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  1. #1
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    Would you get a new, relatively experimental surgery?

    Would you get a surgery your orthopedic surgeon regards as new and "relatively untested" if it meant you could return to an activity you'd been forced to give up? Like mountain biking for example.

  2. #2
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    I'd probably require a little more detail (hint) before making my decision.
    :wq

  3. #3
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    Ok, My Dr. says that without a Meniscus Transplant, running will cause unreversible damage to my knee and I'll need a knee replacement in 10 years.
    It's a really new surgery and there isn't much data regarding long term prognosis or side effects. It's a cadaver transplant meaning it's tissue from someone who has died that will be transplanted into my knee.
    However, if all goes as planned I will not only be able to run again, the risk of severe arthritis is GREATLY reduced.

  4. #4
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    Well. That's a tough one. I think I might have access to some people who have had a similar surgery (on the broken leg site where I'm a member) so I will ask over there if anyone knows anything.

    Knee replacement looks brutal though - member wherewolf (I think the spelling is right) in the norcal forums is going through it right now :\
    :wq

  5. #5
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    I'm a chiropractor, own a large rehab facility, and have employed a number of PTs. We do a lot of post surgical rehab. I can't recall any similar procedure. That sounds WAY experimental to me. I'd be reluctant to go with that procedure. It sounds like a nice idea and it would be great if it works, but I wouldn't want to be the person they found out it didn't work on.

  6. #6
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    It's not all bad, the meniscus transplant is far less scary than CMI (collagen meniscus implant) and it's been around for a little while. The Knee Guru discussion board has some pretty good info on meniscus tears, treatment options and the recovery times.

    Over the course of 3 surgeries I've pretty much lost 95% of my lateral meniscus in my rt knee. I talked to my surgeon after the last removal and he said that he would rather wait until a hint of arthritis sets in before going the transplant route.The problem in my case is that if it fails (the transplant), i get "fast tracked" for a fake knee as what's left on my lateral meniscus would be removed, leaving me with zero protection against arthritis.

    The longer i wait and keep my knee as strong as possible the better the chances I have for a successful transplant or stalling it off completely. So far I'm a little under a year out of the last removal and while it hasn't started to grind as it was expected to by now, I did manage to tear the remaining 5% in late December and possible split the medial meniscus in a nasty hiking fall
    Alea Jacta Est

  7. #7
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    Yeah, my Doc says that the more arthritic damage you get in your knee the worst chance of a successful transplant procedure. That's why I'm trying to decide now. I also had most of my meniscus removed, and at 26, I am really worried that I'll be in bad shape by the time I'm 40. I am worried however, from comments like above, from our chiropractor friend who is obviously a medical professional who is skeptical about the legitimacy of the procedure.
    I'm torn.

  8. #8
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    Hey, Eclipse,

    I posted your question (without identifying you in any manner) on the Broken Leg website. A lot of the members there have TPF breaks, so a lot of them have knee surgeries, hang out on kneeguru forums, etc. They pointed me here.

    Good luck, dude. Hope you get better soon.
    :wq

  9. #9
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    Thanks!

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    Hope you get better as well!

  11. #11
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    I would do it. I have been dealing with an arthritic knee for 4 months now. No working or riding. Checkout my blog for the full story just go back to the 2007 archives and the story starts with the November 3rd blog.
    Comas aren't as fun as riding your bike, so wear a Helmet.

  12. #12
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    Things to consider, having been down this road and am now playing the waiting game with my knee:

    The long term success rates for the transplants are still unknown, the rehab time is pretty lengthy (up to 6 months) and it may still fail even if you take perfect care of it.The best outcome is that the transplant takes and you get at X number of years with out pain and the prospect of a fake knee. The worst outcome if the transplant fails is you get eventually get arthritis and a bonus surgery to remove the donor meniscus.If you do nothing (transplant surgery related), at some point in the future, the joint space collapses and arthritis sets in.

    Personally, I'd go for it. Six months of rehab is nothing compared to years of grinding, pain and waiting to become a candidate for a fake knee.
    Last edited by bbbr; 03-14-2008 at 07:49 PM.
    Alea Jacta Est

  13. #13
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    Quote Originally Posted by EclipseRoadie
    ....from our chiropractor friend who is obviously a medical professional ...
    Funniest thing I have ever read. Good sarcasm.

