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Author Topic: Chrondoplasty & Debridement/Patella  (Read 9422 times)

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Offline eastsidegirl

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Chrondoplasty & Debridement/Patella
« on: October 06, 2003, 06:14:13 PM »
Hi:  I was just wondering what is the difference between chrodoplasty and debridement of the undersurface of the patella.  One other question:  having had debridement of the undersurface of the patella, among other stuff, over 2 months ago why am I now having symptoms like stairs climbing, knee bending, etc. that I never had before?  I was better before this stuff was done.  Does the pain ever go away?  I feel like I am getting worse and not better.  I have been in PT for about 20 sessions so far.  Thanks so much, as always.  
Complex Lateral Meniscus Tear, Large Media Plica and Medial Degeneration at the undersurface of the Patella debrided, softening  of the femoral condyle with Grade II degeneration ... debrided

Offline vetmedgirl

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Re: Chrondoplasty & Debridement/Patella
« Reply #1 on: October 07, 2003, 09:23:38 PM »
Hi,

Debridement and chondroplasty are the same thing, pretty sure anyways.  I had this too in late August in both knees.  My right knee feels pretty good but still have a lot of popping.  My left is not doing as well despite doing my rehab religiously (everyday at least 3 times a day).  A lot of times when doing certain exercises my left patella feels like itt wants o slide off laterally despite having good quad control and bulk.  It has subluxed a couple of times but now I know when its about to happen so I just stop doing that particular excercise.  This never happened before surgery so I am pretty baffled at why it is happening now as is my PT.  We have tried russian stim for about a month now 3X a week to reeducate my VMO but so far haven't seen much improvement.  So I don't know what to tell ya.  I've been searching the internet on this type of stuff and I found one site that says patellar chondroplasty/debridement should never be done without some sort of correction to what caused the rough cartilage like a lateral release or medial tightening etc.  and I've found other stuff that says its good to 'clean up' the patella and the corrective procedures may or may not be needed.  My best bet is to talk to your OS who knows what specifically is going on in your knee and go from there.  Hope to hear its getting better.
Angie
Rt Knee Torn ACL, medial meniscus, MCL in -Dec 97
ACL Reconstruction, medial meniscus repair-Jan 98
Partial Lateral meniscectomy, Patellar and femoral chondroplasty in both knees - August 03

Offline eastsidegirl

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Re: Chrondoplasty & Debridement/Patella
« Reply #2 on: October 08, 2003, 01:03:25 AM »
Dear Angie:  Thanks for the info.  Are you having problems going up and down stairs like I am?  Hate to sound dumb (I am new to knee stuff) but what is russiam stim and VMO? ???

I guess I will make an appt. with the OS which I dreading because he is not the talkative type (to be polite) and is sort of intimidating.  He is supposed to be a very good doctor but poor on people skills.   Everyone I speak to who went to him said the same thing.  Fortunately for them they are not having problems like I am.  Hope you will be feeling better soon also.  

Sheila
Complex Lateral Meniscus Tear, Large Media Plica and Medial Degeneration at the undersurface of the Patella debrided, softening  of the femoral condyle with Grade II degeneration ... debrided

Offline kneebracestace

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Re: Chrondoplasty & Debridement/Patella
« Reply #3 on: October 08, 2003, 03:04:28 AM »
I had a chondroplasty - my doctor said he used a heated tool to evaporate the water in the cartilage under the knee, hardening the cartilage (because it had become very soft).  I'm not sure if debridement is the same but that's what I was told a chondro. is.

Someone asked what russian stim and VMO are -
Russian stimulation is when they put electrodes on your muscles and use a little current to cause the muscles to contract.  This helps after surgery because the muscles have "forgotten" how to work.

VMO is the vastus medialis obliquus (or something liek that), basically it's the inner quadricep muscle.  Weakness of the VMO is implicated in a lot of knee problems.

