Good recovery and then all of a sudden ... what can this be?

[Celina1989]

Has anyone had a microfracture or other articulair cartillage procedure that went well and then all of a sudden it got worse again? What was it and were you able to treat it?

I had microfracture surgery in march 2018 with a good recovery. Was able to do most till Novembre. And since then it only got worse over time.

[vickster]

How big was the defect and what part of the knee? What activities been doing since mfx. Has there been any imaging done to check for fibro formulatin, any bone marrow oedema, deterioration of defect?
Are you still doing physio to maintain condition, strength and Rom

[Celina1989]

Ive posted my story before but unfortunatly there is a sequel.
My defect was on the mfc, grade 4 and was 2 by 2 cm. I had about four months of PT after surgery which went well and had a close to full recovery (not able to sit on my knees and bent for a longer time).

Im not very sportive, I walk much with my dog, went fine at first. Now back to not even one hour painfree and often take rest in between. Beside that I cycle and swim sometimes. I have done Zumba, without the jumping, PT was fine with that and no pain afterwards back then. Atm I don't do this anymore.

My last PT appointment was 3 weeks ago. Since then trying to continue to do it once a week but it is now close to impossible. My ROM is optimal now, was already good soon after surgery.

In January an xray was made, looked fine according to OS. Now MRI is planned but OS thinks it won't show much. He thinks the only way to know is by surgery again.

[vickster]

If on a weight bearing surface, that’s probably on the cusp for successful infill with mfx. Were you non weight bearing? Might be worth getting a further opinion from a cartilage specialist. How’s your alignment on the X-ray? Any bowing? What causes pain? Have you tried a brace?

What damaged the cartilage initially? Maybe the MRI will shed some light but often the knee is not the same even with successful fibrocartilage growth

How old are you?

[Celina1989]

It was mostly non weight baring, only at a certain bend it would slightly come in contact. My OS didn't give me much advice afterwards but with the help of this forum and some other websites I instructed myself to be at least 2 weeks NWB, 2 weeks tip toe and then as tolerated. Then had PT 2 or 3 times a week and noticed good improvement.

The OS didn't say more then that my Xray was looking good. I got insoles 15 months ago for my flat feet and I wear m in every shoe I have. The thing that is most painful is just standing or heavy lifting. It is often Ok in the morning after a night rest but every afternoon / evening it burns on the inner side of my knee, exactly around the microfracture side.

The specialist I would go to for a second opinion has a waiting time of half a year. They are specialised in OCD. I am 29 yo.

I got the date for the MRI, about 1,5 months of waiting still. Problem is my study starts in Septembre and that is going to be a problem if I need surgery again. You think MRI is useful?

Do you think a brace might help me? What kind? The problem is that it is unclear what this is now so it is hard to treat ...

[vickster]

It would probably be an unloader type brace for arthritis, speak to a physio or Orthotist. You’re young though. If you still have a grade 4 defect and it’s unmanageable, see a cartilage specialist for other options. It may not be the defect only that is an issue but inflammation, muscle weakness orbsonetning else.
Do you ice, use medication (oral or topical, voltaren gel helps my burny arthritic knee to some extent)?

[Celina1989]

I don't think I got arthritis: the mornings are best, my knee shows no signs of inflammation and Xray and MRI showed none. I read back from last Xray, it says that the microfracture spot is more "lucent" then the rest of my knee but I think that makes sense as the spot is still healing. I know Xray won't fully be able to show cartilage growth. I am not sure MRI will show that.

I am using ice daily, it helps to lower pain for a while. I am not using any medication. I think strong pain meds would only disguise which might be harmful in the long run. I am not taking anti inflammatory as both OS and PT say there is no inflammation.

I think going to an cartillage specialist is a good option but with a waiting time of half a year it is not an option for now. And I am going to do my study from Septembre till July with never more then 2 weeks holidays in a row so not able to do it in between.

I am now wondering if I should skip the MRI and go to arthroscopy immidiatly otherwise there is no way that I am able to recover from it in time for my study. OS has low hope that MRI will show anything anyways.. 

