"Osteochondritis Dissecans" knee injury. Anyone had it or can advise?

the-big-lepowski

the-big-lepowski

Active member
After skiing pretty hard for a week at the end of march, my knee swelled up. When it got to the point where I had trouble walking, I took it to my pediatrician. I had an MRI done and it was clear that it was not any ligament tear, but instead a piece of bone and cartilage from my femur that had died and was hanging loosely. I was on crutches for 6 weeks and the swelling went down. I expected to be active around mid-summer.

I have MRI #2 done in early July and learn that the lesion has detached, with no chance of healing itself. The big S word (other than shit) was surgery. One method that may be used is called OATES, and it takes pieces of bone from my upper femur, away from the contact in the joint. The other involves growing a cartilage culture in Boston and adding it to the hole. Whatever happens, the floating bone lesion has to be removed. I'll try to attach MRIs/x-rays later.

I am grateful that other than the first week, I have not been in pain at all. However, the worry is that I may get arthritis in 5-20 years if I don't have an operation, so I'll take a year off from sports to help it heal. Needless to say, I am quite active and plan to live a life predominantly on my feet, outdoors.

I have met with one surgeon in Fall River and am going to Boston tomorrow to meet with another, but many seem to be on vacation. I would like to get this over with ASAP so I might have a partial ski season because the recovery periond is +/- 6 months.

I have been very frustrated because I did not blow it on one fall, but rather cumulatively. Also, as a bone injury, there is little I can do for rehab now. Not to mention missing the entire 2009 mountain biking season. Feel free to vent about your knee injuries as well.

Has anyone on NS had this specific problem, know anyone who has, or can recommend a good New England knee surgeon? Thank you, KiP

http://www.aafp.org/afp/20000101/151.html

 
that made me laugh a little how you said you took your knee to the doctor haha but sorry no ive been fortunate to have healthy knees so far...knock on wood
 
i just had surgery because i tore my meniscus and had a microfracture, i live in ct and i went to this guy dr. robert arciero who practices out of uconn, he is pretty well-known he does all the uconn bball players/athletes and has done a bunch of the u.s. ski team guys..im still rehabbing because i just had surgery but my friend tore his acl and both meniscus and went to him for surgery earlier in the summer and he is already up and running again..different injuries than yours but he is primarily a sports med guy and specializes in knees so im sure he has a ton of OD patients, you should check him out pm me if you want his info
 
Sorry to hear that man, knee injuries suck. Luckily, med. technology is getting amazing, and its def possible to come back 95-100 percent, so im sure youll be back out there!

I had a fairly similar knee injury, cept mine started with a blown ACL, and a similar rupture of the cartilage from/with the bone. was pretty good after the ACL, but I had limited flexation (to about 90 degrees). over the 2 years since, skiing on it had totally wrecked it, and i just had my second surgery 3.5 months ago. Just got off crutches, and starting physical therapy within the past few weeks. me and my doc discussed the treatment you were talking about (and it sounds very good), as well as a chondrical drilling, where they scrape the jacked up cartilage away, and drill into the femur, releasing cells that eventually grow into new cartilage. I had the later done, and so far its going very well. I have all my motion back (SWEET!) and pretty much zero pain. Its gonna be another 8 months or so before i can really ski or do anything aggressive, but thats ok.

as for docs, I cant help there, but I will say that after you get it fixed, get into a good regime of knee stabilization training. having good support will take almost all of the pain out of your knee, and will seriously help prevent arthritis. Also, while you prolly wont be able to mt bike, a good road bike should be your best friend. it will do wonders for your knee, and youll be twice as fast when you get back on the dirt.

Good luck man, go with the surgery, tough out the recovery, and stay strong afterwards.
 
I just met yesterday with Dr Yen at Children's orthopedic hospital in Waltham Ma. He seemed very nice and that hospital sees many of these cases because they specialize in children's sports injuries. Apparently, I should have it done soon, because I only have a few more months before my growth plates close up (I'm 17).

I checked out online Dr Arciero of Uconn and he certainly looks qualified. Unfortuneatly, its a much longer drive to CT than boston for NH, so I think I'd like to limit the search to MA, maybe Ri.

