patella lesion repair, microfracture & stem cell implant

[DreamRunner]

Hi all, I had an arthroscopy just over a week ago for a large, 2cm x 1.5cm grade ivb, osteochondral focal lesion on the articular surface of my right patella. The surgery record refers to the procedure as "scaffold augmented microfracture" and they also implanted stem cells taken from the bone marrow in my iliac crest in order to regrow the cartilage (if it is successful). They tidied and prepared the lesion, microfractured the exposed bone, then mixed the stem cells with collagen and fibrin glue and pasted this over the defect. pre-op I was given a 75% chance of success but this may have lowered now, as the actual defect was larger than first thought. The theory is that as the microfracture heals, the collagen and stem cells encourage the formation of new cartilage. Straight after the op I had an hour of CPM and was straight away allowed full weight bearing as pain allows but am needing to use crutches still due to pain & instability, and have to use a knee brace locked at 0 - 20 degrees for standing and walking. The procedure was performed by Professor Anan Shetty with Mr Ahmed assisting, at KIMS hospital in Maidstone where I was treated very well indeed and was allowed home the same day.
I am posting my progress here in case it helps anyone else with a similar condition and also to share the journey's ups and downs.
pain was quite bad the first few days but was not as bad as I had expected, I've had worse back pain in the past. Currently the knee is aching at times, is still a bit swollen and feels hot so am icing 3 or 4 times a day.
The biggest problem I am having is that the knee is completely unstable as the quads don't want to work. It's a problem that I had for the last five years and the knee was giving way when walking, and running and descending stairs in the usual manner, have been impossible. I wasn't expecting this level of instability afterwards though, it's currently much worse. I would not be able to stand or walk without the knee brace right now. I believe the quads won't engage due to the patella pain when I try to tense them. It wasn't a problem that was anticipated by the physio though, as he gave me a set of exercises which included straight leg raise and raising the foot with the towel under the knee - both which are impossible to do, at first the muscles were just going into spasm at any attempt to tighten the quads and now are still having spasms but are more jumping up and down as I try to tighten them, cutting in and out, has anyone else had this? Before the op I was able to do straight leg raises with heavy ankle weights no problem, it was just putting load onto the bending knee that was impossible. One thing that has pleased me already is that I can do the leg extension almost all the way, which has been impossible for five years due to the pain. Range of motion exercises are coming along well too. I'm seeing the physio in about a week's time. I would be very interested to hear if anyone else has had a similar procedure and how they got on  TTFN

[DreamRunner]

Just a mini update. I have been feeling really down the last few days and at times quite afraid that there was something else wrong with my knee that was causing the instability, which surely my physio or surgeons would've warned me about if it was expected?

The knee is still giving out as I walk, despite the heavy-duty locked knee brace and crutches. It 'slips' out as I try to put weight into it at anything beyond about 5 degrees, which is exactly the same as I have had over the last five years only now it's worse.
The giving way started when I was walking up a step (in 2012) and the knee very suddenly and forcefully gave way and buckled beneath me. straight away I had severe pain on trying to bend the knee and walking became extremely difficult - as difficult as it is now. I had a MRI and it was reported as osteochondritis on the articular surface of the patella, not OCD but 'healing' osteochondritis. I can only think that was the cause of the lesion which did not appear straight away, as I had thickened, hypertrophic cartilage and a 'cyst' within the bone on that area. The lesion with full thickness cartilage loss only showed up on last year's scan.

Anyway, I felt a little more cheerful and hopeful today when I managed to do some straight leg raises, although very wobbly ones, but it made me feel like I was making a little more progress because until now I have not been able to do these due to muscle spasms. Even on the morning of my surgery 11 days ago I was doing straight leg raises with 5kg ankle weights so I felt sure this difficulty couldn't be down to muscle weakness. I think it must be due to the area of damage on the patella which is relatively large, given the small size of my kneecaps. Professor Shetty said it was the largest (and deepest) of this type of lesion he has seen on a patella.
Anyway, I am feeling a little happier now for achieving this small step today, and my leg muscles feel a little more 'awake'. I have my first physio session in three days and have a follow up with the surgeon in four days so will update again after that

[DreamRunner]

Hi all,
just updating on my progress.  I had my first physiotherapy session this week. He's pleased with the progress I am making but said it will be a long process of trying to get the leg working again, it will be months as opposed to weeks of physio, which is pretty much what I was expecting given the level of dysfunction I have had for years now, being unable to do most exercise, even cycling and swimming were too painful, I couldn't even kick my shoes off! my vastus lateralis has gone completely and is hollowed in instead of curving out, my right (bad side) thigh had been 1 & 1/2 inches thinner than the other for years so I think it's going to take time to build that up, having said that I can feel that muscle is working again already, the day after surgery I noticed it felt sore and now realize that's because it's working again, it must have completely switched off due to the damage and pain. I had been able to do straight leg raises before so my VMO wasn't so bad.

Currently, my exercises are progressing still, the straight leg raise is still jumpy and wobbly, leg extensions are slowly strengthening but I have noticed there is a strong click in the kneecap as it passes a certain point and then it clicks again as I lower the leg back down. There is also some pain in the patella bone at the region of the defect when I do this exercise, which worries me in case it is damaging the repair.
I have now just about regained full ROM, which pleases me because it helps when turning in bed etc. I still have swelling but it's 50% improved since the first few days when it was like a grapefruit, I can now nearly see my kneecap again. I am getting quite a lot of stiffness too.

I also saw the surgeon this week. He told me it will take 18 months for the cartilage to fully regrow and that it should be 25% grown after 6 months (I think that's what he said). At 6 months, which will be around Christmas time, I will have another MRI and it's then that we'll see if the repair has worked and if it is re-growing. He also explained that the clicking is caused by the line around the edge of the repair and that it's common because it's not possible to get it perfectly smooth. I am guessing this may be permanent as the new cartilage will grow into the filler matrix and there will always be a 'join', I can live with it though, it's nothing compared to extreme pain and loss of mobility.  Best wishes to fellow stem-cellers! Will update again as things progress

[stevew4270]

Dreamrunner Fascinated buy this never knew it even existed!! Can I ask you please where are you and where did you get this surgery? Secondly I have lesion's on both the pack of the patella nd also the femur. Is it possible to get this treatment on  two surfaces opsite eachother ??

Cheers and great news, long may it continue!!

Thanks Steve

[stevew4270]

Sorry missed your location. I see it now, were you private or NHS please and can you get this treatment on the NHS or private only please?