    I would do the experimental surgery based on that if it fails you will not be worse off it you didn't do it. It's that simple.

  14. #14
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    Jeez, why does this have to happen to the people who actually use their knees....
    Yes. Your right, and I intend on having the surgery next fall (after the riding season). I have already lost running and racquetball, and I don't intend on losing MTBing as well.

  15. #15
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    Cmi

    Quote Originally Posted by EclipseRoadie
    Jeez, why does this have to happen to the people who actually use their knees....
    Yes. Your right, and I intend on having the surgery next fall (after the riding season). I have already lost running and racquetball, and I don't intend on losing MTBing as well.
    Just one thought, you are in a cycling forum so obviously you do some amount of pedaling. Running is typically very demanding on the knee joints so one easy solution to your problem would be, don't run, just bike!

    As far as the CMI, there may be a couple things to consider here. One, more often then not, insurance will not pay for a non FDA approved procedure. You may have to pay this one out of your own pocket. Sometimes, if it is of an "experimental" nature, the medical group may have a grant and perform it for free.

    In theory the Meniscal transplant sound great. What you may have to look at is the fact that there have been several similar concepts, procedures, and products that have been used in the past. Carticel and other transplantables looked very promissing as well. When you read the fine print and look at the tissue hystologically it will often resemble scar tissue more so than either true meniscal or cartilage tissue.
    On rats in the lab researchers can grow an ear from a collogen matrix on the back of the rat. This is great, but it hasn't quite carried over to humans yet.

    I am always a bit skeptical due to the nature of the meniscus and its poor blood supply. If it had a much better supply of blood and nutrients we could have all of the tears heal and rehabed to perfection. Unfortunately, when we reach about the age of 30 we are at the end of the time frame for a significant tear/repair to heal promissingly. I cannot see this "matrix" taking and becoming a true, functional meniscus.

    Not to seem like a "black cloud", but I would personally adjust my lifestyle (not running) to preserve as much of my present meniscus at this time and let the procedure gow through its growing pains. Only time will tell if this procedure is worthwhile and effective.
    BoiseBoy

  16. #16
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    That is a tough one. It seems if you fit the criteria as a good candidate... pain in the right place... nothing else works...., then you would want to do it, but if it fails, does it mean you would need a new joint that much sooner? That doesn't sound like a good trade off to me. And at 26... that is another tough one. It is all about quality of life. I wouldn't want to lose more of that experimenting for practice.

    Dang knees... pesky. I had a fairly new procedure not long ago... an ACL repair. No grafts. No cadaver. It seems to be working out great, but if it doesn't, we just strip it out and do a graft, and I am no worse for wear.

    Good luck! I know it is a bit hollow, but every positive attitude helps!

  17. #17
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    Quote Originally Posted by bsdc
    I'm a chiropractor, own a large rehab facility, and have employed a number of PTs. We do a lot of post surgical rehab. I can't recall any similar procedure. That sounds WAY experimental to me. I'd be reluctant to go with that procedure. It sounds like a nice idea and it would be great if it works, but I wouldn't want to be the person they found out it didn't work on.
    Arguing from authority is SO 19th century. You haven't heard about this because you're not an orthopedic surgeon. This not that unusual of experimental. The doctor is right that meiscectomy really is a bad idea with horrible long-term consequences and it should always be avoided if possible.

  18. #18
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    Quote Originally Posted by Tlaloc
    Arguing from authority is SO 19th century. You haven't heard about this because you're not an orthopedic surgeon. This not that unusual of experimental. The doctor is right that meiscectomy really is a bad idea with horrible long-term consequences and it should always be avoided if possible.
    I'm certainly not arguing from authority because I have none. I just pointed out who I am, what my experience has been, and based on that, what I would do.

    I will add that orthopedists I have talked with regarding new procedures are usually concerned because they are unsure of the long term results. There have been a number of surgical procedures discontinued due to poor long term outcomes. Surgeons I have talked to often recommend sticking with proven techniques.

