I had an autograft cartilage repair in January; similar but a slightly different surgery. I was on crutches and braced for 10 weeks. Recovery has been tough (especially through a pandemic). I was cleared to swim the week before pools shut down. That was tough because my PT and surgeon recommended starting to reintroduce walking in the pool. Cleared to bike 2 weeks after that - however turning the cranks was difficult at first. I think my first bike was 10 minutes and about 50 watts. It also took a while to be able to clip out my right foot. I do mostly trainer riding, so that wasn't a huge issue for me to leave my shoe clipped in. Cleared to run 6 months post surgery.

9 months post surgery I can say I am probably stronger than I ever have been biking (I have been really working on this) and probably the same pre-surgery swimming (probably more of an access issue). Running is coming along the slowest and it started badly. I could barely run :30 seconds at a time; I started :30 seconds run/1:00 min walk. After lots of frustration, patience and glute exercises (ugh), I am currently up to about 30 minutes continuously (I'd say about 1:00 per mile slower than my "normal" pace). I also do some run/walk intervals (ex. 3 min run, 2 min walk) and I can hit my pre-surgery "everyday" pace. I am finally starting to feel mostly normal again. Another thing to note, I have some knee pain for a few days after I step up in intensity. It goes away, but I definitely had a few freak outs. Happy to answer any additional questions - I know there isn't a lot of info out about this surgery!

A surgeon at the place I worked in Ontario (this was ~2011) did a technique similar to this but using your own cartilage ("autograft" as the poster above referred to). They would harvest cartilage from the outskirts of your knee (the part that's not weight-bearing) and use that to fill in holes in your weight-bearing cartilage. It was nice because it's your own cartilage so you didn't have the "this is a foreign body, attack it" immune response that can happen with donor tissues.

If I remember right it worked great for like a year but then the cartilage would wear down pretty fast, I would guess because it was not conditioned to sustaining the loads suddenly being placed on it. This was done typically in people with fairly advanced knee osteoarthritis, usually older, obese adults, not middle-aged super-fit triathletes; maybe results would be better in the latter group.

For donor cartilage you could take it from a weight-bearing part of the joint. Articular cartilage also typically doesn't have any connections to the nervous system or the circulatory system, so maybe the immune response issue isn't a big problem.

Definitely don't take my word as fact for any of this, I'm not a MD/surgeon/ortho, but might be worth asking your surgeon about the pros/cons of autograft vs. cadaver source.

That depends on several things, location, what's the damage etc. Talk to your doc.

A "repair" as in ,suture the meniscus back together, can be tricky because the blood supply to the meniscus is really small. Most of the time a meniscus isn't "repaired" its basically "shaved" where the tear is located.

10 weeks!

I’m curious if you get any swelling in your knee after you run or is it just pain?

I had cadaver implant in 2016, in conjunction with a tibial osteotomy and ACL repair. I got back to some racing in 2017, raced Nationals in 2018 and raced both IMLP and IMWC in 2019. I would say that it was successful, but the doctor felt that a future surgery (possibly knee replacement) and/or arthritic knee were possibilities. That said, I'd do it again in a heartbeat.

---

Pat Dwyer
@pdwyer99

Hi Tim,

I’ve never had cartilage repair, but I have had two knee surgeries (one unnecessary and which required a second surgery to fix thanks to scar tissue build up).

What I do know from my own experience and reading pretty extensively around this is that the rehab is very long, very delicate, and utterly essential to the success of the process.

There seem to be some great results out there, and I’m sure you’ll be one of them, but make sure you have a physio you trust lined up, and do the exercises religiously. And if you have any worries about the progress of your rehab, contact your surgeon immediately.

Good luck!

Will

Thank you!

