Advertisement - Hide this advert





Author Topic: Patella Cartilage damage - what is next? (MRI Pictures - page 2)  (Read 2716 times)

Offline reflex_nl

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 5
Hi all,

I already suffer for 10 mths from grade 4 patella cartilage damage. They have done a scope to remove the loose fragments and shave the cartilage. In the last couple of months I visited four OS's with a lot of cartilage experience in the region since I'm not improving on my knee.

Status today:
No pain at night, mild pain during the day, getting worse if more active during the day. I can walk and cycle but not intense. I can stand for 2 hours but not pain free. I cannot do any (light) sports. The knee has a bit of swelling and is sometimes a bit warmer after exercise (details: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=68466.0)

Recommendations:
  • OS 1 (Falke - NL): Grade 4 damage, no mall alignment: do nothing, wait and see, let it "heal" and light PT, let's see later for new options
  • OS 2 (Claes - BE): Grade 4 damage, mall alignment: do micro fracturing on patella and a lateral release
  • OS 3 (Lagast - BE): Grade 4 damage, some mall alignment: need new MRI, maybe bio implant, but low successrate on patella
  • OS 4 (Mortele - BE): Grade 4 damage, no mall alignment: OATS needed asap (Osteochondral Autograft Transplantation Surgery) required, if not condition will worsen significantly over the next year.

I'm a but clueless now... they are not in alignment on the issue and I worry the condition of my knee can worsen. In my country or in Germany/Belgium, they don't offer Denovo NT or (M)ACI and I don't believe in micro facturing or MACI for the patella (read a lot of articles on this).

I'm also hesitated to go the OATS route...  even though the OS gives it a good chance of success. I read good stories on Denovo on the patella, but it is far way any really expensive... :(

Any advice/help welcome!
« Last Edit: September 11, 2017, 08:47:40 PM by reflex_nl »
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline Vickster

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 3946
  • Liked: 289
  • Neelie knee!
Re: Patella Cartilage damage - what is next?
« Reply #1 on: August 03, 2017, 11:57:50 AM »
Have you read this diary? There's a surgeon in Kent, UK doing some new treatment for cartilage repair. Just a short hop across the Channel

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=69426.0

Might be worth a private consultation
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 reflex_nl

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 5
Re: Patella Cartilage damage - what is next?
« Reply #2 on: August 04, 2017, 08:43:01 AM »
Thanks - I will give this a try as well....
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline Brandon123

  • Forum Faithful
  • ****
  • Posts: 275
  • Liked: 18
Re: Patella Cartilage damage - what is next?
« Reply #3 on: August 04, 2017, 09:02:29 AM »
It is frustrating that there is no standardized proven treatment for patella cartilage damage, and everything depends so much on your specific case, and the opinions of different OS. Just wanted to add that I have received the same recommendations as your OS 1 and 2. And my "OS 1" said DO NOT go the "OS 2 route", as micro fracturing and lateral release according to him is old school thinking. So you should probably avoid that one at least!

My OS 1 also says that it is critical what type of cartilage damage we are talking about. In my case, for example, the damage it is quite evenly spread under the patella, kind of like arthritis and hence difficult to fix with any of the above mentioned procedures. If I recall correctly, however, wasn't your damage more localized at one spot? 
« Last Edit: August 04, 2017, 09:20:08 AM by Brandon123 »
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline reflex_nl

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 5
Re: Patella Cartilage damage - what is next?
« Reply #4 on: August 06, 2017, 08:15:42 PM »
yes it is.... knee problems are already complicated and now even the OS's are not in alignment. Indeed I will skip MF and LR, but still need to get rid of pain. Some pro NBA's did OATS, which some success.

My damage is indeed "focal" one spot, but fairly large... :(

For your issue I would try PRP or stemcells.
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline Brandon123

  • Forum Faithful
  • ****
  • Posts: 275
  • Liked: 18
Re: Patella Cartilage damage - what is next?
« Reply #5 on: August 07, 2017, 03:58:49 PM »
Yes, I have actually been thinking of PRP and stem cells, but it is very expensive (at least stem cells) and there seems to be very limited scientific evidence for these procedures regarding chondromalacia/arthritis. On the other hand, I am getting desperate, so let's see:)

In your case, the options seem to be OS 1 route or OS 4 route. Do you see any improvement at all? If so, I would probably try to be patient and give it some more time. If there is no improvement whatsoever, I think you should check if there are any studies on the success rate of OATS for patella cartilage damage. As we know, the patella cartilage is always difficult to fix:/ Also, before considering actually doing an OATS, I think you should get at least one more OS (old or new) to support that procedure in your case.

