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Author Topic: Fast deteriating knee after menisectomy  (Read 374 times)

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Offline Kezza01

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Fast deteriating knee after menisectomy
« on: July 01, 2018, 08:23:41 AM »
Hi all
Hoped to never have to post on here again but I'm back.
Trying to gather as much info as I'm at a total blank at what I should do
I'm 42 yr old woman
179cm tall  approx 60kg
Always been fit and active up until 2011 with my first knee injury
2011 and 2013  I suffered 2 knee injuries
Dr only did ultrasounds and put it down to knee sprains .
2014 suffered a large bucket handle tear lateral meniscus
Operated 10 days later , rom brace for 9 1/2 weeks
Physio etc all seemed good
2015 suffered another knee injury
MRI showed nothing so it was pain relief and continued physio
Didn't improve and in march 2016, surgeon did another op
One of the anchors had pulled out and therefore had a menisectomy
And debride plica
Had a few issues with common peroneal nerve after this surgery ... Live with that as frustrating as that is
Feb this year had a lazy day and when I stood up was in so much pain I nearly passed out
Knee swelled up worse than very first injury
MRI has revealed a subchondral insufficiency fracture
Grade 2 osteo
Full thickness cartlidge loss central lateral tibial plateau with subchondral oedema
Saw surgeon last week and he said my knee isn't good
You expect to have these issues many yrs after menisectomy not just 2 yrs
Too young for a knee replacement
Wants to try synvisc injection and if this isn't effective an osteotomy
This thought scares hell out of me
Been on crutches since feb and it's now winter (Australia) and the cold is making me want
To chop my leg off
So much pain relief tablets it's not funny
Any experiences like mine ?? What did you do ??
Thanks for taking the time to read
Any info will be much appreciated
Cheers

Online Vickster

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Re: Fast deteriating knee after menisectomy
« Reply #1 on: July 01, 2018, 08:59:13 AM »
There are surgeons who do PKR or TKR in younger patients (in this context under 55) but likely only after all other options such as osteotomy have been exhausted or at least considered (in the U.K. for example youíd possibly have to pay unless itís an emergency after an accident)

Is the OA confined to just the lateral compartment? If so have you tried a custom unloader brace? Discuss with an orthotist? If the brace helps then presumably an osteotomy might help although it is a big painful op, possibly even more so than replacement but youíll preserve your joint until a tkr is required.

Give the Synvisc a try, need a good 6 weeks for effect to take. Iíve had good success myself with HA over the last 7 years or so.

Also perhaps try hydrotherapy?

Maybe get a second opinion too?

There's some good info in the relevant primers (and elsewhere in the learning portfolio)

http://www.kneeguru.co.uk/KNEEnotes/learning-portfolio#Primers

This UK surgeon is an osteotomy expert and provides some very good patient focused info (and has written articles for this site)

https://profadrianwilson.co.uk/knee-treatments/knee-realignment-surgery-osteotomy/
https://profadrianwilson.co.uk/patient-resources/preparing-for-knee-osteotomy/

Good luck :)
« Last Edit: July 01, 2018, 09:37:29 AM 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
More tears and wear, scope planned in Jan 2019 to tidy up

Offline PwordsB

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Re: Fast deteriating knee after menisectomy
« Reply #2 on: July 01, 2018, 11:54:15 AM »
I don't have much to say that is helpful, unfortunately, but I understand.

You've been having your knee problems for longer than I have, but I think we're in a similar situation.  I've had a couple of operations since an injury 2.5 years ago.  At the moment, I have had all of my lateral meniscus removed, a cartilage graft to the femoral condyle and now I have a similar sounding full thickness cartilage loss over the tibial plateau and my leg is malaligned.  I also have a medial meniscus tear that's causing problems on the good half of my knee.  In August, I'll be having an osteotomy and then my surgeon will decide what to do about the cartilage and missing meniscus.  Here in the UK, on the NHS, I don't get a great deal of choice when it comes to my surgery, but I am hoping for a cartilage graft and a meniscal transplant once the osteotomy has made its initial recovery.

My experience is that we need to find that ever so delicate balance between rest and rehabilitation.  I'm at a point where I can't work.  I had to quit my job (the fifth job I've had to quit for this leg) about three months ago.  My good leg is now really painful all the time and I'm having an MRI scan to look at that soon.  We need to rest enough to not make it worse whilst exercising effectively enough and regularly enough to maintain or even build strength.  More muscle means more shock absorption, which is a fantastic side effect of keeping the exercise going.

