Knee Surgery - What's Been Your Experience?

[NoEZmoney]

So I have an old knee injury and I'm considering different treatment options.
I had been holding out for years hoping medical technology would improve and offer more (better) options than were available when I was younger.
Long story short: I have damaged cartilage on one side of my knee and a blown Anterior Cruciate Ligament. Exercise and keeping the quads toned has helped but I have found it necessary to wear a brace for the past few years and I'd like to get this repaired. Not planning to run marathons or play hard games of tennis, but I'd like to get the knee better stabilized.

Was hoping MACI procedure would be ideal where I can use my own cells to grow cartilage scaffold for implantation but the surgeon told me that FDA only approves it up to age 55 (I'm older than that).

So there's partial implant, full implant and maybe a couple other options. I'm even considering medical tourism to see if I can get MACI done somewhere outside the US.

So if anyone here has had work done, please let me know how it's going for you, why you chose the procedure, pros & cons, recovery time and pain management.

Thanks in advance.

 

[Dtail]

I had my ACL repaired in the year 2000 using my own tendon. It took at least 8 months to heal with quite a bit of physical therapy, sometimes painful.
The knee is totally fine to play competitive pickleball, which stresses the knee.
However the knee was never truly the same and couldn't ski or play basketball currently if I wanted to.

 

[Aerides]

If you search on TKR threads here you'll find a lot of success stories. I have no cartilage to speak of remaining in one knee (found out during a scope to repair a torn meniscus). When it starts to hurt, I'll be knocking on my Ortho docs door with no hesitation.

The most common thing I hear is people saying they just wish they'd done it sooner.

 

[RunningBum]

ACL repaired in 2012 at age 51, using my patellar tendon. I ran a marathon 8.5 months later, and in the next couple years got pretty close to my previous marathon PR (probably off due to age and weight) and ran further (2 100 milers). I also continued to ski aggressively, limited more by ability than my knee. I'm still running marathons at 60. That's the good.

The not-quite-so-good, often I feel a slight pain going down stairs, and more pain and stability issues running downhill on technical trails. I think this may be due more to my patella than the ACL repair because my knee cap doesn't seem to glide properly. A knee brace helps for the downhill running. I just use a patella strap for road running, and nothing for skiing. I think I probably wasn't quite as diligent in my post-op PT exercises, especially once I was cleared for running.

If I had to do it again I might push harder for a cadaver graft. My surgeon said he'd had mixed results with that, so maybe living with a little pain and the need for a brace for extreme uses was the right call.

I know nothing about MACI. From a quick read it looks like that is for the cartilage, which you've probably worn down from instability due to the torn ACL? I know less about cartilage. My meniscus was also torn with my ACL (and my MCL), but in an area with enough blood circulation that the doc repaired it rather than removed it. So I probably still have good knee cushioning, which helps explain why my knees don't hurt much after activities. Contrary to what some people say about running, the doc said my knees were in great shape except for the injury damage. When recommending knee repair, my doc said if I opted not to (as another knee surgeon recommended "because of my age and not likely being that active"), I would probably be down to bone on bone within 10 years and be looking at knee replacement.

Anyway, if you can get cushioning back in the knee, that seems worth it to me. Seems like worst case (other than infection), you go back to using a brace or maybe doing knee replacement, but do better research than the 2 minutes I've done. IANAD (I am not a doctor).

 

[NoEZmoney]

PS - I have had a doc tell me he could do an ACL repair and work on the damaged meniscus but that would only buy me maybe 10 yrs before I'd likely need either a partial or total knee replacement. The MACI scaffolding has shown some good results for folks but it's only recommended in patients <55 yrs of age. I did see a clinical trial where a soft-but-strong silicon-like wedge was placed in a damaged knee. Made by a company in Israel, the NUsurface Meniscus Implant trials were concluded about 2 yrs ago ...no word of FDA approval. That would offer something less severe than a TKR. Maybe it'll be approved for USA.

 

[levindb]

DW had a total knee done 10/7/21 and was able to walk without a stroller or cane a couple days later. After 1 month she was riding a bike and walked over 1 mile. Key to her success was doing exercises BEFORE the surgery so that she had good muscle tone during recovery. She is 69 is very happy she had it done. We are currently planning on the other knee for October of this year.

 

[scrinch]

I've contributed a little to the TKR threads, but I'll add a short note here also. I had both knees fully replaced at age 58 and 60. Prior to the replacements I was having moderate pain and swelling after hiking/tennis, and I had lost a lot of range of motion gradually over the years. I could still get around, but not very well and not for very long, and not without several days of recovery afterward. I took NSAIDS to help with the pain and swelling, but they didn't do much, and I didn't try any other treatment, as both doctors that I saw said that the knees were worn out (cartilage) and arthritic. Big bone spurs all over the place.

Following the TKRs, after about 5 months of PT, I was back to tennis 2x/week and backpacking in the Sierras again, with no pain or swelling at all. I wasn't able to regain range of motion through any amount of PT, but once I started tennis again, I regained the motion quickly. Surprisingly (to me at least) after 5 years since the first replacement I rarely think of my knees any more. I just go about life without thinking of them. Well, I do baby them a little over rough downhill terrain with a heavy pack on, but that's about it.

So my bottom line is, if and when it becomes time for a TKR, do it. The relief is dramatic, and the recovery process is significant but definitely worth it. Both my FIL and BIL have had partial replacements, and neither was particularly happy with the results. So from this small sample size, I'd go with the TKR rather than with a partial.

 

[Katsmeow]

I would want to know a couple of things if it was me. Why does the FDA only allow MACI for patients up to 55. Is it just because that was who it was tested on or is there a reason it is less effective or riskier for people who are older?

Second thing I would ask if a TKR would help and if it was the most likely to give a good result. If you will eventually need one then maybe do it now. OTOH, if you have reason to think a TKR later is more likely to be effective due to medical advances then that might be a reason to wait.

I would say that it is always hard to know how the individual person will respond to surgery. Many years ago (I was in my 40s) I had a tibial transfer. To me, this surgery was an absolute nothing. I could walk fully weight bearing the morning after surgery. I went to PT and from the beginning was able to do stuff that people couldn't usually do until a month after surgery. At the time, I was overweight and not in great shape. A young woman came into PT who was obviously very physically fit. She could barely move and struggled with tasks I was able to in PT on Day 1 and quickly moved beyond. She had had the same surgery I had had. Her experience was more typical than mine. I just got lucky. But, it could easily have been the other way.

 

[harllee]

DH, age 70, had total knee replacement on his right knee last Spring. The first 2 weeks were rough but in a couple of months he was back walking several miles, going up and down steps without holding on. Now he is biking long distances, dancing and walking playing golf and carrying his clubs. A complete success. He may not have to have his other knee done because it is doing much better.

 

[Boose]

Following with interest. DH is going to have cartilage repair (cadaver tissue) this spring, with a realignment of his anterior tibial-ligament-thingamabob so that the kneecap tracks correctly. He's 50 and has been a runner and hiker for >20 years.