Denovo is difficult and expensive of course, but maybe your very very last option?     

RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline SuspectDevice

  • Forum Faithful
  • ****
  • Posts: 180
  • Liked: 22
Re: Patella Cartilage damage - what is next?
« Reply #6 on: August 08, 2017, 01:55:44 AM »
I agree with Brandon

Re OS 4 - why will the condition worsen significantly?  I'd suggest that with the right amount of gentle movement and rest, it may actually improve?  Though perhaps there are things you have to do which are unavoidable (e.g. work activities) which is why OS4 says it will worsen.

[email protected] you want to avoid like the plague - I got told that lateral release crap too, even though my kneecaps were pretty well aligned.  Those blokes should be booted out of the profession, charged with medical negligence.

The problem might be that they have already done the dreaded patella shave (which I believe has been shown to be worthless, or in fact make things worse), so maybe you have a long time of really careful activity needed to let the cartilage heal....and there is plenty of evidence patella cartilage can heal, but it needs time and patience (years?)
L Medial menisectomy May 2012
PFPS in both knees ever since
Pre-CRPS diagnosed 2014
Also looking into Dr Scott Dye's Tissue Homeostasis & Envelope of Function work
2017 - 80+% cured thanks to Dr Dye's research
2017 - first small triathlon in 5yrs
2017 - back to 30% of training volume - that'll do!

Offline reflex_nl

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 5
Re: Patella Cartilage damage - what is next?
« Reply #7 on: August 09, 2017, 07:15:07 PM »
Hi Guys,

Thanks for the replies. Indeed I first await my new MRI and find at least other supporters before heading into surgery. The patella remains a difficult item to treat and what if it fails...  no clue what options I have left. MF and LR are no options.... and my do more damage.

To be honest, they had to remove the loose bodies in my knee and shave it a bit, otherwise other cartilage can break off and get stuck in your knee. I hope they didn't remove too much...

The other risk I foresee is being in pain and inactive for x year and than still go into surgery. I'm not sure if it will worsen over time by just doing daily life stuff; have you heard or read this before?
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline SuspectDevice

  • Forum Faithful
  • ****
  • Posts: 180
  • Liked: 22
Re: Patella Cartilage damage - what is next?
« Reply #8 on: August 10, 2017, 06:15:06 AM »
Hi Guys,

Thanks for the replies. Indeed I first await my new MRI and find at least other supporters before heading into surgery. The patella remains a difficult item to treat and what if it fails...  no clue what options I have left. MF and LR are no options.... and my do more damage.

To be honest, they had to remove the loose bodies in my knee and shave it a bit, otherwise other cartilage can break off and get stuck in your knee. I hope they didn't remove too much...

The other risk I foresee is being in pain and inactive for x year and than still go into surgery. I'm not sure if it will worsen over time by just doing daily life stuff; have you heard or read this before?

Yes, mine definitely got worse with daily life stuff.  We had a large treed garden that took lots of regular maintenance.  We sold that house and got a smaller block with an easy care garden + a ride-on mower to take the strain of my knees. Also, I could not squat or crouch for about 4yrs. I also tried to avoid stairs (not always possible) and other things which aggravated including most of my sporting activities (triathlon, cycling, running, leg weights, kicking while swimming).  It was some serious activity modification, though nothing like Richard Bedard and even all that was not enough - I needed the Celebrex to take me into the real recovery zone. 5 yrs it took me, but I made 90% of the gains in the last 4-5mths on Celebrex.  That reduced my pain levels enough to start doing some real leg strengthening, which took the load off my knees and hence into a more positive spiral.
L Medial menisectomy May 2012
PFPS in both knees ever since
Pre-CRPS diagnosed 2014
Also looking into Dr Scott Dye's Tissue Homeostasis & Envelope of Function work
2017 - 80+% cured thanks to Dr Dye's research
2017 - first small triathlon in 5yrs
2017 - back to 30% of training volume - that'll do!

