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Author Topic: Chondral Defects Under Patella - Want questions to ask Dr. - 33 y/o athelete  (Read 3339 times)

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ryan.w.noyes

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Great site and first post.  I've learned so much on here already (thank you!).

So, here's the deal.  I'm 33, have run for must of my life, competitively -- and soldiered a good bit in the infantry.  Today I'm pretty much completely out of commission.  I can''t ride a bike without knee pain.  Swimming is painful.  Going down stairs is an absolute nightmare, etc etc.  I'm at the mindset to now move forward with aggressive treatment -- something I've deferred for over a decade.  My initial chondral defect symptoms began after a marathon in 2001.  I was seen by some of the best (Dr. Brian Sennett -- Univ. of Pennsylvania) and opted in the end to try other physical therapy-related treatments, which worked for me then -- but not now.

It is my hope that I can gain some good questions from you guys to run by the doctors on this next go-around.  I'm not so much a fan of MFX/ACI based on the success rates and, above all, the length of immobilization.  Nevertheless, I do have the wherewithal to do that if it's the only viable option.

Some info:

Stage:  unknown
Current MRI's:  both knees last week (and X-Rays).  Results pending.  I am meeting a sports orthopedic surgeon on Wednesday of this week. 
Prior MRI:  Left knee only -- 9/10 -- indicated an articular cartilage laceration under the patella and a Baker's cyst.  Size of laceration unknown.  Otherwise okay knee. 

I've never had an exploratory scope, any cartilage cut to alleviate lateral pressure of the patella to the knee, etc.  In other words, no incisions yet.  I'm open to any and all advise you can offer.  Thanks in advance!!

Best,
19D

Offline crankerchick

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The best advice to make sure you are dealing with a doctor that will look for why your cartilage is wearing under the patella, like if it is a structural problem or if it really is just from the beating you've given your knees over the years. If you end up with a surgery, you want to make sure it is the right surgery to address your root problem.

Some of the questions I might ask are:
What types of procedures do you perform? How many do you perform per year? What is the downtime for the various procedures you think I might be a candidate for?

That's all I can think of. Like I said, my first concern would be making sure the doctor is going to address the cause of the problem and not just the symptoms that have resulted from it.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline Lottiefox

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Hi there

I too have extensive patella defects. As Crankerchick has said, you need to try and find out the cause of the defects you have as much as how large or where they may be. If it is simply overuse and bashing them into the ground you'll be needing to discuss what kind of options you have in terms of conservative or surgical options. Patella cartilage repair is a tricky one, as it is a part of the knee under constant shearing forces and techniques such as MFX are limited in success as the blood supply is in low flow there. MACI/ACI is starting to show some encouraging results for patella defects but it is still relatively early days and as you say, the rehab is LONG and the outcomes variable. I am also exploring a new option combining the stem cells released through MFX with a new collagen based gel called cartifill, currently only being done at one hospital in the UK (not sure where in the globe you are). This is apparently going to be good for the patella as it hardens much faster and is less prone to early breakdown as can be found in ACI grafts on this area. Watch this space....

However, you'll also need to be asking what the scans and X-rays show. Do you have wear in this area of the knee because of a biomechanical flaw? Things to look for are tilted kneecaps, tracking of the kneecap as it moves through flexion and extension, where does the patella tendon insert (the bumpy tubercle on the shin bone) and is this within tolerable range, any malalignments of the bones around the knee e.g. femur and tibia, shallow trochlear groove and so on......Understanding the dynamics underlying the patella problems is pretty key in knowing what you might want to do about the defects. There is an argument that simply fixing a defect without addressing the underlying cause is fairly pointless, especially at a young age. be very wary of surgeons who might offer a "cure all" process without being able to explain why it is warranted. Changing the dynamics of the patella is a non-reversible thing, and you want to be 100% sure before someone cuts anything on you.

And as said, general questions about success rates, rehab protocols, number of surgeries done of this kind, complications, risks, etc are all areas to probe your OS on.  ;D

good luck and I hope you get some good options

Lottie  :)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline Loola

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Sounds like we have similar knee problems, I exhausted all treatments before going under the knife. I had a microfracture that failed. So we decided to do ACI in June. When I had my chondrocyte biopsy my Os did a lateral release as well. I have started a blog that may help you with your decisions. I invite you to check it out.
http://howkneesurgerychangedmylife.blogspot.com

ryan.w.noyes

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Thank you all.  You're the best!  I had most of crankerchik's queries already on queue, but added a few more based on all of your superb -- and common sensical advise.  You are all absolutely correct, there must be an underlying reason all of this is going on.  It could have been mediocre dieting all of my life.  Or a hereditary biomechanical issue.. or something that a podiatrist could addresss, etc.  I need to get to the bottom of all of that very soon.

Call me crazy, but I ended up going under the knife two days ago after doing weeks of research and months of physical therapy with little success.  Due to a 14 degree peteller tilt, I agreed to do a LR in addition to a normal scope/cleaning after consulting four different sports ortho surgeons (in three states).  Three of the four agreed that the LR was the way to go.  I opted to have a trusted local surgeon here in Washington, DC do it -- at a VA hospital.  In the event something goes wrong, I have recourse that way. 

I will start a new thred in the post op area.  Currently, I can't raise my left leg at all.  My throat still kills me.  I opted to not take any pain meds or muscle relaxants so that I can monitor what's going on.  I'm taking ibuprophen sparingly (I know, that's bad) because the 800 MG tablets kinda freak me out on what they're doing to my stomach lining.  I'll be loyal to update all of you, regularly.  This is a long road to recovery without a huge guarantee that this lateral release will work.  Keep your fingers crossed!

Loola, going to your blog right now! 

Cheers mates,
19D in Wash, DC
« Last Edit: June 18, 2010, 03:04:54 AM by 19Delta »

Offline dybinnyc

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I had similiar surgery, OATS (donor) to the posterior side of my kneecap, with an MPFL recon and lateral release.  I did this 02/26/10. I was very active prior to my knee surgery and still can hardly do a SLR despite doing PT daily, Russian Stim. I work with a surface EMG on a daily basis...It is so mentally frustrating to want to get back to tennis and yoga etc yet my knee is tell me otherwise! how big is your scar? Mine is quite large, about 7 inches and it to is painful..it attaches to another 8 inch scar for a past TTT in 93. Make sure you move the scar so it does not hurt in the future...good luck with your recovery!















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