[vickster]

What will an arthroscopy give apart from potentially trauma and inflammation unless youre having more advanced type of repair after failed Microfracture  ?
Grade 4 damage to cartilage is arthritis, burning pain is a result of the damage and inflammation . Have you tried a hyaluronic acid injection?
I wouldn’t have surgery unless there’s actually a mechanical issue like a trapped meniscus. I’d leave the defect alone unless you have a definitive plan for a more advanced repair 

[Celina1989]

Do you think my microfracture already failed. I haven't thought about that. the Xray from January looked fine but Xray won't show all. Will my MRI show the new cartillage (last MRI didn't even show the defect)?
Can it be something else? Any known complications after microfracture / OCD surgery.

Agreed that surgery is useless when microfracture failed cause this OS won't do (and I won't let him) any advanced repair. I am worried about permanent damage on my knee if I wait for too long. Also my left knee is becomming painful as well.

[Celina1989]

One day later I did some more research on the hyaluronic acid injection. I think it is a good in between solution although I am not sure how well it will work for an OCD lesion. I read it is mostly used for osteoarthritis. After MF surgery it has sometimes been used to help to heal the cartilage, but this was between 3 and 6 months after surgery. I never seen it as a lone solution for failed microfracture? Does anybody maybe have some aditional information?

I am now more into thinking it is a stupid idea to do surgery to just find out the MF wore off and then just leave it if an MRI can show me the same. I am just still wondering what else it can be if there is no functional limitation in my knee.

Is it dangerous to walk on an untreated (osteo)chondral defect?

[vickster]

Why is it an OCD lesion specifically?

I have had lots of HA injections, initially when I had a single defect (trauma, filled with fibrocartilage which is still there actually 9 years on much to my surgeon's surprise) and more recently as the arthritis has progressed

Why would it be dangerous? It's non weight bearing you say. Loads of people will have defects and not even know

Are you seeing a physio? You say your other knee is grumbling, it may simply be that your other leg is weak or you're subconsciously trying to protect it, get your gait fully assessed and get a physio programme to make sure your muscles are all working as they should be.
If you've no functional issue, don't go back under the knife without a definitive diagnosis especially

[vickster]

Another thing, have you had imaging to assess whether the fibrocartilage (so scar tissue formed by the microfracture, it's not cartilage like what was there before) ever formed? You could get the MRI but you'd then need to have a plan based on whatever the result is.

[Celina1989]

It is both bone and cartilage that came loose without any trauma causing it. It is also exactly on the place I see on all OCD spots on the internet and my OS calls it this so I think it makes sense.

The MRI is scheduled to find anything that is not as it should be so for example how the fibrocartilage is doing. Unfortunatly my OS thought it wasn't necessary to do follow up on the fibrocartilage. I am now wondering if CT is good enough to show fibrocartilage as that waiting time might be shorter.

My defect is mostly nwb but at some point it slightly comes into contact with the bone underneath. I wonder why it can otherwise be so painful, especially after standing or putting wait if it is nwb. I just keep reading that untreated osteochondral defect can lead to early arthritis. Although the loose part has been removed I wonder if it can still cause more damage.

I am glad to hear your treatment works well still. I read about hyaluronic acid injections as a aid for other treatment to protect the new formed cartillage. I am just unsure about how it would work on failed microfracture.

My other knee is just getting overuse issues. It is always fine in the morning and stinging and pain in the evening (sometimes earlier). But because of pain I stand more on my good left leg and use it more then my right painful leg.

[Dave33]

My other knee is just getting overuse issues. It is always fine in the morning and stinging and pain in the evening (sometimes earlier). But because of pain I stand more on my good left leg and use it more then my right painful leg.

If it helps for context, I had MFX done on my patella, and didn't see a lot of benefit in terms of pain reduction. When I had my partial done and the knee was open, the surgeon noted that there was almost complete fill of the defect with fibrocartilage - so it should have "worked". At the end of the day in my case, poor quality cartilage resulted in poor quality functional results. Perhaps you're having a similar experience.

Best of luck.

[Celina1989]

So I have decided to just wait for the MRI and then will see what happens, but it is scary for me especially since my study application for university is approved now.

@Dave33 I am wondering if you had an MRI in between. Wonder if you can see if cartillage is bad on it. Does anyone know?