Offline Geronimo

  • MINIgeek (20-50 posts)
  • **
  • Posts: 31
  • Liked: 4
Re: Patella Cartilage damage - what is next?
« Reply #9 on: August 10, 2017, 06:26:09 AM »
this sounds weird but walking and hiking actually helps and i feel myself much better when i do that a lot. light cycling helps too. i've forgotten about sports since my issues kicked in and am just happy to be able to move in this world without huge amounts of pain. the only thing which made me much worse is full squat I did yesterday while trying to fix my boat. immediately got worse 3 times :( that's what I forget: as soon as you get better you should still remember to avoid activities which put you back. staying at home and doing nothing doesn't help at all.

i've been doing some heavy lifting trying to move my inflatable boat here and there and despite my expectations to flare up right away I actually felt better, but I tried to bend my knees as less as possible.

i'm now waiting what happens after my surgery when I'm fully healed (5 weeks post op and still have soft tissue pain which is almost gone though) and then will look into carticel option as this seem to be the best way to restore cartilage this days.

Offline Brandon123

  • Forum Faithful
  • ****
  • Posts: 275
  • Liked: 18
Re: Patella Cartilage damage - what is next?
« Reply #10 on: August 12, 2017, 03:39:36 PM »
The other risk I foresee is being in pain and inactive for x year and than still go into surgery.

I'm also a bit afraid of this as I can see how my muscles, general health, and everything are slowly getting worse by this inactive lifestyle. The thing keeping me from having a surgery is of course that there are no really good surgical options for me. I would love if they could just go in and easily "fix" this bad cartilage :)

When will you have your new MRI? Please let us know what it said. I'm also considering doing a new one in a few months, it was over 2 years ago I had my last one done.
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline Geronimo

  • MINIgeek (20-50 posts)
  • **
  • Posts: 31
  • Liked: 4
Re: Patella Cartilage damage - what is next?
« Reply #11 on: August 16, 2017, 06:24:20 PM »
you have to find activities which don't aggravate your condition and stick to them, otherwise things will get worse. i tried rest 10 times already and it never made me feel better. now I try to walk as much as possible, use exercise bike with lowest setting at home, hike, boating etc. no running, basketball and all the stuff i used to like so much of course >:( but looking at other scenarios i'm pretty happy i can walk without pain at all.

Offline reflex_nl

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 5
Re: Patella Cartilage damage - what is next?
« Reply #12 on: August 16, 2017, 09:58:35 PM »
I believe that if you don't use it you lose it... but indeed becarefull not to overdo. The question is what state would you consider surgery or other more invasive procedures... hard to get a answer on this.

Still awating my new mri report
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline Geronimo

  • MINIgeek (20-50 posts)
  • **
  • Posts: 31
  • Liked: 4
Re: Patella Cartilage damage - what is next?
« Reply #13 on: August 17, 2017, 08:29:40 PM »
if you are in lots of pain there is not much to lose in my opinion. as said before, cartiflex seems to be the only option after arthroscopy has failed. you can continue with PT but honestly for me it only made things worse.

Offline reflex_nl

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 5
Re: Patella Cartilage damage - what is next?
« Reply #14 on: August 17, 2017, 08:59:43 PM »
Thanks for the help. Pain is a 2 out of 10 in daily life and gets to a 4 or 5 after being active...
Do you mean cartifill? on what basis do you believe in this procedure?
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline Brandon123

  • Forum Faithful
  • ****
  • Posts: 275
  • Liked: 18
Re: Patella Cartilage damage - what is next?
« Reply #15 on: August 18, 2017, 08:57:28 AM »
Cartiflex seems to be some kind of supplement...do you take this, Geronimo?

http://qualityoflife.net/product/211/Cartiflex%C2%AE.html

Regarding supplements, I have tried glucosamine and chondroitin over long periods of time with minimal results.
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline Geronimo

  • MINIgeek (20-50 posts)
  • **
  • Posts: 31
  • Liked: 4
Re: Patella Cartilage damage - what is next?
« Reply #16 on: August 19, 2017, 05:33:14 AM »
lol...too many words... i meant cartiform.

Offline Brandon123

  • Forum Faithful
  • ****
  • Posts: 275
  • Liked: 18
Re: Patella Cartilage damage - what is next?
« Reply #17 on: August 19, 2017, 09:29:11 AM »
OK :D
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline reflex_nl

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 5
Re: Patella Cartilage damage - what is next? + Pictures (p2)
« Reply #18 on: September 11, 2017, 08:45:48 PM »
Just got feedback on my new MRI (and x-rays) this new MRI is taken 10 mth post operation. The only thing they did was debridement aka shaving the cartilage under the knee cap in Nov'16.

