Cartilage replacement - next 10 years

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Topic
March 28, 2021 at 2:57 am #52465

samtugwell
Participant

Hi,

I’m a few months post op from a cartilage implant in my knee (and ACL & Meniscus repairs).

I’m able to walk and ride an indoor bike, but running is still a while away. I’ve got good mobility back, now I’m working on strength.

I wanted to know if anyone else had experience with this surgery, and what the future looks like for me. Will I be able to run downhill or will this trash the new cartilage and result in a knee replacement? I read Scott’s article about his new knee but haven’t found anything about replaced cartilage.

I’m 38 so I don’t want to ruin it yet.

Also to anyone else out there recovering from surgery, there are good days and bad days, keep your head up, keep working and it will come.

sam
Creator

Topic

Posted In: Injury & Rehab

Moderator

Thomas Summer, MD on March 29, 2021 at 8:45 am #52495

Hi Sam!

I like your last sentence Keep working, it will come.

Your progression and end result depends on the procedure of the surgery and the size and location of the cartilage damage. And also the meniscus repair is something to consider.
Can you share more information?
My advice is to get a good physio, who can guide you through rehab. And also listen to the advice of your surgeon.
Most important is to get the strength back into the muscles of the leg, so that you have good joint stability and proprioception.

take your time, but have a quick recovery!
Thomas

Participant

samtugwell on March 29, 2021 at 10:35 am #52498

Hi Thomas, thanks for your reply.
I’ll share what I can remember, hope it’s not too much.

The location of the cartilage damage was the inside of my left knee… I think. Sorry I can’t be more precise, it was all a bit much at the time.

An MRI revealed a torn ACL, a tear in the meniscus, and a 1-2cm tear in the cartilage (complete tear, not sure of the technical term). Also a bone bruise. The plan was an arthroscopic OP to drill into the bone marrow, as well as repair the ACL with a patellar tendon and sew up the meniscus tear.

When I woke up from the OP I was told that the cartilage tear was much worse than they thought – 3-4cm, so I would need further surgery. The surgeon saw no damage to the meniscus however.

A second arthroscopic OP removed samples of bone and cartilage for developing in a lab to be implanted later. I think this was called Novocart but that may be a trademark.

The third and final OP was not arthroscopic, but everything was cut open. The lab grown cartilage was implanted (I still find that crazy), the ACL was repaired but using a tendon from the back of the leg, and this time they did find the tear in the meniscus and sewed that up.

I have been having physio since 6 weeks after the final OP. The focus has been on mobility and improving the circulation by loosening the scar tissue. They have given me strength exercises, including using a foam cushion to balance on. I have been walking more and more, including up/down small hills. The indoor bike has become more of a recovery tool for getting the knee turning to loosen it up at the end of the day. Overall the physio is positive that I will be back to 100%.

Can you give any more recommendations for strength exercises? I can’t full squat, lunges are painful, walking downstairs is about 70% there. I tend to assume that doing more walking will be good for strength, but I have planned to add a pure stair session as one workout.

The surgeon said I should do more cycling for the next 20 years, rather than running. I’m mostly concerned with scrambling, and whether alpine descents will be possible, and using trail running for training. Let’s just say I’m not fully on board with cycling, though I will do some mountain biking and add in swimming when the pools open.

With regard to positivity – I flit between being sure I will come back stronger, and paralysed at the thought that I won’t improve any more, and certain things are no longer possible. I guess the line is somewhere in the middle, but the further I get away from the OP the fewer bad days I have.

Sorry if that’s a bit of an epic read, I tried to stick to the facts!

sam

Moderator

Thomas Summer, MD on March 30, 2021 at 1:38 am #52522

Hi Sam!

A recent study on athletes showed good long-term results for Novocart 3D.

At the moment I would follow the advice of the surgeon and do more cycling for endurance training. Walking is also fine, but be careful with downhill walking, because it places higher demands on knee stability. If there is more swelling or pain, then it was too much.
A stair session is a good idea if you can go only up. And if you have a stable leg axis and your knee doesn’t collapse inwards (especially if you get fatigued). I would recommend training that with your physio. Focus on stability and proprioception, then shift to strength.
I would also recommend training the other leg. There you can go really hard;-) There are interesting studies that when you train one leg, it also transfers to the other leg. Whole-body strength training is also recommended. This way you get a release in growth hormone, which also helps the recovery of the knee. Furthermore, core strength is also important for knee stability.
Give the knee a year after the surgery. Then see where you’re at. Scrambling and alpine descents are a pretty high impact on the knee. But I think that should be possible if you have good strength and proprioception.