So yeah, not much I can say that's helpful, as I'm right in the worst part of my knee journey (so far).  I'm a 27 year old guy.  Still very healthy and frankly in fantastic shape for someone who can barely walk.  I think the most important part of all this is to try to be okay. 
Snowboard injury 21/01/16
Open cartilage graft (Chondrotissue) 29/06/16
Sub-total lateral meniscectomy, LTP cartilage removal 20/01/17
11mm Closing Medial DFO and LTP Microfracture 10/08/18

Offline LisaWilliams38

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Re: Fast deteriating knee after menisectomy
« Reply #3 on: July 05, 2018, 12:01:31 AM »
I'm not sure I have a lot to offer in the way of advice, but what I CAN offer is experience....Articular cartilage deterioration just doesn't follow any rules. :( I have a history of meniscus tears from doing something as simple as getting up from a chair (happened twice)! One was fro just standing on one leg, shaving the other in the shower. Talk about ridiculous. :)

For info's sake, I'm a 45 yr old female who is athletic/fit.  I've now had 10 knee surgeries, and it's safe to say I lost the genetic lottery with knees. My issues began at 25-26 out of the blue with episodes of unexplained inflammation and meniscus tears for no obvious reasons. One idea is I have a defective collagen gene(s)....

I've also learned MY menisus tears are an early sign of impending cartilage deterioration. We've noticed it since my 6th procedure in 2013. That one involved cleaning out 2-3 meniscus tears and removing a bursa which burst when I knelt to tie my son's shoe. I had suspected a torn meniscus a couple of days prior (yes, from standing up and having it "go")  ::) ::) ::)---but I still wonder if something else was going on in the knee at the time (inflammation-wise??.)

Adding to the weirdness, the bursa didn't heal properly in the time between the meniscus tear (the one I FELT!!!!) and the 9 wks while I waited on a surgery date. The Dr said he removed the bursa because it was the strangest thing he'd witnessed. It had bled profusely inside the knee but didn't even attempt to heal or reabsorb itself. He cut it out, and a new one grew in its place. He also found at least 1 other meniscus tear to add to the one I felt. So there were at least 2 that time around (though my memory wants to say 3 total that time (???).

Regardless, during that 2013 surgery, the ONLY  articular damage in that knee was what he called 2
 tiny "divots" or shallow depressions on my medial femoral condyle. Just something to keep an eye on, right??!!

Fast forward a year--by mid 2014, I had problems with daily life. My knee hurt constantly. Exercising was a challenge. I had to revamp my life based on taking care of a 7 yr old, helping my Dad die from cancer, dealing with my grieving mom, etc. I made the best of things with 2-3 low-dose rounds of oral steroids throughout that fall/winter, just to get by. 

Spring of 2015 came and went, and either I got used to the pain or things improved inflammation-wise.  I made it to May 2015 before I just KNEW something was wrong mechanically. I had spent  20 minutes shooting baskets with my husband and son, yet I couldn't walk when we finished--the knee swelled significantly and stairs were impossible.  It was if "something" finally gave out, and it seemed like something kept sticking in the joint. The end result was a 2.5 inch by 3/4 inch gouge (Grade 4--full thickness articular cartilage defect) on my medial femoral condyle. :o The surgeon said too many loose bodies (some quite large) had come out of the defect and were getting stuck in the joint.

Thus, I had ACI done in Oct/Dec 2015, as the only other option was a knee replacement. I was only 42, and the harvest for the ACI implant showed Grade 2/3 damage on the lateral tibial condyle TOO, so a partial knee replacement wasn't in the cards.

Keep in mind ALL of this articular cartilage damage wasn't there 25 months before during the 2013 surgery. Nothing except those 2 tiny divots/depressions. He still can't explain how things progressed so quickly, other than to say he STILL believes I have an underlying "undifferentiated inflammatory arthritis." He sent me to one of the best Rheumatologists to discuss/diagnose----but after 6-7 yrs, we still have no answers. She agrees  SOMETHING is going on, but the blood work is no help. Until other joints worsen or blood work shows more, I'm stuck being treated as a freak of nature with early onset "localized" OA in my knees---for lack of anything better to call it. I do take a DMARD medication daily (Plaquenil) but we can't really tell if it's helped any. I don't see any benefit personally, but I also no longer have strangely swelling wrists or elbows/tendonitis issues in the elbow...another reason both Drs suspect an underlying inflammatory arthritis. We just can't PROVE it yet.