The conclusions were as follows:
1) limited to no cartilage regrowth in the lesion (as expected :()
2) 2 small osteophytes formed in the lesion (bad news)
3) No more bone bruises at the ligaments (ok news)
4) slight patella alta (already known)
5) very slight mall-tracking (lateral) (already known)
6) Some MPFL avulsion (new for me)
7) Other knee items intact (e.g ACL, Meniscus, MCL) (already known)

The big question is what to do next.... here in the Netherlands they cannot do anything (except for Microfacture or a new knee replacement), both awful solutions to my problem. They strongly advice against OATS (autograft) on the patella, and from most studies that I read, they are right as it has a low change of success and is very invasive.

Some others also mentioned MPFL reconstruction to increase stability but this doesn't remove the pain; the pain is for 99% coming from the damaged cartilage. Hence, the cartilage has to be fixed one way or they other. I willing to travel aboard but I need a local OS to sponsor and support me... (haven't found one yet... what they don't know they consider "experimental"...

Any ideas...?
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline Brandon123

  • Forum Faithful
  • ****
  • Posts: 275
  • Liked: 18
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #19 on: September 12, 2017, 04:03:28 PM »
Thanks for the update!

The only way to "restore" cartilage in the patellofemoral joint that you haven't mentioned, and that I know of, is ACI/MACI. They do repair patella cartilage damages (often larger) with those techniques, but it comes with the same problem as microfracture (and OATS): patella cartilage is the most difficult place to conduct the procedures. It is also quite expensive procedures from what I have read, and hence, many prefer microfracture as a cheaper and simpler alternative. It is also questionable whether at least ACI is much more successful than a traditional microfracture.

See for example: http://savingmyknees.blogspot.fi/2011/07/microfracture-vs-aci-which-makes-more.html 

But it might still be worth checking out? Have you seen Sune's story? His story reminds a bit of yours, I just found it the other day:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=56991.0


 http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=60875.0

Maybe someone else know of any other cartilage restoration techniques?

Then we have stem cells of course, which I have been thinking of myself. Unfortunately, there is little solid scientific support for these procedures and they usually cost a lot. I guess that is why they aren't used in non-profit driven healthcare practice, and many European docs refer to such treatments as "experimental". I am not saying that it doesn't work, only that is seems to be (from what I have read) an expensive gamble.

I think it all comes down to 1) how much money you can spend, and 2) what procedure you are willing to try in terms of risk of failure. Just taking it easy and wait and hope it gets better with time is also a (maybe viable) alternative. In the end of the day, the only treatment with a rather predictable outcome, I guess, is knee replacement (maybe PF-joint only), but I understand of course that you don't want to go that route in your age (me neither).
 
« Last Edit: September 12, 2017, 04:39:47 PM by Brandon123 »
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline Vickster

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 3946
  • Liked: 289
  • Neelie knee!
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #20 on: September 12, 2017, 04:43:13 PM »
Look at DreamRunner's diary of her fairly recent experience of patella repair+stem cells in Kent UK (Prof Sherry team, he's been having some success with patella cartilage for 5+ years going on feedback on this forum) Should be pretty accessible geographically from Europe (via Eurostar)

Don't know if you can get a referral and pay for private consult with your imaging, guessing around £300-500 if not UK resident. You'll likely need to get CT scanning too which isn't cheap (he orders this for full detail of anatomy etc)
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 reflex_nl

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 5
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #21 on: September 12, 2017, 05:06:07 PM »
@brandon, thanks for your reply. Indeed options are limited, but I'm happy to share my experiences so others can learn as well.

I did indeed contact Sune already via PM and had chat about MACI/ACI, the result were ok, not good, and literature hardly shows successful outcomes on the patella, although it is received better feedback compared to OATS. However, for me this is not available here (or in nearby countries) and as you mentioned really expensive...

