PKR Newbie here! Questions about NuSurface meniscus replacement

[Cyclegal]

Hi everyone, I have been reading your posts with stories of Joint Courage, and have learned a lot (especially not to fear joint replacement).

I'm pretty active, bike racing (yes at my age...) doing yoga, strength training. Just after lockdown I was doing a yoga video and transitioned from a side plank back to plank, and felt a bigggg pop in my left knee. No swelling after, some pain but nothing that stopped me from biking, hiking etc, and course at the time wouldn't go to ER with all the covid filling up the ERs.

All was fine, had it checked 1.5 years later, ortho said just some age related aches, didn't do an xray, exam was normal, and I was happy since I was essentially asymptomatic and just wanted to make sure I didn't do any damage.

Less than a year after that had a big, flubby prepatellar bursa, again, no pain, so I ignored that. Just looked bad but felt fine, though I was starting to get some sharp jabs when I was walking, and finally went to see a physiatrist (physical medicine and rehab MD) I thought all that was wrong was this fluid pushing on my kneecap, drain it & maybe put in a bit of steroid and all would be good. This was October '22, exam was suggestive of meniscus tear, xrays showed some joint space narrowing, subsequent MRI large meniscus tear, effusion, tricompartmental osteophytes, leaky baker's cyst, extruded meniscus, old MCL tear, cartilage delamination and fissuring. Right now I walk around feeling like I have a clarinet reed stuck in my knee medially, no locking or giving way though sometimes I feel like my knee isn't properly aligned, have had a couple achy flares lasting a few days, never ever feels normal, some swelling and still a bit of the prepatellar bursa swelling, though that is probably the least of the problems. Oh and I have some varus malalignment.

So in 3 years I went from bike racing (had qualified for masters worlds in '19) was strength and sprint training, doing plyo jumping etc, and now have this fairly messed up knee (I don't know the K-L scale but it isn't bone on bone). Ortho didn't think a partial meniscus removal would be appropriate (and I have to agree because there is evidence that can accelerate arthritis) and since there is all the other stuff going on not sure if that would provide much benefit. Plus I can kinda push through and do most of my activities but have scaled back. This is a different guy from the one I went to before---this at the big university hospital rather than the smaller ortho practice.

I had Durolane (which I thought my knee would explode after...) not sure if that helped, been 2 months. Been doing PT, still can't get the full extension, or get rid of the clarinet reed sensation, always feel that when walking, sometimes it can be way nasty. I do have good strength, BMI in normal range, have an unloader brace that helped x 3 days. Use my voltaren topical, ice, lidocaine patches, doing it all.

One thing that the ortho did mention that the NuSurface is pending FDA approval (been available in the UK, Israel and a few other places for over 10 years) and that would be a good option for me. Anyone have any experience with this? It is indicated for post meniscectomy pain, good for people in the gap who don't qualify for PKR or TKR. It is on the calendar for review this thursday, so it may be available in the US soon.

So 2 questions:

Anyone have any experience, or know of anyone who had this?
Are these findings (I know I didn't post my whole MRI / plain film report) significant enough to consider joint replacement?

Short term I can put up with this, but feel like by fall I need to plead with the doc to do something.

Thanks for reading

Liz

 

[Jaycey]

@Cyclegal Welcome to BoneSmart!

I have been with BoneSmart for quite awhile and can't say I have ever seen a member here with experience in the NuSurface implant. I am in the UK and see this has been available for 5 years.

I guess my main concern would be that your OS doesn't have any experience using this implant. Would you want him to be "experimenting" on you?

Since we don't know all the particulars in your case, it is hard to comment on what direction you should take. But given that you are very active and want to stay active, I would be exploring the best choice to keep active. Do the surgeons say PKR or TKR are not an option? I would want the option least likely to need a followup procedure.

 

[Cyclegal]

@Jaycey thanks so much for the speedy reply.

I think my current ortho was part of the early US trials with the NuSurface, though I think the numbers in the study were pretty small, so I'm not sure how much experience anyone has with this in the US.

I think I'm in the "lets try the conservative stuff" gap, and don't really know what the options are. I was so shocked at my visit that I had far more pathology on the mri and plain films I don't think anything sunk in that they were telling me (except "there isn't an arthroscopic fix for this..). I didn't know about the meniscus extrusion till I looked at the visit summary on line---from what I have read online that isn't a good prognostic sign and leads to accelerated OA changes.

I have a video visit next week, this time I will be armed with good questions!

Liz

 

[Jaycey]

from what I have read online that isn't a good prognostic sign and leads to accelerated OA changes.

OA can take over a joint very quickly. The situation goes from tolerable to horrid in what seems like over night.

Please let us know how your appointment goes.

 

[Cyclegal]

Had a video visit with my ortho today. Options are PKR, or a recently FDA approved medial shock absorber. The meniscus replacement was not FDA approved and I likely wouldn't be a candidate with the degree of meniscus extrusion that I have. I'm going to meet with a joint replacement ortho in July for his opinion on best course of action, and have some surgical intervention in October or so.

