Which knee surgeon to see

[Samiul27]

Hi,

I've had knee issues since i was about 21 when I did in my ACL playing foot and have had 2 further operations since. I quit sports altogether about 6 years ago and recently I decided to play and thats when i got a tear in the posterior horn. But having recently had my MRI scan I've found out I've also got moderate and high grade chondromalacia of the lateral compartment and a Baker's cyst.

I am currently pain free as long as i dont run or twist and turn, i feel a slight crunch in my knee when sitting on the floor and getting up.

My local knee surgeon (DR CHAKARBARTY based in Huddersfield) said i will probably need a knee replacement sometime in the future, this has got me worried so I've decided to get a second opinion and what I can do to prolong my knee as much as possible.

I've made an appoint to see Dr Neil Bradbury https://www.neiltheknee.co.uk/ , is there anyone else that people could recommend to see.

Thanks
Imtiyaz

[vickster]

How old are you now?

Who you see will really depend on what course of action you require. Nothing surgical, maybe a partial knee at some point, an osteotomy to correct bow or knock knees, a physio to help with strength and conditioning, sports massage for tight muscles etc...if you don't have extensive arthritis throughout the knee and severe pain, swelling, loss of function, you're likely many years off a TKR. There are other options if the arthritis is just lateral at present even once it's bone on bone (if this is actually what high grade chondromalacia refers to, technically the term means softening not absent but some drs do use that term for cartilage loss...was there any mention of osteophytes or bone marrow or subchondral oedema?)

Indeed, a specialist physio might be a better option to make sure that your muscles are in good condition and supporting the knee as best they can. They may also be expert in bracing, if you only have arthritis on or side and loss of joint space a custom unloader brace might be helpful for walking, sport etc

Also, get your feet checked by a podiatrist, orthotics can make a big difference to gait and hence the knee

Another option might be injections of hyaluronic acid to lubricate the joint and settle inflammation. Not usually an option on the NHS and private insurers aren't keen on funding (at least Bupa isn't).

Given what you say about lack of pain and wanting to protect the knee, I wouldn't be seeing another surgeon at this point. If your local guy is a surgeon (Mr) why are you wanting to see another surgeon? In your shoes, I'd be looking at non surgical options and trying to avoid things that cause pain.

Is not really as simple as just seeing a different surgeon unless you need a specific surgical treatment where someone else might have more expertise.

There's good info around arthritis and treatments in the learning portfolio

Good luck

[Samiul27]

Im 36.

The posterior horn is whats giving me of the trouble can exercise much, causes significant pain. Hence ive been reluctant to go to a physio at the moment.

Walking up stairs is not a problem but i get cramp in.my hamstring (same leg as injured knee).

Wanted to gain a second opinion due for peace of mind, then will persue best course of action after meeting dr neil Bradbury on the 21st of this month

Thank you for detailed response.

[vickster]

Ah and the current surgeon is unwilling to trim the meniscus? Unfortunately, posterior horn tears are common in the arthritic knee and can come back even after menisectomy. If your knee is locked or giving way it might be worth getting it trimmed. See what the other guy says later in the month. How did you come to choose him if not local, recommendation? If so, no reason to see someone different if it's convenient

My hamstring cramps if I try to pull heel towards backside, stretching is the best way to deal with tight muscles, assuming there's no other medical reason for the cramping

[Samiul27]

Ah and the current surgeon is unwilling to trim the meniscus? Unfortunately, posterior horn tears are common in the arthritic knee and can come back even after menisectomy. If your knee is locked or giving way it might be worth getting it trimmed. See what the other guy says later in the month. How did you come to choose him if not local, recommendation? If so, no reason to see someone different if it's convenient

My hamstring cramps if I try to pull heel towards backside, stretching is the best way to deal with tight muscles, assuming there's no other medical reason for the cramping

The current surgeon said he will have a look inside and do a clean up. Ive had meniscus repairs done twice in the past. My knee doesnt lock up and on most occasions im pain free. But occasionally i get sharp pais on the side of the knee.

