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Author Topic: cartilage damage under kneecap  (Read 6839 times)

Offline shorthairptr

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cartilage damage under kneecap
« on: September 21, 2008, 03:57:45 AM »
I am 42 yr old male that is in good shape but due to recent back & knee problems I am not longer active in playing sports.  I have arthritis in my back and epidural injections have helped alot but about a year ago my back started going into bad spasms because my right knee was giving out.

What I mean by giving out is I would try to take a step and I would go right down to the floor because it felt like there was no knee.

After xrays & a mri the doctors discovered that a good chunk of cartilage under the kneecap was gone. He told me it just happens and the fact that I have always played sports its likely happened to me quicker.

The symptoms I have are:
  1) whenever I straighten out my right leg it makes a sound as if you are driving over gravel or rubbing sandpaper.
  2) often (not always) when I take a step the knee just gives out and I fall to the ground (as mentioned above)
  3) I can't jog at all and I especially cannot run at full speed. Whenever I push off I get a severe pain in my right knee as if bone is pushing on bone
  4) normal walking is painful and the same with walking up & down stairs. In order to go up & down stairs I have to push off with my left leg instead of my right one.

At first he sized me for a knee brace that I purchased in a local pharmacy. This helps ALOT. I can now walk (short distances only) normally without any pain and can walk up & down stairs with minimal pain.

Then he suggested injections. I am not sure of the type of injections I had but they were 5 weekly injections. He said after the 3rd one you should start feeling better. Well, thats not the case. I don't feel worse but I definitely do not feel any better. I am now back to wearing the knee brace

update 9/21/2008 - Hyalgan sodium hyaluronate injections

He then suggested surgery. He wants to clean out the area and a blood clot will form where the space where the cartilage has worn out. 

The problem is I never heard of this type of surgery nor have I read anything about it online.

HELP ME.. has anyone heard of this type of surgery? I would be having it next month if its legit..

thanks in advance
« Last Edit: September 22, 2008, 02:45:49 AM by shorthairptr »

Offline Pit Deputy

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Re: cartilage damage under kneecap
« Reply #1 on: September 21, 2008, 01:37:11 PM »
The injections you had were more than likely cortisone ones. They can be painful to have or at least they were in my case. They can help for a short period of time, but in the long run you will need to have that op the surgeon is talking about.

That nasty gratting sound is called Crepitus which is a medical term to describe the grating, crackling or popping sounds and sensations experienced inside the joints.

Only thing I can think of is; the surgeon is going to scrape undeneath the knee cap and drill bone to try and form some new cartilage. I had that done, but unfortunately I had to have the patella removed a couple years later.


Offline celinenj03

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Re: cartilage damage under kneecap
« Reply #2 on: September 21, 2008, 01:51:47 PM »
the procedure or surgery is called microfracture. if you decide on it, make sure you do your homework and pick the best surgeon in your area with lots of experience and lots of success with microfracture. i think these surgeries fail sometimes because of the protocol from the surgeon not the patient's fault. i think you sound like an excellent candidate for it. i also didn't want to settle for injections and wanted to get back to better quality of life so i had the microfracture done. my symptoms were similar to yours. i picked a doctor with lots of expertise and success with microfracture. i just had it done and the recovery so far is a piece of cake. only major bummer is crutches for 8 weeks. but i can already feel the area healing where i had raw pain before so i'm very hopeful. micro gives your body a chance to heal, something the inejections and anti inflamms don't give you. if u have more questions feel free to pm me or write me here, i'm happy to help.
Terrible Triad - 1/16/06 - Basketball
3/15/06 - Scope/Cleanout of to achieve full ROM
5/3/06 - Surgery-ACL Reconstruction-Allograft
9/12/07 - Large Loose body removed;Grade 4 Lesion on LFC
9/17/08-Microfracture, Lateral Release (all right knee)

Offline JustMeInNC

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Re: cartilage damage under kneecap
« Reply #3 on: September 21, 2008, 02:00:09 PM »
I have the same problem that you do (I am 36), the cartilage is almost completely gone from under my knee cap. I have the same problems that you do
1)knee grinding
2) knee giving out ( which is by far the worst) This can be helped by strengthening the Quad muscles. it doest really help mine cause my knee is giving out when it slides back into the groove that it is supposed to be in all along
3) i cant run or jog at all
4)normal walking is horrible and i cant do stairs at all (thank god i live in a one story house) and unlike you the brace does not help when walking (it does help when i go and ride my horse) in fact it makes the pain worse.

I am getting ready to try the injections but my OS told me that he does not hold out that much hope for me with as bad as my knees have gotten.

I have had 4 arthroscopic surgeries on my right knee where they went in and cleaned things up in there, I also had one done on the left knee.
Not sure if this is the same thing that he is talking about for you. but the first few times that they went in and did this it helped me quite a bit.
Now 4 months ago my doc went in with the intention to clean things up but found that there was a lot of damage in there and that my kneecap had misaligned itself again (i had a lateral release to put it back in place 12 years ago) so he had to redo that again. the pain is no better, i am not able to sleep most nights cause the pain is so bad. I can hardly walk to the mailbox (i have to deal with it)


I wish you the best of luck and hope that you get some positive results from the surgery.
I'm so busy that I'm not sure if I lost my horse or just found my lead rope.

1989 - Right Knee - don't rember what they did
1997 - Right Knee - Orthoscopic clean up again
2000 - LR on left knee
2001 - LR on right knee
2008 -LR on right knee (again)
9-18-2009 - Maquet osteotomy right knee

Offline ex-gymnast

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Re: cartilage damage under kneecap
« Reply #4 on: September 22, 2008, 01:04:19 AM »
A hint for staying active and helping your knee would be swimming.  I also have kneecap issues.  (I have bonespurs that they cannot remove.  I have already had them removed before and now do not have enough bone left for the op to be done again.)

Swimming strenghtens the muscle (and is non weight bearing.)  When you strenghten the muscles you will normally see a reduction in the amount of buckling in your knee.

This information came from my OS.  I know for a fact that I walk better when I have been in the pool.  (If you cant swim holding onto the edge of the pool and kicking does the same thing.)
If I knew I'd be like this now, I'd do it all again.
1998- Lf ACL replace (failed)
1998- Lf ACL replace (worked)
1998- Rt LR
1999- Rt Scope
2000- Rt ACL replace
2001- Rt hardware replace
2002- Rt Scar Tissue Removal
2005- Rt Pattella Scraped
2009- Rt clean-out the mess
To Come: 2 Replace

Offline shorthairptr

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Re: cartilage damage under kneecap
« Reply #5 on: September 22, 2008, 03:00:50 AM »
Thanks for your replies....

I updated my original post with the type of injections I had that did not work.

The doctor that I use is located in Cleveland Clinic (located in Florida) which is a top rated hospital.  I assume he is good because not only is he affiliated with a top notch hospital but his specialty is in arthroscopic surgery.

I did my own research and asked him about knee replacement but he told me that he only does arthroscopic surgery and if I wanted answers pertaining to knee replacement he would send me to another doctor.

I never heard of filling the gap left by the worn cartilage with a blood clot.

while he's inside he will also scope out and cleans the arthritic area..


Thanks for your input & keep them coming...!!!






Offline celinenj03

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Re: cartilage damage under kneecap
« Reply #6 on: September 22, 2008, 02:18:28 PM »
I'm no doc and I have no idea what your knee looks like in there, but micofracture is a procedure that could possibly save you from knee replacement. There is also another procedure called ACI which you may be a candidate for. These are salvage procedures and they are intended for younger active patients who are too young for total knee replacements. Just explore all your options like you are doing. Keep us posted of your progress.
Terrible Triad - 1/16/06 - Basketball
3/15/06 - Scope/Cleanout of to achieve full ROM
5/3/06 - Surgery-ACL Reconstruction-Allograft
9/12/07 - Large Loose body removed;Grade 4 Lesion on LFC
9/17/08-Microfracture, Lateral Release (all right knee)

Offline shorthairptr

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Re: cartilage damage under kneecap
« Reply #7 on: September 22, 2008, 06:55:49 PM »
I just researched ACI and not only is it very expensive but the recovery can take up to a year. I doubt my insurance would go for it.

