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Offline mj/usa

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worried...
« on: June 18, 2004, 12:42:24 AM »
After being so upbeat about my new knee, and indeed it has been wonderful, I am now getting a bit worried...
For the past little while (a couple of months or so)I have been having really strong shooting pains right where the pain was before,  when I twist my knee a certain way.  I can't make it happen, but when it does happen it catches me completely unawares and really hurts.  The knee has buckled a couple of times.  But just as quickly, the pain disappears  so I am trying to ignore it.  
The last MRI in November showed nothing untoward except of course the healed plug and a perfect articular surface (os's words)  So what could this be???  Have I got a loose body?
I am afraid to go to a new os  (I have left NYC where the surgery was done) and I am also afraid about doing nothing as I don't want to damage the knee.... Very down at the moment  as I was hoping the operation would be the end of the knee problems...

MJ
« Last Edit: June 18, 2004, 12:44:42 AM by violin1 »
plica excision 05/01,  followed by OATS 09/02

Offline mayme

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Re: worried...
« Reply #1 on: June 18, 2004, 01:58:16 AM »
Hi MJ:

Don't get discouraged yet. What about just calling your os in NYC & describing the symptons as you've done in this forum?

He might have an answer -- or at least some suggestions as to what , if anything, you should do next.

Best of luck and keep us posted!
CJ

Offline JG

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Re: worried...
« Reply #2 on: June 18, 2004, 10:33:30 PM »
MJ,

Interestingly enough, I thought I was doing really well too then I started having problems about 8 months post op with medial joint paint.  Started out just being a little bit of pain during weight bearing flexion (like squatting).  I saw the OS at 12 months for my annual (April '04).  I had a MRI which showed subchondral cysts in the uderlying bone where the grafts are.   He didn't think it looked good for me (grafts not healing).  So I had a scope a couple weeks later.  The grafts looked great so he thought the grafts were still healing.  Of the 18, only one showed that the cartilage part of the graft was thinning.

Problems is, my medial joint pain started getting worse and worse.  Turns out I have a stress fracture radiating from the graft site on the MFC.  He also thought those grafts weren't doing as well as the scope showed.  He gave me two options...cutches for extended period of time (like 8-12 weeks) or an unloader brace for 6 months.  I decided on the unloader brace that is custom fit.  I will check in every month and if I don't show progress I will have to go on crutch duty.

My gut tells me that I will need to eventually have the MFC regrafted, but I will just keep plugging along.  Thing always work out for me.   The good thing is, he said that once I get the brace, I can do anything I want (no running or hiking).  

Keep your head up, thing will work out.  

Keep us posted as well.

Janice
Sept-99 - L knee LR
Aug-02 - L knee LR/menisectomy
Apr-03 - L Knee Mosaicplasty Using Allograft (18 grafts)/LR/debridement/menisectomy; Right Knee menisectomy.
Apr-04 - L Scope - LR/Lysis Adhesions

jackpowell

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Re: worried...
« Reply #3 on: June 19, 2004, 01:03:54 AM »
Hi Janice,

What is a cyst?

Offline mj/usa

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Re: worried...
« Reply #4 on: June 19, 2004, 11:30:12 AM »
Hi CJ and Janice--

Thanks for your input:  I hadn't thought about contacting my os in NYC, but he did say to email him if I ever had a problem and so I will do that as a first step.
Thank you, Janice for your encouraging remarks:  I am very sorry to hear that you are having such a bad time with your grafts.
I have also decided to try and keep sort of a record of when and how often this strange shooting pains occur.  Or course, I wish they wouldn't occur at all.

MJ
plica excision 05/01,  followed by OATS 09/02

Offline JG

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Re: worried...
« Reply #5 on: June 19, 2004, 11:29:01 PM »
Hi Jack,

Subchodral cysts happens during the natural development or progession of osteoarthritis or degenerative joint disorder.  In my case it can mean the underlying bone part of the graft is either healing/incorporating or dying.  When he saw the MRI, he thought it wasn't healing, but that was before the scope which showed very healthy grafts.  He was a little worried about the MRI primarily because there are no case studies to refer to as far as mega-mosaicplasty goes.  The was the largest procedure that he knows about...by far.  He really didn't know how long it would take for the surrounding bone to incorporate the new grafts.

