Meniscal Allograft Transplantation

hammiemam · 01-11-2009, 01:06 AM

I am having Meniscal allograft transplantation early next month. I am pretty nervous about the procedure being that it is much more extensive that the three scopes I have had previously. I am wondering if anyone else has had the procedure and what their experiences are with it. I know it has only been around for the last five or six years ago, and there are only a few places across the US that actually do it. I would love to hear from you guys and any suggestions to ready me for the whole deal.
Thanks!

King Viscera · 01-11-2009, 04:47 PM

Neat. Thats when they take tissue from the cadaver and place it into your knee, eh? Have heard barley anything about it but its always interesting to hear people who get a transplant from a cadaver.

I wish you luck and let us know how it goes.

hammiemam · 01-11-2009, 10:58 PM

I think I am going to continue to post my updates on here. My surgery date is February 3. I am hoping to get plenty of pics so I can post them. They will probably be pretty nasty. I guess the way it works is they take cadaver meniscus and bone. They shave part of the bone down and make what is kind of like a screw out of the cadaver bone. THey take out what little remaining meniscus I have and then put holes in my bone that the cadaver bone will fit into like a puzzle. If they need to they will also put in a disolvable screw in addition to the "bone screw" they make from the cadaver. I will have two two-inch incisions, one under my knee and the other on the inside of my knee. I will also have a small incision on the outside of my knee where the scope goes. For the first four weeks I am not allowed any weightbaring. I think I will get very stir-crazy. After the fourth week I will start to put some weight on it, but I will still be wearing an immobilizer for the next two-four weeks. After I am out of the immobilizer I will go back to the pretty pink unloader brace I am wearing now for the next few months. I should be back to my old self in six months to one year. It is great in comparison to the alternative of being uncomfortable with my knee daily. I have another pre-op appointment in the middle of the week, so hopefully I will learn a little more about it when I go to that. I will keep you posted, and anyone else that has info on it please hit me up!
THanks

paul0616 · 01-11-2009, 11:24 PM

how much meniscus do you currently have, or don't have?

hammiemam · 01-12-2009, 12:16 PM

I currently have less than five percent. I think one of the qualifiers for the surgery is that one has less than ten percent.

paul0616 · 01-12-2009, 02:50 PM

five percent is not very much. How did it get that way? It's my understanding that the outer 1/3 of the meniscus has a blood supply, so that section was technically heal'able and should not be removed.

there is some dedicated knee boards out there. Maybe kneeguru in the UK, among others. Some of those guys posted experience with allograph, and some sort of artificial meniscus that is being done in Europe and South Africa. I read through some of them, but I couldn't get a sense success rate.

hammiemam · 01-12-2009, 08:25 PM

I have had three scopes previously, and I am actually pretty concerned about the last one. It hurt more than the previous two and instead of using an epideral or putting me under completely, he simply put cortisone shots in my knee. I could feel part of the procedure and had to ask for more numbing to my knee. It was probably the worst doctors experience I've ever had. This may be why I have less than five percent left.

paul0616 · 01-12-2009, 10:07 PM

was this all the same doc? This situation doesn't sound right at all. You got the third knee scope with local anesthesia? And why would they administer cortisone shots? Thats not a pain reliever.

Do you know how much meniscus was removed during each of the procedures? Meniscus "red zone" should have be preserved / repaired, even if its not perfect and still hurts to walk on.

What was the source of the original injury? You still have a good ACL ?

hammiemam · 01-12-2009, 11:07 PM

The first two were done by the same doc. The third was a different one. I had reinjured it working as a bartender, and because it was a workmans compensation deal, I think he may have been trying to get away as cheaply as possible. I had injured it several times with sports when I was in junior high and high school. However, the first time I really injured it was in gymnastics about a year after I graduated. It was a bucket handle tear in my medial meniscus. The second one was about a year afterward with a similar injury. Though I believe the second surgery was on my lateral meniscus. My lateral meniscus is in decent shape, but because I have so little left in my medial, it has caused a nasty bone spur, which is part of the reason for my upcoming procedure. According to every doc I've seen, my ACL is still intact and in good shape.
As for my third surgery, they used something to numb my knee area (probably the same stuff they use on those less pain tolerant before you get euflexa injections) and then they proceeded to give me several cortisone injections. I get pretty sick with most types of anesthesia, and I voiced that concern, but I had no idea they would do this until the nurse came in with her arsenal. I asked her about the injections, and she explained it was cortisone. I told her I had never heard of using it for scopes, and she assured me that they do it all the time. I was kind of at a place of no return, but now I wonder if I should have gone through with it with that particular doctor.

paul0616 · 01-13-2009, 09:01 PM

ouch, so you incurred several injuries. If you are down to 5%, I don't think you would be eligible to try the artificial meniscus, because they have to anchor those to what remains of the vascular part of the meniscus. Sounds like allograft is next step.

sports injuries :-(

I still don't know what the cortizone shots were for. Its been my experience that the ortho's don't really communicate very much detail, unless you press them for info, and even then they sometimes get impatient and act like they are too busy.

