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Author Topic: 5mm full cartilage defect  (Read 1810 times)

Offline Dibeedi

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5mm full cartilage defect
« on: April 08, 2010, 04:33:04 PM »
Hi there,

I'm hoping someone can give me some information about my MRI results and what they mean, am still waiting for an OS appointment and my GP was not much help.

I have problems with both knees, my right knee being the worse of the two, however the mri results concern me that it may actually be the left knee that is the worse of the two, but as i don't understand the mri results I'm not sure what my results mean

Left knee - degenerative changes at the patellofemeral joint with thinning of the articular cartilage and subchondral oedema. There is a 5mm full thickness cartilage defect of the medial patellar facet.

Right knee -  Minor degenerative changes at the patellofemeral joint with thinning of the articular cartilage and subchondral marrow oedema. There are degenerative changes affecting the lateral meniscus but no clear meniscal tear seen.

I would be grateful if someone could give me some information about what my results might mean.

Kind regards,

Di

Offline kscope09

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Re: 5mm full cartilage defect
« Reply #1 on: April 08, 2010, 04:52:48 PM »
Did your problems first start out with the left or the right.

I'm not too sure about the cartliage defect.  I wouldn't hve thought it would be too big to microfracture but since its on the patella I don't think you could have more than a chrondoplasty, so wether or not surgery is realistic I don't know.   You could have cortisone but that messes up your ligaments and tendons, I'd have to be really bad before I'd go near the stuff.  Synvic might do some good but it dones't work for everyone.

I'm sure there's plenty of people here who can help.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline KW

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Re: 5mm full cartilage defect
« Reply #2 on: April 08, 2010, 05:09:30 PM »
You could have cortisone but that messes up your ligaments and tendons, I'd have to be really bad before I'd go near the stuff. 

I'm not sure how accurate that statement is.  Cortisone injections in general are safe...I've had several in each knee and don't have "Messed Up" ligament or tendons.  My understanding is that the issues can occur with repeated long term use which increases the risk for side effects.

Karen
Right Knee
2000 - 2002 - Scope,LR,TTT,Unscrewed
01-10-12 - PFJR

Left Knee
04/07 TTT/LR
08/07 Bone Grth Stim
10/07 Loose/Bent Screw
1/08 Unscrewed/MRI~NON-UNION
02/19/08 Lt  TTT Revision W/Graft
12/09/08 Scope
05/15/09 Scope
09/04/09 PFJR/Unscrewed

Offline kscope09

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Re: 5mm full cartilage defect
« Reply #3 on: April 08, 2010, 05:27:23 PM »
Yes, OK long-term use of cortisone messes up ligaments and tendons and your probably alright if you never have more than one or two in your life but cortisone is just a quick fix and the people who use it have permenatn problems and only get very short relief.  4 is all you can have in a year.  I don't know how many in a lifetime though.  I suppose you'd be alright using ituntil your doctor say's you can't have any more.  I don't know about the rest of the wolrd but that is what happens on the nHS.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline mmrocker13

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Re: 5mm full cartilage defect
« Reply #4 on: April 08, 2010, 05:34:05 PM »
As far as articular cartilage damage goes, yes, the left knee is technically "worse", in that it has a full-thickness lesion. But "worse" can also man which bugs you more...and that doesn't always correlate with type/amount of damage.

As far as yoru other knee, you probably have some fraying/thinning of meniscus. You could also have a tear that they just can't see on the mri. Very possible. Only way to know for sure is  to go in and look. Your patellar AC seems to be thinning, but not gone. You have swelling in the bone below the cartilage.

