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Author Topic: Multiple Lession (Trochlea / Femoral Condylae  (Read 8700 times)

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Offline Basil01

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Multiple Lession (Trochlea / Femoral Condylae
« on: August 03, 2004, 03:42:09 PM »
 :)  :)


Good Morning from SUNNY GREECE

On February 3rd I underwent an ACI in trochlear and femoral condylae and there was a defect on the patella but was left intact as it was a very small one
And i was the FIRST with multiple lessions in Greece.



Today is my 6 months mark.

I feel no pain and there is no swelling even after a 2- 3 miles walk or 2 hours swimming and i have a full extention and 140 deg flexion.

None of the pre-ops symptoms exist anymore...

The only "drawbacks" are a light clicking in the 30-40 Deg flexion and an odd feeling like the flesh being shrunk.


I have to admit that i followed my doctor's orders in every detail and this despite my concern of being very conservative (still I am not allowed to walk any stairs and no running...JUST WALKING)

I had an excellent PT who did an excellent job...(According to my doctor...my quadricept condition was a couple of months ahead)  

If  you ask me what i think about ACI??

Certainly is a very difficult  operation.
You MUST BE DETERMINED That "it is a long way to Tiperrary" but it worths all the trouble.




Offline rob8647932

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #1 on: September 26, 2004, 12:12:21 AM »
How did your trochlea feel at 3 months post op? I have had a few relapses where I took a step but it seem sto be improving although very slowly. I still have a little pain. I can walk about 10 minutes. I am a little frustrated.

Thanks
Rob
Left knee - 1997 debridement, 1999 trochlea paste graft / microfracture), 2002 IAGH injections, 2005 plica and synovium removal, 2009 Regenexx injections
Right knee - 1997 debridement, 2000 trochlea paste graft, 2004 IAGH injections, 2008 Regenexx injections

Offline BarryB

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #2 on: September 27, 2004, 08:39:45 AM »
Hi Rob. i had ACI to the trochlea and patella too. I wouldn't worry too much, as 3 months is still very early in the process. It is hard to remember exactly what it felt like at 3 months, but it will keep gradually getting better and better. trochlea grafts can have more problems with clicking, grinding and overgrowth than other sites, especially as it is in contact with the back of the patella rather than , for example, a condyle lession.
Anyway, goodluck mate.

Offline rob8647932

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #3 on: September 27, 2004, 11:16:40 PM »
How many months since you had the ACI? What can you do at 4 months? Swim, walk? How far?

Thanks
Rob
Left knee - 1997 debridement, 1999 trochlea paste graft / microfracture), 2002 IAGH injections, 2005 plica and synovium removal, 2009 Regenexx injections
Right knee - 1997 debridement, 2000 trochlea paste graft, 2004 IAGH injections, 2008 Regenexx injections

Offline Basil01

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #4 on: September 30, 2004, 09:15:30 AM »
Sorry for my late reply

At 3 months I was on 1 crutch and not able to walk for more than half a mile on crutches.

I got rid of it by the end of 4th / beginning of 5th month post ops and I had the crutch handy till the end of the 6th month . Now being on the 9th month I can walk more than 5 miles with no problem...

However the knee is clicking and is clicking nicely! But according to my doctor  and my PT this is a GODD sign.

I pressume that all these minor problems will be dealt with during the follow up arthroscopy (I am the first Patient in Greece with multiple lessions so i cosider myself more or less a Guiney pig)

What i can tell you is that swimming helped me a lot ( I was swimming - Thank God in Greece we have a long coastline and our beach house is only 35 minutes drive from the office - almost every day during summer and I managed to stay in the water for up to 2 hours.)

Offline BarryB

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #5 on: September 30, 2004, 11:04:57 AM »
Same for me. At about 3-4 months i wasnt limited at all really in terms of movement walking etc, however you could still notice if you had been standing or walking a fair bit and most of the time trying to limit the time spent standing/walking. I went back to my casual job which involved usually about 4 hour shifts walking on concrete without being allowed to sit down....and knee was mainly fine. So you can do what you need to at 4 months but dont push it at all.

I am just over 10 months post-aci and have just had arthroscopic debridement to clean up the overgrowth. I saw the pics and the new cartilage looked really good, so hoping from now that my knee will be perfect!

Good luck mate.