Did you get a video of your knee procedure(s)? Some people have uploaded their own video's to youtube, for knees, shoulder, etc.

hammiemam · 01-13-2009, 09:19 PM

This was the only procedure I've had where I didn't get at least a VHS of the whole deal... what does that make you think? DId I get a botched scope?

paul0616 · 01-13-2009, 09:35 PM

yeah, I don't like the sounds of that scope.

Maybe you can go back to your first doctor, and find out how much meniscus was remaining after scope #1 and #2

For example, if you went from say 100% to 75%, then 65% down to 5%, that would tell you something.

5% sounds like a complete removal, and I didn't think doctors do that sort of thing anymore, even with a flappy meniscus.

taf1968 · 01-13-2009, 09:35 PM

Please do post updates on this . . . I'd be interested to hear how it goes. I had a lateral menisectomy about 7 years ago--had torn up my meniscus when I was a kid playing football and it just never healed right. Locked up for good one day in martial arts and ended up getting scoped. The surgeon tried to repair it but it was a lost cause. So I sometimes wonder if I might look to something like this down the road somewhere.

The surgeon told me "I wouldn't miss" the meniscus--and frankly it doesn't hurt or keep me from doing anything. But I am sure that longer term, I'll be in for some discomfort when I get older.

Anyway, will follow this closely. Hope it all goes well for you!

hammiemam · 01-13-2009, 11:14 PM

I will definitely keep you posted. As of right now with the allograft transplant, you have to be within a certain weight and a cerain age limit. But five years ago this wasn't available to me... so who knows what might happen by the time you need something done... Just be sure to do your research.

hammiemam · 01-13-2009, 11:16 PM

Quote:

Originally Posted by paul0616

yeah, I don't like the sounds of that scope.

Maybe you can go back to your first doctor, and find out how much meniscus was remaining after scope #1 and #2

For example, if you went from say 100% to 75%, then 65% down to 5%, that would tell you something.

5% sounds like a complete removal, and I didn't think doctors do that sort of thing anymore, even with a flappy meniscus.

I am going to try to get back with my original surgeon and see what he has to say.... Thanks for the suggestion... I will get back with you, with what he has to say

hammiemam · 01-13-2009, 11:17 PM

Thank you Taf, for the well wishes, and I will be sure to keep you posted as far as how this goes... I also plan to post pictures, however nasty they may be...

hammiemam · 01-14-2009, 09:38 PM

I wasn't able to make contact with my old surgeon today... but hopefully he will be back with me soon...
My surgery is officially planned for February third at 7:45... I am not sure I will be able to write anything that night, but I will try... Until then I need to stay healthy. If I get the slightest cold, I am not allowed to have the surgery then.

I am curious if anyone has ideas about dieting while I am down... I want to eat enough to heal, but eat little enough to not gain too much fat...
I plan to still work upper body where I am able to, but I realize I will be somewhat limited... ANy ideas are appreciated

paul0616 · 01-14-2009, 10:03 PM

I tend to eat more when I am at home during the day, rather than at work, because of lack of structure. However if you aim for whole food type foods, that might help. My latest thing has been (brown) rice and beans diet, mixing in frozen veggies, such as peas, corn, and collard greens. But it occurred to me that it involves some labor. So you might need a cook to cook for you for a little while.

hammiemam · 01-14-2009, 10:34 PM

thankfully I am staying with my mom and stepdad for a while... but unfortunately that means meat and potatoes

paul0616 · 01-15-2009, 10:40 PM

keep us posted on what your first doctor has to say.

Also, you can stay thin on a diet of meat and potatoes and no exercise, but you just can't eat very much ;-)

hammiemam · 01-21-2009, 09:07 AM

The office of my first surgeon will be faxing over my surgical notes today from my first two ops. The nurse there told me his wording is somewhat ambiguous, in that he will wrote "sub-total" removal of meniscus. Once I get the notes, I'd really appreciate help in deciphering what I can.

hammiemam · 01-23-2009, 11:03 PM

6/11/1999
The right lower extremity was placed in a leg holding device. The leg was prepped and draped in a sterile manner. The limb was exsanguinated, the superiorly, and in line with the joint medially and laterally. Universal cannulae were used. Pump was used. Irrigation was carried out. Patellofemoral joint was within normal limits. Medial gutter and lateral posterior 2/3rds of the medial meniscus. Complex in nature. Using the basket to try to clean the forward part of it. Irrigation was carried out. All the debris was removed. The anterior cruciate and posterior cruciate were within plateau were within normal limits. All the instruments were removed. 10 cc of Marcaine were injected. All the holes were closed with 3-0 Vicryl suture. A soft tissue dressing was applied. The patient tolerated the procedure well and was transferred to the recovery room in satisfactory condidtion.

