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Author Topic: MRI - Patella problems - Help interpret?  (Read 741 times)

Offline Jordan1

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MRI - Patella problems - Help interpret?
« on: April 13, 2017, 02:55:08 PM »
Hi Everyone.

Severe Left knee pain for 3 years, that a Scope from 2015 wasn't able to fix.

2015 Scope: showed grade 3 and 4 changes on the retropatellar surface with loose articular cartilage flaps on the medial ridge extending over onto the lateral facet of the patella in the area of 1.5-2 cm. Those lose flaps were removed, but also found grade 2 changes in central trochlear region.

3/2017 MRI: showed significant cartilage thinning involving the medial patellar facet inferiorly near its junction to the patellar apex with concern for full-thickness cartilage fissures at the patellar apex.

My surgeon is concerned that because I don't have any stress reactions in my bone that this isn't what is causing my pain. But my wonder is...is all the damage mentioned above enough to cause a lot of pain and warrant another procedure? (Considering MACI procedure)

Left knee Mensicus repair 2005
Left knee ACL Reconstruction 2005
Right knee ACL reconstruction 2010
Right knee ACL reconstruction 2014
Left Knee Scope debridmt (for chronic pain) 2015
PRP Injections & Bone Marrow Stem cell injections to both knees - 2016
Left knee Chronic kneecap pain 2014 - present

Offline Vickster

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Re: MRI - Patella problems - Help interpret?
« Reply #1 on: April 13, 2017, 03:12:56 PM »
Has your alignment been fully checked by CT scan etc?

Before you go for any sort of cartilage repair, esp on the patella, you need to be 100% sure that it's all tracking and aligned perfectly or it may not take - you don't want 12-24 months of rehab when it has a low chance of success

Why are you looking at MACI and not the newer Cartiform if in the US?
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
LK New MRI shows lat & medial meniscus tear & other stuff
RK MRI lat meniscus tear
8/1/15 RK Steroid jab,
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation

Offline Jordan1

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Re: MRI - Patella problems - Help interpret?
« Reply #2 on: April 13, 2017, 03:35:33 PM »
Thanks for your response Vickster,

My alignment on all my x-rays looks good/everything is within normal range. Have not had a CT scan though - does that check alignment even further?

The surgeons I have gone to all suggested MACI over OATS because there is no bone reaction showing on my MRI. One doc said that if there was a significant bone reaction then he would recommend OATS over MACI, but since there is not and just appears to be cartilage damage they recommend MACI but can't guarantee it will fix the pain or work
Left knee Mensicus repair 2005
Left knee ACL Reconstruction 2005
Right knee ACL reconstruction 2010
Right knee ACL reconstruction 2014
Left Knee Scope debridmt (for chronic pain) 2015
PRP Injections & Bone Marrow Stem cell injections to both knees - 2016
Left knee Chronic kneecap pain 2014 - present

Offline Vickster

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Re: MRI - Patella problems - Help interpret?
« Reply #3 on: April 13, 2017, 03:40:26 PM »
CT scans are far more detailed than X rays and should be used to check patella alignment prior to major surgeries

What do you mean by bone reaction?  Bone Marrow oedema?  Osteophytes?  Subchondral cysts?  As would be indicators of arthritis?

Have you also had full blood tests to check for rheumatoid factors etc?

Are you seeing a knee surgeon specialised in the patella?

MACI really doesn't have great success for the patella and is a major and painful surgery with long rehab (indeed 2 surgeries are required)

Have a look around the boards for feedback, MACI started in the UK around 10 years ago I believe, so there should be some forum members with experience
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
LK New MRI shows lat & medial meniscus tear & other stuff
RK MRI lat meniscus tear
8/1/15 RK Steroid jab,
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation

Offline Jordan1

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Re: MRI - Patella problems - Help interpret?
« Reply #4 on: May 09, 2017, 05:18:17 PM »
Vickster,

Thanks for your reply! I?ve been busy following up with rheumatologists and pain management specialists. Negative for rheumatoid factors, CRPS, fibro etc. I'm curious as to if a CT or bone scan might be able to shed more light on my case.

They were looking for a bone stress reaction/ bone marrow edema and all 3 surgeons I have gotten opinions from specialize in cartilage restoration of the knee. The 1st recommended MACI, the 2nd said MACI or OATS depending on what the initial diagnostic scope showed, the 3rd recommended MACI but was hesitant because of the lack of a bone stress reactions.

Currently looking for more possible avenues or opinions. Reading the MACI boards it sounds rough and I would hate for it to fail or not fix the pain.
Left knee Mensicus repair 2005
Left knee ACL Reconstruction 2005
Right knee ACL reconstruction 2010
Right knee ACL reconstruction 2014
Left Knee Scope debridmt (for chronic pain) 2015
PRP Injections & Bone Marrow Stem cell injections to both knees - 2016
Left knee Chronic kneecap pain 2014 - present

Offline Vickster

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  • Posts: 3797
  • Liked: 264
  • Neelie knee!
Re: MRI - Patella problems - Help interpret?
« Reply #5 on: May 09, 2017, 05:34:22 PM »
Yep, think it would be 50/50 at best on the patella unfortunately

I had the scope with a view to have a MACI (didn't due to knock knees according to the surgeon and I wasn't prepared to have a DFO, he said <20% chance of the graft taking). 

Before he decided he wouldn't do it, the surgeon (a UK MACI expert, done loads, part of the big European trial) told me...a year to even feel half way normal and two to feel better, that's an approx 2cm2 weight bearing condyle defect

I dicussed OATS (autograft) with my usual surgeon before the MACI referral, he said that wouldn't work either due to the curvature of the bone where the defect sits (also that it was an old fashioned procedure and that was in 2010!!)

Arthritis is definitely the pits, I'll probably need a TKR in the next 10 years (I am mid 40s tho)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
LK New MRI shows lat & medial meniscus tear & other stuff
RK MRI lat meniscus tear
8/1/15 RK Steroid jab,
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation