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Thread: Cartilage Graft

  1. #1
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    Cartilage Graft

    I had surgery on my right knee a few days ago to have a cartilage graft done on my trochlea (the groove under the patella). I had ~1" square full depth lesion. The rest of my knee, including the patella, was in great shape, which is one of the main reasons the repair was an option (vs partial replacement).

    The specific procedure used the DeNovo graft, which is a "patch" made of minced juvenile donor cartilage. The juvenile cartilage will grow, unlike adult cartilage. This procedure was preferred over other grafts (like using cadaver cartilage), because of the complex geometry of the trochlea. The downside is that it takes quite a while for the repair to heal. I'll be in a brace for six weeks with lots of time on a CPM machine during that period. After that I can start easing into some riding. It'll probably be 3 months before I can do anything with much loading. Lucky me, I have a matched set, so I'll get to go through this again in five months or so on the left knee. The bright side is that the surgeon, who has a lot of experience with this procedure, is confident I will be back to nearly 100% in time. Time will tell.

    I never thought I'd end up in this boat to be honest. I'm 52 and have ridden and raced a lot, but I know there are others that have subjected their bodies to what I have and don't have this issue. My knee tracks straight, so it's not uneven wear. It's probably just the sum of miles, age, and injuries. I'm posting this because I figure others might end up in that same stressful place of being faced with giving up the activity you love. Hopefully this side adventure has a happy ending that can give an option and hope to someone else.

  2. #2
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    Quote Originally Posted by bizango View Post
    I never thought I'd end up in this boat to be honest. I'm 52 and have ridden and raced a lot, but I know there are others that have subjected their bodies to what I have and don't have this issue. My knee tracks straight, so it's not uneven wear. It's probably just the sum of miles, age, and injuries. I'm posting this because I figure others might end up in that same stressful place of being faced with giving up the activity you love. Hopefully this side adventure has a happy ending that can give an option and hope to someone else.
    I hope that works well for you over the long term. Be assured that if the NT allograft fails and you ultimately need a total knee, you certainly won't necessarily have to give up mountain biking and could likely be back on the singletrack faster than after the allograft. Alternatively, if your lateral and patellar compartments are in good shape (ie medial degeneration) then a unicompartmental knee replacement would likely have you back on the bike even faster.

  3. #3
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    Quote Originally Posted by Cuyuna View Post
    I hope that works well for you over the long term. Be assured that if the NT allograft fails and you ultimately need a total knee, you certainly won't necessarily have to give up mountain biking and could likely be back on the singletrack faster than after the allograft. Alternatively, if your lateral and patellar compartments are in good shape (ie medial degeneration) then a unicompartmental knee replacement would likely have you back on the bike even faster.
    Thanks for info. My surgeon did present waiting and doing a partial replacement at some point and I considered it. This has nagged me for a while and I was cutting back on what I was doing, so I was ready to do something. Given how good the rest of my cartilage was ("more pristine than normal" as the Dr report stated), I felt it worth the time investment to maintain what I had. I got my head around being off for a while and considering how hard I've been at it for so many years, I can see it being a good thing. Like you said though, there are other options if needed later and that's encouraging.

  4. #4
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    This was the 5th day after surgery and I'm already back at work (engineer). I was off pain meds after the second day and haven't even had to take Tylenol or other pain reducers. I expected worse, but am pleasantly surprised. Now it's a matter of being a patient patient.

  5. #5
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    It's nearly 6 weeks after surgery and am progressing well. The brace was locked out until a couple of days ago. I'm now at 40 deg for a week, then 90 deg for a week, then I'll get to ditch the brace. I was on a CPM machine until last weekend; 3-6 hrs a day. The range of motion and loading has intentionally been limited up to this point, but we are now progressing to get full range of motion and gradually increasing strength. I am just now getting on the trainer and doing partial circles. I expect to be able to do full revolutions within a couple of weeks.

    I am still not at the point to definitely say that the graft has made my knee relatively normal again. I won't know until I can really load it and see how it responds. I am optimistic though. After discussions with curious folks (amazing how much crutches or a knee brace initiate conversations from strangers) I'm glad I took this path and didn't go with a partial replacement. I have a reasonable likelihood of having a life long solution whereas partials are most likely limited in life. For those that don't have other options, they are a great alternative.

  6. #6
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    Well, that happened faster than I expected. The day after I wrote the last post I was doing my second day of trainer "spinning" and was able to pedal full revolutions. That may sound trivial, but hey, I'll take the small victories.

