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Author Topic: Open Wedge & Derotational Tibia Osteotomy of a former Mountaineer: 10-19 & 2-20  (Read 3630 times)

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Offline RGB

  • MINIgeek (20-50 posts)
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Hi Kczech. I speak from a position of no knowledge but considerable personal experience. I counsel careful thought before getting into the whole cartilage repair process, especially for the patella and trochlea, unless you're young and feeling lucky. I spent a 7 years of trying one thing and then another, strictly following rehab protocols, hoping for the best and having those hopes dashed. You can find my posts if you search. I've ended up with a PFJR and it's fantastic - not quite a natural knee but pretty good. For someone in their mid 50s and older with serious isolated patellofemoral issues that's what my evidence base of one indicates to be the best option. You have a lot of other stuff going on with your knees so this may not apply to you. I did a lot of research before trying various other procedures and they all looked promising at the time. However, in hindsight I don't believe any of the current cartilage repair options is sufficiently developed/successful to warrant the investment. I'm not talking about money but time, energy and hope. Feel free to ignore me - others have been luckier than I was, and I have no medical training. Good luck though - it's a tough problem to have.

Offline kczech

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Hi RGB, thank you for your message. Itís definitely not something I take lightly and Iím aware of the mixed results with cartilage repair on the patella. Thatís one of the reasons Iíve decided to go see someone who has arguably the best success rate for addressing these types of defects.

Iím definitely not planning to jump right into it. Iím still recovering from the last surgery and Iíd like to see what happens once Iíve had a chance to build my strength back up. For the time being, Iím just planning to talk to Dr Minas to get a sense of where my cartilage is at right now and what might become of it if I delayed treating it or tried to return to higher levels of activity. That is my ultimate goal and if itís not possible given where things sit right now, I donít really see another option. Iím not quite ready to call it quits and give up hope of returning to climbing at this point.

Iím sorry to hear that cartilage repair didnít work out for you. Youíre not the first Iíve heard from that has cautioned against it because of their experiences. Iím glad to hear youíre doing well with a PFJR though. I will see if I can find your posts about it. Best wishes!
L. Tibia derotational and medial open wedge osteotomy - Oct. 23, '19

"It is not the mountain we conquer, but ourselves." -Edmund Hillary

Offline kczech

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14 weeks post-op 2

I had an MRI and a CT scan done on my left leg a few weeks ago. They showed significant scarring behind Hoffaís fat pad, medial compartment (thatís new) and PF chondromalacia, and damage to the lateral part of the quad tendon (likely from the arthroscopic incision from the last surgery). These all seem to mostly line up with the worsening issues Iím having. Since my last post, Iíve also lost the ability to actively extend my leg. It feels like it gets stuck around 45į of flexion due to pain and restriction underneath my patella. If I relax my quad, it can be moved manually though, albeit with a fairly prominent and uncomfortable ďclunkĒ. The lateral IT band pain is also back intermittently, so back to square one on that too it seems.

About 2 weeks ago, I started to notice a very dull pain in the lateral compartment of my right knee, which I assumed was just my knee getting used to the load distribution from my new 2į valgus alignment. A few days later, it suddenly became very sharp right beneath the anterior lateral joint line during a sort walk and I had to hobble back home. My physical therapist did a McMurrayís and Apleyís test and they were seemingly positive, which would indicate a lateral meniscus tear. I have an MRI next week to see if thatís the case. Before this happened, my right leg was actually doing pretty well.

Iím not going to physical therapy any more now because Iím still extremely limited on the types of things I can do, and what I can do Iíve been doing at home as often as the pain allows. Sometimes this means not getting off the couch for a day or two, and sometimes I can do straight leg raises, stretching, and other simple floor and balancing exercises for a few days in a row.

Iím at the point now where Iím beginning to regret going through with these surgeries. It seems like all the new issues coming up are direct and/or indirect results of them, the issue that started this whole ordeal is back, and Iím possibly looking at several more surgeries to get back to at least being able to walk comfortably again, let alone do any of the things I used to. One thingís for sure, I will never walk through the office doors of Dr Mark Sanders again.

Iíve had two virtual visits with Dr Minas so far and I am impressed by his thoroughness and general demeanor. Iím scheduled for arthroscopic surgery on both knees with him in mid-July to remove scar tissue, asses my cartilage (with a possibly biopsy for MACI), and fix anything else that might be amenable at the time. We also discussed the possible need to redo the osteotomy on my left leg at a later date because itís still at 5į of varus and now I have medial compartment damage.
L. Tibia derotational and medial open wedge osteotomy - Oct. 23, '19

"It is not the mountain we conquer, but ourselves." -Edmund Hillary















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