Osteochondral allograft transplant in the trochlear groove

[Hokieman89]

Hi all,

A little background first, 2003, I had acl recon. Allograft in the left knee. Had the same in 2005 in the right. In early 2012, the left was giving me some problems , so I had it checked out. Turns out, the graft failed, so I had it redone at HSS in NYC, this time with the patella tendon graft. 6 months out, things were going great. I was squatting 305lbs x 5, doing sprints, box jumps, pretty much everything but the final stage of cutting and twisting at high speed. Then one day I woke up and had horrible swelling, catching and pain. Chalked it up as overuse, so I rested. Every couple weeks I'd attempt a slow jog, but it didn't help. Always had pain and swelling.

Eight months after the acl, went back to my doc at hss and we had an MRI. My articular cartilage had given out in the trochlear groove . I opted for conservative treatment. Rest and heavy duty NSAIDs. This didn't work either. However, I was just starting my career after graduating college (23 at the time) so I dealt with it. By December, I couldn't climb stairs, so I went to see my doctor again and had another MRI. The knee had deteriorated further. At this point I opted to have the transplant as recommend by my dr.

On 3/17 I had the surgery. Local anesthetic with some Valium to knock me out. When I woke up, the epidural had worn off, since I needed two plugs and the surgery took longer than estimated. Ouch! The quickly put me on 10mg of oxy every 4 hours as well as a dilauded pump. This help greatly, but I've never been so drugged in my life! The doc assumed I'd need a couple nights in the hospital due to pain, but due to my high threshold (all my other surgeries) I was ready to get the hell out of there by the morning after surgery.

I was started on cpm in recovery, and have continued cpm about 5 hours a day since. I'm 15 days out now, and around day 12 or 13 I was able to switch to Motrin only to control the pain. I've had a game ready ice machine as well, which is crucial to pain management in my opinion. I don't have an obscene amount if swelling at all.

On day 8, I went back to see my doc. I'm weight bearing as tolerated, straight leg only (so the patella doesn't engage the trochlear groove) for 6 weeks. Additionally, I was a little surprised to hear PT doesn't start until the 6 week mark as well. At the three week mark, I can begin to ride the recumbent bike at low resistance, as tolerated. This will replace cpm at that time.

Questions? I'll check back in after my first day on the recumbent bike,as I don't expect much to change until then

[Hokieman89]

I should add, ROM worked up to 100+ easily (relatively speaking, compared to ACL.) Doc has said to just set the cpm to 95 ish at this point, as my rom is good, and the com is just to get the leg moving. I'd say extension is at 0, but I'm struggling to get that -5 to -10 that doctors like to see. Straight leg raises in the brace only until I begin PT, and many, many quad sets. I'd say it took about 5 days to get quad control back, and another 5days to a week to be able to move my leg around In the brace with minimal pain

[Hokieman89]

Got on a recumbent bike today! It's three weeks to the day after surgery. I must say it was pretty painful rotating all around on the bike. I was on it for ten minutes. At first I was only pedaling at about 12 rpm. By the end it was 16-18. I'll be going back to try again tomorrow. I put my hand over my knee, a situation where I used to feel a lot of cracking and grinding, and it felt smooth as butter as I pedaled.

I will say this. My knee feels MUCH BETTER when it's moving. It feels good today. And I have noticed that if I'm up on my feet a lot that the cpm provides relief to the swelling and pain believe it or not. I just need to get this knee moving without creating the shear force that a leg extension creates, because of where my defect is located.

[Hokieman89]

Not a ton of new things to report, but I'm now 31 days post op. I'm riding the recumbent bike twenty minutes per day now, slowly increasing the resistance. After the first couple of minutes my knee loosens up and I can spin pretty good. Swelling has seemingly been the same for a week and a half now, which I feel is restricting my full range of motion. I'm taking two ibuprofen every 6 hours as it still aches. Crutches are gone, but I'm still straight leg in the brace only

[Hokieman89]

Had my 6 week check up this week. Cleared to bear weight in positions other than straight leg, and wean from the brace. Also started therapy and have added step ups to my daily routine. I have to return to work Monday which will be tough.

It's very weak. My hamstring is gone and my quad is very weak. I'm doing step ups of about 4 inches. I also still have about two inches worth of excess swelling, so that's somewhat limiting as well. I'm going back in 6 more weeks to see the doctor

[Hokieman89]

Went back to the doctor for my 12 week check up this week. Not a ton to report. for the next three months, I will continue to build strength through closed chain exercises only. I will go back to the doctor for an MRI and checkup in september, at which time he will be able to tell if my body is accepting the graft (6 months post op)

He felt my knee as i extended it, and said "its not a perfect glide, but it feels pretty damn good. You will have good results if the graft stays this way" so that was pretty encouraging.

