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Author Topic: KNEE LESION WHAT TO EXPECT??  (Read 1143 times)

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Offline glennam

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« on: July 02, 2005, 07:16:09 PM »
Good day,
I had surgery last Tuesday. I am 32. I have had 1 lateral release, a medial reefing, two cartilage repair surgeries. I have a tracking problem and I have/had dislocations and subluxion commonly.  I had ANOTHER LATERAL RELEASE this Tuesday and while the surgeon was in the knee he found a knee lesion. I have not spoken with my surgeon, however he explained what happened to my husband and parents. I am not sure of their translation is what was explained to me.  There is a hole in my bone???...???.. My knee cap was tracking on top and bothering this lesion. The surgeon performed the lateral release, which then altered the tracking so that knee cap was longer bothering the lesion, but is now gliding directly over the lesion/hole in the bone. When the surgeon cleaned the bone fragments (it was a slight fracture) an cleaned the loose bodies and cartilage....there was nothing but a hole. It is to the point that the marrow is clearly seen and not protected.
My question....WHAT IS THIS AND WHAT DO I LOOK FORWARD TO??? My husband asked if this was the beginning of possible knee replacement. The surgeon said, not necessarily but likely. The surgeon said that in a year or so there will be a procedure cleared were they can add a paste that will fill the hole and protect me from some pain. I will have to speak with the doctor next week for my first post op visit. I will be asking him tons of questions. But if anyone has knowledge of this condition, could you please give me some idea as to what this is, how can I treat it and is it a sentence to a lifetime of discomfort???  :'(


Offline Heather M.

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« Reply #1 on: July 02, 2005, 08:02:00 PM »

I'm not sure I understand--you had two surgeries within a week of each other?  On the same knee or one after the other?

Anyway, the hole your doctor is describing is called a chondral lesion.  Technically, it sounds like yours is an osteochondral lesion, which means the hole goes through the layer of articular cartilage protecting the bone and down deep into the bone itself.  This is osteoarthritis, in laymans terms, but since you have a hole rather than widespread damage, it makes you eligible for certain repair techniques.  The one he was describing with the paste is called MACI or Matrix Autologous Chondrocyte Implantation (you can find posts on ACI/Carticel further down the main bulletin board page).

Here is a website that explains in simple yet effective language what is going on in your knee:

My surgeon was the pioneer for a procedure called microfracture, which is often a first step for treating lesions like yours:

Here is a brief overview of ACI (the version your doctor is talking about is slightly newer, but the principle is basically the same):

Here is an article that goes a bit more into technical details of cartilage loss and the various procedures to repair this problem.  Understand that there are at least four different methods, and each doctor is obviously going to be very in favor of HIS particular method.  But it may not be the right one for you and your situation, so I would be sure to see multiple doctors and get several different opinions about what the best way is for your to proceed.

The potential procedures are:  OATS (osteochondral allograft transfer system), MACI or ACI/Carticel, Microfracture (described in second link above), and chondroplasty (the least invasive one, also called 'debridement and lavage' where the surgeon goes in to clean up the area and smooth it down as much as possible.  This is also the least effective for relieving pain, but well worth a try!

Another thing for you to understand is that not every lesion in the cartilage is necessarily painful.  We don't know why, but some people have terrible lesions and no pain, while others have fairly shallow lesions but they are right in a weight bearing spot, so the pain is unbearable.  Others, like you, had a lateral release which then resulted in increased pressure on a damaged area of the knee--that's one of the risks of this procedure.  You might ask you surgeon if an open patellar realignment (also called a TTT or HTO or osteotomy) might help to 'unload' or take pressure off the area.  This may be an option, depending on where the damaged area is.

Finally, here is a great page that goes over long-term patellar pain and tracking problems, which are often lumped together and called PFS (patello-femoral syndrome).  Read through all the sections and you will come out with a very strong understanding of what is going on in your knee and what your options are.  Then, you can make decisions to take next steps in an informed way.

There is a lot of information on PFS, chondral lesions, and the surgeries (like lateral release) to address these problems.  Check out the Patello-Femoral Joint section farther down on the main bulletin board page (under the "Specialists Office" section heading).  Here's a link to get you started:

Also, be sure to use the search feature to look up keywords from your conversations with your surgeon, or the operative report itself.  You might want to research MACI, chondral lesion, articular cartilage damage, hole or divot in cartilage, partial knee replacement, lateral release, etc.  You could spend DAYS doing research, and while you might be frightened at reading some of our horror stories, keep in mind that most here have very complicated knees and some of us didn't receive appropriate or timely care.  Others did but developed severe surgical complications (that would be me).

Hope this information helps.  The key for you would be to find out WHY you developed these deep osteochondral lesions (what caused them--patellar tracking problem or impact accident?).  And then to also figure out WHAT is causing your pain--it's not necessarily the lesions, though they are a good culprit.  Then get multiple opinions from surgeons who do all of the various procedures to deal with PFS and early-onset articular cartilage damage.  If you see a surgeon who only does lateral releases for example, that is the only procedure he/she can recommend.  But you may need something else, a more involved realignment or cartilage restoration procedure. 

Hope this information helps.

Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja

Offline glennam

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« Reply #2 on: July 02, 2005, 08:14:34 PM »
Thank you so much for ALL OF THE INFO!! How very helpful!! 
I am sorry my post was confusing. Here is the gig....I have had a total of 6 knee surgeries. First surgery back in 1988. I have had NOW 2 lateral releases, an open medial reefing, and a basic debriement scope (all on the left knee). ON the right knee I have had a lateral realease, and a basic debriement scope.  Last Tuesday I only had the lateral release and chrondroplasty.
I do have a tracking problem and I have known this for years!!!  The last surgery...earlier this week...was initailly going to be another meidal reffing for patella tracking. But because of the lesion, and that the lateral release was sufficient the surgeon stopped. He wanted to discuss other options with me before he continued. He did do the chondroplasty on Tuesday along with the lateral release.
Again thank you for your information. I will read everything you sent me. I want/NEED to be as informed as I can prior to my meeting with the surgeon. And I will take you advice on getting numerous opinions! 

Thanks again,
Happy 4th!



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« Reply #3 on: July 03, 2005, 12:44:44 AM »

You mentioned a procedure that would be available in approx the next year or so.  That sounds like your OS might be talking about the Cargel treatments.  If so here is an article that might help you.

Good luck to you,