Even so... I need a OS to help and "support" me if I chose for surgery aboard, and these OS's are hard to find.
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline reflex_nl

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 5
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #22 on: September 12, 2017, 05:08:29 PM »
Hi Vickster,

Based on your other comment I contacted dr. Shetty and I'm planning to visit him in October - keep you posted. I'll look into DreamRunner's dairy.

thx. Reflex

Look at DreamRunner's diary of her fairly recent experience of patella repair+stem cells in Kent UK (Prof Sherry team, he's been having some success with patella cartilage for 5+ years going on feedback on this forum) Should be pretty accessible geographically from Europe (via Eurostar)

Don't know if you can get a referral and pay for private consult with your imaging, guessing around £300-500 if not UK resident. You'll likely need to get CT scanning too which isn't cheap (he orders this for full detail of anatomy etc)
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline Brandon123

  • Forum Faithful
  • ****
  • Posts: 275
  • Liked: 18
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #23 on: September 12, 2017, 05:16:35 PM »
I did indeed contact Sune already via PM and had chat about MACI/ACI, the result were ok, not good, and literature hardly shows successful outcomes on the patella, although it is received better feedback compared to OATS.

Ok, thanks for the info! I was actually rather curious about his outcome.
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline Brandon123

  • Forum Faithful
  • ****
  • Posts: 275
  • Liked: 18
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #24 on: September 12, 2017, 05:19:45 PM »
Hi Vickster,
Based on your other comment I contacted dr. Shetty and I'm planning to visit him in October - keep you posted. I'll look into DreamRunner's dairy.
thx. Reflex

Please keep us updated on what he says, I am always interested in possible patella cartilage restoration procedures. Good luck with the visit!
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline reflex_nl

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 5
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #25 on: October 08, 2017, 06:57:49 PM »
Hi all!

I met Shetty last week, a kind an knowledgeable OS, a lot different from those in the Netherlands. He indeed suggested to use a procedure like cartifill (sort of fibrin glue, collagen, stem cell, scaffolding technique) to restore the cartilage behind the patella and maybe reconstruct the MFPL. My injury was caused by subluxation of the patella.

The road to recovery is long and he gave it a 80% chance of success in my case. It seems that if you do nothing to treat these lesions, they get bigger and worse over time... (he confirmed this). I will have to go back for a scan (CT+MRI) before he can really conclude what needs to be done. He did approx 200 of these surgeries. It is pretty expensive and all out of pocket cost for me... but to be honest I have little choice. And from all options considered this isn't too invasive...

Keep you posted on the next steps!
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline Brandon123

  • Forum Faithful
  • ****
  • Posts: 275
  • Liked: 18
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #26 on: October 09, 2017, 09:31:59 AM »
Great that you met with him and the procedure sounds promising! :)

Did he mention any specific challenges when it comes to patella cartilage lesions?

Also, can I ask what type of costs we are talking about for this kind of surgery? 5, 10, 15K?
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline reflex_nl

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 5
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #27 on: October 11, 2017, 06:35:36 PM »
No clue yet, as I also need the MPFL reconstruction, but my guess it will be on the upper end of your range.

Are you planning any other steps?
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline Vickster

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 3946
  • Liked: 289
  • Neelie knee!
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #28 on: October 11, 2017, 06:46:00 PM »
Private cartilage repair will typically run GBP 10-15k. That's based on numbers I was given 6-7 years ago (e.g. For AMIC, a single scope procedure)
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 Brandon123

  • Forum Faithful
  • ****
  • Posts: 275
  • Liked: 18
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #29 on: October 12, 2017, 09:27:06 AM »
No clue yet, as I also need the MPFL reconstruction, but my guess it will be on the upper end of your range.

Are you planning any other steps?

Ok, I understand. Well, I must do something in the near future as the situation is not improving. However, as my patella cartilage damage is more of a wear and tear arthritis type than focal lesions, any cartilage repair surgery would probably be a long shot :-\

I had a chondroplasty in 2009 that worked really well for 6 years or so, but as we know, a new one would be a real gamble. One OS wants to do just that, a new chondroplasty with a lateral release and possible microfracture if he finds any deep focal lesions. I'm quite skeptic towards this, especially the LR and MF parts...two other OS want to do nothing (only conservative treatment), and eventually a patellofemoral joint replacement as last option.

So, it feels like I'm kind of stuck without any good reasonable options. As my next step, I will probably try to get a fourth opinion from a PF joint expert.   
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline Brandon123

  • Forum Faithful
  • ****
  • Posts: 275
  • Liked: 18
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #30 on: October 12, 2017, 09:28:06 AM »
Private cartilage repair will typically run GBP 10-15k. That's based on numbers I was given 6-7 years ago (e.g. For AMIC, a single scope procedure)

Many thanks for the info! :)
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline reflex_nl

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 5
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #31 on: December 14, 2017, 12:20:00 PM »
Hi Guys,

Quick update: I decided to go ahead with Shetty's proposal and get CT scans and MRI's and X-yas. The third MRI within a year. Hence, I traveled back to the UK - see below the results. His conclusion was that I do have tracking issues. Patella tilt and patella shift. Hence he recommended to perform an MPFL reconstruction, a lateral release and the MCIC cartilage repair. A bit of a shock to me; but without addressing the bio mechanics the cartilage repair would not hold. He gave it a 80% chance of success.

If you look at the pictures, you notice a few things
  • You can see the left knee patella is not in the same spot compared to the right
  • You can see that some (fibro) cartilage has grown back in the hole
  • The trochlear groove is flat, hence a risk of dislocating the knee cap
  • Their is a bony avulsion on the MPFL patella attachment area
  • Meniscus and other ligaments intact
  • The patella is clearly tilted laterally

Strangely enough...  sometimes when the knee cap sits "ok" I don't have much pain; but when it tracks wrong, simple walking already hurts (luckly this happens once twice/each month). However, after a year, I still cannot do any sports and I'm at risk for further damage...

Hence, I have to go to surgery to improve the situation.
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline reflex_nl

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 5
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #32 on: December 14, 2017, 12:21:30 PM »
and the MRI pictures...
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline Brandon123

  • Forum Faithful
  • ****
  • Posts: 275
  • Liked: 18
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #33 on: December 18, 2017, 03:33:32 PM »
You do really have a flat trochlear groove, no wonder you have suffered multiple dislocations :/

When will you have your surgery with Dr. Shetty?
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline reflex_nl

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 5
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #34 on: December 22, 2017, 06:13:55 PM »
Yeah, surgery was done a week ago by Mr Shetty himself. He was quite pleased with the surgery it self. I stayed in the UK for 4 days. Currently in a brace locked to 20 degrees and on pain meds. So far so good... the stemcells need to do their job in the comming months :-)

Itís already the third time - getting used to it.
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline Brandon123

  • Forum Faithful
  • ****
  • Posts: 275
  • Liked: 18
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #35 on: December 27, 2017, 10:19:16 AM »
Sounds good! Keep us updated on how you are doing :-)
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline reflex_nl

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 5
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #36 on: December 31, 2017, 03:45:32 PM »
A update after a knee surgery: MCIC + Lateral release + MPFL reefing all on LK

Week 1:
Surgery completed; stayed one day in the hospital and got some pain killers for @ home. Knee swelled a lot, as usual, but so far so good. Pain levels quite acceptable. No complications and I even got a pictures from the surgery itself. Shetty is as kind as ever and explained all the steps. I stayed 5 days in the UK for recovery and followup. I was in a CPM machine for 2 hours after surgery and the next morning the physio gave me a brace. I can bear full weight on the knee, but the flex is limited to 20 degrees. I can slow walk a bit with the brace and crutches. ROM w/o brace, not weight bearing: 20 degrees

Week 2:
At home. I can move around the house without crutches, just the brace. Pain is minimal, and wounds are healing nicely. The advantage of a swollen knee is that you hardly feel any cartilage or bone related pain. I do limit my movements around the home and ice the knee 3x a day. I do some light physio to keep the leg active. I stopped taking pain killers. ROM w/o brace, not weight bearing: 30 degrees

Week 3:
Enjoying my time off, the knee is a bit slimmer now. Increased the flex to 30 degrees per OS advice. I'm still amazed by how well the recovery is progressing compared to my two other knee key hole surgeries. These were far simpler, but both times I had for weeks a lot of "pain", "redness", "soreness" post surgery. Of course it will take at least 6 to 12 months before I know if the last surgery was successful, but a smooth recovery does help to stay positive :-). ROM w/o brace, not weight bearing: 60 degrees

Keep you updated - any questions, let me know!
« Last Edit: December 31, 2017, 04:03:05 PM by reflex_nl »
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline Brandon123

  • Forum Faithful
  • ****
  • Posts: 275
  • Liked: 18
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #37 on: January 01, 2018, 09:32:03 AM »
I'm still amazed by how well the recovery is progressing compared to my two other knee key hole surgeries. These were far simpler, but both times I had for weeks a lot of "pain", "redness", "soreness" post surgery. Of course it will take at least 6 to 12 months before I know if the last surgery was successful, but a smooth recovery does help to stay positive :-)