However, it does sound like something my doctor mentioned. He said another type of surgery (if this does not work) is taken cartilage from another part of your leg and implant it into your knee.  This too requires a longer time of recovery but he said he'd only do this if surgery #1 does not do the trick.

dont forget he is a surgeon and gets paid only when he does surgery. Of course he'd approve a 2nd surgery instead of going right to the 2nd option.

like everyone says "you don't know how bad it is until he goes in and takes a look".

guess my 1st step is to have the arthroscopic surgery and let him go in and take a look to see how bad it really is..

Offline celinenj03

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Re: cartilage damage under kneecap
« Reply #8 on: September 23, 2008, 01:43:11 PM »
That's the way I approached it. My OS went in and found unfortunately that I had cartilage damage on the femur and some on the tibia and a tiny bit under my kneecap. The good news is he actually addressed and treated everything during that one operation. Some other docs might have just done what they were planning to do when they got in there. My doc wound up doing 3 additional things more than he thought he would have to do and I am so relieved because he saved me from additional problems and surgeries! So make sure you have a good plan, a great doc, and make sure you are both clear as to what he will do if he finds this or that... Good luck. In the longrun you will be okay, but it is a long road. I agree that microfracture is a good choice. If you think about it, no professional players here in the u.s. ever had ACI, they all get microfracture. If you rehab it right you have a great chance of making it work. But you have to be very patient. Any knee surgery takes 6 months to a year to feel the improvements to the fullest. Even a simple meniscal scope can take up to that long. Do it when you can fully devote yourself for a good 6 months...
Terrible Triad - 1/16/06 - Basketball
3/15/06 - Scope/Cleanout of to achieve full ROM
5/3/06 - Surgery-ACL Reconstruction-Allograft
9/12/07 - Large Loose body removed;Grade 4 Lesion on LFC
9/17/08-Microfracture, Lateral Release (all right knee)

Offline shorthairptr

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Re: cartilage damage under kneecap
« Reply #9 on: September 24, 2008, 04:02:03 AM »
That's the way I approached it. My OS went in and found unfortunately that I had cartilage damage on the femur and some on the tibia and a tiny bit under my kneecap. The good news is he actually addressed and treated everything during that one operation. Some other docs might have just done what they were planning to do when they got in there. My doc wound up doing 3 additional things more than he thought he would have to do and I am so relieved because he saved me from additional problems and surgeries! So make sure you have a good plan, a great doc, and make sure you are both clear as to what he will do if he finds this or that... Good luck. In the longrun you will be okay, but it is a long road. I agree that microfracture is a good choice. If you think about it, no professional players here in the u.s. ever had ACI, they all get microfracture. If you rehab it right you have a great chance of making it work. But you have to be very patient. Any knee surgery takes 6 months to a year to feel the improvements to the fullest. Even a simple meniscal scope can take up to that long. Do it when you can fully devote yourself for a good 6 months...

I got a 2nd opinion today and this doctor said the only thing left to do is surgery where they go in and clean out / scrape the arthritis from the bones.

After I heard this I called to make an appointment but of course the surgery coordinator was in meetings all day so it looks like I'll make the appointment tomorrow.

From what I was told the surgery will be approximately 1 hour. From that the recovery time depends on the patient. I should be walking in a day or 2 but because it is my right knee, I will not be allowed to drive for 2 weeks. Again, this is what I was told. I haven't heard anything about 6 months. I am staying with family during the recovery period because 1) i am single , 2) they live in a 1 level home, 3) they are retired, and 4) they live only 10 min from the hospital where I live an hour away. I wont be able to survive mentally if I have to stay there for anything longer then 1 month...lol

celinenj03 - my email address should be viewable if there is anything you need to tell me privately. However, I do like posting in the forum in case there is another person with similar problems and if he or she reads this, then it might help them too.

Thanks for your help... I always knew that I would eventually be needing this type of surgery so I always thought positive then anything else. Yes, surgery is always scary but the only thing that scared me is when the surgeon mentioned knee replacement. I wont go into that because I am thinking positive that this surgery will fix my needs and I can get back outdoors...



Offline shorthairptr

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Re: cartilage damage under kneecap
« Reply #10 on: October 12, 2008, 04:44:02 PM »
The surgeon does NOT believe surgery would work. That's odd because you would think that a surgeon would be for surgery considering he only gets paid to perform surgery.

Even though I had injections back in March of 2008 he wants to try a different injection. His comment was "some people choose Advil over Tylenol because it works for them. So, lets try a different type of injection to see if I have better results".

