Knee arthritis and ACI

[danix]

I haven't played serious tennis in over year, and haven't hit a ball in about 2 months.

A few years back, I had knee pain and swelling. MRI led to arthoscopy, and the doctor found a small lesion and performed microfracture. Seemed to get better.

More recently, swelling returned. Doctor advised another arthoscopy. I decided to lose some weight, be conservative. It got better, then got worse.
A month ago, went in for the arthoscopy. Doctor found that I had a grade 4 cartilage lesion (the worst grade) below the kneecap in the trochlea, as well as one on the inside top of the femur. In his words, it was so bad he didn't know how I could even walk.

He's now advising that short of a knee replacement, my only option is to do ACI - a procedure where they grow tissue in a lab, open the knee up, and stitch a patch over the lesion, injecting the new tissue in there.

This doctor is world renowned (ortho for the SF Giants) and has performed many of these ACI procedures.

I'm obviously going to get a second opinion, but I'm also thinking of checking out the Egoscue clinic in SF, since buying the book alone didn't help much (I confess, I never made it past page 5).

Has anyone else had this ACI procedure? What's worse than the ACI is this - he's suggesting that unless we correct my bone alignment, the repair will eventually wear away too, so he wants to "shave" down part of the bone as well. This sounds incredibly unpleasant...

 

[danix]

Still unsure of what to do. I did just visit the Egoscue clinic and will report back.

I'm OK with the idea of ACI but the dr also wants to do an osteotomy where they break the bone and repin in so it heals in a different position. No thanks.

I found a knee forum and also did some searching - can't find any evidence of people returning to sport after this procedure, at least 2 years out.

 

[Chas Tennis]

Your arthritis sounds too advanced for this correction. But consider if this issue could have contributed to the conditions in your patellofemoral joint.

https://www.mrtherapy.com/articles/article3.html

This stretch could be stressful for your knees or back so I would discuss with your Dr.

My interpretation of the main idea is that if the rectus femorus is tight and short it will cause the patella to track higher on the femur than it otherwise might. Damage to the cartilages in the PF joint results.

There are other well known muscle problems that can lead to knee problems.

See "Muscles that Control Pelvic Tilt" illustrations. (The rectus femorus can also affect pelvic tilt.)
http://fixtheneck.com/posture.html

I have some damage under my patellas seen in MRIs but not much in pain symptoms yet. My rectus femorus is tight and short and it affects the range of motion. If I have any knee pain from this joint area it improves when I do these stretches. I don't have any pain now but 15-20 years ago I would get knee pain after sitting for a while. I'm tall and not young.

 

[danix]

Update. The loss of knee cartilage is quite common and unfortunately there is no good fix. I'm still trying to figure out the right solution, but if anyone needs input, post or email me and I will share my findings.

 

[tennisgotomarket]

Update. The loss of knee cartilage is quite common and unfortunately there is no good fix. I'm still trying to figure out the right solution, but if anyone needs input, post or email me and I will share my findings.

I heard he's good. Never saw him.

http://www.emedx.com/mishra/

 

[F L O B B E R]

Was recently told the cartilage under my kneecap was "crushed", surgery would be a 50/50 proposition to help any, and that it would put me out 3 months possibly for nothing. Recommended 3 months of physical therapy, no tennis. That was 2 weeks ago, knee is painful and not getting any better... 2nd opinion time?

 

[danix]

I heard he's good. Never saw him.

http://www.emedx.com/mishra/

Thanks for the link. He's local. He seems to specialize in tendon repair as well as the use of PRP for treatment. I'm way beyond that, but will bookmark him to look at my tennis elbow if I ever get back on the court

 

[danix]

Was recently told the cartilage under my kneecap was "crushed", surgery would be a 50/50 proposition to help any, and that it would put me out 3 months possibly for nothing. Recommended 3 months of physical therapy, no tennis. That was 2 weeks ago, knee is painful and not getting any better... 2nd opinion time?

Doing PT can't hurt, as long as they know what they are trying to help with. The description of crushed doesn't make a whole lot of sense to me.
Here's a good site that provides an overview of these injuries and the treatment options: http://orthoinfo.aaos.org/topic.cfm?topic=a00422

Definitely try the PT and no tennis. It sounds like perhaps the surgery would be a simple scope and debridement, which is probably not going to help you unless you have an impingement. Have you had an MRI done?

 

[RogueFLIP]

Was recently told the cartilage under my kneecap was "crushed", surgery would be a 50/50 proposition to help any, and that it would put me out 3 months possibly for nothing. Recommended 3 months of physical therapy, no tennis. That was 2 weeks ago, knee is painful and not getting any better... 2nd opinion time?

Well, if you or whoever is working on you isn't trying to figure out the cause the compressive forces acting on your knee which lead to the "crushed" cartilage, then you're going to be in for a very long and frustrating journey IMO.