Your lesion is fairly small, and in what sounds like a non-weight bearing area, so it should be fairly easily treated, if you want to.
89 (age 12): Pat. dislocation, lat. meniscus tear, femoral OCD lesion
89: debridement, chondroplasty, lateral partial menisectomy
02: partial lateral menisectomy, debridement
02: microfracture
09: subtotal menisectomy, debridement, c'plasty
10: scope/debridement
10: open wedge varus DFO
13: HWR

Offline crankerchick

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Re: 5mm full cartilage defect
« Reply #5 on: April 08, 2010, 06:46:34 PM »
Yes, there is someone else on this board, the name escapes me now, but they have a cartilage defect under the kneecap and it doesn't bother them at all. A cartilage defect is a localized area of cartilage damage and depending on where it is can affect how painful it is and how it can be "treated."

I think an important question for you to ask the OS when you meet with him is why the cartilage is thinning and/or defecting. Sometimes, there are bigger reasons for why the cartilage is wearing, such as poor tracking of the patella, then just degenerative changes over time. If there is a root reason causing the cartilage to wear, it's best to get at that reason and fix it and save what is left of your own cartilage.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline Lottiefox

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Re: 5mm full cartilage defect
« Reply #6 on: April 08, 2010, 06:47:56 PM »
Similar issues to my kneecaps - although I've now progressed to some larger full thickness defects.

The defect is small, and may have been there a long time and may never give you specific problems. Mine unfortunately are now large enough to be an issue with extending my kne against gravity and descending stairs. Microfracture is an option although on the patella it isn't great as there isn't a high blood supply. Smoothing the surrounding cartilage may allow the defect to stop getting irritated and calm things down. The other knee has thinning patella cartilage and some swelling underneath it. A possible meniscal issue which could be creating more pain than the patella thinning. Hard to know!

I'd also be inclined to ask WHY you have wear on the patella surfaces - are they tracking correctly, do they tilt, have you been upping something like running mileage and changed shoes or have incorrect shoes? The joints above and below the knee have a big part on how the knee slides and works, as does muscle strength. If nothing else I'd get a decent physio assessment of gait, strength, muscle balance etc and stop the wear getting any worse. That might help matters a lot.

Good luck

Lottie  :D
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline kscope09

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Re: 5mm full cartilage defect
« Reply #7 on: April 08, 2010, 06:56:00 PM »
Yes! I think Lottie is right a physio assessment would be a good idea.  Do you know if the knees are tracking correctly or not?  see if you can find out what is going on to wear down the cartliage.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline Dibeedi

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Re: 5mm full cartilage defect
« Reply #8 on: April 08, 2010, 11:16:58 PM »
Thankyou so much for your responses.

Up until about 2 years ago I used to do a lot of running, i stopped because of the pain in my right knee. If I rested it for a few months it would feel ok, but soon after running again it would be back to square one again. I was professionally fitted and wore correct running shoes and always stretched. I also did a variety of strengthening exercises for the quads, hams calves etc. Then through gym workouts the left knee started to become painful, though always quite mild compared to right knee.

Anyway to cut a long story short I have just got used to the pain being there and knew when to rest it and how far I felt I could push it, but now I can't do lunges, right knee doesnt feel strong enough to get me back up and left knee feels likes it could give way. I no longer can do leg extensions on the gym equipment  even with a very light weight and sometimes even hovering in the plank position puts pressure on the front of the knees behind the patellar. If I wear a heeled shoe I can't walk down the stairs unless it is sideways as my left knee feels painful and unpredictable. Even cycling is beginning to aggrevate things.

Do you think seeing a physio would be of benefit, as my doctor didn't seem to think so after I mentioned the exercises and stretches I already do.
Thanks again, Di
« Last Edit: April 08, 2010, 11:27:02 PM by Dibeedi »

Offline crankerchick

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Re: 5mm full cartilage defect
« Reply #9 on: April 08, 2010, 11:23:58 PM »
Seeing a physiotherapist will likely be a conservative measure your OS might recommend when you see him. It is important that you see an OS that specializes in knees and preferably has an interest in the patello-femoral joint. Some people find relief with strengthening the muscles around the knee, wearing a brace, and anti-inflammatory medicines.

It's a good idea to exhaust all the conservative options for before going the surgical route, and its important when deciding on surgery to see a knee specialist, preferably one that deals with kneecaps.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor