~OK~ Acl Meniscus Cartalige Microfracture

[mcguinncat]

I'm sorry so many of you have had some major issues this season.
I was sidelined from the slopes this season after 2 surgeries within 6 months and I really don't know what to say anymore..
Is the third time really the charm

Has anyone come across the situation where they really never got full use of the knee after the acl healing response and meniscal repair.

ACL Meniscus repair in Jan 07'after a catch an edge and fall backwards move.
Partial Menisectomy Jun 07' after being overzealous w/ weighted squats and full rom not there after ACL surgery
Now:Cartalige Microfracture on Femur and possible retear of meniscus.
I don't remember doing anything to make this one happen.

Post op will be 6 weeks ~~No Weight Bearing ~~ UGHHH

Due to scheduling my 3rd Surgery won't be until early May. The doc said that I could use the bike at the gym but no leg presses anything twisting ect.. Most of you know the drill. I guess walking is fine as long as I tread lightly.

Just wondering...Has this happened to anyone where after 12 months they still haven't gotten full ROM or functionality. Any ideas on
preop strengthening or anything else for that matter would be
greatly appreciated.

Sorry for the rant but 3 in a year is beyond my scope of reality. #@^&(()

 

[altagirl]

Very sorry to hear that.

You need this place: https://www.kneeguru.co.uk/KNEEtalk/

I'd be cautious about having microfracture done as I've heard very mixed results about it. And it puts you non weight bearing for a long time, which is going to put you back at square one.

It sounds like you're not getting full ROM? How far away are you from getting it? What have you been doing to get there? So is your doctor thinking it's meniscus problems preventing you from achieveing full ROM? (How is the microfracture going to fix your ROM - I've only heard of that for arthritis pain?) I've had ROM problems but only very temporarily - that's just what I had done about a month ago - my knee locked up while skiing, they did a partial medial menisectomy 2 days later and I was up walking and feeling 98% better immediately.

Honestly I would go get a second opinion before doing this third procedure if you haven't already. Especially since it looks like you have some time.

Very sorry you're going through all this.

 

[MaineSkiLady]

Check this site for info:

https://www.orthoassociates.com/meniscus.htm

Might have a slightly different perspective, I didn't read through all of it. They rebuilt both my son's ACL's and did medial meniscus repair (trim work ) on one. Spectacular results.

Wishing you well - oh, how discouraging....:(

 

[Ealexandra212]

I'm really sorry.....that's horrible. I was non-weight bearing for 6 weeks after an ACL and menicus tear last January. When I had surgery and PT I did run into quite a few people who had to have their surgery redone because scar tissue had developed and had prevented them from getting the full ROM back. Many of those people ended up having their second surgery at the clinic where I had mine because they had a reputation for avoiding scar tissue. I don't know if that's an issue for you, but maybe a second opinion would be helpful?

For my part, I do have full range of motion, but some days I do feel that I can quite hyper-extend my "bad" knee as far as the good one. Don't know if that will ever fully go away.

For building up strength before surgery, bike riding helps. Are you doing any PT before the surgery? They should also be able to recommend some additional exercises to strengthen your quads. I also was really grateful that I had been doing Pilates for a long time before my injury. It helped enormously in being able to trigger muscles after the surgery. It also helped in being able to balance on crutches and move around without one leg for six weeks. You may also want to think about strengthening your upper body because the crutches take a lot of work if you have any distance to go.

 

[SuperMoe]

OH...I feel so bad with you for non weight-bearing 6 weeks. I had a knee surgery (cartilige) and was 6wk NWB. I was truly stunned at how fast I lost everything. It's taken me 1.5 years with TONS of skiing (XC and DH) to finally feel back to normal. To me, that was the worst part of the surgery (good for my triceps though and my other leg got REALLY strong)

No matter how much elliptical, treadmill, weights, I did...it wasn't until I was forced to balance in 3-D (not in just one plane) by XC skiing that I really feel like I'm back to regular.

It will take a bunch of time because of the NWB...there was a girl who tore her ACL and we were doing rehab at the same time and I was so jealous because in her rehab she made much faster progress because she was able to keep using her leg.

Good Luck

 

[num]

So sorry to hear this. I don't really have anything to add, but if you were in the area there'd be some cookies coming your way

I hope the experts weigh in for you, and I'm wishing you a full and speedy recovery.

 

[mcguinncat]

What a great group we have here ~ Thanks for your support!
Glad to hear everyone is doing so well post op... ~You go girls ~

In response to Alta, after my 2nd surgery 7 weeks ago they took out part of my medial meniscus, but also found a good chunk of scar tissue so they got that too. As of 4 weeks ago I was 0 deg/120 deg..not bad, but anything past that w/weight felt like it would give out. Knee stability still pretty weak.
I don't know how microfracture will affect the ROM, but he said it would lay down new cartilage that is close in material to original cartilage. In theory, I think it should smooth the joint into moving freely again, but that's my guess.