Indications: A very pleasant 18 year old white female who had no injury to speak of but had difficulty with her knee for some time. SHe is a gymnastics instructor. She was seen in the ER and placed in a brace. MRI showed sever tear of the posterior half of the medial meniscus. The patient is brought to the Operating Room for arthroscopic surgery.

5/17/2000

Preoperative diagnosis: Extensive complex tear of the medial meniscus of the right knee

Postoperative diagnosis: Extensive tear of the medial meniscus

Title of Operation: Arthroscopy of the right knee; subtotal medial meniscectomy

Indication: Unfortunate very pleasant 19-year-old, white female, injured her knee at work. She previously had a partial medial meniscectomy, now she tore the medial meniscus in a very complex way. This was documented by MRI. The patient understands the risks and potential complications associated with surgery.

Procedure: After satisfactory anesthesia, the right lower extremity was placed in a leg-holding device, prepped and draped in a sterile manner. Three portals were established superior medially in line with the joint and with visualization superiorly. It did not show major findings. Patellofemoral joint showed very minimal degenerative changes. Medial gutter and lateral gutter were within normal limits. Medial meniscus showed extensive tear which was irreparable. A complete subtotal medial meniscectomy was carried out followed by partial debridement with Arthrotek and cauterizeing all the edges to make sure there would be no bleeding. Once that was achieved, all the meniscus was removed, irrigation was carried out, all the debris was removed. The anterior cruciate ligament and posterior cruciate ligament were intact. The lateral meniscus, lateral femoral condyle, lateral tibial plateau were within normal limits. 10 cc of Marcaine were injected. Portal holes were closed with 4-0 Novofil suture. Sterile dressing was applied. The patient tolerated the procedure well and was transferred to the recovery room in satisfactory condition.

paul0616 · 01-24-2009, 08:42 PM

sounds like the dirty deed was done on surgery #2 ~ all meniscus removed. In the third surgery, the doc probably saw there was nothing to do, and just did some cortizone, and hoped for some placebo effect. Thats just what I gather from a quick read.

hammiemam · 01-25-2009, 12:29 AM

do you feel as though there is a legal action to take?

I suppose it is past the statute of limitations...

hammiemam · 01-25-2009, 12:40 AM

and I was told the cortizone was used as a local anesthetic. If I had no meniscus, would that show up on my third MRI, or would there be too much scar tissue to show?

paul0616 · 01-25-2009, 09:04 AM

you probably should sift through these websites. There is alot of material on meniscus trims, allografts, and CMI grafts, etc.

http://www.kneeguru.co.uk/KNEEtalk/index.php?board=19.0
http://www.knee1.com/forum/index.cfm...ked=1&userid=0

Post your story on these, and see what they say. From what I read in the past, often what happens is someone will get a meniscus trim, maybe 35%. Then they develop another tear for whatever reason, , and the doctor will tell them to just live with the pain, as there's not much more to be done. In the old days, they would just remove the whole thing, but they try to avoid doing that now. Although its still done, because people on the knee forums talk about allografts.

As for legal action, I have no idea. You could consult a lawyer just to see what they say. Chances are, the doc made you sign consent forms, and I don't think there is anywhere you can specify the technical aspects of the scope. Such as "I authorize removal of no more than 30%", or whatever. Maybe ask over at Kneeguru, why the doctor might have removed the whole thing, rather than leaving the red-zone meniscus there, and whether that's reasonable and customary. From what I understand, 1/3 of the meniscus has blood supply, so very few people should have under 30%

Re. 3rd MRI. I don't know. Post that question to kneeguru as well.

hammiemam · 01-31-2009, 10:26 PM

Thanks for those links... They seem very helpful for information. I am starting to get a little more nervous reading both good and bad issues with the allograft. Well, only a couple more days to go. If I am feeling up to it on Tuesday I will post what I can. I will probably be pretty doped up though, so bear with me if I don't make too much sense. Wish me luck!

paul0616 · 01-31-2009, 11:12 PM

it's been a couple of years since I poked through those threads and I cannot recall what's involved, or the pros/ cons. I imagine the rehab is lengthy and tedious because bone has to heal, along with revascularization, and you don't want to stress it during the process.

It probably won't get you jogging or squatting heavy, but should be an improvement.

If you later post to kneeguru, or where ever, then maybe cross-link.

hammiemam · 02-02-2009, 12:27 PM

I will most definitely do that.... less than twenty four hours!

paul0616 · 02-02-2009, 04:18 PM

Best of luck ! May you get many years of good service with that allograft.