Also, I had peroneal nerve impingement/damage after my ACI surgery. I wish this on NO ONE!!!! Mine was likely because of 4 major procedures/traumas to the knee area in 6 months, as my Quad freaked out too after the 4th procedure. ((For simplicity, the ACI harvest was Oct 14, the ACI Implant was Dec 8th, the Lysis of Adhesions was March 2, and the MUA was March 8th.)) The lysis of adhesions surgery PLUS a Manipulation Under Anesthesia was necessary because I laid down an obscene amount of scar tissue in 11 wks while immobilized following the Implantation of Cells on Dec. 8th. The immobilizing period following ACI created adhesions inside the knee but also in between the different parts of Quadricep muscles. Breaking the quad adhesions during the MUA is what caused my quad to freak out and swell severely.......thus more TRAUMA around the knee.

The surgeon suspects there is STILL  some scar tissue wrapped around the fibular head (top of my fibula bone), and that's where the peroneal nerve runs through. Certain things inflame it worse than others, and about twice a year the surgeon gives me an injection (can't remember if it's lidocaine or an anti-inflammatory injection ???) to calm things down. It works like a champ every time, but I also have to choose my shoes carefully. My ankles tend to roll out easily, and I need shoes with awesome lateral support, or it adds to that nerve irritation.

My physical therapist also had me tweak my leg-press workouts to maintain quad strength. I can't just NOT work out or the knee replacement will be in my immediate future. :( Plus, I'm just an active person overall and have always been a fitness/sports nut. I can't participate in sports any longer, but I walk, weight-lift, bike, and occasionally use the elliptical. ((It created some of my recent problems though)) :) Anyway, my quad atrophy was severe so I have a strict regimen to maintain (and still try to build what we can) without putting too much force/pressure on the area where the nerve runs through. We've pretty much maxed out the muscle gain and accept my right quad will never look like the left......It took a lot of trial/error, but we found a good balance between the workout changes and staying on top of my shoes (not letting them wear out laterally, etc) AND not ticking off that nerve constantly. I would see if you have any injection options into the nerve sheath to help the pain. I'm in the United States though, so I know our options here are usually MUCH more extensive than those in the UK.

So yeah---I'm just saying the degeneration/deterioration can happen very quickly. Mine seemed to speed up drastically once I hit 40. I'm currently 45, and it seems like my 40's will be known as "the decade of Lisa's knee surgeries."

We're to the point of having major quality of life decisions in the next few years, as now the "good" left knee has gone downhill severely in 14-15 months, after not giving me any trouble for 15 yrs. Again, the MRIs, though not precise, are showing a rapid deterioriation of the articular cartilage surfaces, though on the left knee it's mostly lateral instead of medial, plus A LOT of patellar damage (whereas the RIGHT knee had no patellar damage). A Microfracture surgery with Biocartilage Fill confirmed most of this back in May and I'm currently rehabbing it while trying to keep my kneecap from deteriorating further. It wasn't severe enough for insurance to cover a Microfracture and Biocartilage-fill to it, though it bothers me a lot still. I figure we'll go back in and fix THAT in a couple of years. :(

Just know I feel for you, and I wish you weren't dealing with this. We're supposed to be in the best years of our life, yet I feel like I either gamble on early knee replacements (and multiple revisions) or sit back and watch my 40's go by while waiting on my 50's to get here and lower the odds of multiple revisions. 
 
I wish you the best though. :)

--Lisa
« Last Edit: July 05, 2018, 12:26:22 AM by LisaWilliams38 »
'98 R plica
'99 L resect discoid meniscus
'01 L  meniscus tear
'02 R  meniscus tear
'10, R meniscus tears, Bursectomy
'13, R 3 meniscus tears, Grd 3 Biocartilage fil
'15 R Oct-ACI harvest,
'15 R Dec-ACI implant
'16 R Mar-lysis of adhesions
'16 R Mar-MUA
'18 L 3 menis tears, Grade 4 Biocartilage fill















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