To be fair, i have slight symptoms and a pain level on a scale of 3 sometimes. Nothing that prevents me doing loads of gym work or function day to day like most of the ‘healthy’ people. I d like to know your improvement, whether it’s worth it, it’s true I don’t jump like before, and I’m more careful, but that I suppose I’d. Have to be anyway, even with a meniscus replacement, is that the case?

[LateralMeniscusIssuesGuy]

Hi Catherine,

Yes its 15 months so far, it does feel like forever, I anticipate perhaps another +6 months ahead of me, I think this is really a 2 year recovery.  But earlier (I think after the first 9 months) you are able to do all normal living activities (wash the car, all manner of gardening and house work), so the face I am rehabbing still to work towards jumping and running and sport is fine for me, as I am kept busy with my young family.

It was the toughest decision of my life to go ahead with the transplant, it took me a year to decide, as I had a decent quality of life before the surgery, so could be taking a step backwards if/when it fails, but the pull of my sport won in the end so I bet the house, so far it seems I may managed to make it back to my sport fairly soon, so I'm very lucky and very grateful for how things have turned out.

My expectation is that the condition of your articular cartilage in the area will have a significant impact on the success of the surgery, and the choice of activities you do in the future.  Avoiding running and cutting sports, and being willing to take my time, and having a fairly small area of articular cartilage defect seems to have me pain free atm.

Good luck with your continued management!

[LateralMeniscusIssuesGuy]

Quick 16 month update.  Massive sport progression.  I can't singe the praises of FRC training enough.  I wonder if I had been doing this type of training and joint articulation training from before my injury if I would have had the initial injury.  I feel that without it, I would have pain manifest in my lateral compartment due to insufficient range of motion in my hip and ankle, and imbalances throughout my body.  I personally believe the training is massively responsible for relieving these pains.  I continue to take a vast number of daily supplements and a fairly strict nutritional regime, which I hope helps.

The sport progression is me playing full ice hockey goaltending without restriction.  Function jogging (to catch a mode of transport that is about to leave) is no issue, as is running up or down stairs, hopping, all manner of squats and kneeling.  Its a work in progress, I'm exciting for how robust and 'in-control' I might feel 6 months down the line when I can reintroduce certain resistance training into my routine alongside FRC (no time due to the arrival of a second child).  I would hope by the beginning of the summer, unless I have an accident, I might be approaching peak confidence and fitness and playing the sport at the highest level I aspire to again, a real dream come true.

Absolutely no complaints with my current state, i'm not indestructible, but am tailored to the things I consider important and enjoyable and am steadily unlocking them all, where they have been off limits for 5 years.  It will be another 8 months until I have a 2yr MRI to determine if my current activities are having a negative impact to my cartilage state, for now I don't have any swelling or pain during or post exercise, vastly different to the massive reactionary swelling when I was eating through my articular cartilage before.  I do have many more anti-inflammatory supplements in my system now compared to back then which could be suppressing that reaction, so who knows, for now I will be guided not only by pain but also function.

Good luck everyone in your constant managing of your bodies.

[badleftknee1]

JT- This is great news and inspiring for those of us in the potential que. Some questions for you...

-How are things like prolonged walking and standing- do you get any discomfort or sense that you should unload the joint?
-How are repetitive motion activities such as cycling, elliptical, hiking (if you have tried)? 
-Does your gait feel completely normalized, and has it changed at all from pre-operative?
-Can you officially say you are better off now than pre-surgery?

One thing that very much struck me as I checked back in at your story was the expected lifespan of the transplants- man, how nice that would be!

Best of luck with your continued recovery and thanks again for your updates.

[left knee]

Hi JT,

I am 6 months yesterday post lateral meniscus transplant. It has been very helpful following your post. I am definitely not back to baseline yet and have good and bad weeks.  I had an MRI yesterday which indicated some graft extrusion. From reading the literature it is very common and seemingly doesn't affect outcome of graft ( I find it hard to believe)

Just 2 questions, from your MRI did you have graft extrusion? You mentioned you had an abnormal bump at the lateral aspect which Mr Spalding put down to suturing technique. I too have this and feel it may be meniscus related given MRI results

[LateralMeniscusIssuesGuy]

badleftknee1

-   Honestly, rarely but it has happened with prolonged standing, less so as time continues, I can be on my feet most if not all day now without pain or swelling, prior to surgery if I was standing more than 30 mins the evening would mean reactive swelling
-   Only cycling of those you mention, in the saddle I feel very strong, and feel confident to push to my max exertion, out of the saddle im not stable enough to crush down on the peddles, perhaps that will also come if I train it more
-   I’m not a very present person, so can’t give a confident reply to that, I think far too much about my walking, my instinct is my left and right side are identical now
-   I can in more ways than I am not.  I had more confidence with a short sprint pre surgery (tho the fallout in the evening could be severe), but in every other aspect I outperform pre surgery

left knee

-   I can’t recall any remarks from my surgeon regarding extrusion or shrinkage of my graft when observed using MRI, I believe every graft probably has one of the two, but I guess mine was unremarkable
-   Yes I have a protruding almost nobbly knee where the existing rim was used to sucture the donor meniscus to, meaning it sticks out now.  Bit funny that my knees now look very different, but I guess that was unavoidable, and not an issue if not painful.
-   You have done amazingly well to get to the 6 month phase, have you got more on your journey on this site that I can read?

[left knee]

Hey

I haven't actually logged progress up till now. Im just over 6/12. Current issues low grade swelling , not visible to physio/surgeon but feeling of fullness in kneecap. Similar to you i have a bit of medial kneecap pain close to entry port. IT band has also been an issue. Function wise I am back in work, swimming a few times a week and cycling out on road up to an hour twice a week. Need to up my rehab in gym to start building up VMO etc.
Overall Im definitely not back to baseline. Have pains intermittently but different from previous pain which is reassuring ...... I too have high expectations of returning snowboarding by next winter , getting back to golfing regularly without pain after and possibly doing the odd 4/5km jog. Seems like the impossible at the moment but hopefully will get there and longterm delay the knee replacement by 10/15 years...

[LateralMeniscusIssuesGuy]

I am obviously a sample size of 1, but my brief experience has convinced me that if I have to go through this again, I will get into FRC training much earlier in my rehab.  The ankle and hip work with those movements seem to have been transformative to some of the discomforts I had, but it could simply be the passage of time (18 months).

I am about to embark on 3 months of Keto diet + OMAD, in an attempt to retain and gain muscle, while stimulating autophagy, hopeful that could have some positive impact to the cells within my knee capsule.  Even if it doesn't, it should mean I am a good deal lighter which in it's self will be helpful.

I am continuing my FRC movements and feel more and more comfortable in ass to grass squat positions, I am hopeful for the spring / summer!  I didn't mention previously however I competed in a hockey tournament in December and won it with my team, a really satisfying milestone, with much less fallout than I expected or would have had should I have done that post my initial partial meniscus removal.

[LateralMeniscusIssuesGuy]

Very brief note update.

Diet went well, basically ate calorie maintenance and didn't lose or put on weight as best I can tell.  Probably a beneficial move in body composition.  Knee swelling is good but by instinct is that going full keto didn't have much if any impact from that angle, so will likely stay low carb but increase protein for better muscle gain and retention.  Eating once a day is convenient and has really helped cut down on unhealthy snacking.

I have had a session with a Neural Kinetic Therapy (NKT) professional and they have deemed that the impact if the surgery has left a neural lag / road block that needs retraining and stimulating to get full proprioception of my leg again.  After 1 session I think I am seeing a difference, she wants me to lay off the lower body work and hockey for 2 months to give this a go, so no sport until April.  Excited that this might be the bit I was missing.

Will update probably at the end of that treatment.