Quite amazing, based on my own key hole surgery, I have always assumed that a "real" knee surgery would be a rather horrible experience :-)

Btw, is the patellofemoral joint (and PF surgeries) Shetty's key area of expertise?
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline Vickster

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 3946
  • Liked: 289
  • Neelie knee!
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #38 on: January 01, 2018, 10:38:00 AM »
Knees, especially PF and cartilage repair (and hips which isn't unusual for a knee surgeon here)

https://www.spirehealthcare.com/consultant-profiles/professor-anan-shetty-c3444306/

A UK NHS surgeon will generally treat whatever is referred to him by GPs in the area in addition to tertiary referrals for any special interest
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 reflex_nl

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 5
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #39 on: January 01, 2018, 11:27:06 AM »
To me it seems his main interest is helping people with cartilage issues. He is in favor of less invasive methods. If you still have knee pain, you can always visit him to talk about your concern.
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline Brandon123

  • Forum Faithful
  • ****
  • Posts: 275
  • Liked: 18
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #40 on: January 01, 2018, 05:42:05 PM »
Knees, especially PF and cartilage repair (and hips which isn't unusual for a knee surgeon here)
https://www.spirehealthcare.com/consultant-profiles/professor-anan-shetty-c3444306/
 

Many thanks for the info and link, Dr. Shetty has a very impressive resume indeed! I suppose he is one of UK's leading PF/cartilage repair knee surgeons?

To me it seems his main interest is helping people with cartilage issues. He is in favor of less invasive methods. If you still have knee pain, you can always visit him to talk about your concern.

Yup, I still struggle with my PF cartilage damageÖDr. Shetty seems to be a world-class expert on this area, so I will definitely keep him in mind for the future.
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline reflex_nl

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 5
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #41 on: January 20, 2018, 09:52:50 AM »
Week 4:
ROM is improving and I'm a bit more mobile. Still super carefull not to damage the graft and every step I take is with help of the brace. Pain is acceptable although I do get occasionally some minor "cartilage pain shoots" in the knee. The knee is somewhat slimmer and hence the surfaces can rub agains one and other occasionally. I'm working full time from home and take it easy. Also made some short trips to friends/supermarkets and a dinner. ROM w/o brace, not weight bearing: 80 degrees

Week 5:
The knee behaving quite ok; I expected worse. I did a first 10 min cycling on a stationary sit-bike, which went well. I will now try to do this daily. The pain on the side of the latteral release is increasing a bit and when touching it, it does feel sore. However, still manageble. After week six I have a call with Shetty to discuss the status and to find out if I can drop the brace and start PT. ROM w/o brace, not weight bearing: 90 degrees
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline reflex_nl

  • Regular Poster
  • ***
  • Posts: 104
  • Liked: 5
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #42 on: February 03, 2018, 08:19:53 PM »
Week 6: I had a chat with dr. Shetty, and he was pleased with the progress so far. Recovery is going well. the swelling is still there but that seems to be ok (I've send him some pictures). I can remove the brace at the end of this week and slowly start with PT. ROM w/o brace, not weight bearing: 110degrees

Week 7: First week without the brace; it feels weird as I got quite attached to it. I walk slowly with a limp, but the pain is level is ok. I need to work on recovery of the stability as the knee doesn't feel strong. The first PT session was walking in a swimming pool and this went fine. I also starting driving the car again. ROM w/o brace, not weight bearing: 120 degrees

Week 8: Being a bit more mobile increases the occasional sharp pain shoots in the knee. Maybe I should take it down a notch. Otherwise it is ok, I can stand for 30 min and walk for 15 min all without much problems. The skin is still sensitive to touch and the knee is still swollen and a bit warm, but not red.
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline Brandon123

  • Forum Faithful
  • ****
  • Posts: 275
  • Liked: 18
Re: Patella Cartilage damage - what is next? (MRI Pictures - page 2)
« Reply #43 on: February 04, 2018, 09:21:47 AM »
Week 8: Being a bit more mobile increases the occasional sharp pain shoots in the knee. Maybe I should take it down a notch. Otherwise it is ok, I can stand for 30 min and walk for 15 min all without much problems. The skin is still sensitive to touch and the knee is still swollen and a bit warm, but not red.

Great that you can stand and walk rather normally (for short periods) without any major problems, and do not experience any redness.
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

 















support