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Author Topic: Flap Tear of the Patellar Articular Cartilage  (Read 8991 times)

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Offline bruisedkneecap

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Flap Tear of the Patellar Articular Cartilage
« on: November 12, 2005, 02:38:30 AM »
I fell on my knee one year ago. At that time I had an MRI and was diagnosed with a bad bone bruise.  The bone bruise healed up but I still had pain. My first Ortho doc said I must have a nerve problem and told me to see a pain specialist.

I have been working out of town and went to see another Ortho doc and he sent me for an arthrogram and an MRI.  The film showed a grade 2-3 flap tear of the patellar articular cartilage at the junction of the median ridge and lateral facet.  This Ortho doc showed me the tear on the film.  He told me that there is nothing the surgeon can do for me other than "clean up" the area but that would not relieve the pain.  I am still in a lot of pain, even when I am sitting or laying in bed.  The pain is draining my energy and my spirit.

Is there anyone out there who has had or has this same diagnosis?  If so what have you done for this?  I need some hope!!!

Thanks,
Bruised Kneecap

Offline Heather M.

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Re: Flap Tear of the Patellar Articular Cartilage
« Reply #1 on: November 12, 2005, 05:32:09 AM »
You have what's known in the business as a chondral lesion.  Here's a good explanation of it, with a very brief overview of your options:  http://www.steadman-hawkins.com/knee_chondral/overview.asp

Your doctor is proposing a 'chondroplasty,' also known as shaving, where they clean out the damaged bits of cartilage and try to leave the joint moving more smoothly.  If the cartilage is damaged, it's like hitting a pot hole when you drive.  Chondroplasty just cleans out the junk, it doesn't address the actual damage--What you need for that is called cartilage restoration.  You are a doctor's dream patient, because you had a perfect knee until an injury.  You're an excellent candidate, you just need to find a doctor who does these types of procedures.  There are a variety of cartilage restoration procedures, and each doctor thinks his/her particular procedure is the best.  The procedures are:  abrasion arthroplasty (more often done in Europe, but some in the US do it), microfracture (a procedure pioneered by my current surgeon, but now done by many around the world; see http://www.steadman-hawkins.com/knee_microfracture/overview.asp ), OATS (taking plugs of bone with the covering of articular cartilage intact from other parts of the knee and putting them in the damaged area), and ACI (also known as carticel, where cartilage cells are harvested in a scope and grown in a lab, then replaced in the damaged parts of the knee 4-6 weeks later in an open procedure, though some doctors do this with scope as well).

Each procedure has its pluses and minuses, so you definitely will want to see more than one surgeon--preferrably, at least one who does each kind of restoration.  The doctors tend to be 'loyal,' meaning the ones who do ACI generally don't do OATs, etc.   You can read more about each of these restoration procedures in the very last section of the main bulletin board page.  Each type of procedure has its own section, so check it out.  Do research on the web.  Check out the patello-femoral joint section for lots of posts on dealing with chondral lesions and chondromalacia.  Remember, though, that many people posting in that section have a very different problem than you do (myself included).  Many people with chondral lesions on this board have had lifelong problems with their knees due to poor mechanics and kneecaps that aren't positioned correctly, among other problems.  Your situation is very different, because you had a normally functioning knee until you gouged a divot out of the cartilage.  This is terrible for you, of course, but it makes doctors MUCH more likely to take the major step of doing a cartilage restoration. 

Cartilage restoration procedures involve a major commitment from the patient--to be compliant with the rigorous post-op regimen (including an often extended period of absolutely no weight-bearing, being on crutches for every single movement, usually with a bulky brace) and to take care of the restored cartilage.  It's a long procedure.  Most doctors agree it could be 12 months--even 18--before the patient forgets he/she had surgery.  But in patients who are not able to have a knee replacement because they are too young (replacements don't last very long in younger patients, who tend to use their knees more than older ones), cartilage restoration is a great opportunity to restore quality of life.

Usually, doctors will try every other option first--clean up surgery, rehab, bracing, arthritis meds like Celebrex or Mobic, and life-style modification (weight-loss, giving up impact sports, etc.) before going for cartilage restoration.  But depending on the size and location of your damage, you could be an ideal candidate.  If you want to post the general area that you live, perhaps someone can recommend a surgeon proficient in cartilage restoration nearby.  You may need to travel, especially if you live in a small town/rural area. 

Here are some more resources--some in medical language, some in more user-friendly forms.

http://www.kneeguru.co.uk/html/knee/knee_arthritis_02/cartilage.html

http://www.emedicine.com/orthoped/topic595.htm

http://www.cartilagedoc.org/

As for your diagnosis and doctor's comments....I know it sounds bad, but you are actually lucky that you had a traumatic injury, because it means doctors will be more inclined to help...it's more complicated when you have poor knee mechanics or lifelong problems and multiple surgeries.  Obviously, your doctor doesn't know how to help you, but that doesn't mean that you can't be helped!  Find an expert in cartilage restoration.  Good luck.

Heather
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
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