Offline rob8647932

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #6 on: October 21, 2004, 12:11:22 AM »
I am about 4 months for trochlea defect and have tried to walk 15-20 minutes. This has caused pain and I am getting frustrated as I am afraid that my past mistakes (took some small stair step at 2 months and 3 months) might have done irrevisible damage. It is still tender and sore if I do any walking over 5 minutes. Any encouragement would be greatly appreciated.
Left knee - 1997 debridement, 1999 trochlea paste graft / microfracture), 2002 IAGH injections, 2005 plica and synovium removal, 2009 Regenexx injections
Right knee - 1997 debridement, 2000 trochlea paste graft, 2004 IAGH injections, 2008 Regenexx injections

Offline Basil01

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #7 on: October 21, 2004, 10:34:08 AM »
 am about 4 months for trochlea defect and have tried to walk 15-20 minutes. This has caused pain and I am getting frustrated as I am afraid that my past mistakes (took some small stair step at 2 months and 3 months) might have done irrevisible damage. It is still tender and sore if I do any walking over 5 minutes. Any encouragement would be greatly appreciated.
_______________________________________

I think that you are pushing it.....DO NOT
I, at 3 months was still on crutches and at 4 months was on one crutch
As far as your "mistakes".... no one is unmistakeable.
Small mistakes I think are forgiven but the repetition of them is like "opening the Pandora's box"
My opinion is that the name of the game is "Patience" and rest assure that the progress through time is an exponential one...

Me, being on the 9th month i can walk 7 miles with little pain and no swelling at all but when i visited my doctor and asked him to increase the activities a little bit he FLATLY refused.

Last week I took a isokinetic test of both quadricepts to find out their condition and i was a little bit frustrated find out how weak my left (the operated leg) was.

I think that i still have a long way to go.

Offline rob8647932

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #8 on: October 22, 2004, 06:54:07 PM »
Basil,

Were there times when you thought there was no improvement at the 4-5 months stage? It feels like it is never going to get better. It still feels tender and bruised. Maybe the trochela takes longer than the medial condyle area due to its contact with the patella.

Thanks
Rob
Left knee - 1997 debridement, 1999 trochlea paste graft / microfracture), 2002 IAGH injections, 2005 plica and synovium removal, 2009 Regenexx injections
Right knee - 1997 debridement, 2000 trochlea paste graft, 2004 IAGH injections, 2008 Regenexx injections

Offline Basil01

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #9 on: October 23, 2004, 02:19:26 AM »
Sometimes indeed I felt pessimistic....Do not loose your courage.
But I underwent the trouble for getting better for being able to ski and play tennis again.
Surely the trochlea takes longer to heal and the greater the lession the greater the time it takes.

Just be patient and persistent and everything will be all right.

Basil


Offline Jules

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #10 on: December 22, 2004, 09:13:56 PM »
Hi all,
Reading your posts, i'm 6 weeks post ACI with one graft under the patella and two on the trochlea.
My concern is when I can go back to work, I'm due to go back mid March which will be 4 months post op. I'm a midwife and am walking up and down the ward all day, by the sounds of it I may not be able to go back that early? What do you all do, and when did you return to work and how was it on your knee?
Best regards.
Jules
Apr 01 - bi-lat debride
Dec 01 - bi-lat mircrofracture & LR
Nov 02 - bi-lat debride & LR
Oct 04 - bi-lat A'scopy & harvest
Nov 04 - R ACI
June 05 - R A'scopy/shave
May 06 - R TKR
Aug 06 - L  PFJR
Jan 07 - L open LR
Oct 08 - L open LR
Feb 09 - L A'scopy/shave
July 09 - L TKR......
20 ops in 13 years

Offline BarryB

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #11 on: December 23, 2004, 03:54:52 AM »
Hi jules. After my trochlea/patella implant i would say that i didn't go back to work untill 5 to 6 months after implant. I only work casually and this involves about 4 hour shifts on my feet the whole time. When i first started back, i would have a tiny bit of swelling and the knee might feel a little sore, but it would settle down quickly after ice and elevation, so that by the next day it was back to 'normal'. This was opposed to before the implant where any swelling would stay in the knee for months untill i had it drained or literally did nothing for a few weeks to let it settle.

Even when i did go back to work, i tried to spread my shifts out over the week, as if i did a lot of shifts close together i didn't feel like i had enough time to rest the knee.

Anyway, any q's just ask. Gook luck with your rehab.

Offline Basil01

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #12 on: December 23, 2004, 08:47:40 AM »
Hi Jules

I returned on the 4-months mark on crutches but I am a "white collar labour".
Off course it was not easy as sitting on a chair the leg was swelling due to insufficient blood circulation.

Nevertheless I was able to work for about 6-7 hours per day.

