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Author Topic: Arthroscopy, Chondroplasty, Microfracture w/ Biocartilage Application and TTO  (Read 3720 times)

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Offline Meralus

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Hello All,

My name is Nathan, I am a 24-year-old male currently living in Bozeman, MT but was born in Sydney, Australia.

History:
  • I've had a problematic right knee for many years know after repeat injury/trauma to the area
  • Have had three previous arthroscopes/chondroplasty to the right knee all between Oct-14 and July-17
  • In July 2017, after flying back to Bozeman from Australia, I was 13 days post-op from my 3rd knee scope and was admitted into the ED in Bozeman with a significant hematoma in my right knee, a 4th surgery was performed to fix the issue - 175 CC's of blood pulled from the knee

Clinical Diagnosis:
Year by year, my knee was constantly degrading due to normal wear and tear as well as other unknown causes. Once I recovered from my 4th right knee surgery, we ran extensive tests to get a full analysis of the knee.

  • Full-thickness loss of articular cartilage on the patella involving the medial facet and lateral facet
  • Full-thickness loss of articular cartilage on the lateral aspect of the lateral trochlea with underlining subchondral marrow edema
  • Partial-to-moderate thickness loss of the articular cartilage in the central weight-bearing portion of the medial femoral condyle
  • Moderate-to-severe tricompartmental osteophyte formation
  • Tendinopathy of the patella tendon - suggesting a mild longitudinal split
  • 12mm of lateralization in the tibial tubercle
  • Oddly enough, my meniscus and ligaments are in generally good health

With this, I cited three professional opinions. One from my surgeon back home in Australia who had done two previous knee arthroscopes on me - A/Pro. Munjed Al Muderis, from a doctor in town - Dr. Timothy O'Brien, and one of the best surgeons in the Rockies/West USA - Dr. William Sterett. All of them suggested the same method of surgical intervention given my age and wanting to preserve the joint. An arthroscopy/chondroplasty (Had many of these before), microfracture of the patellofemoral joint (with a biocartilage application) and a TTO to help preserve the quality of the microfracture procedure by lowering the friction, re-aligning the patella and fixing any stabilization issues.

Due to insurance and other logistics, I decided to go with the surgeon in town, Dr. Timothy O'Brien who has operated on me before and is considered one of the best in Montana.

Surgery Day:
The surgery was booked for 9/11/17. I got to the hospital around 11:30 am and was in the theater by 1:30 pm, the surgery was roughly 2 hours in total, and when waking up in recovery, my heart was racing around 160bpm+ which had the nurses in a state of panic. Eventually, this settled and I was taken to my room. I opted for both the nerve block and IV painkillers until I could get a consistent dose of oral medication in me. Because of my previous hematoma and the significant damage in my knee, the surgeon recommended it was best if I stay in the hospital for two nights, which my insurance approved.

I had no pain the first day but was pretty much forced to stay in bed the entire time and not even move, which wasn't fun.

Rest of my hospital stay:
The following two days in the hospital were honestly a breeze. I was expecting significantly more pain and mobility issues, but I had no complaints at all. The surgeon was surprised, as most people tend to struggle after a TTO. I was weaned to the oral medication, and my pain was around a 2/10 (and still is), I could do leg raises no issues, quad tensions, calf raises and more without issue. I made a full loop of the hospital wing without issue and even attempted stairs. The surgeon was happy (and surprised) with the result and had no complaints.

Time at home:
I was discharged Wednesday night and since then have been home. I'm now 4-5 days post-op, and I honestly feel incredible. I'm a full knee immobilizer so getting around is pretty frustrating. Otherwise, I have no issues. I'm sleeping great, the pain is non-existent, I can get myself in/out of the CPM without issues, and more. I must say, it's been super smooth for me thus far. I've had amazing help from friends in getting around and assistance with food and such.

