Meniscal Allograft Transplantation

[hammiemam]

Thanks so much for that. I am very tired, and still very loopy right now. I wanted to take pictures in between naps, but my doc wants me to keep my dressings on until next Monday when I visit with him.. He is convinced (or did a good job convincing me) that the procedure went very well, and I should have very little trouble with it.
I will also be sure to post pics and let everyone know how my progress is coming along. Thanks again for the well wishes!

[hammiemam]

In addition to gneral anesthesia, I additionally had a nerve block done on my leg to help out with pain for the next few days post-op. I am glad it is there, because I am still feeling pretty uncomfortable, however I don't like the feeling of my whole leg being asleep. It feels like that pins and needles sensation. I amall up to date on pain meds, and will probably continue to do so. So if I have some loopy posts over the next few days, please bear with me!

[paul0616]

good to hear the surgery went well. I imagine that surgery is fairly involved, probably more than an ACL. Did they say how long it took? I'm sure we will all appreciate the status updates, loopy or otherwise ;-)

[fitz1]

I tore the same meniscus twice about 5 years apart. The second doctor said that there could have been microscopic tears left in there/gone unnoticed by the first doctor. Over time the tears got bigger.

[hammiemam]

My doc told me and my family to expect me to be in surgery for about two hours. I was actually in over three hours. Of my three scopes, none of them too more than a half hour. My nerve block is starting to wear off now, and I am starting to feel quite a bit more pain. I probably did too much today also. We had to put a family dog to sleep today (we did the same thing with the other family dog less than three weeks ago), and after we did that, mom took me out to lunch. I was up and down a lot. We were probably out for a good three hours or so, and that was probably way too much time to be away from my ice machine. Doc has me on Hydrocodone, Ibuprofen and promethazine. The first two I am supposed to stagger, so there is always something in my system. THe last one is kind of an as needed basis. It helps with nausea associated with anesthisia and pain killers. I have always had trouble with that. But this time I didn't get sick. I'm told that day three and day four will be the worst for me because that is when my nerve block will be completely gone. I have only a few exercises to do until next monday when I have my check up. One is to be able to do ten leg raises in a row. Earlier today, before I got in more pain, I did twelve. I didn't lift them very high, but it is a start. The other exercise is to get my leg to go straight. If I don't do it now, I could have a bend in my leg forever... That is no good.
There is my report for day three. I will at least try to take a picture of the new brace with ace bandage, and maybe my yellow-stained sausage toes (that foot is so swollen!) tomorrow.

[paul0616]

over three hours, wow. That does sound more involved than an ACL. Try not to do too much, or get too tired during rehab period.

[entropy1]

hope it all goes well

[hammiemam]

So again, I didn't get pictures... I promise I will. I may have to go into doc's office on Friday so I can get my dressing straightened out. It has started to fall down some, and I don't want it to fall down much more over the weekend. Today I did fifteen straight leg lifts. I am not quite sure how straight they were because of all the dressing and this new brace, but I did do them. I've also been working really hard on forcing my leg straight, it is so difficult. With the block sort of in effect still, I can't quite feel all the muscles the way I normally do. But the block is definitely wearing off more each day. The inside of my knee feels really hot all the time, but I am keeping the ice machine on almost twenty four hours a day. I stopped by the pharmacy to pick some things up with my mom. I wear out so quickly. I am not going to try to be all big and bad and say that this procedure is no big deal. It is uncomfortable as hell. I know it is for the best, but it is sucking pretty big time right now.
I think my pain would not be so bad except for these twitches I keep having. My leg keeps twitching, sometimes my calf, other times my quad, other times it feels like my entire leg is in one big twitch. Whenever I have these muscle twitches, it hurts. And it is uncontrollable, I got what felt like a charlie horse in my calf today, wow, did that suck. I am assuming it has something to do with the nerve block, and the incisions, I am not twitching anywhere else on my body. I am sure there is a reason my brain tells my muscles to twitch, some sort of survival thing. If anyone knows the reasons, I'd sure like to be informed.
I never thought I would be so exhausted after a day of watching tv with my feet up.
I'll report more later!