Well I hope I was of some help!  Take care,

Stacey

Offline vetmedgirl

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Re: Chrondoplasty & Debridement/Patella
« Reply #4 on: October 08, 2003, 03:13:27 AM »
Hi Sheila,

Thank you and by the way you don't sound 'dumb'  :).  I am also having problems on stairs mainly going down though.  I have to lead with my left, if not my left patella wants to slide off laterally, which doesn't feel too good ;). To answer your questions Russian stim is a form of electric muscle stimulation (EMS), which is where 1 electrode is placed on your VMO and one usually on the rectus femoris (muscles of the quad or thigh).  The machine sends an electric signal which takes the place of your neurons to stimulate the muscle to contract.  The machine will send electric signal to make your muscle contract, I think the normal is 10 sec contraction and 10 second relaxation, I do this at therapy for ten minutes.  Anyways russian stim is a form of EMS but more powerful and penetrates deeper into the mucle to recruit more muscle fibers,  I think the difference is like the frequency and length of the signal I don't know, too much physics for me. On a little side note I think they call it Russian cause the Russian olympic team used it first to help build muscle mass.  Anyways the VMO is a cute abbreviation for the vastus medialis obliquis (spelling is probably wrong).  It is part of the quadriceps, its the one on medial (inside) of leg that helps extend the knee and pull the patella medially.  This is the muscle that is usually weak if you have lateral patellar tracking.  Hopefully this helps.  I am just  going on what I know from previous rehab and my physiology/anatomy classes, by no means am I an expert!  I hope your appt. with your OS goes well.  You might need to get a little pushy with him but not overly confrontational, you know, let him know that you want to figure out the problem and work to correct it.  If you do see him soon I would like to know what he has to say and I'll tell you what mine says cause I have an appt. in two weeks, so keep me posted.  

Angie  
Rt Knee Torn ACL, medial meniscus, MCL in -Dec 97
ACL Reconstruction, medial meniscus repair-Jan 98
Partial Lateral meniscectomy, Patellar and femoral chondroplasty in both knees - August 03

Offline eastsidegirl

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Re: Chrondoplasty & Debridement/Patella
« Reply #5 on: October 08, 2003, 06:15:30 PM »
Dear Stacey and Angie:  Thank you both for your help.  It was very imformative and you are both so kind to take the time to explain it to a "novice".  Re: Russian Stim- I didn't know what that was but I now realize that I have been getting it in PT all along.
Angie:  I will be making the dreaded appointment, probably in the next two weeks and I will let you know the outcome (I don't expect a good response from him but hopefully I will be wrong.
One question:  what would cause the problem with stairs,etc. after a procedure to help.  Like I mentioned I never had any of the problems I have now before the procedures and I am sure my quads were much weaker then than now!!??

Hope you both are feeling better.  

Regards,

Sheila
Regard




Hope you both  (I tend to be a pessimist p e Yes, E
Complex Lateral Meniscus Tear, Large Media Plica and Medial Degeneration at the undersurface of the Patella debrided, softening  of the femoral condyle with Grade II degeneration ... debrided

Offline vetmedgirl

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Re: Chrondoplasty & Debridement/Patella
« Reply #6 on: October 08, 2003, 10:34:43 PM »
Sheila,

I was wondering the same thing about the stairs.  Before surgery going down stairs hurt but my knee cap never felt like it was going to dislocate.  Now going down stairs my left wants to do that.  I don't know what the deal is.  I've been talking about this with my PT and the only thing he can really think of is that my quads are still weak and/or that I have a malalignment that before surgery my muscles were stong enough to keep the patella from sliding laterally but now aren't.  That seems logical but my quads look good an look just as big or even bigger than before surgery.  So I don't know.  Anyways have a great day, You're welcome for the info, glad to help.

Angie
« Last Edit: October 08, 2003, 10:36:54 PM by vetmedgirl »
Rt Knee Torn ACL, medial meniscus, MCL in -Dec 97
ACL Reconstruction, medial meniscus repair-Jan 98
Partial Lateral meniscectomy, Patellar and femoral chondroplasty in both knees - August 03

Offline eastsidegirl

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Re: Chrondoplasty & Debridement/Patella
« Reply #7 on: October 09, 2003, 01:51:27 AM »
Dear Angie:  I made the dreaded appointment for next Thursday.  Any suggestions how I can broach the question "what the hell did you do to my knee?" (ha ha!) with alienating him and putting him on the defensive?

Yesterday I went to my pt and explained my situation about having pain, etc.  She had me biking, russion stim, massage and ultrasound.  (Usually I do much more).  She also taped under my knee and said it might help.  It didn't.  I had to take the tape off this afternoon as I felt it was irritating my patella tendon  ??? more.  Did you ever have taping of the knee?

