Sunday, March 21, 2010

An Examination of My Knee

On Dec. 8, 2009, I entered the Washington University/Barnes-Jewish Hosptial Surgical Center anticipating microfracture surgery as well as a repair to my medial meniscus. I had already undergone a repair to my lateral meniscus, as well as an ACL replacement, in June 2009. I did everything right in rehabbing my knee following that surgery. However, I overdid it in October 2009, when I was warming up for some upper body exercises by doing push-ups and some modified jumping jacks. Do not attempt jumping jacks--even modified ones--until your doctor approves! I thought I was safe four months out from surgery, but obviously I was not.

My knee swelled up like a balloon and an MRI revealed that I had torn my medial meniscus. My doctor drained 40 cc's of fluid from my knee and gave me a cortisone shot. He said the ACL allograft was still in tact but felt a bit loose. He told me I had options, but he wasn't excited about any of these options. He knew from the ACL surgery that there was a lot of damage to my articular cartilage. He told me, "I do a lot of knees, but I see one with this much damage about once every three years." I decided it was time to seek out a surgeon who sees my level of damage on a more regular basis.

My due diligence led me to Dr. Matthew J. Matava, whom I described in an earlier post. We discussed several options, including microfracture or knee replacement. He said I was pushing the age limit on microfracture, but I was about 20 years too young for a knee replacement. Ah, middle age. Still, he wanted to try microfracture first.

Upon examining my knee during that Dec. 8th arthroscopy, Dr. Matava determined that the lesions in my articular cartilage were too large for microfracture. He clipped the damaged meniscus, took precise measurements of the lesions, and removed two tic-tac sized pieces of cartilage to analyze. He reported that one lesion was "partial and full-thickness cartilage defect 30x20 mm." The other was 10x10 mm full-thickness defect of trochlea."

I awoke from surgery expecting to be on crutches for six weeks, recovering from microfracture. Instead, I was faced with another surgery. Dr. Matava recommended either an osteochondral allograft (cadaver implant) or an autologous chondrocyte impantation (ACI), also known as Carticel. My insurance company, Anthem Blue Cross/Blue Shield, denied coverage of the allograft, which it deemed "experimental." This procedure would have cost approximately $25,000. Carticel, at an estimated cost of $50,000 was approved. Go figure.

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