My ortho had done some of the shock absorber implants with the clinical trials and thinks it would be a good thing for me.

My docs are all at a big university hospital and up on the latest and greatest, down side is you get the residents working on you, and everyone is so specialized.

In the meantime I'm going to enjoy my summer!

 

[Axx72]

Absolutely enjoy the weather. I hope you end up with excellent news!

 

[Axx72]

Hi everyone, I have been reading your posts with stories of Joint Courage, and have learned a lot (especially not to fear joint replacement).

I'm pretty active, bike racing (yes at my age...) doing yoga, strength training. Just after lockdown I was doing a yoga video and transitioned from a side plank back to plank, and felt a bigggg pop in my left knee. No swelling after, some pain but nothing that stopped me from biking, hiking etc, and course at the time wouldn't go to ER with all the covid filling up the ERs.

All was fine, had it checked 1.5 years later, ortho said just some age related aches, didn't do an xray, exam was normal, and I was happy since I was essentially asymptomatic and just wanted to make sure I didn't do any damage.

Less than a year after that had a big, flubby prepatellar bursa, again, no pain, so I ignored that. Just looked bad but felt fine, though I was starting to get some sharp jabs when I was walking, and finally went to see a physiatrist (physical medicine and rehab MD) I thought all that was wrong was this fluid pushing on my kneecap, drain it & maybe put in a bit of steroid and all would be good. This was October '22, exam was suggestive of meniscus tear, xrays showed some joint space narrowing, subsequent MRI large meniscus tear, effusion, tricompartmental osteophytes, leaky baker's cyst, extruded meniscus, old MCL tear, cartilage delamination and fissuring. Right now I walk around feeling like I have a clarinet reed stuck in my knee medially, no locking or giving way though sometimes I feel like my knee isn't properly aligned, have had a couple achy flares lasting a few days, never ever feels normal, some swelling and still a bit of the prepatellar bursa swelling, though that is probably the least of the problems. Oh and I have some varus malalignment.

So in 3 years I went from bike racing (had qualified for masters worlds in '19) was strength and sprint training, doing plyo jumping etc, and now have this fairly messed up knee (I don't know the K-L scale but it isn't bone on bone). Ortho didn't think a partial meniscus removal would be appropriate (and I have to agree because there is evidence that can accelerate arthritis) and since there is all the other stuff going on not sure if that would provide much benefit. Plus I can kinda push through and do most of my activities but have scaled back. This is a different guy from the one I went to before---this at the big university hospital rather than the smaller ortho practice.

I had Durolane (which I thought my knee would explode after...) not sure if that helped, been 2 months. Been doing PT, still can't get the full extension, or get rid of the clarinet reed sensation, always feel that when walking, sometimes it can be way nasty. I do have good strength, BMI in normal range, have an unloader brace that helped x 3 days. Use my voltaren topical, ice, lidocaine patches, doing it all.

One thing that the ortho did mention that the NuSurface is pending FDA approval (been available in the UK, Israel and a few other places for over 10 years) and that would be a good option for me. Anyone have any experience with this? It is indicated for post meniscectomy pain, good for people in the gap who don't qualify for PKR or TKR. It is on the calendar for review this thursday, so it may be available in the US soon.

So 2 questions:

Anyone have any experience, or know of anyone who had this?
Are these findings (I know I didn't post my whole MRI / plain film report) significant enough to consider joint replacement?

Short term I can put up with this, but feel like by fall I need to plead with the doc to do something.

Thanks for reading

Liz

I can’t say my competition career was as elite as yours, but I road cycled and XC MBiked competitively for about 8 years with my highlight being the Canadian national level. I have been a professional firefighter for 18 years now during which, my right knee underwent two arthroscopic surgery’s and continued to deteriorate because of lateral osteoarthritis originating from an acute lateral joint injury.

I was never given an option for any meniscal shock absorbing or meniscal replacement technology. I would imagine some of that technology is harder to find in Canada. I was originally scheduled for a partial knee replacement, but because of the lateral aspect, my iOS suggested I go with a TKR, because of the reduced service length of a lateral PKR.

I ended up with a non-bonded 3-D printed prosthetic that actually organically integrates with my bone. This type of prosthetic is relatively new, say, less than 10 years old technology. Longevity reports say that it will outlast most knee replacement technologies.

Since my replacement in March 2022, I can now ride up to 160 km in a day with no adverse side effects on my knee.

I know this doesn’t answer your inquiry on meniscal therapy directly, but when it comes to a TKR for an athlete, I am extremely happy with what I received. I am a bit more than a year post surgery and my knee is still getting better.

With the advent of technology, there are so many more options available nowadays.

 

[Cyclegal]

@Axx72 thanks for the reply. Hahaha don't be that impressed with my cycling career!

I think Canada and Australia see what the US approves and goes from there. I think I'm looking for the easy way out, hoping that I don't need a PKR or TKR. On the other hand people for the most part seem to be happy with their joint replacements.