After some research on knee surgery developments i came across Dr Neil Bradbury, just want a second opinion on things.
Ive got an arthroscopy in July with current surgeon for clean up.

[vickster]

Sounds good. Keep us posted

[Samiul27]

Had the consultant today and he discussed my mri scan is thorough detail. Due to a little amount of my lateral meniscus being removed and slight wear in cartlidge he says it will be roughly 5-10 years when it will be very painful.
He recommended meniscus transplant and Chondrotissue Graft that would prolong the need for a full knee replacement.
He also said my leg was not straight and curved out. That would need be treated first.

meniscus transplant and Chondrotissue Graft he quoted 10-12k cost. (London price)

In the mean time im starting physio to get my posture right and build my quads.

[vickster]

So he's recommending an osteotomy, transplant and cartilage graft?. That's 3 big surgeries.

You might want to take a read of this diary, he had the transplant and an OATS cartilage repair in the midlands (no osteotomy though I think) by one of the foremost UK meniscus transplant surgeons

https://www.kneeguru.co.uk/KNEEtalk/htt ... ic.php?t=6

Good luck

[Samiul27]

So he's recommending an osteotomy, transplant and cartilage graft?. That's 3 big surgeries.

You might want to take a read of this diary, he had the transplant and an OATS cartilage repair in the midlands (no osteotomy though I think) by one of the foremost UK meniscus transplant surgeons

https://www.kneeguru.co.uk/KNEEtalk/htt ... ic.php?t=6

Good luck

That is a long recovery process..
Id have to quit work.
Does anyone know how much Dr Tim charges for the transplant

[vickster]

The OP of that post went privately, but I don't know if through insurance of self pay (the latter usually costs the patient more than the cost negotiated by insurers)

As for his cost, contact him for an appointment? I'm not sure if he does MACI anymore however if you're keen on cartilage repair

If you have any sort of physical job, driving or travel, I think you'd need at least 3 months off. Office job, maybe you'd get away with 2. Wouldn't be driving for at least 2-3 months due to bracing. Right or left knee?

[Samiul27]

Right knee.

Did you have hydoflast done, anyone in uk do that procedure?

[vickster]

Me? No I did recently have microfracture

Not heard of the thing you've mentioned, typo?

Right knee will keep you from driving longer as you need to be unbraced and able to do an emergency stop comfortable.

[Samiul27]

Me? No I did recently have microfracture

Not heard of the thing you've mentioned, typo?

Right knee will keep you from driving longer as you need to be unbraced and able to do an emergency stop comfortable.

Sorry typo its HYALOFAST.

So roughly 8-12 weeks sounds a reasonable time to get back to work.

Just really confused at the moment, thinking to wait as im in no pain at the moment, unless i run or sit cross legged on floor.

[vickster]

If that's the case, leave well alone especially major surgery, I would even avoid arthroscopy. Try cycling and swimming for exercise. I very much doubt you'd be able to run after any of the three procedures you're considering. Discuss recovery times and potential outcomes with the surgeon before making any decision

Ref Hyalofast, the manufacturer appears to have removed the info from their website...which doesn't bode well surely?

[Samiul27]

If that's the case, leave well alone especially major surgery, I would even avoid arthroscopy. Try cycling and swimming for exercise. I very much doubt you'd be able to run after any of the three procedures you're considering. Discuss recovery times and potential outcomes with the surgeon before making any decision

Ref Hyalofast, the manufacturer appears to have removed the info from their website...which doesn't bode well surely?

Yes my inclination is to wait but then in the back of my mind is that i want to prolong the need for a FKR, Dr Neil Bradbury said it should in theoy last for a while.

Its a two step procedure, one to straighten the leg and second to do the meniscus transplant and Chondrotissue Graft together.

This is the procedure, he sid say the lady is actually playing low level football again.

https://youtu.be/QNV8Gwah208

If i did go ahead the main issue for me would be able to afford the procedure.