Advertisement - Hide this advert





Author Topic: Avascular necrosis after injury -- what's in the future for me?  (Read 681 times)

0 Members and 1 Guest are viewing this topic.

Offline kaylachrist

  • MICROgeek (<20 posts)
  • *
  • Posts: 15
  • Liked: 5
Avascular necrosis after injury -- what's in the future for me?
« on: September 16, 2018, 03:33:03 PM »
Hi guys,

I had an injury earlier this year that resulted in patella cartilage damage that was cleaned up via arthroscopy. My surgeon took x-rays back in March that he said looked fine.

I recently saw a second surgeon who does stem cell injections with his patients to see if they'd be worth a try to fill in the cartilage damage. I'm 31 years old and the defect is small, so I figured it was wise to be well-informed. He took separate x-rays and zoomed in on a small area in my lateral femoral condyle that had gone black; it was evidence of a previous fracture, something I'd always suspected, and now the bone in that area has died. So either my first surgeon didn't catch it in his x-rays in March or the bone hadn't necrosed by then. Since it's surrounded by healthy bone on the sides and still has cartilage on top he said there wasn't anything he could do to fix it, only that we'd need to hope it doesn't spread.

Has anyone had AVN after trauma to their knee and know what's likely in the cards for my future? It's hard to find information since AVN seems to be caused by different things and I'm only dealing with a small patch of it after an injury. I wonder if it will put me into the knee replacement camp at an early age regardless of whether I attempt to fix the cartilage or not, or if it's less likely to spread since it's post-traumatic.
Jan '18- Injured RK, age 30
June '18- RK arthroscopy, smoothed out patella cartilage damage
Diagnosed with post-traumatic cartilage lesion and osteonecrosis of lateral femoral condyle

Offline Bella Gamba

  • MINIgeek (20-50 posts)
  • **
  • Posts: 45
  • Liked: 8
Re: Avascular necrosis after injury -- what's in the future for me?
« Reply #1 on: September 17, 2018, 06:25:48 AM »
Hi Kayla,

After the metal implant used to fix my TPF was removed, I learned that I have a 0.5 cm diameter void in my tibial plateau the OS called AVN (I read this in the surgery report as I was never told this in person).  I am not sure if this is large or small.  Most likely the AVN originated from the fracture I had last year (so it is post-traumatic). I also tried to find information on this type of AVN without success.  The OS is keeping an eye on this defect and so far it seems stable but has not said much about what to expect.
Sorry I am not of much help!

Take care,

Bella

Offline kaylachrist

  • MICROgeek (<20 posts)
  • *
  • Posts: 15
  • Liked: 5
Re: Avascular necrosis after injury -- what's in the future for me?
« Reply #2 on: October 19, 2018, 01:27:23 AM »
Hi Bella,

Sorry to hear you're in the same boat with AVN! I did some research and found some info that may be of help both of us as well as others who come across this thread in the future.

Post-traumatic AVN shares some commonalities with osteochondritis dissecans (OCD), where cartilage and bone die and separate from the joint, so there are some crossover possibilities for treatment if the lesion is small and in an accessible spot. Usually OCD happens to children or adolescents who have bones that'll heal themselves but some unlucky adults get it too. If it was caused by trauma it's probably more contained and seems less likely to grow than more widespread AVN caused by something else like medication, *if* you're diligently nice to your joint and avoid further impact or injury. Everybody is different, though, and I'm sure things like AVN location, activity level, and body weight have an effect on that.

If it's near the "edge" of the bone, like the tibial plateau or the distal femur like mine is, I read on a few posts that the OATS procedure helped some people with OCD. They used a bone/cartilage plug to act as a transplant over the lesion. It's a big surgery with brutal recovery and moderate success rate, but it's nice to know there's some possibility for treatment if it ever came to that. My lesion isn't full-thickness, but I doubt I'd be turned away if I was really debilitated and OATS was my only option to live normally.

I read strengthening your leg muscles will help take pressure off the AVN area. Kind of common sense, but a good lifestyle thing to keep in mind.

My personal plan going forward is to strengthen my muscles as much as I can over the next season so that if I'm still experiencing pain in the springtime I'll have a good idea of what can or can't be solved conservatively and whether it's intrusive enough to warrant an operation. Right now I'm just thankful to be living better than I was 6 months ago before my arthroscopy. I'm really treasuring every step I take these days!
Jan '18- Injured RK, age 30
June '18- RK arthroscopy, smoothed out patella cartilage damage
Diagnosed with post-traumatic cartilage lesion and osteonecrosis of lateral femoral condyle

Offline The KNEEguru

  • Administrator
  • SuperKNEEgeek
  • *****
  • Posts: 2547
  • Liked: 93
  • The KNEEguru
    • The KNEEguru
Re: Avascular necrosis after injury -- what's in the future for me?
« Reply #3 on: October 21, 2018, 08:12:25 AM »
Besides OATS (where the tissue is taken from your own knee) there are commercial osteochondral implants eg https://www.zimmerbiomet.com/medical-professionals/biologics/product/chondrofix.html but also there are on the market focal metallic implants which are like mini knee replacements.
--
KNEEguru