Back in 2011 I had a bad case of Osteochondritis Dissecans. After a few bad surgeries with a surgeon that didn't recognize what was going on, I switched surgeons. I had to clear an infection from the previous surgeons work and have the measurements taken so I ended up receiving the cadaver graft at the beginning of 2013. Recovery was very, very slow. About 6 months post surgery or so I was cleared to start easy cycling and then weightlifting a few months after that. Keep in mind at this point, I could barely maintain 12 mph on a road bike. I have a distinct memory of a 75 year old cyclist passing me on a slight uphill because I had almost no muscle mass on either leg. At a year post op, the doc said that I could try jogging if I wanted to. In other words, no restrictions.


I ran in highschool, but never took it that seriously and never enjoyed it all that much. I would never train over the summers and then come into fall cross country season and injure myself because I never had any meaningful base. After crutching around my college campus for two years, unable to really be active in any meaningful way, it's safe to say that my perspective on running changed. My PT would often tell me that I shouldn't think about running again. That kind of irritated me, and I knew if I was going to run again that I would need to be really smart about it and that it couldn't be all that I did. So I started looking into triathlons and reading coaching books in my abundant free time.


On my way walking back from the gym one night I tried jogging about 400 meters. It felt fine but weird. I knew that I couldn't train myself in a safe manner, so I emailed the college's club triathlon team coach. I explained my situation, asked about any requirements to join the team, and asked about how much it would cost for him to coach me over the summer. I actually went back and looked at the slowest person's time to make nationals that year and wrote the times down on a sticky note as a goal. Safe to say I didn't hit that crazy goal, but quite a few 70.3's later, a ton of olympics and 30 mile running weeks, my knee is feeling better than ever.


I actually got an MRI two years ago to check up on my knee. Outside of the giant screw and some residual scar tissue, my knee looked relatively normal. The doc actually used the MRI as a case study. I'd keep in mind that I got the surgery when I was 20 years old so your mileage may vary. I also required a slight meniscus repair, but my surgeon mentioned something about how the long term efficacy of those relative to no surgery is surprisingly unclear. Not sure if thats still accurate, but it doesn't really matter if they are already going to be in there for the graft.


I'm not sure if my recovery is atypical, if I just had a really great surgeon or what but it certainly can work incredibly well. My initial recovery was worsened by the initial surgeries but I would still buckle in for a long road to recovery. You can't really take any shortcuts, and you're going to have to find something to keep you entertained. Mine was bodyweight exercises like the rings, a pull up bar, and boxing. Happy to answer any more questions about it, but I hope it goes well.

I do occasionally have a little swelling. Ice usually takes care of it. If it doesn’t go away, I’ll go to aspirin. I have stepped up to 4 run/walks per week the last 2-3 weeks and haven’t had to take any. I was told not to worry about a little swelling, only worry if my knee turns into the size of a cantaloupe (lol).

Also, my surgery went a bit farther than the poster before me stated that this surgery wears down in a year. I had a mix of stem cells, my cartilage scrapes and other stuff. I’m not sure how similar your’s was, but my surgeon (and hopefully your’s) is in full support of return to high level activity!

Try using these guys- they do the application down in Mexico and supposedly have high volumes of umbilical cord derived cells. Much more robust than anything available in the US.


https://stem-cells-mexico.com/stem-cell-therapy/

I had a scrape and microfracture done over a decade ago and I was back biking in just a few weeks and running maybe 3 months later. I was fortunate though that the amount of cartilage I had an issue with was very small. There is all kinds of new therapies coming - like the stem cell one previously mentioned that looks VERY promising. Whatever you get done hopefully you'll have a successful recovery.

@Laura - seeing your racing results posted in other posts look quite good - are you completely pain free? Do you know how big the area treated was?
I think you must have had some sort of minced cartilage like Arthrex Autocart / CAIS / paste grafting - but not stem cells (you may have confused this with chondrocytes). 1 step procedures aren't that many and none of them is like MACI/stem cell but usually some mincing of cartilage and reimplantation plus fibrin glue. All autologuous.

