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emmae
04-09-2006, 07:01 PM
So I went to my knee surgeon, who has told me I have torn/worn the cartilage on the medial side of my knee and gave me a cortisone injection, said to call him in two weeks if it has not improved. Just wondering if anyone else has had this treatment for this injury and did it work, if so for how long. Kinda think he took the band-aid approach. Next stop MRI.
Thanks Emma

kjwilkin
04-09-2006, 09:07 PM
Hi there,

Imagine he's just taking the conservative approach. An operation is a big step and involves a reasonable bit of rehab.

According to my OS not everything will be picked up on the MRI.

Let us know how you get on.

Good luck !:)

emmae
04-09-2006, 11:18 PM
Hi kjwilkin,
already had surgery on the knee, lateral release and chrondroplasty. OS said he knew about the cartlidge and hoped it would hold, dont really want to have another op, but better than not being able to walk or grab knee every few steps. Anyway hope this works. OS said give it two weeks, Yay! fingers crossed
Will keep you posted

jellybean
05-09-2006, 08:07 AM
Hi Emma,

I'm not a medico, just someone with a messed up knee (so what I say may not be entirely correct, medically).

From my experience as a patient, the effectiveness of your cortisone shot may depend on whether the cartilage damage you have is to the articular cartilage (i.e. the cartilage that covers the ends of your bones) or the meniscus (the cartilage "shock absorber" that sits between the femur and tibia), or both. If it's articular damage (the cartilage that covers the ends of your bones is worn down), then the cortisone shot may help reduce the inflammation and relieve the pain (cortisone shots seem to be pretty commonly used for this but are only a bandaid - short term solution). If it's meniscal damage (torn cartilage), it's difficult to see it helping unless there's some associated inflammation (again I'm no medico). Probably why he said to call him in 2 weeks if it doesn't work.

I've just been in a similar situation (I have worn articular cartilage but also seem to have another meniscal tear and some other issues) and was given 2 options - try a cortisone shot first and then surgery if that doesn't work or go straight for the surgery. I also saw cortisone as a bandaid (I want a permanent solution) and couldn't see it fixing my biggest problem (inability to fully extend my leg) so I opted for immediate surgery. I was told by my OS that if I went the cortisone route first and it didn't help I'd have to wait 4 - 6 weeks after the shot before I could have surgery. (I know some anti-inflamm tablets can increase bleeding and make surgery more difficult and assume that cortisone has the same effect).

Go back to your surgeon if your knee is still bothering you.

Good luck!

JB

Syd Uni sports clinic
05-09-2006, 11:15 AM
Probably better injection option for worn articular cartilage is Hylan type injections which replenish joint fluid (e.g. Osteoartz, Synvisc, for example see: http://www.surgicalsynergies.com.au/index.asp?pgID=11 )

These are more expensive than cortisone (private health may cover part of the cost, but the drug itself is A$500 per course approx.). However, they are better for the knee long-term. For lining cartilage problems, cortisone has a role in giving short term pain relief if the short term is critical - e.g. patient heading on a once a year holiday and wants to enjoy extra movement in the knee. However, we know that cortisone eventually contributes to further knee degeneration in O/A.

emmae
05-09-2006, 05:42 PM
Hi JB
Thanks for the reply, i have articular cartilage damage on the medial side, will see what happens with the cortisone injections, thought it was a temporary fix, OS didnt give me a surgery option, said if this doesnt work, then MRI, although not sure that will show anything. said he really didnt want ot go in again, not sure why. I am guessing that eventually I will have to have surgery. How many cortisone shots can you have?
Emma

kjwilkin
05-09-2006, 10:20 PM
Hi JB
Thanks for the reply, i have articular cartilage damage on the medial side, will see what happens with the cortisone injections, thought it was a temporary fix, OS didnt give me a surgery option, said if this doesnt work, then MRI, although not sure that will show anything. said he really didnt want ot go in again, not sure why. I am guessing that eventually I will have to have surgery. How many cortisone shots can you have?
Emma

Hi Emma,

Interesting to hear you've already had a lateral release etc.

I think I may have articular cartilage damage in my left knee. Am trying anti-inflammatories for a few days. If that doesn't work I'll probably have a cortisone injection or some synvisc injections. My doctor had really good results with the synvisc when he worked in the UK. Am seeing my knee specialist in early November so will be interesting to see what he says.

Good luck with it all and let us know how you go.

jellybean
06-09-2006, 02:28 PM
Howdy,

Emma, I've got a few things going on in my knee - the damage to my articular cartilage (Grade 3 damage and a defect in the back of my patella and Grade 2 damage on medial femoral condyle) is only part of it and not the reason I was offered the surgery (that's to fix, I hope, other things).

My plan in dealing with my articular cartilage damage (O/A)(once I've had the next 'scope) is to look at a cortisone injection initially (I seem to have quite bad inflammation and anti-inflamms are not helping at all any more; apparently if you try the HA injections when you have severe inflammation you can actually aggravate the inflammation), then probably the HA injections that Dr J (I assume?) has mentioned above. I don't like cortisone at all and would rather use more natural products and, as mentioned above, cortisone can actually damage your articular cartilage if used repeatedly. In our discussion last week my OS told me that about 20% of his patients have had good relief from HA injections (he's used Synvisc) and have a course every one to two years (other people have no or a poor response to the injections). I'll give it a go even though I don't think my health insurance will cover it (I have cover for a "healthy young person" :D ). In the meantime I am using a glucosamine/chondroitin/MSM supplement plus fish oil tablets (am also going to see a naturopath friend about other things I can do nutrition wise) and am trying to keep as active as possible (swimming, walking, I was cycling but it is just annoying my knee at the moment - hopefully that is a temporary thing).

Your OS, assuming he has a good reputation, is the best person to tell you what's best for your knee - be prepared for your meetings with him, don't be afraid ask questions, and if you're not happy with how your knee is progressing be direct (in a polite way) - your OS is probably a bloke after all and sometimes they just don't get it unless you are very direct!! ;) . If you have an MRI - ensure that it's at a place that has an MRI with a strong magnet and top quality technicians and radiologists (it can be the difference between a crappy quality and good quality scan and report). If you're in Sydney I'd recommend Castlereagh Imaging in Crows Nest (part of North Sydney Orthopedic and Sports Medicine Clinic), I've had a few ultrasounds and MRIs over the last few years and they are by far the best I've experienced - very thorough both in their preparation for the scans and in their reports.

KJW - keen to hear what your OS says re the HA injections when you see him next!

'Hope that helped.

Take care all,

JB