Sorry to ramble - hope you are feeling good today.

Sheila
Complex Lateral Meniscus Tear, Large Media Plica and Medial Degeneration at the undersurface of the Patella debrided, softening  of the femoral condyle with Grade II degeneration ... debrided

Offline vetmedgirl

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Re: Chrondoplasty & Debridement/Patella
« Reply #8 on: October 09, 2003, 02:24:45 AM »
Hi Sheila,

I've never had my knee taped, but I have tried one of those knee sleeves with the hole cut out for the patella and that lasted for about 5 minutes. That thing drove me crazy.  Too wierd feeling for me.

It sounds like we had about the same problems with our knees.  In my left I had a "flaky" lateral meniscus with shredded cartilage on the medial half of patella and some on femoral condyle like you, my right was pretty much the same but my lateral meniscus had torn away from its anterior attachment and was flipping over all the time so he removed that part. He didn't mention any plicas though.  

As for how to approach your Doc that's a little touchy.  My PT wants to write to my doc some not so nice stuff, but he's too chicken to do it. :)  All I can think is to just tell him your problems and ask if he thinks there is something else going on with your knee or if there is some kind of exercise, etc. that you could do that would alleviate the problem.   So it doesn't sound like you are accusing him or somthing, you know.  I haven't decided how to approach my Doc either.  Last time I saw him he accused me of not doing my exercises so I guess its fair game for me to accuse him of screwing up my knee  :D.  Oh by the way he recorded about 10 min. of my surgery just to point out everything he did and stuff and at the very end it shows the little shaver near my patella.  I guess he hands the shaver over to his little resident and says "Here Tex, go for it brother."  "Make the boy work a little bit, while I'll go do some damn paper work. Trying figure out which knee is which, that's half the the battle.  Okay we had some rough stuff here and some spoogy stuff there..." and the tape ends. Meanwhile his little resident guy is shaving my knee cap, which you could totally tell how inexperienced he was compared to my Doc.  It was kind of funny but then again I was like hey that's my knee you're poking.  Anyways sorry to ramble on, Good luck Thursday and have a great weekend.

Angie  
Rt Knee Torn ACL, medial meniscus, MCL in -Dec 97
ACL Reconstruction, medial meniscus repair-Jan 98
Partial Lateral meniscectomy, Patellar and femoral chondroplasty in both knees - August 03

Offline eastsidegirl

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Re: Chrondoplasty & Debridement/Patella
« Reply #9 on: October 09, 2003, 02:39:59 AM »
Angie:  Thanks for your help. I know when I am in his office nothing will come out the way I plan proberly.  The funny part (not really!) is that I thought I was going in for a peripheral tear of the medical meniscus only-- that is according to my MRI.  My OS didn't even tell me what he actually did or why.  The thing that got me was I never had any sort of pain on the lateral side?? Unfortunately now I do. Go figure.

Thanks again, stay well.

Sheila
Complex Lateral Meniscus Tear, Large Media Plica and Medial Degeneration at the undersurface of the Patella debrided, softening  of the femoral condyle with Grade II degeneration ... debrided

Offline Janet

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Re: Chrondoplasty & Debridement/Patella
« Reply #10 on: October 09, 2003, 05:39:44 AM »
Sheila:

I have had debridement/chondroplasty three times. They are same thing, as far as I know. My last surgery was in June, so I am now almost four months out. It is only now that my PT feels my VMO is firing correctly, although I am still very weak (cannot yet leg press 50% of my body weight with one leg). My patella still moves around because the quads are still weak. I really don't have a tracking problem, just a muscle weakness problem.

I have been told that the combination of chondromalacia and quad weakness is a very difficult combination to manage. And I'll tell you....it hurts! We have to be careful in PT because I get so sore, it just sets me back. In fact, just this week we have cut out two of the exercises to see if my knee will calm down some. I think I shoudl be having less pain as time goes on, but that's not the case. The pain really wears you down, doesn't it? Just keep working on your quad strength.

