Can a patella defect be treated w/out a fulkerson?

[Davidf66]

I recently was diagnosed with a defect in the articular cartilage behind my patella.  I was diagnosed by a hands on exam so I am not sure of the exact size but my dr said it was about the size of a nickel. I am also assuming it is a higher grade legion since it only took a manual exam to diagnose it. Right now, my doctor is just going to do a scope to evaluate the damage. He said he wants to see how it plays out over the next several months but I could have to have it resurfaced. However, he has not discussed the the options for resurfacing yet.

It seems like any resufacing of a patella defect also requires a fulkerson or some type osteotomy to unload the patella. Is this true? Is there anybody that has had a patella defect successfully treated without a fulkerson? The fulkerson seems like a really drastic procedure. It scares the crap out of me, and I want to avoid it all cost. My defect was not cause due to misalignment so I not even sure an osteotomy would help.

Does anybody have any stats on patella defects treated with fulkerson vs w/out. Are there certain procedures that are more likely to be successful without a fulkerson? The trufit obi plugs and the microfracture seem offer the quickest initial healing time, at least in younger athletes, so I was thinking they might be sucessful in treating a patella defect w/out an osteotomy. It just seems like there would be less of window to damage the graft during the intial fragile period. However it seems like some type of realignment is always necessary with the ACI or oats.  I'd appreciate it if anybody can give me some more insight on the matter. 

[jonhark]

a long story short--a fulkerson is required for any cartilage repair of the patella.

As you probably know it "unloads" the kneecap by raising and most times medializing the joint. Don't be scared...it has a high success rate and is only bad for about 10 days.

I will say although the fulkerson cricitical, the most important thing is you choose the correct cartilage repair or your pain probably won't be much better.

Most times patella defects tend to get larger with time and activity. I would also caution your expectations that the defect is only the size of a nickel. Most times, with CR the doc debrides to healthy cartilage and you end up with a larger repair area. The idea is to "resurface" the joint and not have any fibrocartilage or fissures in the surrounding area of the repair.

I would stay away from MFR and lean toward the bone plug or ACI if you can talk a doc or insurance into it for that size defect. I had a horrible experience with patella microfracture and a subsequent with ACI and just had ACI #2 on my other leg...

Jon

[JulieRose6]

I don't know what to say honestly but I have had a fulkerson and an Oats Procedure about 6 years apart so I am unsure which one to say. The fulkerson is not that scary at all, but from what I remember it was just they moved my bone and tendon over so it would be straight, I'm unsure if that is what you are talking about. I don't remember it helping with a defect under the knee. I don't know how they could tell it was just a size of a nickel but it may help to look into the oats more, but I am a little bias on that since the fulkerson wasn't as successful as my Oats procedure considering I had 3 surgeries afterward the fulkerson.

I did talk to Dr. Fulkerson the one that actually invented this surgery through an e-mail and he explained that since I still had a lot of pain it was more maybe a defect that they didn't catch prior in which I had to have an Oats Procedure and transplant another person's bone and cartilage into part of my knee.

[FormerlyActive]

Do they know why you had the defect if you don't have an alignment issue? It does some like there are some various options you really would want to research well, many people on the KG site can help you. Let us know how you go. I have not heard great results from the microfracture but that is just anecdotally.
Best healing wishes.