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Author Topic: patellar chondral lesion: indications for TTT?  (Read 1319 times)

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Offline sune

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patellar chondral lesion: indications for TTT?
« on: July 31, 2011, 08:31:13 PM »
Dear all!
I have a received two scopes for a chondral lesion on the patella, cause unknown. (details below). Since I feel restricted in daily living and am unable to do any exercise that will get my pulse up, I am looking into alternative interventions. The last OS I saw has suggested I get a TTT combined with patella microfracture, and possibly lateral release. His examination has included MRI and ultrasound.
My question is:
Is this a proper basis to decide that kind of surgery?? Or should I ask for a standing CT, as some members continually advocate here on this forum? I would be interested in references documenting that this makes a difference, although I acknowledge that designing a proper study showing this must be hard...

My history: I had knee arthroscopy for the first time in 2000 at age 27, where they removed a large piece of loose cartilage on the backside of the patella. They shaved and flushed the knee. During many years, I did not have problems with day-to-day life, climbing stairs, and moderate walking/hiking. However, I was never able to ride a bike for more than a maximum of 15 to 20 min., or to jog at all. Being unsatisfied with that, and pretty naÔve in hindsight, I had another arthroscopy in May 2009. Again the cartilage was shaved and the knee was flushed. During the first four months, it actually felt like my knee was going to get better than before the last arthroscopy. Then, somehow I overdid it, and now my condition is pretty lousy† . It is now a major restriction in my day-to-day life, and I often have a sore knee, even with irritation or pain below the kneecap or hollow of the knee.† Only very little walking is necessary normally, as I have an office job, but nevertheless I frequently have pain. Thus I have problems if I stand up more than 30 min., walk more than about 1km, and sports of any kind is completely out of the question. It is my impression that the lesion is about medium size, and the thickness of the remaining cartilage is such that a thin layer covers the bone over the affected area treated. The surrounding cartilage is degraded, and there are deep furrows on the trochlear cartilage.
My right kneecap is also acting up, although nowhere near the level of the left.

1999: Chondral lesion on medial patellar facet. Synovium changes, grade II degeneration of neighbouring cartilage. Debridement (shaving) and lavage.
2009: 2nd arthroscopy,† debridement (shaving) and lavage.
2010: steroid injections
2012: MACI (2 patella, 1 trochlea)+Fulkerson+Lateral release

Offline chandra

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Re: patellar chondral lesion: indications for TTT?
« Reply #1 on: August 16, 2011, 09:55:50 PM »
Microfracture genarates secondary cartilage which is not of the quality of noramal cartilage hence less durability and start wearing off very soon.  you Can regenarate the cartilage using Denovo NT or ACI which is near to normal helathy cartilage. The rahabilitation is about 8 months to 1 year for microfracture or any cartilage regenaration process.