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Arthroscopy Lost and need advice post meniscus surgery

jeljohns

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Some background:
I'm a 41-year-old female who has been pretty active through my 30's (running, Crossfit, Orange Theory) without any issues except the occasional IT band tightness.
I went for a run this past spring and felt an odd ache on the inside of my left knee. After an Xray and an MRI it was confirmed that I had a meniscus tear and an osteochondral lesion on the medial femoral condyle. The doctor said the injury looked a few years old and was not caused by a sudden impact activity. It was decided that I should have surgery to clean up the meniscus and have a microfracture procedure done on the lesion.

When I woke up from surgery the surgeon said the articular cartilage was soft, but intact and looked healthy so he did not proceed with the microfracture. He removed roughly 15% of my meniscus. I was elated because that meant a quicker recovery. Recovery was still not easy as most of you here know well. I had PT 2-3 times a week and made about a 90% recovery in three months. I still can not bend into a full squat or do any activities that required being on my knees, but other than that I felt great. I had some residual soreness near one of the incisions and the surgeon said it was just inflamed still and healing from surgery. He said that goes away typically at the 3 months mark.

Four months post-op the pain was increasing again. I had another MRI. The MRI showed that the articular cartilage area lesion had not grown larger or changed and was still intact. However, it showed that the bone underneath was severely inflamed with edema. He cannot explain why everything seemed fine with no pain and now this happened suddenly. I have not increased my activity level and have not attempted running activities. He now recommends an allograft with donor bone/cartilage to replace that spot. The recovery process he laid out was long and painful. Roughly a year.

Now, I know a lot of you have gone through MUCH MUCH worse, but the last surgery almost broke me. I am very independent and I could barely stand being non-weigh bearing on crutches for two weeks and stuck doing nothing for months. The allograft surgery would be six weeks on crutches and then starting over again at zero for PT, which I just finished gaining strength and flexibility back in my leg. I do not think I can handle the mental and physical pain.

So I feel lost and helpless. I am looking for advice on any other options for surgery. I do not know how long the knee will hold out in its current state and if the bone will continue to decline. I want to know the best way of maintaining a healthy knee for the rest of my life. I also would like to avoid full replacement if I can.
 

smokey1

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Jeljohns,
I am so sorry you are having such a hard time with your meniscus surgery. How frustrating for you. I would definitely get a second and maybe third opinion. You must seek out the best option for you. Your young and don’t want to end up with a knee replacement down the road , so early in your life. Best of luck !
 

Ginger1210

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Hi jeljohns I can relate with you. I tore my Medial meniscus cartilage back in 2014 i put up with the odd sharp pain for a couple of years i was a keen martial artist and competed in Kickboxing and grappling, trained 4 times a week and loved it. In 2016 i was advised to have my cartilage cleaned up through key hole surgery. I had it done in the summer 2016 and i was back to training within 8 -10 weeks. I was OK for a year then i started with a persistent pain in my knee in the same place. I had another scan in 2018. the result was my meniscus had torn again. I sought out a knee surgeon specialist who operated on me in December 2018. Despite following all the Physio protocol i never recovered to return to the sport i loved and had participated in for 20 years. My Pain increased to a point in 2019 i underwent another procedure for Micro-fracture to try and regrow my dwindling cartilage. Again this was not successful. Slowly over the next two years my pain increased and i ended up on strong medication in order just to carry on working. fast forward to 2021 last April I had a partial knee replacement Medial Right Knee in order to ease my pain. I am still recovering but i can no longer feel my bones grinding together. I guess the only advice i am trying to give is. Put your knee first i know it may be tough giving up a sport you love but believe me I tried to get back to my chosen sport by having numerous operations unfortunately the more cartilage you loose the less cushioning you have. save your knee and take up swimming or cycling. My goal is now to be able to walk with out a limp and swim. I hope this helps.
 
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jeljohns

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@Ginger1210 thank you for sharing your story. One big question that came up in my research was why is the recovery for partial knee replacement LESS than an allograft? The allograft is a year recovery with the chance that it might not work or I may have to have a replacement later anyway. The partial seems to be a few months recovery in comparison, so is there a reason I wouldn't just go straight to a partial replacement?
I have completely given up on running and I only cycle or walk now. I am okay with that as long as I can keep my weight in check because that damages the knees as well.
 

Ginger1210

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Hi jeljohns the allograft is a really tricky operation i looked into this myself they will not do it on the N.H.S in England it is only under trial. The reason for such a long recovery is because the grafted cartilage needs a long time to bond with you knee due to the extreme stresses put through your knee and this can damage the newly grafted cartilage. Regarding the partial i thought the same that recovery would be quicker than a full TKR and it may well be. Partial is still a major operation and it causes massive trauma in your knee. Before i found bonesmart i was in mad panic mode because i was two weeks out form my operation and was really struggling with the trauma to my hole leg. This has been a massive wake up call for me and i now know although i am on track in my recovery ( 7 weeks ) I am still a fair way from total recovery if ever. The advice i can offer is take your time deciding what is best for your quality of life, and seek more than one opinion. For my partial i found a professor who practiced out in Harrogate West Yorkshire he performs more partial knee replacements in England than any body else and as a really high success rate. That being said this is not a easy recovery and i still struggle with pain and swelling. Look at some of the threads in bonesmart and these will help you a lot. I hope this helps, you are not alone in this. I thought i was until i found this forum.
 