Janice
Sept-99 - L knee LR
Aug-02 - L knee LR/menisectomy
Apr-03 - L Knee Mosaicplasty Using Allograft (18 grafts)/LR/debridement/menisectomy; Right Knee menisectomy.
Apr-04 - L Scope - LR/Lysis Adhesions

Offline JG

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Re: worried...
« Reply #6 on: June 19, 2004, 11:36:13 PM »
MJ,

Although I am having problems, it really hasn't stopped me at all (except running which I was only doing about 10 minutes 3x per week).  My PT really thinks I should not do anything at all, to give the bone time to calm down.  However, I did that for 3 weeks with no relief at all.  Actually it was worse.  It wasn't bothering me when I walked until about 2 days ago.   I'm still waiting for my insurance company to pre-authorize the custom OA unloader brace.  Usually my insurance is pretty quick about turning  around pre-auth stuff.  I think my PT will be more comfortable with my activity level once I start using it.   My gut tells me that it will need regrafted, but hopefully not.

My best coping mechanism is to not believe that I have a problem.  So that's what I continue to think.  Well I'm off for a long bike ride....hope to get in 30-40 miles.

Keep rehabing and keep the quads strong.

Janice
Sept-99 - L knee LR
Aug-02 - L knee LR/menisectomy
Apr-03 - L Knee Mosaicplasty Using Allograft (18 grafts)/LR/debridement/menisectomy; Right Knee menisectomy.
Apr-04 - L Scope - LR/Lysis Adhesions

Offline kathleenj

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Re: worried...
« Reply #7 on: June 22, 2004, 06:15:08 PM »
Hi MJ,

Sorry to hear about the problems you are having lately.  Just like you, I had an Oats in Dec 03 for a 10 mm plug  (I think I remember seeing your was about the same size) please correct me if I am wrong.  Anyway,  I started having serious ice pic type shooting pains about 2 months ago.  When I saw my OS he did an xray and saw that the graft had shifted somehow.  He decided to redo the graft and started with an arthroscope but was a bit baffled because the graft looked ok, he said if I wasnt complaining so much of the shooting pain he would have left it alone.  He proceeded to the open procedure and 'low and behold' that is when he saw the
defect and the kissing lesion.    I am not trying to scare anyone hear but if it hurts then there is something wrong.  So many doctors look at xrays and mri's and swear up and down that you are fine.  My OS truly believed me and continued with the operation because he knew that something had to be wrong to cause me so much pain.  I guess in a way he was taking a chance of cutting me open for no reason but I'm glad he did.  He found the defected plug and fixed it.
I am now 12 days out and it is honestly feeling great.  Very stiff and sore but better than after the first surgery which was a scope.  GO FIGURE!
I just wanted to share my experience to show you that you really need to be persistant if you are experiencing pain.  I had a gut instinct that something was wrong and my OS believed me.  If your current OS says that everything looks fine but in your gut it just doesnt feel right, you really should find someone else who can help you.
Good luck........let us know what you decide to do.
Kathy
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline mj/usa

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Re: worried...
« Reply #8 on: June 22, 2004, 07:34:48 PM »
Hi Kathleen!

I am glad to hear that you are doing so well after your surgery--I didn't know that you had to have the oats redone!  Our lesions are more or less the same size, I think my os said 15mm diameter plug...I hope that this time your operation solves the problem.
I have emailed my os since posting, no reply yet though.  I also reread the mri report and there is mention of some "prominent offset of the bone in a focal area due to stress remodeling " (what could that be?) at one edge of the plug.  Perhaps this is what is causing the problems. At the same time the report says the plug is "fully incorporated" with the surrounding bone and the surface is intact.
For the moment  my knee is behaving well--the shooting pains are there every now and again, but the knee hasn't buckled on me for a few days.  let's see what the doctor says.
Thanks again for all the input!

MJ

plica excision 05/01,  followed by OATS 09/02

Offline kathleenj

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Re: worried...
« Reply #9 on: June 22, 2004, 07:58:14 PM »
Interesting thought for you...
My OS told me before surgery that the plug was not sitting right, that the edge of it was 'sticking out'.  He said it was probably totally incorporated but somehow not flush.  Your MRI report mentioning the 'prominant offset of the bone' sounds very similar to what my problem was.  He said that even though the cartilage surface may be smooth if the bone surface is not...it can cause all sorts of problems. That was the case for me.
That little piece of surface not flush with the rest was the culprit.  
Since it is mentioned in your MRI I would not take it lightly and I would think your OS wouldnt either.  It has caused me so much pain and may be why my tibial defect has gotten worse.  
Keep me informed.
Kathy
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline JG

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Re: worried...
« Reply #10 on: June 23, 2004, 04:03:14 AM »
Hi Kathleen,

It sounds like you recovery is going well.  I hope it works this time and your recovery is speedy.  So how long did your OS say to stay off the knee?  The whole weight bearing thing seems to differ from MD to MD.  I just heard some comments from Dr. Steadman in Vail about microfracture.  He actually thinks the patient should be NWB for 8 weeks (rather than 6) and that in part is why he had the success he does with microfracture.  Now microfracture is not the same, but his comments were interesting about letting the cartilage and bone heal.