Some pointers:
I know a lot of people struggle with this surgery and rightfully so, I honestly have no idea why it's going so smoothly for me, but here is what I am doing in case anyone needs advice:
  • If you can, start PT before your surgery and focus on quads/hamstring exercises, it makes life a ton easier
  • Get your hands on a drink called "Ricochet" - it's an expensive nutrient rich drink ($288 for 24 bottles) but is worth every cent. It boosts your immune system with amino acids and other essential vitamins and minerals to aid in recovery and surgical trauma. 2 bottles a day six days before and six days after, it's worth it
  • Cold therapy units are the best invention ever, if you can, get one. It beats a traditional ice pack

I'll update this more as time goes on, but I'm thrilled so far.
« Last Edit: September 16, 2017, 05:26:28 PM by Meralus, Reason: Grammar and spelling »

Offline Brandon123

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Hi Meralus,

Many thanks for your story and post-op diary. As a fellow (right knee) 'damaged patellofemoral cartilage sufferer' (one chondroplasty so far) I find your case interesting. I'm looking forward to follow your recovery!

Keep us posted!
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 Meralus

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Hi Meralus,

Many thanks for your story and post-op diary. As a fellow (right knee) 'damaged patellofemoral cartilage sufferer' (one chondroplasty so far) I find your case interesting. I'm looking forward to follow your recovery!

Keep us posted!

Hi Brandon!

Thank you very much. It is indeed an experience and something that troubled me for a long time. So I honestly wanted a big step to fix it, as non-operative treatment was giving little relief.

The most frustrating part so far is not being able to drive/loss of independence - which takes some getting used to.

I've attached some photos to this post. One is a post-op XRay of the TTT, the knee post-surgery in the brace/ace wrap and the incision its self.

Let me know if you any questions and I'm happy to help!

Offline Brandon123

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Good that all your OS agreed on the procedure. Often, recommendations differ between OS, which then makes it difficult for the patient. Anyway, do you know what areas of the PF joint they did the microfracture on? Patella cartilage? Trochlear groove?
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 Meralus

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Good that all your OS agreed on the procedure. Often, recommendations differ between OS, which then makes it difficult for the patient. Anyway, do you know what areas of the PF joint they did the microfracture on? Patella cartilage? Trochlear groove?

I'm glad they all agreed, at first Dr. Sterett was leaning towards the OATS procedure, but after running some tests and measuring the TT-TG he decided the microfracture was the best, providing the biocartilage application was used. This helps increase the success of the surgery and also the longevity of this new fibro-cartilage.

My surgeon back home was tossing up between the two, but said the hardest thing about the OATS (Allograft, so a cadaver) is how long one can generally wait to get a viable donation. This, paired with my young age and good health made him lean towards the microfracture as a younger patient has a higher success rate with this surgery to older patients.

I believe from what we discussed post-operatively, and I could be wrong as I was fairly drugged up at the time that due to the significant denudation on both surfaces he microfractured the trochlear groove and cleaned up the patella best he could and did a few microfractures there as well, but not as many.

Because I opted to have multiple procedures in one surgery, the recovery timeframe is all the same. A few weeks NWB (two crutches), eight weeks in a locked brace at zero degrees, and the need to wear the brace for about 2-3 months in total afterwards with further extension allowed as advised by the surgeon. This is to protect the osteotomy as well as the microfracture from over-extension.

Five day post-op:
Today the full scale of the bruising has come through and it's starting to make the brace slightly irritating to wear, but no major complaints from me in the scheme of things. I just kept it well elevated and iced-up (I've gone through so many bags of ice). Still have great strength and have been doing the following exercises at home:

CPM Machine: -2 degrees to 40 degrees - 5-6 hours a day (2-3 hour sessions x2)
Straight Leg Raises: 10 x 2 sets (2 times a day)
Ankle Pumps: 10 x 2 sets (2 times a day)
Leg slides (With brace unlocked to 30 degrees): 5 x 2 sets (2 times a day)
Quad/VMo tensions: 15 x 2 sets (2 times a day)

I have been doing exercises for my left leg as well, this is just to my limited motion and mobility I don't want it cramping up.

Offline Meralus

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Edit: Oops. Extra post. Please ignore.

Offline Brandon123

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Ok, thanks for the info!

Interesting about the OATS vs. microfracture decision, as many on the forum with similar damages in the PF joint have been suggested one or the other by different OS (who seldom agree which is best). Seems that microfracture is getting some traction again with the biocartilage application approach. 

Overall, sounds like you're doing great. Always encouraging to read stories of recoveries that are going really well!
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 Meralus

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Ok, thanks for the info!

Interesting about the OATS vs. microfracture decision, as many on the forum with similar damages in the PF joint have been suggested one or the other by different OS (who seldom agree which is best). Seems that microfracture is getting some traction again with the biocartilage application approach. 