I do wonder you got back to running so quickly - and didn't mind the little swelling. I had a minced cartilage (Autocart) surgery 8 months ago (1.5cm² on lateral femoral condyle, 7cm² on medial femoral condyle) and so far did not try running yet - because it pretty quickly starts to hurt. I do everything else however that does not involve running or jumping on one leg.
I had been 25% weight bearing 2 weeks, 50% another 2 weeks, then slow increase to supposedly full weight bearing by week 7 - which I did not manage (been using one crutch from week 6 for short distances) and finally of crutches by week 9-10 or so - if carrying heavy backpack I think single crutch still in week 11 once or so.

I had been on a stationary bike in the 5. week and by the 6. week I managed to keep cycling for 50 minutes at 85w (however I guess the wattage was wrong and it was more 120w or so in reality). Then I had a 2 week hotel quarantine due to travel to Taiwan and by week 10 I instantly started biking much more. Within 1 week I started my first 80-90km rides including 1500m uphill. By 12. week I think I hit my first 100km ride and 2000m uphill as well as started riding out of the saddle more and more. 4.5 months past surgery I was hitting 3.9w/kg and had my first 200km/4000m uphill ride. 6 months post surgery I finally felt fine doing sprints and 15 sec max effort intervals and hitting up to 900w (65kg) and got 4.2w/kg. I had done some sprints from 4.5 months or so but limited them.

Stairs up had been possible from 3 month post op or so without crutches/handlebar or one on one - stairs down normally took like 4 months, but comfortable only after 4.5 months.

Hiking I had started on trails with handlerails on wooden logs and with hiking poles at 12 weeks post op or so - and it took me to the 4 month until I could do some longer trips with backpack. Downhill I heavily supported my leg with double hiking pole use - I did do quite a lot of bike and hike with like 100km cycling and 1000m up/down hikes from 4.5M post surgery. By 6.5 months past surgery I was finally able to do 500m downhill without hiking poles. Actually walking in the flat is my biggest problem - still limp a bit but it's hard to notice now. At 6 months post surgery also started kitesurfing on directional surfboard and slowly increased it. Took over 6 weeks till I could ride and not have to stop because of knee pain (and then afterwards hobbling over the beach to sit down and relax my knee). But still not feeling like I can run.

I still miss some muscle but my power balance is now mostly 47-48% / 53-52% according to Favero Assiomas. I do feel like I could run if I accept the pain (and actually I think it would not swell) - but so far if I did impact sports my knee would feel a bit worse the next day - and I tried to avoid anything that makes my knee feel worse next day. In some studies (though with ACI/MACI) it seems people who got back into impact sports before 12 months past surgery fared worse at the 2 year mark - so I kinda thought I may just wait til 1 year past surgery before I go running again in the flat - but think I may do some uphill mountain running next month (so 9 months post surgery). I never liked running much but did it for fitness. I do like trail running a lot or fast packing (so like 50-60km, 3000-4000m up/down days partly walking, partly running with 10kg backpack in remote places for a week or so).


Maybe I am too cautious? My doctor told me also way too little when to start - except don't do anything that still leaves the knee swollen the next morning or quickly hurts. Was thinking about trying BFR training to get my injured leg muscles fully back - because I cannot do really heavy loads for quads or so - or single leg quads even with body weight only from 90° knee angle not so good yet (I can do 2x my body weight on the leg press single leg however from 90° starting, hurts if I try more weight - in comparison to about 3x body weight from 90° with healthy leg). And yeah really sucks not being able to find much reference on when to do what. With MACI which is still the best resource for looking up progress and a similar surgery very few patients go running pre 9 months, many just start 1.5 years post surgery or never.

