But the inside of my knee, on the femur, has a LOT of bare bone exposed. He showed me three or four photos of it. "Bare bone," he exclaimed. "That's bare bone, and that's bare bone!" (He gets a little excitable.)
"Well, just how much is 'a lot'?" I asked. He wouldn't elaborate. "Is it, for example, the size of a quarter?"
"Oh no, much more than a quarter."
"An acre?" I deliberately selected something unreasonable.
"Yes, an acre," he said unhelpfully. He showed me on a knee model sitting on the counter. "See how we've marked a few patches? If you combine all those patches, and then some."
I summarized. "So basically, all of it." All of it that comes in contact with the rest of the joint at any rate.
He took an x-ray of my knee, to make sure I didn't need a Steve Yzerman-like knee reconstructing osteotomy -- but my alignment wasn't bad enough to need it. whew! That basically involves breaking and realigning the bone, none of which sounds like fun.
So he said that the solution which (in his opinion) had the best chance of providing me with knee health is Carticel. I am a bit dubious of this though, because it's not used much (if at all) at U-M. I get the feeling it might kind of be his pet project. I've asked M to talk to doctors at U-M and see if other surgeons have different opinions or experiences.
He then said, if I were his sister, he would recommend the Carticel injections. When he went in there last week, he harvested some cartilage. All they have to do is grow it in a lab, and then stick it back in. Although they wouldn't just "stick it in" - they would in fact take a biological membrane, and stitch it to the good cartilage, making a little covered hole. Then he'd inject the cartilage into the pocket, where it would multiply, attach itself to the bone, and act like cartilage is supposed to act. Voila, new cushioning!
Then I asked him about recovery time, and he said it would involve two months on crutches. Two months! I asked about success rate, and he said around 80%. But then I looked at the online literature, and they say that needing an additional arthroscopic procedure is common, perhaps as much as 50% common! Ack.
So this is what he is advocating, but he said I should go home, read the literature, see how my knee feels when it's fully healed, and make my decision from there.
He said that the cells are good for five years, but by that time my knee will probably have deteriorated enough that I'll no longer be a candidate. He said I was likely to only be a candidate for a year, maybe two. It is his opinion that the cartilage will deteriorate further, to a state when it can't be repaired with Carticel.
I was fairly discouraged. Reading about it online, it looks like a LOOONG recovery period. Like as long as my first ACL took, maybe longer. Practically a year of my life. I don't really want to do that. But I'd like a nicely functioning knee.
He kept stating, "You're 37, not 47. We need to buy you more time." A statement which left me with the uncomfortable impression that when I am 47 or 50 he sees himself giving me a new knee. Or maybe just a partial knee replacement. Either way, another big nasty surgery.
I'm not sure if he's just too gung-ho about cutting up my knee, or if this is reasonable given what he found inside? M's ideas of surgery and recovery seemed much more conservative when we spoke earlier -- like he thought the surgery I just had should last 15 years or something. I've asked M to talk to some of the docs he works with, and get their opinions on Carticel and stuff.
Anyway I'm discouraged right now, but really no decisions need to be made until a few months from now. Once it fully heals from the scope, and once I start using it for day-to-day activities. Once I try some skating and other more aggressive sports, then I'll know if I've achieved any pain reduction, and if so if it's enough.
For now it's all speculation, and thus not particularly helpful.
On the plus side, I got my stitches out -- YAY! Plus, when I got home I found a big box of flowers sitting on my porch!! They were sent from my ex-employer, "Wishing you a speedy recovery, -The Xede Family" How wonderful and kind, especially given my resignation! It made me feel guilty and warm and fuzzy at the same time. They smell lovely. I sent them a very nice thank-you email.