Overall, sounds like you're doing great. Always encouraging to read stories of recoveries that are going really well!

Thank you very much! I certainly had a fair bit of worry heading into this surgery (Mainly the TTT) given some articles I read on here. But everything is smooth so far. The weekend was boring (Pretty much confined to couch/bed).

PT is super happy with my progress and that I am "ahead of the curve." I don't get to see the surgeon until next week and until that time I'm still NWB (toe-down if needed). Hoping to start graduating off the crutches after that visit. Cut back on my narcotics as well, which is always a welcome change.

Offline Brandon123

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PT is super happy with my progress and that I am "ahead of the curve." I don't get to see the surgeon until next week and until that time I'm still NWB (toe-down if needed). Hoping to start graduating off the crutches after that visit. Cut back on my narcotics as well, which is always a welcome change.

Sounds awesome! :)
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 Meralus

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Ten days post-op:

I'm about ten days post-op now and I'm feeling great. Have already reduced my pain killer user significantly. Still doing 5-6 hours a day on the CPM machine. Pain overall is a 2/10. I'm having some localized numbness on the medial side of my osteotomy incision, which is not unusual and will repair in time.

I'm back to see the surgeon on Monday and hoping that due to the immobilizer, I can start bearing more weight on the operated leg. PT has been going great and getting to 40 degrees flexion has been no issue.


Offline Susan17

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Re: Arthroscopy, Chondroplasty, Microfracture w/ Biocartilage Application and TTO
« Reply #10 on: September 24, 2017, 10:04:45 PM »
This is awesome. I'm jealous!
6/20/17 - ACL Tear
7/25/17 - ACL Patella Autograft Reconstruction
8/11/17 - Started PT

Offline Meralus

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Re: Arthroscopy, Chondroplasty, Microfracture w/ Biocartilage Application and TTO
« Reply #11 on: September 25, 2017, 06:28:31 PM »
Thanks! Thursday night through the weekend the pain picked-up a little but, I figure this is mostly due to the bruising and increase in swelling (Nothing of concern). But I didn't medicate it, I just pushed through and had a relatively easy weekend.

I'm only taking one Oxy before PT now and an extended release before bed, as well as Tylenol during the day and this is giving me perfectly fine pain relief. However, I am having some withdrawal symptoms right now from reducing the Oxy, as per normal after sustained use (I was taking it before surgery, as I had a scope a few weeks prior).

Back to see the surgeon tomorrow. Judging by our phone conversation on Friday. I should be allowed FWB with one crutch or cane and 90 degrees NWB flexion. However, extension locked at 0 degrees when weight bearing. I'm just glad the staples finally come out! They are starting to get somewhat irritating.

Offline Meralus

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Haven't posted an update in a few weeks, so thought I would put something up.

Everything is progressing very well, around the 3-4 weeks mark the OS allowed me to start putting down more weight providing I had crutches for assistance and the brace was totally immobilized. I was also allowed more freedom in flexion, can have the brace unlocked while sitting down and sleeping.

It's been a tough road no doubt as the small things become frustrating. Not being able to drive, cook dinner, do things around the house, etc. But I'm back to see him next week and can hopefully graduate from the crutches and just use the brace for a few more weeks.

I will say this, any major surgery like this that inhibits you is just as much of a mental test as it is physical. It will push you mentally. Being stuck at home unable to do much, with only your thoughts racing. The loss of independence and everything else too. It is tough, but if you can have a strong mental approach you can do very well to getting ahead and overcoming this.

Overall, I'm very happy with my progress so far and looking forward to the next few weeks and starting to feel like myself again.

Offline Brandon123

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Glad to hear your recovery is going well! Also very true everything you said about the mental part. Looking forward to hear about the final outcome of everything :) Did they say approx. how long it will take to fully recover from this rather major procedure?

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 Meralus

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Glad to hear your recovery is going well! Also very true everything you said about the mental part. Looking forward to hear about the final outcome of everything :) Did they say approx. how long it will take to fully recover from this rather major procedure?

At the moment, it's looking like this:
  • Another 1-2 weeks in the brace locked - putting me around the 6 weeks post-op mark
  • Another 2 months of physical therapy (3 months in total)
  • 3 months to start being cleared for moderate exercise (jogging, more weight, resistance, etc
  • 6 months until cleared for more vigorous exercise
  • One year for complete rehabilitation and full sport/contact clearance















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