Pain Pain go away. Partial thickness defect?

[KneeZilla]

hey everybody just doing some fishing for information. Back in feb of this year I hit myself in the right knee with a pulp hook. Google image pulp hook and you will understand what I mean when I say F*!$^& OW. Anyway Had a scope got a grade 2 lesion from it. I was wondering if the cartilage under the surface of the grade 2 lesion was softened by the blow? seems likely. Anyway in pain still hard to walk around allot during the day if I want to keep the pain down. I know defects are better to treat earlier due to wear and tear. I was wondering if partial thickness defects are treatable via surgery. My concern is to fill the pothole before it creates extensive damage to the rest of the knee. Anybody know if something like ACI could be used to fill this defect? I'm pretty bummed about the concept of permanent pain but even more so about it getting worse. I just want to get this stabilized. Thanks for your help guys, appreciate any info.

PS

I lost my work due to my injury and don't have health insurance. I want this fixed anyway I wonder if the surgeons will go through with the surgery and maybe I can pay it off with a payment plan. Who knows. I'm 21 I just want to be able to walk down the street alright.... Thanks guys.

[Vickster]

Certainly here in the UK cartilage defects aren't treated with repair techniques until they are grade 4, or through to bone, not even grade 3.  The thinking being that it is not prudent to scrape away existing cartilage to exposethe bone to then try to cover it up again. 

These are also seriously expensive surgeries.

You'll need to talk to a surgeon about this really.  Good luck

[KneeZilla]

So let me get this straight. For ACI to happen it has to reach the subchondral bone? My guess is that it must have something to do with anchoring it? I'm not sure what to do. If i leave it alone it will ruin the surrounding cartilage but there is a huge risk of surgery.  That's life I suppose.

[Vickster]

Why will it ruin the surrounding cartilage?  Plenty of people for sure with one focal defect due to trauma and rest of knee is sound.  I have one defect on the femur, yes I have softening on the other surface of the tibia, but I am not perfectly aligned.  To my knowledge, the rest of the cartilage on the femur is ok (my injury was nearly 3 years ago)

You need to talk to a doctor about your specific circumstances - this is how it is the UK.  It may be down to cost partly - getting these surgeries done for free on the healthcare system is pretty tough (you may be looking at the equivalent of USD 30-50k)

I don't think you can stick an ACI patch over cartiilage, as you say it has to have clean bone beneath.  Cartilage itself has no nerves - it is perhaps unusual to have lots of pain due to softening with the subchondral bone intact

Have a read of this   http://www.kneeclinic.info/download/CKC_ACI_Information.pdf
and also the osteoarthritis section in the information hub

[KneeZilla]

Thanks for the pdf pretty informative. Yeah it says there they drill down to the bone. I saw this and thought maybe they can do it on partials.

http://www.ncbi.nlm.nih.gov/pubmed/21319216

Although I'm not a horse either..

[Vickster]

You will only get the complete answer from a surgeon who does ACI.  Personally, I wouldn't want to go through major surgery (2 operations indeed) and 2 years of heavy rehab (which you'll have to pay for if not insured presumably on top of the surgery costs) unless I was through to the bone, on the thinking that the defect may spread.  I do have a grade 4 focal defect that is currently filled with fibrocartilage - it is tender all the time, however while it is still liveable I am not going near more surgery.

If you have a lot of pain, why not try injections first - hyaluronic acid, cortisone, PRP?  The pain does not need to be permanent

[KneeZilla]

I guess i'm just so scared it will be permanent that I am looking at all the doomsday scenarios. Thanks for the motivation. I might even look into prp or iagh. I don't have a car and can't walk anywhere cause of my knees. It just makes it easy to feel like a caged animal  . At least I have kneeguru forums to vent on lol. Goodluck guys.