    If you want to know about orthopedic surgeons and procedures, ask an experienced physical therapist. They see the results of hundreds of surgeries from most of the area surgeons. When I worked alone as a chiropractor, my experience was limited to the opinions of a handful of surgeons I worked with. When I began employing physical therapists and I began seeing the post-surgical rehab on most of the area surgeons I really learned a lot. Some surgeons have noticeably higher rates of complications. Some surgeons doing the same procedure as others get far better results consistently. Some procedures have very difficult recoveries. Some procedures have been discontinued.

    Based on my experience, I would be reluctant to undergo a major surgical procedure with unknown long term outcomes. That said, with no other good options and some reassurance with further investigation, I might be willing to do it. In the end, I suspect the person in this case, will have the option of a traditional total knee replacement or other surgery if the meniscus transplant is not successful in the long run.

  19. #19
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    Thank you for all the input. First of, I am blessed enough that the monetary aspect of this surgery is not an issue. Also, I have exhausted other avenues to this point to no avail, and I am quite surprised given modern day technology the lack of treatment for these types of injuries. Anyway, I have talked more to numerous doctors and the advice given here was echoed by them as well. I have to give up running for good. While this sucks in a big way, I guess I can pick up road biking again, in addition to my already healthy mountain bike obsession. Maybe in the future new treatment will open up. However, I do think I will go ahead and try the transplant, because, as my surgeon put it, I already have no meniscus, so it can only be better or the same.

    Jeez, if someone had a sure fix for this I would pay just about ANY price.

    On a bright note, I can now justify the purchases of many more bikes to my wife !

  20. #20
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    Quote Originally Posted by lidarman
    Funniest thing I have ever read. Good sarcasm.

    I would do the experimental surgery based on that if it fails you will not be worse off it you didn't do it. It's that simple.
    Hehe, I didn't mean it as sarcasm. Really.

  21. #21
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    Wow, that's a really tough call. If my everyday functioning (including sports) is impacted big-time, I think I would take a risk if there was a decent chance for improvement. Research it up and down and inside out; get all the info you can. But before doing anything experimental, I would definitely exhaust every other alternative treatment. Recover from the current surgery and then do physical therapy, prolotherapy, or whatever else might be applicable and then see where your pain level and functioning stands. You might have nothing to lose, but if you can buy time until the procedure is proven or other alternatives come up you might be in a better position. Recovery time alone is a big factor to consider.

    Just my 2 cents. Best of luck, that is a major decision and I'm sorry you're in this situation...

  22. #22
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    Quote Originally Posted by heatherct
    ...If my everyday functioning (including sports) is impacted big-time...
    Years ago doctors thought that meniscectomy was an appropriate treatment for damage to your meniscus. Because of the horrible long-term disease that this surgery caused they've changed their mind. Today they will do anything to allow you to keep it. Having no meniscus will have a huge impact on the rest of your life. Meniscus replacement isn't that new or experimental. You are trading the devil you know for the devil you don't. I can tell you from experience that having no meniscus is a devil bad enough to try the replacement. Your only decision is whether to do the allograft or the collagen implant. My impression is that the collagen implant is the newer and more experimental procedure. I'm not familiar with the collagen implant so ask your physician about which one is preferable.

  23. #23
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    Give up running

    Quote Originally Posted by EclipseRoadie
    Ok, My Dr. says that without a Meniscus Transplant, running will cause unreversible damage to my knee and I'll need a knee replacement in 10 years.
    I know from personal experience that you do not want to hear this, but give up serious running now before it's too late! Getting a meniscus transplant to continue running is not a good idea. You'll surely wear that out too. At my age I would do any experimental surgery if that was my only alternative for having useful knees. But at your age I would not. Keep at the biking and perhaps that will eventually help fill the void left from not running.

  24. #24
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    Quote Originally Posted by Tlaloc
    Years ago doctors thought that meniscectomy was an appropriate treatment for damage to your meniscus. Because of the horrible long-term disease that this surgery caused they've changed their mind. Today they will do anything to allow you to keep it. Having no meniscus will have a huge impact on the rest of your life.
    Twenty nine days ago I had a partial meniscectomy. I sure hope I didn't make a mistake by having this type of surgery: Medial meniscus knee surgery: have you had it done? (I have) here's an overview

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