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Articular cartilage defect... surgery?

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Created by ZaZz Two weeks ago, 31 Jan 2018
ZaZz
WA, 87 posts
31 Jan 2018 12:28PM
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I have a cartilage defect in the femoral lateral condyle (knee).
After sports, my knee is often swollen and painful.

Numerous techniques exist to repair or regenerate a cartilage defect...with varying degrees of success.
Some newer techniques are not even covered by Medicare or Health funds.
I was recommended surgery, if possible (waiting on advise from specialist).

Just wondering if anyone has had that kind of operation (and which technique?) and is happy with the outcome and result? Is it worth it?

Cheers

Slashrockson
NSW, 118 posts
2 Feb 2018 5:06PM
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Yeah wot he said, anyone got info ?

bgil5470
12 posts
3 Feb 2018 3:47PM
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I've got the same thing...initially diagnosed with an MRI a few years ago. My ortho basically said that I should wait until 60 to have a knee replacement....too young at 46 apparently. I've tried an arthroscopy (basically to flush and scope the joint to see what was going on) and also Synvisc injection (it's like artificial top-up synovial fluid)....these procedures are IMO a bit of a waste of time. I'm now sitting in bed with a joint effusion where my knee is swollen like a balloon from excess fluid in the synovial space....hobbling around like an old man.

Apart from a full knee replacement your only options are partial knee replacement (the Makoplasty robot-assisted surgery sounds interesting) or cartilage repair techniques (orthoinfo.aaos.org/en/treatment/articular-cartilage-restoration). The cartilage repair techniques don't sound like they're covered by medical insurance but my surgeon reckons he's had some success with them if the defects are in an area of the knee that doesn't have too much shear force on them.

Your basic problem is that hyaline cartilage has no direct blood supply, so that prevents it from healing. And kitesurfing places great shear and compression forces on the knees My GP's best advice: - "Your body is trying to tell you, through pain, to slow down"....yeah, thanks Doc...

bgil5470
12 posts
3 Feb 2018 3:51PM
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Oh and my ortho reckons that stem cell injections are a waste of time and can cost around 8 grand with no proven clinical success.

ZaZz
WA, 87 posts
4 Feb 2018 9:16AM
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Cheers bgil5470. Sounds bad, I feel your pain.

My current option is cartilage repair. Some repair techniques (e.g. microfractures) are covered I think by medical insurance, but some are not (e.g. MACI and ACI).

My ortho thinks that at my age (32) and type of defect (single lesion 1-1.5 cm), I should get surgery. But it's not his specialty so going to see another ortho to discuss my options.

It's quite an extensive postoperative rehab so it would be nice to discuss results with someone that has had that kind of surgery.
The non-operative options are to slow down a bit (duh), injections, and maybe get a brace...but overall it can only get worse with time I think.

bgil5470
12 posts
4 Feb 2018 8:18PM
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Yep it's a bitch - do you go hard when you're young and wear out too soon or sit on your arse and slowly rust away. Same outcome in the end hey.

The MACI cartilage repair technique is worth looking into but it's not covered by health insurance. The cost of it was initially prohibitively expensive but has come down a lot apparently. Might be worth a shot. I'd do it myself but have been told that my lateral condyle defect is in a bad spot and probably wouldn't respond to that treatment as it would just wear away again. Good luck with it. Let me know how you get along because I'm weighing up my treatment options too

bgil5470
12 posts
4 Feb 2018 8:22PM
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From what I understand microfracture is an inferior technique that doesn't produce true hyaline cartilage but more of a scar tissue type plug which doesn't have the same durability. Sort of like a scab on a wound I guess

VR46
WA, 2 posts
5 Feb 2018 3:07PM
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I had the partial Makoplasty done in March 2017, started playing ice hockey four months later and started kiting in October 2017. Would recommend it to anyone, does come with pain but i had pain anyway
John

ZaZz
WA, 87 posts
6 Feb 2018 7:51AM
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Yes it's also my understanding of microfracture. It's still a really popular technique.
MACI looks promising but not sure about $$. It's not covered and the argument is that there is no scientific proof that MACI leads to better outcomes than microfracture (Australian Gov), and microfracture costs about 10% of what MACI does (prices might have gone down). Will see what the ortho proposes.

Makoplasty looks like next level. Not quite there yet. Good to hear you got back to doing sports only a few months after surgery.

bgil5470
12 posts
6 Feb 2018 9:02AM
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Select to expand quote
VR46 said..
I had the partial Makoplasty done in March 2017, started playing ice hockey four months later and started kiting in October 2017. Would recommend it to anyone, does come with pain but i had pain anyway
John


Glad to hear you're doing well John. Which knee compartment did you have the Makoplasty on?

bgil5470
12 posts
6 Feb 2018 9:39AM
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Select to expand quote
bgil5470 said..