I had MRI done at 6 months post surgery with Mocart scores of 65/75 small/big damage which is really good for 6 months post surgery (like top 10 percentiles), and while the small site was more or less fully flush / the big side had only 75-80% filling in height yet (much better than 4w post surgery where the big side had a hole and wasn't anywhere near flush or so). But bone edema was similar to pre surgery - with edema under both surgery sites and this had not improved yet (vs 4w post and 3 months pre surgery). However this is quite normal I think because the edema will only start healing once the cartilage has not only reached full size but also hardened up and 6 months post surgery it is not anywhere near final hardness.


The problem with cartilage surgery recovery is - do too little and you don't nurture the cartilage - do too much and you may damage it or stop the growth. So I thought I postpone high impact sports while keeping high load of non impact sports like cycling and hiking - and now increase more on mid impact sports like kitesurfing and enduro mountainbiking (let's see how I feel about downhill next months - If I will hit some DH race tracks at enduro race pace, don't have a full DH bike anymore - only a 180/180mm enduro/mini-DH). I wrote much more detailled about my progress on the kneeguru forum (https://www.kneeguru.co.uk/...ex.php?topic=79546.0 - hope it*s okay to post that link - that forum was very active 10-15 years ago but kinda died down 5 years ago - still the best forum about cartilage problems).

Here is the surgery I had with my surgeon as an author: https://www.ncbi.nlm.nih.gov/...articles/PMC7029053/. I am about 2.5 years post surgery and I have very few issues. Sounds like we had similar recoveries - I was very conservative as well. I started running 6 months post surgery with 30 seconds at a time and walking 1 minute. It was painfully slow. Swimming helps a lot too - good fitness boost, no impact. Currently, the main issues I have are downhills hurt occasionally and occasionally my inner thigh muscle/band tightens and kind of pulls on the knee - I have to be diligent with stretching (which I am terrible at). We went to Hawaii in December and did quite a bit of hiking (I’d say easier hiking) but I seemed to do fine - I can still take a bad step here and there and feel it for a second.

That's a bit of a precursor to autocart. They skip the microrafture now, and also skip the bone marrow. It's chondrocytes not stem cells however.

Not sure if you really still had that method or already missing the bone marrow aspirate. Leaving out the microrafture is only done since 2.5 years or so I believe. Originally even when they termed it autocart they still had optional microrafture.


Well you started running at 6 months, even if only 30 seconds. I'm now 8.5 months and still not running. I could surely do it - ran in 70cm water already sometimes so my muscles still know how to do it. Just afraid and will wait out a bit longer and start with uphill running first.
For hiking however I started much earlier. Had some 1000m +- altitude hikes at 3.5 months and now would be fine with anything as long as my backpack isn't over 12-15kg.


Running after 6 months is actually very early. Very few people after cartilage surgeries start before 8-9 months, most around 12-18 months or never...
Actually what size was your damage and where? If your damage is on the smaller side it's much easier to come back. I rarely ever feel pain in my small repair site (around 2cm² vs 7cm² or so for the big lesion) but mainly at the place of the big lesion. I did have bone edema under both sites at 6 months post surgery in the MRI however (plus another edema on my tibia no clue why).

I honestly don’t remember the size of the hole - I remember him saying it was significant and twice the size he thought it was on the original MRI. It was on the medial femoral condyle. I probably have it in my paperwork somewhere…. He also said that he’s aggressive with return to exercise - so he cleared me at 6 months to run. I was able to swim at 3 months (he told me to walk without crutches for a week and then I could swim) but that was the week pools closed down d/t covid. He then allowed me to bike inside with little power and I had to leave my shoes clipped in - I could not unclip them. I think all recovery and return to exercise is very individualized. I found it frustrating there was no information about this surgery and return to exercise. I tried to keep tabs on what I did in case someone else needed it someday.

Yes the return to sports there is still no information. My recovery schedule by the doctor was for the first 12 weeks - then the comment I can do everything that does not make the knee feel worse the next day or significant swelling more or less.
My strange problem is that I have problems on full extension (while the damage is at 90° more or less) - and that's for my power too. So with running as you touch down pretty extended it's like I better wait.
After surgery I asked what about if I start running at 4 months - doctor answered the above solution too.

