The Super Whites The ordinary life of a Super Mum

The Super Whites
The knee

What follows is an extract from an email we sent to family this afternoon about our follow-up appointment at the Orthopaedic surgeon.

Ron’s arthroscopy showed a signifigant tear in the lateral meniscus, some loose chondral matter (cartilage) and in an unexpected and bad twist, signifigant deterioration of the hyaline articular cartilage known as a lesion of the lateral femoral condyle. The surgeon was able to remove the loose cartilage and repair the “bucket handle” tear of the lateral meniscus with 4 sutures. With regard to the articular cartilage the Dr took blood and healthy articular cartilage cells which have been sent to cultivate the cartilage for possible grafting or MACI – Matrix-Induced Autologous Chondrocyte Implantation. This is a relatively new prodedure for treating defects in the articular cartilage by filling them with regenerative tissue.

The Dr thinks Ron’s particular case is ideal for MACI cartilage grafting for various reasons, 1) Ron’s age, he is young enough to benefit from trying to preserve the integrity of his articular cartilage in order to avoid early onset oesteoarthritis and the possible need for a knee replacement before optimum age of 60. 2) the particular area or lesion is suitable for grafting because it has clear shoulders or margins and should take the graft. 3) the injury causing this damage was acute, in that it happened in an instant, was not related to a knock or a blow and the damage is signifigant.

Ron has to remain in the straight leg brace for a further two weeks, this is to try and ensure the repair of the meniscus has time to heal, as it was right in the middle of the meniscus, the Dr is not certain how effective the blood supply is to that particular area and so Ron needs to be very cautious in his rehabilitation to give the repair enough time to heal itself. In two weeks we go back to the surgeon who will then assess the movement in the knee and hopefully put Ron into a hinged brace so he can bend his knee to sit in the car or at his desk. Thereafter Ron can start light physio to help with the rehab and should be able to return to light exercise within a few weeks.

Ideally the Dr would prefer to perform the cartilage graft within 6-8 weeks of this arthroscopy giving Ron enough time to heal the wounds from Friday’s procedure. He has the standard two small holes where the arthroscope and surgical instrument went into his knee plus a 5cm stitched incision on the outside of the knee where the surgeon removed some healthy articular cartilage for the cultivation process. The Dr says that while Ron is resting and undergoing rehab from this procedure it would make sense to perform the other, more complicated grafting surgery as the recovery is more signifigant involving a few days in hospital, leg immobile in a full, straight brace for 2-3 months and limited movement after 3 months. But the timing is bad because we are going back to South Africa at Christmas so we can’t do the additional surgery before January which lengthens the recovery time for this whole process to minimum a year.

To make things even more complicated the Dr believes that Ron has a valgus deformity of his knee, or in other words he is knock-kneed. A valgus alignment shifts the load-bearing axis to the outside of the knee increasing the stress across the lateral/outer compartment of the knee and in order to optimise the results of the cartilage grafting, the Surgeon is suggesting he perform a particular type of surgery (I have forgotten the name for now but they are sending us some more info) where he breaks Ron’s femur above the knee joint and inserts a 5mm wedge designed to negate the effects of the valgus deformity allowing the articular cartilage graft the perfect environment to grow allowing Ron many more years before he starts to suffer from oesteoarthritis or require a knee replacement.

In the meantime we need to decide whether we proceed with the cartilage grafting and/or the surgery to correct the valgus deformity at some point early next year. Both these procedures can be done at the same time, the grafting cannot be done by arthroscope, it needs a longer incision hence the hospital stay and longer rehabilitation. Its all very overwhelming and hard to make sense of right now but we are doing our best to look to the future and be positive. Thankfully Ron’s job is in an office at a desk and even though the Surgeon has signed him off for a month, Ron will be able to go into the office for meetings and hopefully by the end of the week he will have been able to arrange the files and information he needs to be able to work from home.

As for me, well I just want my husband to be fixed and back to his usual self, unable to sit down for too long, eager to get into the garden and keep busy, happy with the odd game of golf with his mates. Although its very hard on me right now, I was relying on Ron’s help for some sleep training for Stella who is still waking twice a night for a feed, there is nothing I can do except follow Ron’s lead and be brave and optimistic. As Ron says, there is no reason why he can’t continue working from home a couple of days a week if it works and that means time for me. Having him around is lovely even though he can’t pick up Stella or carry anything, its great having adult company during the day and the time that Ron will get to spend with his girls over the coming months will be precious indeed!

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