Offline Jules

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #13 on: December 23, 2004, 10:29:31 AM »
Thank you for your replies,
It sounds like I will need another month off at least! But I will have to see. I get paid full pay up to six months, then half pay for a following six months, but I've been off work since the harvest. So I can stay off work untill the end of March, but I feel that I may need a few weeks longer, which I can't really afford to do, so its a case of wait and see. I'm sure things will work out.
Thanks again.
Jules.
Apr 01 - bi-lat debride
Dec 01 - bi-lat mircrofracture & LR
Nov 02 - bi-lat debride & LR
Oct 04 - bi-lat A'scopy & harvest
Nov 04 - R ACI
June 05 - R A'scopy/shave
May 06 - R TKR
Aug 06 - L  PFJR
Jan 07 - L open LR
Oct 08 - L open LR
Feb 09 - L A'scopy/shave
July 09 - L TKR......
20 ops in 13 years

Offline Basil01

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #14 on: January 23, 2005, 07:16:07 AM »
Just to give you an update
Yesterday after 11.5 months i underwent an artheoscopy to evaluate my ACI

My friends I have  a BRAND NEW KNEE!!!!!

It was a success and according to my OS the success was rated as follows

femoral condylae lession area abt 8 sq.cm "More than excellent"-his comment
Trachlea "excellent"

in other words a score 100 over 100

my final comments on this method !

It did worth it the whole fuss!! but you must be patient, persistent and  never give up  because during the last year i suffered a lot (i could climp a stair, alays to be carefull could sleep on my tummy, could go to work and faced a lot of problems in general it was a one year  nightmare.

Now it is time to teaching the knee and leg (although both are old dogs) new tricks, How to walk to run climb stairs to bend....a long and full of thorns way.

But i can assure that on August i will be playing tennis and enjoy a good water ski ride(doubles) I think that I am too pld to slalom again

Take care my friends and should you need anything to ask pls do so....

Basil


Now it is  

Offline Basil01

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #15 on: January 23, 2005, 07:19:15 AM »
and to add at the end....

Many thanks to my OS and to my PT- despite the hard time they had given me-  because i owe them a lot

Offline Jules

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #16 on: January 23, 2005, 12:51:46 PM »
Hi Basil01,
A big Congratulations to you!
Well done and enjoy your new knee now!
I went to see my OS 10 weeks post op and found I had been told the wrong lesion sites by the junior doctor, whilst in the hospital. I have two grafts behind the patella and one on the medial femoral. I have corse crepitus and have to go back in 2 months for another review.
Its great to hear your news as I am feeling a little negative about my knee at the moment.
Again congratulations.
Jules.
Apr 01 - bi-lat debride
Dec 01 - bi-lat mircrofracture & LR
Nov 02 - bi-lat debride & LR
Oct 04 - bi-lat A'scopy & harvest
Nov 04 - R ACI
June 05 - R A'scopy/shave
May 06 - R TKR
Aug 06 - L  PFJR
Jan 07 - L open LR
Oct 08 - L open LR
Feb 09 - L A'scopy/shave
July 09 - L TKR......
20 ops in 13 years

Offline Basil01

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #17 on: January 24, 2005, 11:13:47 AM »
Thank you Jules.

Just one wish for you  and everybody else who is in the rehabilitation process ....At the end  to feel the same emotions as i was on Saturday...

Basil

Offline mariajuvan

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #18 on: April 07, 2005, 08:41:14 PM »
HI Basil


I'm happy for you and your success.

Was your trochlear defect full thickness and how limited were you before the surgery?

Did your surgeon recommend surgery? Or after the arthroscopy did he say lets see how you do and then you complained of not being able to do anything and he recommend it?

Thanks

Maria


 

Offline Basil01

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #19 on: April 08, 2005, 06:59:18 AM »
Hi Maria,

Yes the trochlea was indeed full thickness and I was limited to no more than 300 mtrs walking. In the past I was able to jog more than 20 km.
It was not the first arthroscopy.
In fact in the past i had undegone 2 more for debridement so there was evidence of the damage.
I have only to decide who will perform the surgery as i had consulted various experts in ACI in Greece, Europe and USA who all of them suggested ACI.
Needless to say that several other doctors have commented as follows ....My apologizes or the Free translation from Greek
"What do you want to under such a surgery.....which is doubtful and with no results!!!!"
I can assure you that i have start running again.... going up and down stairs and on summer (if the quadrisepts are ok) skiing...no slamom but surely double... As far as tennis is concerned I prefer to stay of the safe side and start late this year...
The only drawbacks are
1. Patience to become one of your virtues.
2. Gain of weight

Otherwise it is worthwhile

Hope i was of some assistance






 

Offline Nick_Knack

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #20 on: April 08, 2005, 01:34:30 PM »
Basil,

Have you had success in regaining your quadriceps strength?  Also, is your range of motion same as other leg and was it ever not the same (as result of surgery actually I mean extension not flexion)?