So I kinda followed the MACI instructions when it comes to running. I had problems with walking down steps for pretty long - while being fine to walk up / also double steps up and my cycling/hiking was very early return and high volume without probs (took me like only 2 weeks after getting onto my road bike at 9 weeks - so at 11 weeks to get smashing my pedals at 600w standing - just not doing any dedicate 30 seconds or less sprints - at 67kg). As for every surgery I had biking was allowed as soon as possible - I just followed the pain / swelling advice and just out of precaution avoided max effort short sprints (so yes I sprinted for red lights, but I did not try to really prepare for 30 secs intervals or similar mentally). Running is my only thing missing - but yeah many sports are attached to running.

When you read up the literature on Autocart the return to sports, IKDC scores and so on are all over the place. From some case playing basketball in 1. Spanish league after 6 months (basketball is one of the most dangerours sports for knee problems with soccer) to no running before 12 months.
I did not but think about BFR training. Might be a way to get my muscle balance fully back which I never achieved since my second ACL surgery over 15 years ago. whil

For MACI/ACI there were some studies which kinda claimed worse results if return to sports before 12 months - however their IKDC scores were so bogus that I think return to sports was interpreted very wildly by the participants (meaning the later returning to sports group still had IKDC scores below 80, which means no running is possible more or less) while the pre 12 months return to sports group said they were back to sports at even lower IKCD scores. All a big mystery. As I still had bone edema on my 6 months MRI I thought to push out running for a bit. Then however seeing kinda every knee cartilage surgery has best results with people dedicating their life to rehab and doing sports at more than 10 hours per week - it seems to be beneficial to go back early and aggressive.

Well I finally started running on the 10 months surgery anniversary. 900m at a slow pace - 9km/h or so. I do feel pain while running in the usual spot on my knee (2-3 out of 10). On the second day increased it to 1800m. My knee is not swelling and pain is gone instantly when I stop. However I feel next day now my knee is a tiny bit stiffer / less comfortable. Not sure if I should wait one more month or push through.
My reasoning is: I believe it's beneficial for the new cartilage to run - so it get's used to impact and hardens up a bit more. My reasoning against it is: I believe this may deteriote my bone marrow edema which likely still hasn't fully healed out. Also my running is a bit of hoppling along. Small strides with 160SPM.

However when I started kitesurfing after my first weeks when I got of the water I could barely walk - and now it's just fine. The knee needs to get used to some impact - otherwise it will never get back. I had planned to increase to 2700m today and keep that distance daily then for a few weeks. Maybe I will just keep 1800m now for a few weeks and see hot it evolves. I'm not taking any sorts of painkillers - just a whole load of food supplements that have study data backing them up (UC-2 Collagen, normal collagen powder 20g a day, Glucosamine 1800mg, Chondroitin 1200mg, MSM 1g, Vitamin D 4000IU only if I don't get much sun (so will start soon again - but skipped it over summer), 2x1g Niacinamide daily, 2x1g Omega 3 daily, Arginine also quite high dosed, Hyaluron with Zinc.) - Sometimes thinking if I should do a week or two weeks of Ibuprofen or Voltaren to see if it can end the bone edema - but so far not convinced. Thinking of looking for a doctor to get some PRP/ACP shots to speed up / improve recovery.

As running/jogging is the base for so many other sports I would like to do again - I really have to push through at some point. My knee is so strange vs most peoples - because my problem is with extension. At 90° angle I have full power and no pain whatsoever. So kitesurfing I don't feel ready for big jumps yet (did a couple 10m jumps when we had a stormy day lately) but my knee felt like it's not ready for the landings just yet. But yeah, hiking, trailrunning up or down, kitesurfing, supposedly snowboarding should all be fine for me. Just running in the flat is a PITA.