The patello-femoral joint :

PLEASE READ HIGHLY CONFUSED - - Posted by funkymunky (funkymunky), 14 January 2005

Hi,

Basically my OS told me these were the results of my MRI scan in my knee. My knee quite frequantly 'pops out & in very quickly' (instability), and this is a re-occurring problem since dislocating my knee 10 years ago.

-Cartilage worn away on back of knee cap and my bone has been rubbing on bone for 10 years and has been waring away

-I have a cist behind and down from my knee cap

-I would have to cosider my options on a major operation to take some tissue from my leg, grow some sort of membrane in a lab, drill lots of small holes in my knee cap and put the membrane over the knee cap to promote groth of cartilage on the back of the knee cap. This is apparantly new surgery because of the complexity of getting cartilage growing on a 'floating joint'

- I would also have to have surgery to 're-arrange' the anatomy of the knee with the ligaments / muscles etc.

Basically this has freaked me out! Has anybody had any of these problems before?

He suggests having an arthroscopy and lateral release first just so we do not burn any bridges before the 'major' op in which case things will not really be reversable. The surgeon seems to think the old lateral release may not have been done properly and I may have lots of scar tissue present down there. Mr. Bullah if anybody has heard of him.

I has an arthroscopy & lateral release 10 years ago, and the knee still 'pops out' but not dislocate since. GHowever I have been shielding the knee for 10 years and lost all confidence in it anyway.

Any feedback at all would be appreciated? Sorry for the basic description and long text!

Thanks,

nick x
Posted by Leta_MT (Leta_MT), 15 January 2005

Hey Nick!

Sorry you are having to deal with this! It really bites, I know first hand.

I'm not familiar with the cartilage repair procedures at all. I think your best bet is to search the internet like a maniac and learn as much as you can about what the doctor told you. Find out what the name of the procedure is so that you can visit sites to learn about it. Sometimes medical company sites yield great info on procedures. I am familiar with patellar realignment procedures and patello-femoral replacement options. I won't bore you with info that you are not interested in, so if you wish to ask me stuff about those things, you can IM me as I jump around the board and may not notice this thread if you reply.

Lateral release (LR) is rarely successful by itself. It corrects patellar tilt and not really much else. If you have malalignment, which it sounds like you do, LR won't correct that alone. It appears that surgeons do it routinely in conjunction with realignment procedures and there is a place for it. Done alone, it is NOT an "easy little arthoscopic procedure"! Maybe it is for the surgeon, but not for the patient. My LR failed and it took me a year to get back into surgery and have the "big procedure". For a year, my mobilty was compromised, my quads wasted away to nothing and I was in agony. I wish I could have skipped the LR and went directly to the final solution. This is just my opinion, so take it for what it is worth. I know that I regret losing a year of recovery over a shot at an easier surgery that was doomed from the start. Since you are bone on bone, I would NOT agree to any surgery until you have had a CT scan of that joint. MRI shows soft tissue and does not give a clear picture of what is happening with the bone.

Anyway, please feel free to IM me if you wish. I'll share whatever I know with you.

Leta
Posted by mike_bknee (mike_bknee), 15 January 2005

Hello Nick  

Leta gives some good points.  I would add that you should also get a second opinion.  Then if you still are undecided, get a third or fourth.  If you decide to do arthroscopic surgery, have the doctor agree to give you some arthroscopic pictures of the damage.  There are no fail safe solutions to patella-femoral problems, and everyone's situation is different.  Too many physicians try and pigeonhole you into their favorite "solution".
Posted by Jimb (Jimb), 16 January 2005

Hi Funkymunky.

I can understand your problem. I haven't been down the road of lateral release yet but I too have the worn down articular cartlidge on the back of the patella as you.  I had the major op back in march (Fulkerson)  to basically buy me about 10 years until a full replacement would be needed.  I just couldn't stand the knee pain anymore but didn't want to have a replacement at 43 yrs old.  

Anyhow what I was going to get at was I did a lot of reading here and other medical sites regarding the "articular cartlidge transplant" you spoke of. I asked my OS about it and he had offered it to me as an option BUT,  He ststed that the cartlidge takes weeks to grow in the lab and once transplanted could take 4-6 weeks or more to really grow/form in your knee. He said I would most likely be out of commision for at least 6 weeks, And the new cartlidge that forms is usually softer and more prone to damage than the cartlidge from birth.  He gave me around a 30% chance of successfull long term cartlidge life.  I did a lot more reading and the medical articles I read pointed to close to the same odds. Who know, things may have changed in the last year so it might not be a bad idea to at least investigate the option.

Good luck with whatever you decide to do.

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