Good luck...Janice
Sept-99 - L knee LR
Aug-02 - L knee LR/menisectomy
Apr-03 - L Knee Mosaicplasty Using Allograft (18 grafts)/LR/debridement/menisectomy; Right Knee menisectomy.
Apr-04 - L Scope - LR/Lysis Adhesions

Offline kathleenj

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Re: worried...
« Reply #11 on: June 23, 2004, 06:10:40 PM »
Janice,

It would be interesting to read about what Dr Steadman thinks about an Oats rehab.  As much as I have tried I cant seem to find anything.  My surgeon trained with Dr Minas in Boston, one of the best up here regarding cartilage issues, and is very confidant about the 6 weeks NWB for a single autograft.  But then again, I did need to have it redone, right?  You are right about so many MD's differing about the NWB issue.  I suppose some are overly cautious and go for the longer range while others do not.  
I am definately not going to push things.  I am looking at the 6 weeks as a general guideline but ultimately I am going to go with what feels right for me.  I do not want to have this done again.  Although, I do realize that at some point I will need to address the tibial lesion.  
If you have any links as to where I can find info on Dr Steadmans feelings on autograft, I would really appreciate it.  
Kathy
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline JG

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Re: worried...
« Reply #12 on: June 23, 2004, 08:07:53 PM »
Katleen,

I don't think Steadman does a lot of OATS or osteochondral grafting procedures, he is a huge microfracture guy.  Normally if you read some of the more in-depth articles about cartilage repair techniques, Steadman's name only comes up with microfracture.  I just know that he is a big believer in the longer NWB and conservative rehab for microfracture.  However, microfracture produces online fibrocartilage and not hyline cartilage.   As you know there is a big difference between the two.  In my case, because multiple plugs were used, I needed the fibrocartilage to fill in the gaps.  With you, having a single graft, it may be different.  I don't know how much fibrocartilage fills in the edges if any at all.

Janice
Sept-99 - L knee LR
Aug-02 - L knee LR/menisectomy
Apr-03 - L Knee Mosaicplasty Using Allograft (18 grafts)/LR/debridement/menisectomy; Right Knee menisectomy.
Apr-04 - L Scope - LR/Lysis Adhesions

Offline kathleenj

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Re: worried...
« Reply #13 on: July 07, 2004, 11:20:21 PM »
Hi MJ,

I was just wondering if you had a chance to speak with your doctor and if so, what he had to say.  

Hope the knee is behaving.
Kathy
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline mj/usa

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Re: worried...
« Reply #14 on: July 08, 2004, 11:40:40 AM »
Hi Kathleen!

Thanks for your post--yes, I did exchange several e-mails with my os in NYC.  He feels, based on what I told him and what the last MRI in Nov. showed,  that there is nothing wrong with the  plug, but that I probably have a meniscal tear....He said I should come and see him in the office which I would dearly love to do, but since I am living in Dublin at the moment, it isn't that easy.  I will try and find a good os in our hometown Vienna, when I am back home in August.  We will be moving there permanently in December.
At the moment, my knee is behaving. The shooting pains and occasional buckling still happen, even though they are not getting worse.  Sometimes I feel like being an ostrich and just forgetting about the whole thing, but knees need to be taken care of and so I will have to go and see the os this summer.
How are you doing?  Is the new graft sitting in the right place?  I hope all is well with you.
Take care

Mary Jane
« Last Edit: July 08, 2004, 11:44:55 AM by violin1 »
plica excision 05/01,  followed by OATS 09/02

Offline kathleenj

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Re: worried...
« Reply #15 on: July 08, 2004, 06:31:58 PM »
MJ,

I am glad for you that your OS feels the plug is ok.  A meniscal tear doesn't seem as bad to deal with, although, shooting pains and buckling sure isnt fun.  You definatley should not play ostrich and hide your head in the sand as we know how troublesome these knees get if we ignore them.  
So far things are looking good with this new plug of mine.  I am going to the OS next week for an xray so we will have a much better idea on how it is looking.  It really feels good though.  Rom and strength is coming along and I got the ok to start light weight bearing this week.  A little nervous about that but it seems to be going ok so far.  
Good luck with the new OS this summer.  
Kathy
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline mj/usa

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Re: worried...
« Reply #16 on: July 08, 2004, 10:02:19 PM »
Kathy---

Thanks for your reply and GOOD LUCK with weight-bearing.  I can remember how tentative my first steps were, but you'll ge fine soon, I am sure.  
I will go and find an os this summer and then report back what he says....

MJ
plica excision 05/01,  followed by OATS 09/02

Offline Heather M.