What caused your trochlea defect?  I thought trochlea defects were usually caused by mal-aligned knee caps.  Did you need to have an osteotomy of any kind?

Thanks,

Nick
Age: 35
1989 rt ACL (+25 degrees ext loss)
1994 rt ACL resection (+ 10 deg)
2001 rt ACL revision (+ 10 deg)
2003 rt med meniscus repair (+10 deg)
2004 rt LOA and post capsulotmy (zero degrees)
2005 rt LOA and tib bone plug removal (even w/ other leg)
2006 rt Fulkerson TTT & ACI Carticel

Offline Basil01

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #21 on: April 08, 2005, 03:55:03 PM »
Dear Nick_Nack

As far as quadriceps strength....Is getting stronger and stronger day by day but it need quite some work....I think that it is a matter of huch you are committed to...
The range of motion ....About 145 deg The Right knee is about the same
As far as the damage is concerned yes indeed have valgous malalingnment but accoring to the oppinion of various doctors is insagnificant.
Most probably cause of damage is an old blow from the kneecap when while slept on a stair i hit the knee on the edge of the stair.
This including my obsession with skiing (water and Snow) as well as tennis are the major factors for the trochlea defect.

Do not forget I am 44 years old...

Hope  i was of some assistance to you

Vassilis
   

Offline mariajuvan

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #22 on: April 08, 2005, 08:01:15 PM »
Hi Basil,

Thanks for your response.  yes it was helpful.

In a previous post you said you have a patellar lesion.  Do you know where it is and how big it is.   Does yours bother you?  Mine is 1cm2 superior and lateral but not full thinckness. 

You also mentioned that you had a couple of previous debridements.  How was your knee after them?  Were you ever able to get back to unlimited walking and any sports between debridements?

Thanks again,

Maria(NYC) 

Offline Basil01

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #23 on: April 09, 2005, 11:04:01 AM »
Hi Maria

The patellar lession is abt 1 CM2 but unfortuantely i can not recall its location.
As far as the previous debridements is concerned i can assure you that after the knee was feeling OK even during skiing (water skiing - passing buoys- at 33 miles)  for at least 4 years... However it was a deteriorating condition...I mean that there was a significant difference in the recovery period.. But may be it was due to "aging" (The last debrediment was carried out in when I was 41)

Basil

« Last Edit: April 09, 2005, 11:06:11 AM by Basil01 »

Offline mariajuvan

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #24 on: April 11, 2005, 04:57:20 PM »
Hi Basil,

So, it sounds like it took  4 years of "regular activity" for you to get to full thickness lesions where you needed ACI.

I too am "older"  I'm 38 and I'm sure my lesions will continue to deteriorate also.

I guess I will try to get my legs as strong as possible, continue with my sports and be followed closely by an orthopedist.

I don't recall, did you have ACI or MACI?

In the US they are not doing using the biologic scaffolds they have in Europe;MACI yet.  I guess I shoud wait until then, I think everything can be done arthroscopically then.


Best Regards,

Maria

Summer is coming... have fun, you sure earned it!

Offline Basil01

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #25 on: April 12, 2005, 03:37:09 PM »
Maria,
It took me more than 4 years... it seems that it has started weill before and it was my strong quadricepts that save me..

No  i had only arthroscopies for debrediment and some prillie drilling nothing more.

As far Europe is concerned I think that in Germany are more advanced than in USA... Even today they are performing ACI arthroscopically in 25% of the cases

For more information Check the Freiburg University Clinic

Hope I have been of some assistance

Basil

Offline Nick_Knack

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #26 on: April 13, 2005, 12:17:43 AM »
Hi,

In February, Genzyme bought the Verigen company (German) which makes the MACI scaffold system.  Hopefully, we can catch up a bit.  I agree that the Europeans are ahead of the U.S. in this technology. 

What is the real advantage of MACI?  Is it that there is no periosteum flap needed?



Basil,

Have you built your quadricips up? If not, how far along are you?

Nick
Age: 35
1989 rt ACL (+25 degrees ext loss)
1994 rt ACL resection (+ 10 deg)
2001 rt ACL revision (+ 10 deg)
2003 rt med meniscus repair (+10 deg)
2004 rt LOA and post capsulotmy (zero degrees)
2005 rt LOA and tib bone plug removal (even w/ other leg)
2006 rt Fulkerson TTT & ACI Carticel

Offline blackbeltgirl

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #27 on: April 13, 2005, 01:41:06 PM »
Genzyme is currently in preclinical testing for Carticel II.  There's very little info on their website, but I get the impression that the next generation will be arthroscopic for many patients.  Maybe there's a connection....
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline mariajuvan

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #28 on: April 13, 2005, 04:49:52 PM »
Hi

Your right, when they use these "scaffolds"  they do not need your periosteum to hold the cells in place.  So it saves you a scar.  I believe they can also do it arthroscopically, which saves your knee a whole open procedure.