VR46 said..
I had the partial Makoplasty done in March 2017, started playing ice hockey four months later and started kiting in October 2017. Would recommend it to anyone, does come with pain but i had pain anyway
John



Glad to hear you're doing well John. Which knee compartment did you have the Makoplasty on?


Is your surgeon happy to let you kite surf on it?

VR46
WA, 2 posts
6 Feb 2018 10:12AM
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medial compartment, he knows what sports i do and he is happy with me doing them, no running or jumping, i hate running

bgil5470
12 posts
6 Feb 2018 12:34PM
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Nice one...thanks for the info. Yup, running sucks so you're not missing much there at least

Andrash
WA, 552 posts
8 Feb 2018 9:43PM
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Cartilage damage is a nasty one because cartilage have limited circulation to promote repair (compared to muscles). They do not naturally regrow once they deteriorated... sometimes they do, but this is more the exception, As they have limited nerve supply, the deterioration eventuates in symptoms only at the later stage, often too late. For this reason, it is utmost important to pick it up early, i.e. never put up with even mild pain if it keeps coming back. Act immediately, but not symptomatically. You need treatment to promote regrowth, not mere pain relief.
As far as I can see, you need to keep going (with kiting), because circulation is essential, or if it is nasty, try something milder, like roller blading... but all withing your sensible limits. Sitting all day is the worst....
...there is so much more to it, but at the end it is rather common sense, then rocket science.....

bgil5470
12 posts
10 Feb 2018 7:55AM
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Andrash said..
Cartilage damage is a nasty one because cartilage have limited circulation to promote repair (compared to muscles). They do not naturally regrow once they deteriorated... sometimes they do, but this is more the exception, As they have limited nerve supply, the deterioration eventuates in symptoms only at the later stage, often too late. For this reason, it is utmost important to pick it up early, i.e. never put up with even mild pain if it keeps coming back. Act immediately, but not symptomatically. You need treatment to promote regrowth, not mere pain relief.
As far as I can see, you need to keep going (with kiting), because circulation is essential, or if it is nasty, try something milder, like roller blading... but all withing your sensible limits. Sitting all day is the worst....
...there is so much more to it, but at the end it is rather common sense, then rocket science.....


Hmmm, I'm not so sure that kite-surfing is great for knees just to maintain circulation...too much chop-hopping and pistoning of legs up and down, over and over again. It's like tread on a tyre - eventually your cartilage is going to wear down but, like you say, it's usually too late by the time you notice chronic symptoms because by then the damage is already done. I think I'm going to have to transition to a foilboard just to prevent further wear and tear...good excuse to learn a new skill.

The big problem is that there really isn't any effective treatment for osteoarthritis. Treatment advice I've received is pretty much: - do nothing but pop some pain-killers and wait until you're old enough so that the surgeon can tear your old knee out and replace it with titanium and hope you get at least 15-20 years out of it before that fails too and you need revision surgery. There's no really effective conservative treatment that sits in between not having any treatment at all or having a total/partial knee replacement.

Any kite-surfing doctors or surgeons on here with more informed info than mine? What's the best treatment for dodgy knees? Is kiting beneficial or bad for your joints?

dafish
NSW, 1165 posts
11 Feb 2018 8:00AM
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Select to expand quote
bgil5470 said..

Andrash said..
Cartilage damage is a nasty one because cartilage have limited circulation to promote repair (compared to muscles). They do not naturally regrow once they deteriorated... sometimes they do, but this is more the exception, As they have limited nerve supply, the deterioration eventuates in symptoms only at the later stage, often too late. For this reason, it is utmost important to pick it up early, i.e. never put up with even mild pain if it keeps coming back. Act immediately, but not symptomatically. You need treatment to promote regrowth, not mere pain relief.
As far as I can see, you need to keep going (with kiting), because circulation is essential, or if it is nasty, try something milder, like roller blading... but all withing your sensible limits. Sitting all day is the worst....
...there is so much more to it, but at the end it is rather common sense, then rocket science.....



Hmmm, I'm not so sure that kite-surfing is great for knees just to maintain circulation...too much chop-hopping and pistoning of legs up and down, over and over again. It's like tread on a tyre - eventually your cartilage is going to wear down but, like you say, it's usually too late by the time you notice chronic symptoms because by then the damage is already done. I think I'm going to have to transition to a foilboard just to prevent further wear and tear...good excuse to learn a new skill.

The big problem is that there really isn't any effective treatment for osteoarthritis. Treatment advice I've received is pretty much: - do nothing but pop some pain-killers and wait until you're old enough so that the surgeon can tear your old knee out and replace it with titanium and hope you get at least 15-20 years out of it before that fails too and you need revision surgery. There's no really effective conservative treatment that sits in between not having any treatment at all or having a total/partial knee replacement.

Any kite-surfing doctors or surgeons on here with more informed info than mine? What's the best treatment for dodgy knees? Is kiting beneficial or bad for your joints?


Though not a doctor, I had surgery 3 weeks ago for torn medial and torn meniscus that was curled and stuck under my knee cap giving me more pain than I care to admit. I had a previous injury surfing Puerto Escondido 8 years ago and my surgeon told me then to stop running as I has osteo. Problem was I started to gain too much weight and another doctor said that running and bike riding would be better than gaining the extra weight so I persisted. The next year I took up kiting.
Seeing my surgeon last week we talked about stem cell work and that it's not quite there yet, but will be. I am hoping that it will be working well in ten years when I will be due for a knee replacement. He also told me that people were getting great results with Duralaine instead of Synvisk. Lasts 6 months to a year and is a wonder for osteoarthritis. Shots run about 500 bucks. The caveat is that they don't work for everybody, but I think it's worth a try if you are suffering from that.
As far as foiling goes, it is the smoothest way to kite and is easy on the knees. In saying all that, I can't wait to get out and boost some big airs and hope for nice and soft landings. I can't imagine kiting and not being able to jump at some point in a session. I have another week of rehab and hopefully will be out on the foil. Good luck, I certainly feel your pain....

Andrash
WA, 552 posts
Sunday , 11 Feb 2018 7:50AM
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You brought up some very important points, which I think may effect a lot of us.

1. Yes, kiting is one of the best activity for the knee. Basically, it is frequent dynamic bending with limited impact (not talking about missing megaloops) on soft surface (i.e. water). You can't think of better than that. However, having one or two sessions a week will not be enough, when the rest of the week is mainly sitting at a desk. and if the knees are already badly damaged, the options are limited.

2. If a ride in choppy, gusty conditions feels and looks bumpy, it is because of inflexible knees caused by weak and inflexible quads. Better riders on the chops look and feel like riding flat water.

3. No, cartilage do not wear like tyres. They do regenerate, and they do it constantly. The problem is that the process is slow, because the source of repair is the synovial fluid, rather than blood (as in case of muscles). So the equation applies to joints even more that to muscles: for tissue repair you need circulation, and for circulation you need movement/exercise.

4. Excessive tightness of the knees, which eventuate in excessive wear and tear (osteoarthritis), may simply be the result of weak and inflexible supporting muscles which go into contraction when they work at their limit. These are mainly the quads which weaken and tighten immensely with prolonged sitting.

5. There is an aspect of riding surfboard which no one seems to notice. Kite specific surfboards are extremely tuff and rigid, so they do not dampen subtle high frequency vibrations coming from a bumpy ride. It is like with tennis. It's not the shots, but the subtle vibration coming back from the racket that damage the elbow. Vibrations coming from a rigid surfboard may damage the ankle and the knee all the same. No one can feel these vibrations only their effects. I got alerted to this when I switched to surfboards about 10 years ago. I had to come in after a couple of hours due to a subtle discomfort, and my knees were noticeably unhappy for about an hour after each sessions. Since I put a high density EVA foam under my pads, I haven't had any problem.

6. Yes, there is no effective treatment to reverse osteoarthritis. But there is prevention, and there is a possibility of slowing down the deterioration. Quite a few years back, a clinical trial (I think in England) showed that glucosamine (taken for five years daily) significantly reduced the progression of osteoarthritis of the knee, and significantly reduced the need of surgery. Glucosamine is not a cure, and not an anti-inflammatory. It is a preventative measure to slow down degeneration. So anyone with hereditary predisposition to OA, or early signs of damage, may prolong the life of the knees. (saying all this, I have seen cartilage regrowth in the shoulder of an 80 years old woman.)

7. Catch it early!! Being tough and putting up with or ignoring pain is counterproductive.

(sorry for the word-count)

ZaZz
WA, 87 posts
Monday , 12 Feb 2018 8:16AM
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Thanks for the info. Really appreciate.

I have an appointment next week with the ortho to discuss the MACI procedure. From first assessment (MRI), I would be a good candidate for this type of surgery.
Just want to make sure surgery is really the best option at the moment. I can kind of manage the pain and swelling, I just take a break after kiting multiple days in a row to keep my knee from getting too sore (back leg surfing). I do plenty of stretching and some exercises to strengthen the muscles around the knee (no impact).
MACI costs a lot of $$$ (around 10K back in 2010), and no driving for 2 months afterwards with my right leg in a brace...
But I am sure it is worth if you get results in the short and long terms. It is a "new" technique so there's not a lot of studies to demonstrate the durability though.
Will learn more next week.

towradgi
NSW, 173 posts
Monday , 12 Feb 2018 7:35PM
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On free to air news before 2017 xmas, one of australia's leading knee experts said . "Don't waste your money on glucosamine and fish oil and similar products , they don't work. Spend your money on other things in life. As well ,arthroscopes are a pointless exercise."....I am only repeating someone else's opinion.

Andrash
WA, 552 posts
Monday , 12 Feb 2018 9:34PM
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towradgi said..
On free to air news before 2017 xmas, one of australia's leading knee experts said . "Don't waste your money on glucosamine and fish oil and similar products , they don't work. Spend your money on other things in life. As well ,arthroscopes are a pointless exercise."....I am only repeating someone else's opinion.


...yes, opinions may differ, so it's good to look at facts, evidences, i.e. medical research, clinical trials etc...
Who was this "knee expert", btw?

dafish
NSW, 1165 posts
Tuesday , 13 Feb 2018 7:17AM
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Select to expand quote
towradgi said..
On free to air news before 2017 xmas, one of australia's leading knee experts said . "Don't waste your money on glucosamine and fish oil and similar products , they don't work. Spend your money on other things in life. As well ,arthroscopes are a pointless exercise."....I am only repeating someone else's opinion.


I disagree with that statement from that knee expert. Krill oil does work. So does glucosamine. There are not the be all end all, they are just small steps of help and they take time to show any results. As far as scopes go, that is crazy. I just got scoped and had a bit of torn meniscus that had curled and got stuck under my knee cap and that was the end of any exercise for me until it was removed. I instantly felt better once the drugs wore off. I also had a torn medial that was stitched up easily via keyhole. 35 years ago that would have resulted in a six inch scar and lots more physio to regain strength. I can't believe an expert would make such a blanket statement. Thank goodness there are plenty of doctors around to give you more opinions.

Tbaggn
NSW, 35 posts
Tuesday , 13 Feb 2018 7:33AM
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In the past 18 months I've had two arthroscopic surgeries on medial right knee. I was a cripple beforehand, hobbling around basically on my good leg. Things are back to normal now. My orthopedic surgeon suggested to cycle as often as possible which i have done every day. My leg now feels strong and stable and i'm back surfing and kitesurfing. The doc said avoid running at all costs.

towradgi
NSW, 173 posts
Tuesday , 13 Feb 2018 7:41AM
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Select to expand quote
Andrash said..


towradgi said..
On free to air news before 2017 xmas, one of australia's leading knee experts said . "Don't waste your money on glucosamine and fish oil and similar products , they don't work. Spend your money on other things in life. As well ,arthroscopes are a pointless exercise."....I am only repeating someone else's opinion.




...yes, opinions may differ, so it's good to look at facts, evidences, i.e. medical research, clinical trials etc...
Who was this "knee expert", btw?



Sorry guys I know this may be a sensitive issue. I saw it on free to air news 2 months ago. So I don't remember his name , I wish I did ,only what he said which surprised me at the time.

towradgi
NSW, 173 posts
Tuesday , 13 Feb 2018 9:44AM
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This was in today tuesdays sydney daily telegraph 11 feb......im just contributing info that readers may be unaware of.

Andrash
WA, 552 posts
Tuesday , 13 Feb 2018 2:26PM
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Select to expand quote
towradgi said..


Andrash said..




towradgi said..
On free to air news before 2017 xmas, one of australia's leading knee experts said . "Don't waste your money on glucosamine and fish oil and similar products , they don't work. Spend your money on other things in life. As well ,arthroscopes are a pointless exercise."....I am only repeating someone else's opinion.






...yes, opinions may differ, so it's good to look at facts, evidences, i.e. medical research, clinical trials etc...
Who was this "knee expert", btw?





Sorry guys I know this may be a sensitive issue. I saw it on free to air news 2 months ago. So I don't remember his name , I wish I did ,only what he said which surprised me at the time.



The reason I was asking was that rheumatologists are trained and experienced in drug therapy and surgery, these are in their "toolbox". They rarely have the time (let alone the need) to follow research done on preventative medicine.



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"Articular cartilage defect... surgery?" started by ZaZz