Progress Report: 5 Weeks

So far, so good. The thing with cartilage repair is that activity advances soooo slowly, particularly in the early weeks, that it's hard to gauge your progress. The primary goal is to protect the graft site and regain some ROM. There are some real wins here though:

1. Minimal pain. My incision feels very tender. I have a little stiffness and achiness in the morning and at night, but true pain? None. Overall, my pain has been very manageable throughout this process. 
2. Hello VMO! I'm allowed to do a few quad sets in full extension. I've heard that a lot of folks can't get their VMO to fire for months. I was doing my mini quad sets last week and lo and behold, that little bugger fired!
3. Incision. My surgeon made an awfully big incision. It's about 5 inches, but they did close it cosmetically. It's long, but it healed up great and is a very fine (albeit purple) line. It's really a blessing that I've had no complications in that arena. I've started using a scar product called Bio-corneum. Like Mederma, it's silicone based, but it contains sunscreen. It's crazy expensive. I'll let you know how it goes. 
4. Purple leg. There's this crazy thing that happens when you stop bearing weight...your leg forgets how to send blood back to your heart. Normally, your calf muscle contracts when you walk and helps pump blood back to your heart. Since you're not using your calf much, the blood pools in that leg and it turns a delightful shade of Barney. And it hurts. No fun. The good news? This means you've done a GREAT job of staying off that leg and protecting your graft! If your doctor allows, calf/ankle pumps help a lot. Massaging your foot and calf also helps. I'm told this gets better when you advance to full WB status. 
5. Partial weight-bearing. In full extension only. This is going well. I started at 2 weeks. This also really helps with the "purple leg syndrome". One more week until I advance to full WB. Woohoo!
6. Pool. Ok, this isn't fair to pretty much anyone who lives north of Miami, but it's November and I can get in the pool. Oh joy! It feels so darned good. A surgeon I spoke with in Virginia recommended gentle pool exercises. That's going great. 
7. CPM. Still doing about 6 hours of CPM/day. I reached 90 degrees a week ago and I'm not allowed to advance for another week. So I'm just getting real comfortable at 90 for now. Wondering how the next 30 degrees will feel. Stay tuned. 
8. Sleep. This is still a little tough. It's hard to get comfortable and I find myself tossing and turning a bit. Started sleeping without the brace at 4 weeks. Follow your doctor's recommendations, but I wouldn't sleep without it for at least 4 weeks. 

The Injury and The Decision

On October 8, 2013, I became acutely (if unwillingly) aware of the value of articular cartilage. I sustained an injury to my left knee while walking across a dance floor. A stranger kneed me in the side of my knee and I fell to the floor (in fact passed out) in pain. Yes, really. A freak accident, to be sure.

Doctors appointments and imaging studies quickly followed and showed a 2 cm x 2 cm "chondral defect" (in other words, a big old HOLE) on the back of my patella. Essentially, the very tough cartilage on the back of my kneecap was chipped off down to the bone. The pieces of cartilage were floating around my knee. Naively, I thought, "They'll just take those pieces out and it will right up heal up!" No such luck. If you're over about 13, your cartilage does not regenerate. And it turns out that this cartilage on the back of your patella is pretty darned important. It protects the other surfaces in your knee. Without it, you're fairly quickly a candidate for a knee replacement. Thus began my odyssey into the tricky world of articular cartilage injuries. 

When the MRI results came back, the doctors used words like "tough injury", "not too many options", and "no guarantees". In fact, when I asked some direct questions about outcomes and prognosis, my surgeon actually shrugged his shoulders. But then he brought up....an option... 

Denovo NT is a relatively new option for cartilage repair. It consists of juvenile cartilage cells that are glued into the cartilage defect with fibrin glue. These cells are harvested from cadavers of children under 13. Macabre, yet a beautiful gift to be given if you happen to need them. The idea is that these young cells will regenerate and incorporate with your own remaining cartilage to ultimately fill the defect.

As this was really the only option presented, I elected to proceed, but not without caution. I am a healthy, active, young woman and a former athlete. I am also a nurse. I had a lot of questions. I kicked into high gear and sought out information from every available source. I spoke with the rep from Zimmer. I spoke with a surgeon in Virginia who has done many of these cases. I scoured the internet for data and reassurance. At the end of the day, I agree this was my best option. 

I had surgery on 10/21/2013 and am now a little more than 4 weeks post op. It is my intention to document my experience, my progress, and share any of my lessons learned in the hope of helping someone else in the same situation.