I've started a new blog - http://returntorunning-djs60.blogspot.com/ - to share to story of how my attempt to return to running turns out.
I think it's relatively uncharted waters; when I asked my surgeon at my 2 year followup visit in April, 2009 if he could think of any patients who he had done a patello-femoral ACI on who had returned to a high level of athletic activity, he looked thoughtful and said he couldn't immediately think of any. Which wasn't what I was hoping to hear. I should add that this surgeon is the most experienced ACI surgeon in the United States. So, I am hoping I can tell him the next time I see him in April, 2010 that I am back to running...
Thursday, September 24, 2009
Tuesday, June 24, 2008
Surgery
In December of 2005, I saw a second orthopedic surgeon, an expert in cartilage repair. He went over my history and the report of my original arthroscopy. He did some xrays which showed a mild degree of malalignment in my left knee, which he felt was the reason for the excess wear on the articular cartilage.
There are two commonly done techniques for repairing articular cartilage defects. One is OATS - osteochondral autologous transfer surgery. In this technique, a plug of bone with overlying cartilage is taken from a healthy, non-weight bearing part of the knee & implanted in the damaged area. Kind of like a patching a bare spot on the lawn. The second technique is ACI - autologous chondrocyte implantation. In this 2 stage process, a small biopsy of health cartilage is taken from the knee arthroscopically. New cells are then grown in the lab (by Genzyme). This takes several weeks. The surgeon then opens the knee up and debrides away the damaged carilage. The then covers the hole with a patch (made from shin periosteum in my case - the fibous tissue that covers bones), and then injects the cartilage cells under the patch. Then - hopefully - the cells settle in and form healthy new cartilage, a process that takes 12 to 18 months.
The doctor told me I wasn't a good candidate for OATS because I had too large an area of damage, and he was concerned the patella might also need work, and OATS isn't done on the patella. He also told me I would need a concurrent TTO - tibial tubercle osteotomy. This is a procedure where the attachement point of the patellar tendon below the knee is moved to improve alignment of the patella into the trochlear groove. He told me he thought it was about 85% likely that I would be better after surgery, 10% I would not really be different, and 5% I would be worse. He told me to give this some thought & let him know what I decided.
There are two commonly done techniques for repairing articular cartilage defects. One is OATS - osteochondral autologous transfer surgery. In this technique, a plug of bone with overlying cartilage is taken from a healthy, non-weight bearing part of the knee & implanted in the damaged area. Kind of like a patching a bare spot on the lawn. The second technique is ACI - autologous chondrocyte implantation. In this 2 stage process, a small biopsy of health cartilage is taken from the knee arthroscopically. New cells are then grown in the lab (by Genzyme). This takes several weeks. The surgeon then opens the knee up and debrides away the damaged carilage. The then covers the hole with a patch (made from shin periosteum in my case - the fibous tissue that covers bones), and then injects the cartilage cells under the patch. Then - hopefully - the cells settle in and form healthy new cartilage, a process that takes 12 to 18 months.
The doctor told me I wasn't a good candidate for OATS because I had too large an area of damage, and he was concerned the patella might also need work, and OATS isn't done on the patella. He also told me I would need a concurrent TTO - tibial tubercle osteotomy. This is a procedure where the attachement point of the patellar tendon below the knee is moved to improve alignment of the patella into the trochlear groove. He told me he thought it was about 85% likely that I would be better after surgery, 10% I would not really be different, and 5% I would be worse. He told me to give this some thought & let him know what I decided.
Thursday, June 19, 2008
My Knee - The Early Days, Part II
In December, 2004, I was ramping up my running in preparation for a marathon I had entered in 2/05. After a long run on a snowy day, I noticed I had quite a bit of swelling of my knee, along with swelling _behind_ my knee. I recognized this as a popliteal cyst (aka Baker's cyst). I was alarmed about the swelling, so I made an appointment with an orthopedic surgeon. He agreed this was a popliteal cyst, and suggested an MRI to evaluate further, since popliteal cysts usually indicate damage within the knee joint. I liked that idea, since the knee had been a little sore for a long time, so I figured it would be good to find out what was going on in there.
The MRI showed a full thickness defect in the articular cartilage of the trochlea (the groove in the femur bone where the patella (knee cap) fits. There was considerable swelling in the bone under the defect. It seemed to hurt more after I knew there was something seriously wrong...
I curtailed my running after this, although I continued to run a few times a week. If I ran more than about 5 miles, the knee would hurt. I saw a physical therapist to see if building up the muscles on the inner part of my thigh would help. It did not.