I'm just kinda hanging on, my knee seems to be more symptomatic these days and I can be pretty uncomfortable on my rides, keep telling it to hang in there till November!

BTW was impressed with your Countryman Derek Gee at the Giro. Woohoo!

Liz

 

[Roy Gardiner]

had qualified for masters worlds in '19

The masters is in UK this year - there's no concept of 'qualifying' as far as I know

I had both my knees done awhile ago now Dec 2011 BILATERAL TKR Recovery Diary

My knees work better now than before, many years before, the TKR. They are the strongest part of me for cycling. Completed the 'London Ride 100' last Sunday (May 28th) in 6hr 48. Pedestrian I know, not even fast touring pace, but got round. At the other end of the spectrum, I've taken part in the UK Masters' 2k pursuit twice and not quite finished last My knees gave ZERO trouble or pain, either endurance or high speed. If you go for TKR I don't think it need curtail cycling.

Gee, brilliant. Shame about our Gee, but Roglic took it fair and square. What about CAV!!!! Will he win one at the TdF? I wouldn't bet against it now!

 

[Cyclegal]

@Roy Gardiner to qualify for UCI worlds (in Scotland this year) you have to be in the top 20% of a gran fondo, or win a national championship. I qualified via the Gran Fondo option and in 2020 Worlds was going to be in Vancouver, same course.

Wow if you can blast around the velodrome then those knees are super!!

I had a hard time with the Giro because I am fond of Thomas, Roglic, and of course our Americans. Tour should be a good one, and I'm hoping to see Cav get some more wins.

Happy riding!

Liz

 

[Roy Gardiner]

to qualify for UCI worlds (in Scotland this year) you have to be in the top 20% of a gran fondo, or win a national championship

I'm of course thinking of the track championships in Manchester.

 

[Axx72]

@Axx72 thanks for the reply. Hahaha don't be that impressed with my cycling career!

I think Canada and Australia see what the US approves and goes from there. I think I'm looking for the easy way out, hoping that I don't need a PKR or TKR. On the other hand people for the most part seem to be happy with their joint replacements.

I'm just kinda hanging on, my knee seems to be more symptomatic these days and I can be pretty uncomfortable on my rides, keep telling it to hang in there till November!

BTW was impressed with your Countryman Derek Gee at the Giro. Woohoo!

Liz

He’s definitely a rising star!
Us Canadians don’t know how to quit… even after TKRs

 

[Cyclegal]

Bit of an update:

I saw the joint replacement specialist and we discussed options. I was interested in the Moximed Misha shock absorber that was just FDA (US) approved in April, which he didn't think was a good idea. Offered a PKR, I was kind of bummed since the Misha is a shorter recovery, less invasive etc, but is really new, and his thinking was it could affect a knee replacement in the future, though the company literature says no. I would have a ridge of a thing sticking out medially and he also didn't think I would be happy with that (it would scratch my bike ).

I was pondering the Misha + maybe some PRP, and the other new treatments out there, but maybe the tried and true PKR is the way to go....

He said he would also do some correction to preserve the lateral compartment.

My xrays haven't shown huge disruption in the joint space, and in my head the big issue is the extruded meniscus, which is a poor prognostic sign for further joint destruction, so maybe getting that meniscus out of the way and replacing the medial compartment is the way to go. I also have a prepatellar bursa, baker's cyst, some loose bodies, bit of an effusion and limited end range ROM (can't do yogic childs pose..)

Thanks for reading and letting me blab on! Oh my these decisions!!

 

[EalingGran]

Good luck!
I have had a pkr nine months ago and I have great ROM and a very natural feeling joint. It has taken several months for me to be largely pain free but I had a lateral pkr with correction of over 20 degrees valgus deformity and a very stretched MCL. I still have a small Baker's cyst and slight patellofemoral arthritis symptoms.
My understanding is that medial pkr is much more straightforward than either lateral or patellofemoral pkrs. That said pkrs are less common than TKRs and it is very important to get a surgeon who does plenty.

 

[mendogal]

My perspective is based on having a thoroughly blown R ACL and medial meniscus 20+ yrs ago: the ACL graft was a grand success but the medial meniscectomy led to traumatic osteoarthritis with some areas of bone on bone within three years. Over the years I slowly did less walking, less rigorous exercise, adapted my martial arts to baby the knee until I finally gave up beloved aikido for senior tai chi.... Long story short, I say definitely go for the PKR!!!!

 

[Cyclegal]

Thanks for the helpful info! My doc does lots of PKRs so I feel confident that he would do a super job. I notice that I am doing less and less these days, avoiding longer hikes, stopped yoga. Sigh.

@mendogal are you in Mendocino county? I have a place at Sea Ranch

CG

 

[mendogal]

Thanks for the helpful info! My doc does lots of PKRs so I feel confident that he would do a super job. I notice that I am doing less and less these days, avoiding longer hikes, stopped yoga. Sigh.

@mendogal are you in Mendocino county? I have a place at Sea Ranch

CG

Yep, inland. Had my surgeries with Dr. Howe in Santa Rosa.