In Europe they are using "biologic scaffolds". (something that holds the cartilage cells in position)some are made of collagen others are made of carbohydrates and they are like small thin sponges almost.  They pour the cartilage cells on the scaffold and put it directly where the cells need to grow new cartiage and it sticks to the area all by itself.

I believe we are waiting for FDA approval here for use.

I believe you are right; this is Cartical II and I heard that certain centers of excellence for cartilage repair  in the US may using them in 2006,  if everything goes alright.


Maria
« Last Edit: April 13, 2005, 05:58:53 PM by mariajuvan »

Offline jtk

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #29 on: June 07, 2005, 07:16:08 AM »
Hello all,
I underwent multiple lession repair (Trochlea and Medial Femoral Condyle) on November 30, 2004. At the same time, they also did the procedure to realign my knee cap (Fulkerson procedure). Surgery was four hours long, but I was fortunate to live in Atlanta and have a fantastic surgean located hear who is a leader in this field. It has been six months and I have followed the rehab exercises very closely for the first 5 months, now I am on my own. Overall, I would have to say I am doing well and my doctor agreed at my 5 month check-up.

I have to say each week it seems to get slightly better, with occasional setbacks when I over do it. What hurt last month does not this month, but not fully normal yet. Overall, my knee is better then it was before the operation and I am hopeful at this point it will continue to heel until I reach complete recovery. I am 40 and when my knee gave a year ago spring, I did not hesitate to choose this operation. I wanted a chance to get back to normal with my own cells at work as quickly as possible. I had my operation within the first year of trouble occuring. My advice is pick a very good experianced doctor, and find a rehab person that is also well trained, as you will need them for many months afterwards. 

Now a quick question. I golfed 18 for the first time after 5-1/4 months, then stayed up most of night catching up on work emails with my leg on the coffee table. It hurt pretty bad for about a week afterwards. I took the next weekend off, then played again the following week and after this second round, it did not bother me as much afterwards as I iced when I got home and also later that night. However, ever since I golfed, I noticed that if I hold my knee while bending it fully and extending it, I feel a slight click. While doing my rehab exercises, (I continue to do these each day possible), when I am laying on my back in bed, bringing the knee up tight, and sliding it down, I now feel a slight click when I have my hand on the knee during extension. I do not feel a click when bending it up from the sitting position straight and back down, only when fully bending it.

Has anyone had this also and what did your doctor say? I am concerned it is a bad sign that I may have perhaps hurt it somehow. Pain is not bad, can walk normal, shoot some hoops with my kids (round the world type game), so overall I think it is strengthening. First time I felt a click however, so I am nervous.

Let me know if anyone has similair issue, or if anyone has any questions about my experiance
« Last Edit: June 07, 2005, 07:36:12 AM by jtk »

Offline BarryB

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #30 on: June 07, 2005, 09:41:26 AM »
Hi jtk.
From my experience, i had a lot of clicking and still do. i had a scope at 9 months to try and smooth out some of the clicking, but now at 18 mnths still have it. But anyway, the OS always says its not a big issue unless their is pain associated with the clicking. If there is no pain, it is probably the new cartilage just being a little rough and needs time to mould into a smooth surface. So i wouldnt worry too much if i was you.

Cheers.

Offline jtk

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #31 on: June 08, 2005, 12:33:27 AM »
Hi jtk.
From my experience, i had a lot of clicking and still do. i had a scope at 9 months to try and smooth out some of the clicking, but now at 18 mnths still have it. But anyway, the OS always says its not a big issue unless their is pain associated with the clicking. If there is no pain, it is probably the new cartilage just being a little rough and needs time to mould into a smooth surface. So i wouldnt worry too much if i was you.

Cheers.

Thanks for the input, appreciated.

Offline jtk

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Re: Multiple Lession (Trochlea / Femoral Condylae
« Reply #32 on: June 10, 2005, 03:24:57 AM »
FYI,
Doc checked me out today and said no issues, little cracking in the knee is not an issue, tracking great and I can continue to golf.
Pain is from increased use, but this is normal.

I asked him what the cells are like at 6 months. He said they are now cartledge, but more like infant cartlege and would not be fully adult cartedge until about 12 more months. Therefore, golf OK, but avoid any activity that would be high impact.

Thanks,
jtk