In February, 2006, I went on a ski vacation to Montana. Great snow, but my knee really didn't do well. A lot of swelling and some pain, too. Upon my return, I again consulted my orthopedic surgeon, and we decided to go ahead with an arthroscopy to definitively evaluate the knee and to see if there was anything that he could do to help. The arthroscopy confirmed the "hole" in the trochlear cartilage, and also showed considerable thinning of the articular cartilage on the underside of the patella. The surgeon removed some loose bits of cartilage and smoothed things out, but I didn't notice any improvement. I had another course of physical therapy with a more expert therapist, and I made an appointment with another orthopedist who specializes in cartilage repair. I had to wait a long time for the appointment (8 months), but I wasn't in a hurry since I knew that any surgery to try to repair the "hole" would be a big one.
The MRI showed a full thickness defect in the articular cartilage of the trochlea (the groove in the femur bone where the patella (knee cap) fits. There was considerable swelling in the bone under the defect. It seemed to hurt more after I knew there was something seriously wrong...
I curtailed my running after this, although I continued to run a few times a week. If I ran more than about 5 miles, the knee would hurt. I saw a physical therapist to see if building up the muscles on the inner part of my thigh would help. It did not.
In February, 2006, I went on a ski vacation to Montana. Great snow, but my knee really didn't do well. A lot of swelling and some pain, too. Upon my return, I again consulted my orthopedic surgeon, and we decided to go ahead with an arthroscopy to definitively evaluate the knee and to see if there was anything that he could do to help. The arthroscopy confirmed the "hole" in the trochlear cartilage, and also showed considerable thinning of the articular cartilage on the underside of the patella. The surgeon removed some loose bits of cartilage and smoothed things out, but I didn't notice any improvement. I had another course of physical therapy with a more expert therapist, and I made an appointment with another orthopedist who specializes in cartilage repair. I had to wait a long time for the appointment (8 months), but I wasn't in a hurry since I knew that any surgery to try to repair the "hole" would be a big one.
Tuesday, June 17, 2008
My Knee - The Early Days, Part I
I created this blog a while back, with the intention of writing about my recovery from a major knee surgery I had on 4/27/08. I'm actually now nearly 14 months into my recovery, and I've finally decided to start writing about my experience.
I am doing so because the surgery I had - autologous chondrocyte implantation - is a relatively new procedure that isn't done all that often, so I hope reading about my experience might be helpful to people who are considering having the procedure. I feels I was well-informed about what I was getting into, but it's still been a long and pretty difficult road.
So, I'll start with a little background about how I came to be in the operating room on that Friday in April.
I started running seriously when I was a sophomore in high school. I turned to running by default, really, since I wasn't good at other sports. I wasn't all that good at running initially, either, but by my senior year I was a better-than-average high school runner. I ran through college (varsity at at Division III school), and ran my first marathon my senior year (I ran 2:47, which I thought was OK-but-not-great at tthe time, but now I think was pretty good). Anyway, I continued to run regularly, usually doing one or two marathons a year. I was quite injury-free through the years, although I never ran truly high mileage.
Right around my 40th birthday, I had some moderately severe left knee pain with swelling, and had trouble running. I saw an orthopedic doctor, who thought it was ileotibeal band syndrome, and sent me to a physical therapist. I improved with PT and staying away from running for a few months, and was able to resume running pretty much as before. I continued to have mild knee pain, but it wasn't too bad, and so I didn't pay much attention to it.
I am doing so because the surgery I had - autologous chondrocyte implantation - is a relatively new procedure that isn't done all that often, so I hope reading about my experience might be helpful to people who are considering having the procedure. I feels I was well-informed about what I was getting into, but it's still been a long and pretty difficult road.
So, I'll start with a little background about how I came to be in the operating room on that Friday in April.
I started running seriously when I was a sophomore in high school. I turned to running by default, really, since I wasn't good at other sports. I wasn't all that good at running initially, either, but by my senior year I was a better-than-average high school runner. I ran through college (varsity at at Division III school), and ran my first marathon my senior year (I ran 2:47, which I thought was OK-but-not-great at tthe time, but now I think was pretty good). Anyway, I continued to run regularly, usually doing one or two marathons a year. I was quite injury-free through the years, although I never ran truly high mileage.
Right around my 40th birthday, I had some moderately severe left knee pain with swelling, and had trouble running. I saw an orthopedic doctor, who thought it was ileotibeal band syndrome, and sent me to a physical therapist. I improved with PT and staying away from running for a few months, and was able to resume running pretty much as before. I continued to have mild knee pain, but it wasn't too bad, and so I didn't pay much attention to it.
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