This past Friday (10/10/2008) I had the 3rd and final injection. I am not experiencing any pain but as per the surgeons requests, I need to test the knee to see what it can and cannot do.

I will keep you guys posted


Offline mccartjt

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Re: cartilage damage under kneecap
« Reply #11 on: November 06, 2008, 04:31:46 AM »
Hi All

I too am suffering from Retro patella damage. I am doing the Regenexx procedure. I am two weeks post my first injection. The jury is still out as far as I am concerned, however so far so good.   You can look up Regenexx on this site or Google it & go from there. Dr Joe Marroon had a bad knee & since his Regenexx procedure is back to competeing in the Hawaii Ironman Triathalons!  Surgery isn't always the solution. JM

Offline Linds

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Re: cartilage damage under kneecap
« Reply #12 on: November 06, 2008, 02:48:08 PM »
Quote
The surgeon does NOT believe surgery would work. That's odd because you would think that a surgeon would be for surgery considering he only gets paid to perform surgery

A Good surgeon won't do surgery just because that's what they get paid for, a GOOD surgeon will do surgery if he feels it will benefit the patient!

I to have similar problems to you, both kneecaps however have this problem, i'm 28 years old.

The microfracture and other procedures may help, but I just thought I would pipe up here and suggest you find a surgeon who specializes in PAtello Femoral problems and locate the actual cuase of the problem. It is most likely with the kind of damage you have to the cartilage on that knee that you have some sort of tracking problem... IF you don't address the cause of the damage, even having microfracture done will not work because there will still be wear and tear on this area. It's just something to consider, So far we haven't tried any cartilage salvage procedures on my knees because the cause of all the damage is yet to be satisfactorily corrected.

Are you in Physiotherapy? This may also be something to consider... they can help you to build muscle mass in a balance fasion, as you lose muscle mass (from lack of activity) the knee will likely just continue to detiorate..

Just some food for thought!

GOODLUCK
1997 Scope RK
2002 LR RK
2002 Scope and hematoma evac RK
2004 LR LK
May 06 Fall from Horse, partial ACL tear and meniscus injury, Tibial plateau injury
2007 Scope, Plica Excision and Debride LK
2009/2010- Possibly Ankylosing Spondylitis?

Offline hugo

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Re: cartilage damage under kneecap
« Reply #13 on: November 06, 2008, 03:14:47 PM »
I'm on the same boat I'm 27 and have grade 4 cartillage problems (down to the bone) underneath both kneecaps, a certain degree of dysplasia (flatter kneecaps), and very subtle or mild subluxations. I've had surgery which didn't resolve the cartilage issues. I had an LR and medial plicature.

In hindsight I'm not too sure it was the right thing for me. My doc's colleagues have told him not to touch my knees again. The plan now is physical therapy. The doc that did my surgery is of the opinion that surgery to recover cartilage underneath the kneecap have low success rates.

My advice is to see some top notch PFS specialist, hear their opinions and maybe take up a conservative course of physical therapy. And be patient, maybe you can get better, but it might not be a magic bullet that'll do it.

I also took up swimming like some here. I take it easy though...
« Last Edit: November 06, 2008, 03:18:32 PM by hugo »

Offline Heathers new knee

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Re: cartilage damage under kneecap
« Reply #14 on: November 07, 2008, 02:07:47 PM »
Hi!   ;D

I just received an opinion from a patellofemoral OS fortunately quite close to me. He did offer to look at my x-rays and responded. Both the patella and femur behind it and pretty rough and chewed up. He wants to do resurfacing. It's either that or a patellectomy... NO WAY!  :o

In your situation, I agree that contacting a PF specialist is your best bet. Sometimes they can just resurface the patella itself. Lots of articulation going on back there and I was also told that cartilage plugs and what not aren't great to use in that compartment. Good luck to you!!

Heather
5/07 Sev. comminuted,displaced L patella fx,ORIF,brace,crutches
7/07 PT
9/07 Hardware removal,MUA,crutches,PT
5/08 J brace,patellofemoral arthritis,PT
12/08 Appt w/ patella specialist: L-TTT,LR PFJR,scope,scar tissue debridement-1/26/09
8/09-RSD,PT
2/10-TTT screws removed,scar tissue debridement