I've missed mountain biking a lot, but I was just working on trail maintenance in VT, so its better than nothing. I have almost fully stripped a '70s road bike and will fully fix it up in the next month so that I can use it during rehab. That is, if I have the dignity to wear lycra :)

I'm worried by the length of time in rehab some of you are mentionning, but I guess I'll do whatever it takes to limit arthritis in the future. Thanks for the help so far, KiP
 
Knee injuries suck so much man good luck to you on your recovery. My friends dad had something like this i think when he was younger but it wasnt really found out for a while and he had surgery and now he still sometimes has knee issues but that he thinks is because it was never found out about for so long. I have pretty weak knees and wear a knee brace on my right knee when I ski and I try to do everything to make them stronger.
 
i had osteochrondritis dissecans back when i was 9 and it lasted for e few years until i grew it out of it. since i was so young i didnt know what it really was and wasnt so concerned about it but my parents were. i cant really give you any advice except i never had surgery but i easily could have if it never went away and i had to sit out a season or two from skiing and other sports. all i really remember is that the pain came in waves and was like no pain i have ever experienced. also my knee would give out sometimes and it was very unpredictable.
 
bump for my surgery in 2 days. Anything I can do while on crutches for 6 weeks that could be remotely fun? other than the mountain of painkillers
 
Try looking up "Subchondral Cyst". You damaged the surface of your joint, like pressing your thumb into an orange, it leaves a divot. Sometimes it presses through the peel.

If they're wanting to do an OATS procedure (Osteochondral

grafting or Osteoarticular Autograft Transplants.. hence the OATS), it involves taking/harvesting cartilage grafts from non-weightbearing aspects of your knee and drilling/transplanting them into the damaged divot. It replaces articular cartilage that you've lost which leads to subchondral cysts, and osteoarthritis down the road, inevitably.

You're looking at 6 weeks on crutches, and at LEAST 6-8months before you can ski, and probably 18 months before you're painfree from the surgery. I've had microfracture a number of times an am in a similar scenario as you. I wish you luck, but it does take time to heal, don't rush it, or you'll damage the transplanted grafts and be back at square 1 or worse. Don't expect to be without some ammount of pain for a while either, its a fairly invasive surgery.

 
havent read the thread yet but when i hurt my knee i went to Dr Busconi at UMASS Memorial in Worcester. im pretty sure hes the best around for knees (Red Sox team doctor i think), so look into him
 
Post-op update -

I did go with Dr Lyle Micheli because he had a more open schedule and he operated on Monday, 8/17. The lesion had in fact detached and was floating in the knee. Upon inspection, it was no longer viable, and he threw it out. Micheli then scraped the soft cartilage of the divot and took a pin to push about a dozen holes in my lower femur. Both of these were done to stimulate bone generation through more bloodflow to the area. He did not do the OATS procedure, nor was he able to screw the piece back on, which would have been the ideal scenario.

I was under general anaesthesia, primarily morphine, for about an hour. Wow, that stuff really works! and I'm on a 6 hour dose of Vicodine now. I'm also icing it constantly and keeping it elevated.

I turned 17 last month and my growth plates are still active, so it made sense to still go to a pediatrician. Micheli specializes in adolescent sports injuries.

Thanks for the feedback everyone. Any ideas on how to occupy myself these next few weeks while its still amazing out and I'm stuck on crutches? summer reading of course, but I'm thinking lots of hanging out at the beach and maybe starting to do some surf photography.
 
arthritis is a major issue for most skiers. your 5 to 20 year prediction sounds great to me. I tore three ligaments in my knee about a year and a half ago, got the surgery, and now have 6 screws and a pin in my knee, four will eventually dissolve, the rest stay. my doctor said I was guaranteed to get arthritis in 9 years, which is pretty standard for knee injuries. So, you might be screwed either way you go. You kinda just have to accept the fact that you will have to deal with arthritis in your knee via surgery or deal with the constant pain and swelling you are experiencing now. if you want to ski in the short term, surgery is probably your only option. long term? idk its up to you. I'd rather ski now while im young and deal with the other issues when the time comes
 
so I have a second surgery sometime in the next 2 years with another 6 month recovery period. I'll have more details around thanksgiving when I might get a date when I can ski. So I don't want to miss another summer by being on crutches, but of course I want to ride next winter. Should I do it late winter/early spring? or later?
 
turns out the second operation has a full six month recovery period. anyway, I was given the go ahead to ski, but was told pretty ambiguously that I should "avoid any impacts". Well, unfortunately thats most of skiing to me. how can I lessen the impact on rails and jumps? or am just going to be the filming bitch this season? any mount snow riders need a filmer?
 
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