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Re: worried...
« Reply #17 on: July 09, 2004, 09:44:05 AM »
Hi Mary Jane.

If you'd like, I can message you the name of a top knee doc in Vienna.  He's the colleague of a good friend's brother (don't you love these shirt tail associations?) and is considered one of the top OS's in the region--does the ski team, and in general puts Humpty Dumpty back together again.  

He's been kind enough to consult for no charge on my knee--I'm getting together x-rays and stuff and once I get up the nerve, I'll send it.  He sees a lot of salvage cases...

Let me know if you're interested.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
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Offline JG

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Re: worried...
« Reply #18 on: July 10, 2004, 01:20:52 AM »
Kathy,

I hope all is well.  I was a little surprised that you decided to go PWB at 4 weeks.  I figured that you would have waited  until 6 week like your previous message mentioned.  Interesting that some MDs will say 4 and other 8 for a similar procedure.

I went for my 6 week post op about a month ago and continued to push my surgeon about my medial joint pain (which I have had since Feb).  He was a little skeptical that it really was coming from my joint since the graft look so good via scope (despite the MRI showing otherwise).   Basically he injected the joint with simple lidocaine.  If I performed a movement that normally bothered me and the pain was gone, then it was in the joint.  If not, it was outside the joint.  Within 15 seconds, I knew it was in the joint.  He did a quick x-ray and re-reviewed my pre-op MRI.  Turns out I have a fracture radiating from my MFC grafts.  He was surprise I was comfortable walking.  

This is not the first time this has happened.   When I was first diagnosed with a chondral defect it was really due to joint fluid seeping into the fracture and the only way that would happen is if I had no cartilage.  This was about two years ago.  

So, he gave me a couple choices, NWB crutches for 8 - 12 weeks or use an unloader brace from the remainder of the year.  I really don't like either option, but I am now using an unloader brace.  It is not a big help with walking, but thing like function squatting it helps a tremendous amount.

Keep us in the loop on your progress.  I am very interested in how you heal since you were regrafted.

Janice
Sept-99 - L knee LR
Aug-02 - L knee LR/menisectomy
Apr-03 - L Knee Mosaicplasty Using Allograft (18 grafts)/LR/debridement/menisectomy; Right Knee menisectomy.
Apr-04 - L Scope - LR/Lysis Adhesions

Offline kathleenj

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Re: worried...
« Reply #19 on: July 12, 2004, 11:39:17 PM »
Hi Janice,

I was wondering how you were doing.  I had read another post of yours where you mentioned the unloader or NWB and wondered what you decided.  I think I would have opted for the brace rather than the crutches as well.  Sorry it is not helping much with the walking, maybe it will help in time.  

I'm doing ok...started light weight bearing last week and so far it seems to be going alright.  I have an appointment with the os this thursday for xrays so I suppose we will know more about how the plug looks then.  
I am beginning to think that I'm having some issues with the scar.  It has gotten really hard the past few days and massaging it really hurts more.  The whole knee is beginning to have a constant ache which I hadnt had before.  Even keeping me from sleeping.  I really dont think it is coming from inside the knee, definately feels more like an outside the joint tissue ache.  If that makes any sense.  
Anyway, I will bring it up with my OS on thursday and see what he says.  

Good luck with the unloader and keep us informed on how it is working for you.
Kathy
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline kathleenj

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Re: worried...
« Reply #20 on: July 15, 2004, 07:38:15 PM »
Just thought I would update on my 5 week check this morning.  OS did xrays and the graft looks great.  It is sitting very flush and OS is very pleased, as am I.   He was really impressed with my rom...10-105 actively and 0-120 passively.  I have been partial weight bearing for a few days now and OS said to go ahead and try for fwb by the end of next week!  I am pretty excited about that because right now it is feeling great with partial.  The only concern he has is with the scar tissue.  My kneecap is pretty restricted which is what has been causing that general achiness and discomfort I have been having recently.  He feels that I need some more ultrasound and patellar mobs and we should be able to kick it in the butt.  
Overall I am feeling really good about things right now.  Considering this is my second surgery and I still have a ways to go with PT, my knee honestly hasnt felt this  good in a long time.    Keep your fingers crossed for me and I will update again soon.
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline mj/usa

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Re: worried...
« Reply #21 on: July 15, 2004, 08:23:59 PM »
Kathy--

Congratulations!  Sounds like all systems are go at the moment which is great news and I am very happy for you.
As for the patellar tightness, I had some of that at the beginning too, but with the ultrasound at pt and the mobilizations, it soon disappeared, thank goodness.
I wish you continued good luck.

Mary Jane
plica excision 05/01,  followed by OATS 09/02