[hammiemam]

I did three sets of fifteen leg raises today. I had quite a rest in between, but my goal is ten leg raises in a row before monday's appointment. I am well ahead of the game. My block has worn off, however, my leg is very swollen still, and it is causing my circulation in my foot to be a little off. It still has the pins and needles sensation. The twitching in my leg has not been as persistant today, although, when my leg has twitched, it has been pretty uncomfortable. I am still pretty tired, my leg gets super hot if I am up for more than ten minutes or so. I am somewhat concerned because I am only supposed to use the ice machine for a few days, and I am heading into my fifth day, and still am quite swollen and warm. I think I will just keep my ice on it most of the time until after I see my doc. It is possible I am overdoing it with the leg raises, and trying to straighten my leg. I am just trying to be proactive with my recovery, I don't want to hurt it in the process...

[paul0616]

I think with a knee surgery, its theoretically possible to get a blood clot. Although those might be more common when they do knee replacement surgery with metal parts. Still, you may ask (or google) about that to know what to watch for.

this is just something I rummaged off of google:
http://answers.yahoo.com/question/in...4233356AAkje1K

[paul0616]

@hammiemam, I hope my previous post didn't cause you anxiety. Later, I grew concerned you might be sitting upright at the PC google'ing what-if situations instead of resting and recovering. Please understand that I am layman here and my musings may not be appropriate or helpful.

[hammiemam]

I am doubtful I have a blood clot. I called the resident on call a couple of nights ago to find out about the swelling. He said because I am not walking on it, I am not getting all the circulation I normally would, and it is absolutely normal for me to be so swollen at my ankle.

Now that I am not quite so loopy, I can elaborate a little more on what my doctor said. He mentioned I had absolutely no meniscus left. They took me back for surgery at 9:30am and I was awake (if you call it that) around 1:00pm. The surgery itself actually took over three hours. He had to put in the disolvable screw, it will be there for another two to three years. One of my incisions was about two inches, another about 2.5 inches and the other was a simple scope hole that they used a previous scope incision site for the third. I will see what those look like tomorrow.
My doc told my mom that he is going to do a little experimentation with my recovery. I may be walking sooner than expected! I will be very detailed with that.
As for right now, my pain is relatively limited. WHen I stand up it feels like someone put a giant rubberband around my leg cutting off my circulation. I haven't been up and around the last few days. I tried to go outside to visit with my puppy and I slipped on the wet garage floor, I landed with most of my weight on my newly cut up leg. I have also had a little trouble with twisting. If I am laying down and twist at the hips to grab something (I am terribly stubborn and hate to ask others around me for a whole lot of help), I also twist at my knee inadvertantly. I have done that a few times... It also seems to twist when I am crutching around or getting in and out of vehicles. That is probably the most irritating feeling I've had thus far.
I am doing really well with my assigned therapy. I am hoping they give me more tomorrow, or even assign real physical therapy. I just want to get up and around as soon as I can. I am able to get my leg straight, and I am able to do over ten leg raises.
Well, I am off to do some rest before my big appointment tomorrow. I promise pretty pictures tomorrow!

[orthodoc]

the peripheral 1/3 of the meniscus does have a better blood supply than the rest and thus has a higher healing potential, but that's only one factor when considering repairing the meniscus versus removing it. there are many tears of the peripheral 1/3 that can't be repaired and therefore are removed -- that's the reason why procedures like allograft transplantion were developed.

it sounds like (and remember this is just a guess on my part since i don't have your records and wasn't there for surgery) most of the meniscus was removed on the second procedure. since the 2nd doc hadn't seen the inside of your knee the main pupose of the 3rd scope (probably) was to confirm the lack of meniscus and evaluate the cartilage for degeneration -- while some of this can be seen on MRI the gold standard is still direct visualization.

Knee scopes under local anesthetic were more common years ago. they are still done periodically these days -- usually when the patient specifically requests that they want to be awake for surgery. i personally won't scope knees under local due to the possible pain issue like you had.

good luck with the recovery. hope everything works out for you!