Jockette

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The partial seems to be a few months recovery
This may happen in a few, rare cases, but the reality is, even a partial takes an average of a full year to recover from, in spite of advertising that is a quicker recovery.
For my partial i found a professor who practiced out in Harrogate West Yorkshire he performs more partial knee replacements in England than any body else and as a really high success rate.
I agree.
The average year recovery is only if you have a very experienced surgeon doing it, as experience in any surgery is key to a good recovery. Partials are done much less often than totals, so many surgeons don’t do enough of them to get really good at it, and some surgeons won’t even do a partial. That is one of the reasons some partials fail rather quickly.

And, my knee is an example of bad outcome.

So if you ever get to the point where you are seriously considering a partial, get several opinions, and don’t have it done in an area with a small population, travel to a larger city, if you can, where there would be more cases and more experience. I regret that I didn’t do either of those things. Not knowing any better, I trusted the first surgeon I saw and had my surgery in a small area.
 

Celle

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One big question that came up in my research was why is the recovery for partial knee replacement LESS than an allograft? The allograft is a year recovery with the chance that it might not work or I may have to have a replacement later anyway. The partial seems to be a few months recovery in comparison, so is there a reason I wouldn't just go straight to a partial replacement?
I know that other people have addressed this correctly, but I do want to warn you that the promises of a quicker recovery from a partial (PKR) are partly advertising hype. While it's true that a few fortunate people do have a relatively fast recovery, the majority find that complete recovery can take as long as a full year.

In addition, doing a partial knee replacement (PKR) successfully requires a particular skill set, acquired through extensive experience.
Many PKRs fail early, because arthritis has continued to increase and it has spread to other compartments of the knee.

When it comes to a choice between a PKR and a Total Knee Replacement (TKR), I would choose a TKR.
 

Celle

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@jeljohns ,
Please will you tell us the full date of your knee arthroscopic surgery and which knee it is, so we can make a signature for you? Knowing the exact date will help us to advise you appropriately.
Thank you.:flwrysmile:
 
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jeljohns

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@jeljohns ,
Please will you tell us the full date of your knee arthroscopic surgery and which knee it is, so we can make a signature for you? Knowing the exact date will help us to advise you appropriately.
Thank you.:flwrysmile:
February 12, 2021, Left knee. :)
 

Celle

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Thank you for your surgery date. I've done your signature and added your name to the February Valentines surgery team thread.
 
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jeljohns

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I started having some pain in my inner knee last September. I have never had any knee problems or pain in the past.
After an MRI the doctor/surgeon said I most likely had a meniscus tear and also some damage to the cartilage over my femoral condyle.
He cleaned up the meniscus during surgery in February but opted not to do a microfracture because he said the cartilage was soft but completely intact and stable.
After PT got going and I gained flexibility back in month 2 I felt pretty good. I had some soreness near the surgery entrance point and was told this is very normal and pain/swelling in this area can take months to heal.

My PT progressed to jumping exercises at the end of 3 months post-op and she had me try running a few times. The surgeon's plan had me returning to running at month 3. The running never felt right and against my better judgment, I followed her jumping exercises even though they felt like a lot slamming on my knee. After the second run attempt (just running a minute on, a minute off for 8 minutes total) the inner knee pain came back.

I stopped PT and saw the dr who said to come back in a month if it got worse. He said I should have zero problems running at this point post-op. It got worse at night so I went back to see him. I had another MRI which showed edema in the bone, but everything else looked the same as my first pre-surgery MRI. No new tears and no further cartilage damage. I have no visible swelling, no limping, and do not take any pain meds. No sharp pain, just a dull ache, and tenderness near the surgery site, most noticeable at night if I lay on my side.

The surgeon went right to wanting to schedule an allograft. I declined for now.

Here is the interesting thing.....I decided to go back to my biking PT to at least do something non-weight bearing and magically the days I bike I have no pain the rest of the day. If I don't bike I usually have mild pain. I walked yesterday for 2.5 miles with no pain and no pain at night.

I am starting to think perhaps I caused some small stress fractures doing too much too soon with PT? Or maybe doing the biking helps relieve some of the edema build-up in my knee?

Has anyone else had any experience like this where they feel better after physical activity? I guess I'm trying to be hopeful and also am not ready to accept that another surgery is the only answer. Maybe I just can't run anymore. Could I still be healing?
 

Roy Gardiner

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You'll notice that I have merged your newest thread with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:
  • That way, you have all your information in one place. This makes it easier to go back and review your history before providing advice.
  • If you start new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
  • Having only one thread will act as a diary of your progress that you can look back on.
So please post any updates, questions or concerns about your recovery here.
 

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