Currently my PT routine consists of stretching, Riding an upright bike (now clear to go to town on the resistance), straight leg raises with 5 lb weights, bridging, body weight squats, step ups, single leg deadlifts (will move to two leg once my strength gets more even), side stepping with an elastic band around my angles (hip strength), calf raises, leg presses. Its pretty extensive. I'm going to be going to PT once every two weeks, due to the fact that my routine will not be changing, with the exception of resistance, for three months. Once i begin to do more agility/running?/open chain stuff, i will go back to PT once or twice a week.

I have good days and bad days. on good days, i can almost not notice the pain when walking/exercising. Bad days usually come after i have been on my feet alot, where the swelling increases, and the knee becomes more stiff and tender. I'm trying not to take any ibuprofen anymore, as i want to be able to listen to my knee to know when to back off, but i do occasionally still need to calm it down with an NSAID.

I'm not expecting much change for a while, but i will report back when there is news to report

[MDAL]

Good to hear things are going well so far, how is ROM now?

Keep working on those muscles, I know getting them back to shape takes ages, I'm still working on mine almost a year after my last surgery....

[Hokieman89]

I have had full ROM since about 8 or 9 weeks out. Extension is easily at 0, but i do have some issues getting the little bit of hyperextension. What did you have done?

[Hokieman89]

things have been pretty much the same for the last two months. I've kicked up intensity on the upright bike. I've also started doing some barbell romanian deadlifts (3 sets of 12-15 reps, right now about 175lbs), as a weight lifter, it at least makes me feel like im doing some real work. I'm also leg pressing, but with the pressure that puts on my knee im taking that very slow. Same thing with body weight squats, i do three sets of them with about 20 lbs in my hands.

the last little bit of swelling is being pretty pesky, im having trouble getting rid of it. Stairs are getting easier, but going down is still a little bit of an issue. its usually not very sore, unless i had been up on it more than usual, so that is promising. I still have about 5 weeks before i go back to the doctor for my 6 month MRI and check up, and things will likely be about the same then as they are now

[intheways]

Just curious as to how your progress is? I'm four months out from a meniscus transplant, but the OS noticed some grade 2 wear in the trochlear. If it gets worse, I presume OAT or ACI will be in my future.

Also, have you changed your lifting at all. I started lifting again as the result of my most recent surgery and am curious as to whether you have restrictions regarding certain lifts.

[Hokieman89]

I"m about 11 months out now. My last visit was a couple of weeks ago. The graft has finally begun to "take" i.e. my body is beginning to incorporate it.

The doctor told me that I can do anything that doesn't hurt (with the excpetion of quick stopping and starting, things like jumping and sprinting) (he knows after 5 surgeries i know my body). I jog a few times a week at about 6mph, ride the hell out of the stationary bike, and eliptical machine every once and a while

In terms of strength, i can leg press a pretty good amount. It's easy to focus on pushing through my heels and keeping my knee out of a vulnerable position. My deadlift is getting back to where it used to be, as it is mostly a hip related movement. Squats are limited to bodyweight, plus a 70lb dumbell. i'm doing some reverse lunges. The doctor said i could do leg extensions within a range that doesn't hurt, but i never really like those anyways. I'm pleased with my progress, and not really in a rush either.

I go back for a visit and MRI in june

[EYBC]

Hi all - Figured I would add on to this thread since this story is the most similar to mine. ACL reconstruction in 1993. Scope to debride rough cartilage on patella in 1994. Then, many years of feeling great. In 2015, knee started to feel like crap. Found my way to one of the best cartilage repair guys in the world and the culprit appeared to be a defect in the trochlea. Tried for almost 2 years to rehab to a place where it felt OK. Was a rollercoster ride. Some days felt great, most days felt like crap. Tried stem cell shots and couldn't tell if they worked or not. Has a scope to clean it out and evaluate in 5/16. 2 cm defect in middle of trochlea. Went on list for OCA in fall of 16. They found a match and had the proc to put it in my knee in early Feb 2017. I am 5 weeks out now and making good progress. Full weightbearing in a straight leg brace since 3 days after surgery. Have full ROM after I loosen it up. Doing leg raises and hip work and praying that at my 6 week appointment the graft looks good. Definitely some grinding under the knee cap but doc said to expect that. Still pretty swollen too. I'll check back in after 6 week appointment.

[EYBC]

Now 8 weeks out. Graft looked good on X-rays at 6 weeks. Still some swelling and the knee feels cranky if I don't move it a lot. Walkiing normally and Going up and down stairs fine although very deliberate on stairs and going down still awkward. In the gym 3 days a week doing closed chain work and on bike 3 days a week. Totally lost my quad so a long way to go to build strength and need to go slow as I don't want to inflam it or damage graft. No more arthritic pain but still working through the post surgery soft tissue damage so it is cranky. Think I am on right track but will a slow going.

[Bdiddy18]

How has your OCA been?