Now I have intermittent (like every 4 days) of knee crunching, then out of the blue shooting pain that you buckle under and hobble to couch and ice/wrap for another 3 days and then it feels better, not great, until the cycle continues. It almost feels like a dislocation when it clunks back into place and the pain goes away.

Good idea about a second opinion..My doc is one of the US Ski Team docs, I tend to trust him completely, but who knows? What I do know is he gets everything that needs to get done while he's in there.
I saw the arthroscopic pics of before and afters of both surgeries and the post op ones looked clean as a whistle.

I think what Ealexandra and SuperMoe are right on with the preop
work..I'm back at the gym doing upper body stuff to get that ready. I love those dumbell pullovers...Like I'm addicted to them.. Whoo Hoo
Started up the the recumbent bike w/ no resistance today. My OS says no PT for now. Just stay straight and no twisting.. Like that helps! I did call my PT and he said that stationary bike, very very light leg presses would be ok..but no hiking/long walks as it will just aggravate it.
I used to do some ballet stretch/strengthening work, so I'll start some light work in that area too.

Thanks everybody..you're awesome and wishing you deep powder with the wind in your hair Hugs

 

[mcguinncat]

Thanks for the Cookies Num

 

[altagirl]

As of 4 weeks ago I was 0 deg/120 deg..not bad, but anything past that w/weight felt like it would give out. Knee stability still pretty weak.

I've got to say - I've been through this 5 times and I've never had anyone in PT have me do anything where my knee was bent 120 degrees with weight. Not even my body weight. My knees make crunching noises and basically it's just not something I would do - I do squats/lunges to 90-100 degrees and that's it. (Well and then biking with heavy resistance at whatever that is - what, like 115 degrees?? But then I'm standing when it's heaviest so the angle is actually less... I digress.) I kindof put that in the category of doing weighted leg extensions - just something you don't do anymore once you have "bad knees". And I can't think of anything in the sports I do that would require some functional use squatting past 90-100 degrees, short of having flexibility when I fall, so I don't worry about it. Now the instability... that's not good - THAT you need. But that usually means more PT if your ligaments are still intact.

I don't know how microfracture will affect the ROM, but he said it would lay down new cartilage that is close in material to original cartilage. In theory, I think it should smooth the joint into moving freely again, but that's my guess..

I'm not trying to be negative here, and microfracture has never been suggested for me. But over on TGR there has been some discussion of this, and there are a few people who have had it done and said it worked. But there are also studies saying the microfracture actually does nothing and the benefit is from the debridement and meniscus trimming that is done at the same time (and thus the 6 weeks on crutches was nothing but a waste of time. It's notable that one of the guys on TGR who had microfracture and swears it worked actually didn't spend any time on crutches and was skiing in a few weeks - obviously not following the protocol at all, so it couldn't have healed right and must have been the meniscus trimming and such that actually helped him.) Now I have no idea, I'm not a doctor, and I know some people swear it helps them. My thought though is that if you're unstable - that's probably a muscle deficiency. Putting you on crutches for 6 weeks is going to take those muscles down to nothing, and it seems to me that would be a bad thing for you. Again - just my non-professional thought on it, but I'd just make sure you ask your doc (and second opinion doc) about it.

Now I have intermittent (like every 4 days) of knee crunching, then out of the blue shooting pain that you buckle under and hobble to couch and ice/wrap for another 3 days and then it feels better, not great, until the cycle continues. It almost feels like a dislocation when it clunks back into place and the pain goes away...

That sounds like what my knee was doing before it finally locked up and I had the partial menisectomy to fix it. I could literally feel it clunk out of place and back in - it felt sickening hen it would happen. Only mine was just painful while it was out, then would feel fine and I'd go back to skiing / biking / whatever immediately. And then finally it popped out and stayed that way until surgery, with my knee stuck at about 30 degrees flexion for several days. THAT was painful.

Anyway, best wishes and I hope it all works out great, whichever route you go! It's always a tough decision when it comes down to these things - graft choices, various newer procedures, etc. It's nice to have input but not a fun decision to make. I'm a researcher by nature too and I just keep searching for the "right" answer - like I'm going to find some irrefutable proof that I'm making the right choice. And the reality is that after all the research you still have to make a leap and go with your gut because there are pros and cons to everything. Ugh. (And you're very right - having a doctor you trust helps immensely.)