I would also recommend eating enough protein (2,5g per kg body weight) and supplement with collagen. You can take the collagen before the rehab training, with Vitamin C and creatine. You can also supplement with Vitamin D and K2 and Omega 3 fatty acids.

Maybe Pete has some more recommendations!?

Focus on what you can do at the moment. You will learn a lot along the way. And the mountains will wait for you!

kalipe!
Thomas

Participant

Pete Dickinson MS,PT on April 6, 2021 at 10:37 am #52820

Well, we all get dinged up leading an active lifestyle, but the benefit outlasts the negatives of inactivity!! There are some short term issues here, and some long term considerations. First, do whatever is needed to optimize the outcome of the surgery and the tissue integrity of the implant!! This means that a slow progression with focus on activity methods that allow for careful loading of the new tissue is what’s needed. Biologic tissue needs a long time to respond to gentle shear stress with gradual strengthening of the tissue (mechanotransduciton). The bike is the tool of choice. Gradual strengthening avoiding high impact loads is also a key component. All big surgeries take a year to get back to low baseline, and ANOTHER year to specifically prepare for sport participation.
Now, don’t sell yourself short. You can do this. It takes resiliency, and a team around you for support. Reach out to others. I can’t recommend enough having a mindfulness practice as you live in the moment, and know that impermanence tells us that everything changes, and that this will not stay the same.
Cheers,
Pete

Participant

samtugwell on April 6, 2021 at 1:03 pm #52832

Hi Thomas, thanks for your excellent replies. I was taking some time to digest “give it a year” before Pete came in with the second year body blow :).

If I may, I’d like to clarify a few things.

I’ve used Uphill Athlete plans before and was planning on keeping the same structure here – that is 4 aerobic days (2 walking and 2 bike), 2 strength days (Killer Core & General routine) and one rest day.

On top of this I will do stability / proprioception work each day, as well as 1-2 x 30mins on the bike trainer.

Does this sound like a reasonable plan, with enough focus on bike?

For reference, walking will be in the forest on rolling terrain. Bike will be mountain bike on the same terrain but nothing too steep and with no fall potential.

Secondly are there any exercises in the Killer Core & General routines to avoid? I just ran through it and skipped Hitler’s dogs, side planks, TGUs as they didn’t feel sensible.

Thirdly, I was hoping to get a rough timeline on activities… nothing fixed but i figured from 6-9 months I might be able to start jogging. I also kind of thought Golf might be on the cards soon (the injured knee is the back leg so not as load bearing). Further still I was reallly holding out hope for a scramble in September – this would be 10 months post op. I can’t tell if this is too optimistic or if it is reasonable. The feedback from my physio has so far been to try things out and see what goes.

Thanks again for your replies, it helps a lot.
sam

Participant

Pete Dickinson MS,PT on April 7, 2021 at 6:24 pm #52893

Sam,
Good muscle function protects the knee from shear and strain, they are the shock absorbers for the knee. You would want to have excellent hip and leg strength that has been developed gradually with a focus on the posterior chain. You’re program sounds great, nice mix of aerobic activity that won’t beat up the knee. When you start getting ancy about going on an adventure, you can do a test activity comparing your good leg to the….special one. A deep chair step down is a good test for strength, as is a single leg hop for distance. We like to be within 10% of the good leg. Let your leg make the decision, not a timeline that is created outside of your actually physical state.
Cheers,
Pete

Moderator

Thomas Summer, MD on April 9, 2021 at 9:30 am #52952

Hey Sam!

I fully agree with Pete. Don’t focus on any timeline. See what you can do each moment. Your leg will guide you. But if you are in doubt it’s always better to be conservative. 10 months after surgery is very early for a scramble. I wouldn’t recommend that and risking anything. But once more: don’t focus on a timeline! It’s better to wait one more week or month, than risking anything too soon. Whatever will come will come. Work with your physio and try to enjoy the process.

kalipe!
Thomas

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Cartilage replacement – next 10 years