[hammiemam]

My visit with the doc went well today. He is very pleased with my ability to straighten my leg, and do my leg lifts. I am only the fourth transplant he has done. When he learned, the incision sites were much, much larger than what he does. I know I keep promising to post the pics, I will tomorrow. Doc still wants me to stay off it for another five weeks, however I do get to start physical therapy as soon as I find one that takes my insurance. There was some concern that I might have a blood clot because of some discomfort I've had in my calf, but after a sonogram that concern was alleviated. I still have a bunch of swelling, it looks as though I sprained my ankle if you look down there. Doc still wants me to spend most of my time hanging out with my ice machine, with my leg elevated until the swelling goes down. Hopefully that will not be too much longer. I am pretty much done with my pain meds, except the ibuprofen since it helps with the swelling. My next goal (until I get into PT) is to work on bending my knee more. I can't wait to get into physical therapy. I hope to be like a pt overachiever or something. I want to get the best out of it I can, and considering it is probably my only gym time for the next few weeks, I want to take advantage of it.

[chexmix78]

hope you have a speedy recovery! i am currently rehabbing my knee acl w/allograft.

[hammiemam]

As promised...

Most of my bruising, and my biggest incision are on the inside of my knee. I do have a small circular birthmark in their too, so that might add to what looks like a bruise. In kneeweek1-1, check out the difference in size of my ankles. I am still really swollen after one week, hopefully a few more days and that will be gone.

[chexmix78]

that looks good for 1 week. most of the swelling should go down soon, but you may have some of the swelling that lasts weeks.

[bubba g]

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!

I have seen several football players get it done, and come back and play at their previous level.

I have a friend that had it done a couple years ago, and he says it hurts all the time. His case might be different though, because He tore his knee, and doctors didn't diagnose the problem correctly, and he went on working for 3 months afterwards doing more, and more damage.

[hammiemam]

I have seen several football players get it done, and come back and play at their previous level.

I have a friend that had it done a couple years ago, and he says it hurts all the time. His case might be different though, because He tore his knee, and doctors didn't diagnose the problem correctly, and he went on working for 3 months afterwards doing more, and more damage.

I think you have to have a really good relationship with your doc to make sure you are in good communication. If something like this is causing problems, they need to know about it. I am hoping this puts me at the level I was at before or after my first scope...

[hammiemam]

What causes all this twitching? Anyone else have leg muscle twitching post op? Mine started the day after, and hasn't stopped... I have theories as to why I am twitching, but is there anyone that really knows why?

[paul0616]

were the slippers included as part of the knee surgery? ;-)

[hammiemam]

Ha! They are my luck penguin slippers. I've been living in them since surgery. I don't have quite enough bend to comfortably put a sock on my right leg, so slippers it is.

[hammiemam]

So does anyone know what this twitching has been? I keep getting these muscle spasms... mostly in my quad. Or this constant tickling feeling under my skin, it is such an erie feeling. THe twitching has subsided somewhat (still annoying) but my incisions are getting itchy now...

As far as my incisions are concerned, my doc put sutures that are disolvable, and he put them on the inside of my wound, instead of the outside. SO I expect my scaring to be more minimal than I initially expected. I have started putting on a little vitamin E oil, hoping that will help with the scaring...

[art_of_war]

What causes all this twitching? Anyone else have leg muscle twitching post op? Mine started the day after, and hasn't stopped... I have theories as to why I am twitching, but is there anyone that really knows why?

First of let me tell you: I am not a doctor, nor do I play one on TV. But here's my unprofessional opinion on the twitch.

I've had a bunch of knee surgeries, probably will need more when I'm alot older. As for the twitching, in my case (may or may not be yours), it was just due to the rediscovered uses of the leg. For me, I had aches and pains a long time before I even thought about surgeries. In fact is was so bad that I couldn't be as active as I wanted. After the surgeries , just even using and bending the knee that was put under anesthesia was enough to "tax" my quads causing the twitch, because being limited in motion, it wasn't geting the normal contractions of even something simple as walking.

Good luck with your rehab.

p.s. nice blog

[hammiemam]

I was feeling pretty darn good today. I got up and around really well, even took a shower, most of which I stood up (I sat down to shave my legs). I took quite some time getting about, but that is to be expected. My stepdad went into the hospital today and I spent a decent amount of time out of my comfy chair with my feet up being iced. So my foot got so swollen I had to take my shoe off because it was cutting into my skin. I am hoping that my swelling goes down soon...
AOW, thanks for stopping by. The twitching has gone down a lot, very itchy though at the incision spots. I put some Vitamin E on those, hoping to eliminate as much scaring as I can. That seems to make it feel a little better too.

