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Should I Have A Meniscal Allograft or Arthrosurface?

Posted Oct 11 2009 10:00pm
I've enjoyed your blog for some time now and would appreciate your thoughts on my situation:
  • 51 years old and 10 years post right lateral meniscectomy.
  • Now with valgus deformity and bone on bone laterally.6'3" and at least 80lbs overweight (290).
  • Formerly tennis player and snowboarder now windsurfing is all that's still worth the "pain price".

Looking at osteotomy to correct valgus combined with "arthrosurface" partial knee vs  meniscal allograft. What has been your experience with regard to survival of the repair in these scenarios?

Thanks

Joh n


John, thanks for reading the View and for your question.

Just to bring everyone up to speed, I'll decipher the medical terms and John's situation first.

A meniscectomy is a surgical procedure that removes the meniscus - a crescent shaped cartilage in your knee whose purpose is to both provide some cushioning and stability. Research has shown that people who have had meniscectomies tend to develop arthritis more readily than those who have not had a meniscectomy so most surgeons now will try to save the meniscus by doing a repair or by removing as little as possible.

Valgus deformity is an alteration in the normal angle of the knee such that it angles inward. This Osteoarthritis2 is often referred to as "knock knees". The altered angle creates an abnormal stress through the joint and increases the wear on it.

An osteotomy is a surgical procedure that removes some of the bone from your knee to reduce the valgus deformity.

A meniscal allograft is a surgical procedure that uses a cadaver meniscus to replace the missing or damaged meniscus in your knee. This procedure is usually performed on younger people with a severely torn meniscus to prevent or retard arthritic changes in the knee. The cadaver tissue is sutured into place and you usually have about 12-18 months of recovery and modified activity while the tissue heals and becomes firmly entrenched.

Arthrosurface HemiCAP for the knee is a relatively new surgical procedure for people who have relatively focal joint surface damage (cartilage) and may not need or want a total knee replacement. Usually the patient has a relatively small area of cartilage damage. You can see a animated video if it here.

So, now that we have the basics in place, I'll tackle John's question.

Considering your weight, the valgus deformity in your knee, and likely the joint damage, I'm surprised that a meniscal allograft is a consideration and you're not facing just an allograft but an osteotomy as well. An osteotomy is a significant surgical procedure as is the allograft. Then, you'll have at least six months of rehab with at least about two months of that time on crutches. Because the graft is fragile, you'll not be able to exercise with much intensity which means you could gain weight unless you also adopt a weight reduction plan. So, then, you have two major things going on: recovery from two significant surgical procedures and altering your diet and lifestyle to reduce your weight.

I've not seen anyone following an Arthrosurface procedure. As far as I know there's only one surgeon in Austin who is trained in it. In theory, the recovery and rehab should be less than that for a total knee replacement but in your case, I'm not so sure. The osteotomy may delay the recovery time.

If you were my client, the first thing I would talk to you about is getting your weight down into a more ideal range. You can work on that now. For every pound you lose, you gain three pounds of force capacity in the knee. So, if you really are eighty lbs. over weight, your knee will feel considerably better with even just a twenty lb. weight loss without surgery or any other procedure. The most important part of the weight loss plan is your diet. Exercise can't overcome a bad diet unless you're in the elite, professional athlete class. Think of Michael Phelps. He can eat whatever he wants, right now, because his body churns through calories from hours of training. You'll need to take an honest look at your diet and make the adjustments. You may want to meet with a nutritionist to get some customized advice.

For your exercise, training in water could be a great starting point and depending on the drills, can be very demanding. I would use anti-gravity exercise tools to reduce the force going through your leg while increasing muscular demand and drills that require large muscle group activation. This would create a significant metabolic event, drive up your caloric expenditure, and make you feel better all at the same time.

So, at this point, here's what I suggest:

  • Get started on a weight reduction program.
  • Ask your surgeon why he or she thinks a mensical allograft would work and how many Arthrosurface procedures he or she has done.
  • Try to talk to some other people who have had an osteotomy to get an idea of what the procedure is like and what you feel like after it.
Again John, thanks for reading and your question. I hope things go well for you and that my post was helpful.

Image Source: www.zimmer.com

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