As for your uncommunicative doctor, before you go, try to keep a diary of the problems you are having. For example, if your patella subluxes while doing X, write it down (date and time). You can also keep a pain log. Then you can show him your journals or give him a synopsis ("I kept track, and my patella subluxed four times in eight hours on Monday, usually when I was doing X, and it brought my pain level up to a 7 until I iced " or something like that). Also write down any questions you have and start asking them while he is doing your exam. I have found if I wait until the OS is done, he is ready to get out the door. But if I start with the questions right away, he will spend more time with me. Good luck!

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline eastsidegirl

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Re: Chrondoplasty & Debridement/Patella
« Reply #11 on: October 09, 2003, 04:32:35 PM »
Dear Janet:  Thanks for your help.  My pt also cut down on my exercises on Tuesday for the same reasons your did.  She taped my knee under the patella which she thought might help.  It didn't.  Yesterday afternoon I removed it because it felt like it was irritating my patella tendon (I think that what it is right?? --)  Now I have a pain on the front of my leg in the area where the tape was.  You know, I am so sorry to always be complaining.  Everyday is a different pain.  Sometimes I can't stand myself (ha ha).  I usually keep it to myself as I don't want my friends and family to think I am a hypochondriac.  Thank heavens for this board and the great people on it.  Anyhow here in NY we are having a Light the Night Walk for the Leukemia & Lymphona Society--Walking across the Brooklyn Bridge.  I will try to do as much as I can.

Sheila
Complex Lateral Meniscus Tear, Large Media Plica and Medial Degeneration at the undersurface of the Patella debrided, softening  of the femoral condyle with Grade II degeneration ... debrided

Offline gillyfish

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Re: Chrondoplasty & Debridement/Patella
« Reply #12 on: October 09, 2003, 10:07:38 PM »
During my first surgery (for meniscus) my doc decided to "clean up" underneath my patella.  Result was incredible stabbing pain under that knee when I walked up any kind of incline or tiny step and complete inability to bend that leg with weight on it.

I was NOT happy as I had only the most minor and occasional aches under the kneecap originally, that were the result of a car accident 10 years before.  Plus the meniscus problems were worse too.  I went form being very active to basically crippled.

I went to another OS who evantually did a LR to address tilt issues and try to take pressure off the patella.   She told me I had so much damage to my kneecap that I could only expect minimal improvement.  Weirdly enough it worked quite well, still have pain but not stabbing pain, now it's definetely do-able.  It's better than it was after the first surgery although not as good as it was pre any kind of surgery.  I'm still amazed that neither OS was willing to relate my pain to the surgery though....  Kept referring to it as my "injury"  ::)

My advice would be to wait a while then see another surgeon.  IME cartiledge takes forever to heal/ settle down but it does evantually as long as it's not still being actively aggravated.   I tore cartiledge in my shoulder and it took a good 9 months to really "heal".

Offline Wtg

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Re: Chrondoplasty & Debridement/Patella
« Reply #13 on: October 10, 2003, 03:58:36 AM »
Hi,

I am 5 months post op (same surgical procedure I think (I have chondro)) and am still having symptoms of pain and trouble going up & down stairs. I did not expect this!!! In some ways, I feel worse post op. BUT, things are improving, just very s-l-o-w-l-y. I can do more this month than I could the last. It not getting worse  although progress always seems "two steps forward, one step back". If I push the excercises, anxious to build muscle, my knee hurts. But, as time passes, I can do more and with less pain.  It is just taking  forever. So hang in there and you WILL get better!

Offline eastsidegirl

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Re: Chrondoplasty & Debridement/Patella
« Reply #14 on: October 11, 2003, 04:31:12 PM »
Dear Gillyfish and Wtg:  Thank you both for your support.  I guess the old saying it takes one to know one is true.  Lately I have been thinking I am getting worse and not better.  The other day I was walking and I got a pain on the lateral side which I never don't recall ever getting while walking.  Every day it is a different pain.  I have eased off the PT this week.  Sometimes I wonder if this is making it worse??  I'll try to hang in there.  The hard part is I was told this procedure would be a breeze, blah blah blah.  I thought I would be back in action in a few weeks.  Yeah sure!!.  Again thank you both for writing.

Sheila

P.S.  What is IME cartilage?
Complex Lateral Meniscus Tear, Large Media Plica and Medial Degeneration at the undersurface of the Patella debrided, softening  of the femoral condyle with Grade II degeneration ... debrided