[art_of_war]

I was feeling pretty darn good today. I got up and around really well, even took a shower, most of which I stood up (I sat down to shave my legs). I took quite some time getting about, but that is to be expected. My stepdad went into the hospital today and I spent a decent amount of time out of my comfy chair with my feet up being iced. So my foot got so swollen I had to take my shoe off because it was cutting into my skin. I am hoping that my swelling goes down soon...
AOW, thanks for stopping by. The twitching has gone down a lot, very itchy though at the incision spots. I put some Vitamin E on those, hoping to eliminate as much scaring as I can. That seems to make it feel a little better too.

Yeah actually the itching is normal, it's just means your healing well. Often it's the sensory nerves healing which causes the itching sensation. Vitamin E and cocoa butter is good later (I used Palmer's brand). But this early after the operation I would suggest vitamin E oil. Don't buy it already in the bottles. Just buy the vitamin E gel caplets, take a pin and squeeze the oil out of them. Nice to hear your doing well. I've had a few knee surgeries, not so fun. And give it 100% in physical therapy.

[hammiemam]

I haven't had any twitching today, and my itching of my incision spots has gone away. I think the vitamin E has really helped there. However, I am still really swollen. I've also been up and around much more, so it is possible I haven't been icing it as much. I figured after nearly two weeks it wouldn't be so bad. I have my first day of physical therapy tomorrow. I plan on taking a pain pill before I go in, just to help with what I am able to do. I haven't actually had any pain meds in several days. For the first three days I took both Ibuprofen and hydocodone. After that I took just the ibuprofen, and mostly for the anti inflamitory capabilities. I probably should be taking that still, since I've been so swollen. It was so bad the other day that I had to take my shoe off because it was cutting into my skin.
Well, I am off to bed, I will let you all know how first day of PT goes. I am pretty excited!

[hammiemam]

Therapy went pretty well today. I mostly just did stretching and bending. My PT, Kim, thinks I am doing incredibly well. I already have a ninety degree bend, which is the maximum I am allowed for now. I am able to straighten it all the way as well. My inner quad is very weak. Kim says it is because the rest of my body isn't quite sure it is there yet. My outer quad is working just fine. I am still really swollen, but we are hoping that some of the given exercises will help some of that go down. I am really starting to feel better, as though I could put weight on my leg, but because we need to make sure the allograft takes well, I won't be able to do weight bearing for some time. I want to start lifting again, at least upper body, but I am not cleared for that yet. They are afraid I will twist it... It is really amazing how much you use your legs for everything... even upper body movements. Well, I am off to ice.

[hammiemam]

Sorry its been a little bit since I've posted. My therapy seems to be coming along well, I just have a few at home exercises to do, pretty simple stuff. Nothing that I am doing really hurts, and I don't feel challenged. I am frustrated because I've accidentally stepped on my right foot and felt no pain. I just want to walk, but understand the importance of the tissue adhering to my own. I am not having any twisting difficulties as I was having before. I rarely have any pain at all, other than some mild discomfort from bruising. It is actually getting a little more difficult to sleep because I am starting to kick in the night, and they want me to wear the brace they gave me after surgery. I have quite a few bruises on my opposite leg, just from moving around in the middle of the night. I don't have a cankle anymore, that went away probably the second day after I started PT. A little blood flow down there goes a long way. Though the lower part of my leg is no longer swollen, the area around my knee still is. I think it looks tons better than it did before. I will try to send at least a cell phone picture of it later today. SO this is my halfway point. I am rallying to walk one week earlier because I am taking a trip to new york and would love to at least be able to walk around some once I am there. We will see what doc says, I go in March 11 and will definitely give updates.

[paul0616]

I am rallying to walk one week earlier because I am taking a trip to new york and would love to at least be able to walk around some once I am there. We will see what doc says, I go in March 11 and will definitely give updates.

I'm concerned that walking around NY seems might expose you to getting tired and working the knee too much too soon. Also, getting tired increases odds of tripping.