  7. #7
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    Yesterday was my 8 week post-op appointment. I had been out of the brace for a week. The past few weeks I had made big gains in range of motion and I've been spinning on the trainer with no load. The trainer loosens things up nicely. I haven't done too much strength work yet.

    My main concern going into the appointment was that I feel some "ticks" at certain spots in my range of motion if I load it in a certain way. I want it to be smooth. Some of the spots also have pain associated with them if there's loading. He says we will have to watch this closely and that at this phase the graft is still malleable and it may self-correct and smooth out; somewhat ironcially by pedaling (easy stuff on the trainer or road). If it doesn't improve over the next month or two, I will likely need a scope done so that the graft can be contoured to address any irregularities or high spots. He warned me from the get go that this was a possibility, though not common. Ugh, not excited about that prospect. Let's hope the magic medicine of cycling does the trick!

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    I did my first "real rides" this week on the road with my 'cross bike. The first was<1 hr and yesterday was almost 1.5 hrs. The knee felt pretty good both rides, and definitely better during the second ride. I have other grumpy joints that were complaining more!

    I spent all morning on my feet doing maintenance on the local 'cross course and helping run some kids races. Then all afternoon I was doing yard work so by the end of the day my knee was feeling pretty stiff but not sore. I'd say overall it is doing pretty well. There are certain angles that I can't load it because of the pain, so I'm anxious to see when that goes away.

  9. #9
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    I am at 12 weeks from surgery and have been able to do progressively more since I last posted. The longest road ride I've done is ~2.5 hrs, and that was a couple of weeks ago. I've also done some easier mt biking and am riding to work regularly (my commute is ~10 minutes each way). The stiffness is minimal. I still can't stand and climb, but I'm close.

    I have two nagging issues though. One is what I believe is sciatic nerve compression when I left my leg while on my back that makes it next to impossible to lift or extend my leg in those positions. I've had sciatic nerve issues on this leg in the past and I think the surgery trauma and the quad weakness cause loading in certain positions. The other is the fact that there are apparently some "rough" spots in some areas of the graft. There was some chance that those would smooth out as the cartilage matured, but they are still present so I suspect I will have to have a scope done to have those smoothed out. I will bring both of these up in my next post-op in a couple of weeks.

    I have the left knee scheduled for the same procedure at the end of Nov. We will see what the surgeon suggests regarding cleaning up the right knee relative to when we do the left.

  10. #10
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    As mentioned in an earlier post, I had the same thing going on with both knees and I had the left knee done just under a week ago. That knee had actually been the one that bothered me the most riding so it will be a good reference of the procedure's effectiveness.

    The routine will be the same: 2 weeks with crutches, 6 weeks locked in a brace. From there it will be range of motion work and strengthening. Last time I was doing reasonably long rides 3 months after surgery. I even did an (easy) 'cross race 3.5 months in. The progression was pretty fast after 3 months, though I intentionally didn't go overboard.

    The right knee continues to evolve. It still has some roughness if you feel the knee cap as I extend my leg straight while sitting. It did have a few weeks where it would catch while standing up which would indicate the cartilage had grown to be proud of the surrounding surface (hypertropic). That has mostly gone away since we did an intense week of hiking in Kauai with lots of steep up and down hiking. Encouragingly the knee handled that pretty well. It's possible the surgeon may go in and smooth things out, but I'll need to get at least a few months into this last surgery. I still have a bit of nerve entrapment that I feel was a preexisting condition that was aggravated by the surgery, but it has been manageable. Stretching helps.

    The winter will be a drag, but I have my sites set on next spring to get rolling again, get back into shape, and get stronger. I am naturally skinny and don't build muscle fast, so the atrophied muscle is slow to come back. We have a week night mt bike race series that starts in May and my plan is to work towards that. My body responds well to racing, so if I can get a good foundation ahead of time, the racing should hopefully put me in a good place for summer.

  11. #11
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    Hope you can heal up! Just had arthroscopic ankle surgery and reading some stories here. im looking m forward to the easy riding like commuting and wide XC ski paths in a few months. It looks like you are going through quite the process! Hope you can get back to the same as before.
    "It's only when you stand over it, you know, when you physically stand over the bike, that then you say 'hey, I don't have much stand over height', you know"-T. Ellsworth

    You're turning black metallic.

  12. #12
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    Thanks! Getting back to 100% is the expectation and goal. Hope your recovery goes smoothly.

    I noticed the Catherine Wheel reference in your signature. I saw them at Rock Candy in Seattle in the mid 90s. Saw LOTS of great bands there during that time.

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