What’s Next?

I left off my story when I had run out of non-surgical options and was forced to consider more specialty procedures, and was specifically looking at ACI. My surgeon, who had performed the MFX, did not perform ACI, so I sought out Dr. Trice.

By the time I got to him, I was in an awful lot of pain. I had been forced to start taking Tramadol again (a non-narcotic prescription painkiller) and it was making me very confused. It seems I always get the “messed-up head” side effect. This was truly a bad time. It didn't take Dr. Trice long to classify me as a failed microfracture.

ACI requires two surgeries and we scheduled the first for September 23rd, 2009. The purpose of this relatively minor first surgery was to see what was going on in my knee and also to perform the cartilage biopsy, so we would have a sample to grow in the lab. Actually trying to fix my knee was not a goal of this surgery. So unfortunately, when it was over and I had healed, I was in as much pain as before. Bad times.

Dr. Trice found that the microfracture had actually been somewhat successful in forming fibrocartilage over the worst of the damaged area. At least I got a little vindication since it showed that I had followed the rehab instructions to a T! However, there was an area of about the same size next to it where the cartilage was soft and squishy and that appeared to be the source of the pain. Here are some pictures which I will give a gross rating of 3. (Picture 1 and Picture 2)

At this point I went to a pain management doctor since things were getting way out of control. He gave me four things to try together: a different pain medication, an anti-inflammatory, a goop that is used externally, and a new short hinged brace. The anti-inflammatory made me really ill, so I was only on that for a few days. It turned out that it was good that I stopped that. Dr. Trice didn't want me on an anti-inflammatory since apparently it can interfere with bone growth. That was definitely a lesson learned.

The other three things improved the situation enough that I could return to work (at least from home) and not be quite so miserable. Having the right tools to manage the pain can make a huge difference, but it isn't the same thing as healing.

At my next appointment with Dr Trice, I was doing better but of course was still experiencing pain. Dr. Trice was beginning to worry whether ACI would even be able to provide sufficient relief to make it worth the recovery. He wanted me to try a custom unloader brace. This specialty brace takes the weight off the damaged side of the knee and redirects the load to the good side. If it provided relief, then we know that the identified defect is the source of the pain and that would be an encouraging sign.