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Author Topic: Is it the cartilage damage? the missing meniscus? or something else?  (Read 243 times)

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Offline cm100

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Hi

It's been 12 years of hell. I had Lateral meniscectomy + ACL reconstruction in 2010, and there was also cartilage damage that wasn't treated. I have 4th degree cartilage damage in the tibial plateou. I'm 38 years old.

Basically, my knee can't take ANY impact at all, just ONE stomp or a small jump will cause the knee to get swollen with fluid and delayed burning pain. I can't run in an emergency situation, etc, as every impact feels like is causing more damage to my knee. Is there anyone else who's experienced a similar syndrome? doctors opinions are driving me crazy:

First doctor says this is due to the chondral defects, in the tibial plateau and due to the missing meniscus. He suggests meniscus transplant + OATS in 1 chondral defect, and  for the rest of cartilage damage only microfracture can be done, how ever he says that what's causing the worse symptoms is where he will perform the OATS (and not the microfracture). And  also that just by placing a meniscus there the whole situation will improve.

Second doctor doesn't believe in first doctor suggestion, he says that chondral defects are not focal, but generalized and that my level of damage does not fully correlate with my symptoms. He says I should be doing bad, but not AS BAD as I'm doing, so perhaps it's something else and not the cartilage, so he suggest an arthroscopy, he needs to see and touch the cartilage to evaluate the real quality of it, and in case it's really bad, a PKR could be the way to go or MAYBE he could evaluate if I could benefit from chondrocite implantation, but I think he was more inclined toward PKR, that's what my gut tells me.
« Last Edit: June 06, 2022, 08:49:15 AM by cm100 »

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The pain and swelling you describe could be due to damage to the bone beneath the areas of cartilage damage, thatís where the pain comes from where cartilage wear occurs as well as any associated inflammation. As youíve lost the shock absorption from the meniscus, these areas could be under increased pressure.

Have you tried all the conservative measures such as injections (hyaluronic acid, PRP, physiotherapy, hydrotherapy, ensuring that the muscles around the knee are strong, have you tried a custom unloader brace as the wear is one sided?)

38 is young for a PKR but cartilage repair and meniscus transplants have long rehabs with no guarantee of success especially where thereís multiple areas of wear. How is the alignment of the knee? Lack of meniscus can lead to loss of joint space and also Valgus or Varus misalignment (have either of the surgeons considered an osteotomy as an alternative?)

Can you get a further opinion?

An arthroscopy to check what is actually going on, tidy the joint up might be sensible before embarking on much more major surgery
Good luck
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffaís fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline cm100

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The pain and swelling you describe could be due to damage to the bone beneath the areas of cartilage damage, thatís where the pain comes from where cartilage wear occurs as well as any associated inflammation. As youíve lost the shock absorption from the meniscus, these areas could be under increased pressure.

Have you tried all the conservative measures such as injections (hyaluronic acid, PRP, physiotherapy, hydrotherapy, ensuring that the muscles around the knee are strong, have you tried a custom unloader brace as the wear is one sided?)

38 is young for a PKR but cartilage repair and meniscus transplants have long rehabs with no guarantee of success especially where thereís multiple areas of wear. How is the alignment of the knee? Lack of meniscus can lead to loss of joint space and also Valgus or Varus misalignment (have either of the surgeons considered an osteotomy as an alternative?)

Can you get a further opinion?

An arthroscopy to check what is actually going on, tidy the joint up might be sensible before embarking on much more major surgery
Good luck

If I have a strong quad I can basically walk without issues, pain free, but that's pretty much all I can do, still can't take any minor impact, so the benefit is limited.
Knee is very hypersensitive.

I'm constantly battling the muscular atrophy, I was always a sports men so this is something I actually enjoy. But the quad of the bad knee never gets as good as the other leg, no matter what.

I've tried steroid injection and hyaluronic acid, far from being a solution. I haven't tried the unloader brace, actually no one has ever suggested it to me.
I haven't tried PRP or stem cells.

alignment of the knee is good, so osteotomy is not an option.

So, for you, the second doctor makes more sence right? I think he will offer a PKR but he wasn't very specific. He said he wants to be 100% sure that what he's going to offer is what must be done and also that he wants to offer a long term solution and not something that will require continuous repeated surgeries.
First doctor says he understand very well what's going on, but he may not?

Yes, I will see 1 or 2 more doctors before proceeding

Thanks!

Offline cm100

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I just saw another doctor today, but I didn't like him at all, he was very cold and didn't have much interest. In few words he said "you have arthritis in the lateral compartment and there is no solution, except a knee replacement in the future, but not now as you are yoo young for a replacement" he said the other compartment is not bad but the cartilage is already affected there too, "thinned" cartilage in the other compartment. He said a PKR will lead to a TKR in 10 years in my case.

Offline cm100

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Another doctor opinon today: He says I have lost the mechanical axis in my genu varo, so I'm charging a lot the lateral compartment. He says probable the way to go is to correct this + probably doing something for the cartilage, but he said he will need to study my case and wants an updated RX as he says the "Rosenberg" wasn't taken properly. He said an OATS won't work

Offline SuspectDevice

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Another doctor opinon today: He says I have lost the mechanical axis in my genu varo, so I'm charging a lot the lateral compartment. He says probable the way to go is to correct this + probably doing something for the cartilage, but he said he will need to study my case and wants an updated RX as he says the "Rosenberg" wasn't taken properly. He said an OATS won't work

I have no idea what the lost mechanical axis bit means, but this Dr seems to be a better option than the last one as he wants to investigate some more.
At your young age, I think investigating the options and taking your time is the way to go, rather than rushing to a dubious 'quick fix'.  It is good you can walk pain free, though I understand 12 years of pain is hard to deal with (I had about 6 years of Hell).
L Medial menisectomy 2012
PFPS both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2021 - ride 3x/week, swim 2x/week, gym 2x/week, short runs 2x/week, back to short races

Offline cm100

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Another doctor opinon today: He says I have lost the mechanical axis in my genu varo, so I'm charging a lot the lateral compartment. He says probable the way to go is to correct this + probably doing something for the cartilage, but he said he will need to study my case and wants an updated RX as he says the "Rosenberg" wasn't taken properly. He said an OATS won't work

I have no idea what the lost mechanical axis bit means, but this Dr seems to be a better option than the last one as he wants to investigate some more.
At your young age, I think investigating the options and taking your time is the way to go, rather than rushing to a dubious 'quick fix'.  It is good you can walk pain free, though I understand 12 years of pain is hard to deal with (I had about 6 years of Hell).
Sorry, as english is not my native language some times I don't know how to properly translate complex medical terms.
He meant my bad knee has lost my natural aligment (wich is Genu varum) due to the problems in the lateral compartment, and now I'm giving more load to the lateral part of the knee, when naturally it should be the opposite. he said I've lost 4cm of aligment, compared to the good knee. I think he is thinking in an osteotomy?, he said he needs to bring my knee back to his original position.
« Last Edit: June 09, 2022, 07:46:15 AM by cm100 »

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If an osteotomy is being considered, trying an unloader brace could give you an indication whether an osteotomy could help without the major surgery yet. Donjoy do one called an OA nano as an example (I have one, itís fairly comfortable), probably around 500Euro if you have to pay and itís available in your country (you may need one of their physio fitters to organise)
https://www.djoglobal.com/products/donjoy/oa-nano
« Last Edit: June 09, 2022, 09:04:03 AM by vickster »
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffaís fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone