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Author Topic: Full-thickness cartilage fissure on the patellar articular cartilage  (Read 11324 times)

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Offline aisopous

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Dear all,

I'd greatly appreciate some opinions on what future outcomes and potential treaments my injury may have. I feel that my surgeon did not answer my questions in the ten minutes he had for me (NHS, British system, surgeons are very busy).

According to the reading given by my surgeon, the MRI shows only one injury: a slightly curved full thickness flap-like fissure going all the way to the bone in the middle of the patellar articular cartilage. The underside of the cartilage is clearly inflamed, which may explain the fact that I am in a constant state of discomfort 9 weeks after the injury, and any weight bearing at more than 15 degrees is unbearable (ha) due to sharp pain under the knee cap.

I was not quite discharged and told to run it off, but that's the feeling I had after my final appointment. I'm worried that even if the knee begins to work again after a couple of months, the cartilage may degenerate quicker than it would if some form of aggressive treatment was undertaken. In particular, my surgeon suggested I could get back to full function (i.e. playing high-impact sports), and wouldn't "hopefully" have to worry about this once the inflammation is down. Should I really be contented by a hope? 

Lastly, I want to leave my warmest regards to anyone reading this who has suffered a more complex knee injury - I know I can probably count myself lucky amongst those reading this board.

Many thanks,

Anton
« Last Edit: May 07, 2012, 12:28:20 AM by aisopous »

Offline tobypaw

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Re: Full-thickness cartilage fissure on the patellar articular cartilage
« Reply #1 on: January 27, 2012, 01:31:26 PM »
Hi Anton,
Can you get back to see the Surgeon again and ask a few more questions? You should probably be in Physical Therapy. Strengthening the muscles and tendons around the knee will give you a better chance of using your knee normally again, but it's best done under the supervision of a PT so you don't overdo it. The involved muscles, esp the quads, sometimes atrophy (shut down) when there is a traumatic injury to the knee. They need to be strengthened.
Did the surgeon mention any surgery needed for this? Maybe the "flap" is considered stable enough that they dont want to remove it?
I have a full thickness cartilage defect in my knee, I had a piece break off completely and had surgery to remove that loose body. I didnt have Microfracture yet as my defect is on a fairly non weight bearing surface. Going to wait it out. So far so good. Did the surgeon mention if this is likely to cause you more problems down the road?

I gave up playing soccer a few years ago due to an overly aggressive and unnecessary slide tackle to my right ankle that caused a hairline fracture. I donated my cleats and shin guards to GoodWill and stick to cycling and swimming now. My husband is on a soccer team and it's so tempting to jump in when they need a sub but I just take a look at the 250lb guys out there and remember that it just takes one bad tackle to be on crutches again!

Best of luck!

Offline aisopous

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Re: Full-thickness cartilage fissure on the patellar articular cartilage
« Reply #2 on: January 30, 2012, 05:00:47 PM »
Many thanks for your reply tobypaw.

My theory (and hope) is that once the inflammation caused by bone edema settles, I will be absolutely fine, and only a traumatic event would cause it to flare up again. And in the mean time, it is safe to use the knee as long as what I'm doing does not cause pain. As for confirming this, I am probably just going to have to cough up and get myself to an experienced OS who works with athletes privately.

I've been in physiotherapy for the past eight weeks. I know what you are talking about when you mention quadricep atrophy. I feel quite simply unable to anything about it. Any exercise seems to lead to more inflammation, and hence pain. I've spent an excessive amount of time in my life taking care of my quadriceps throughout my life, and in the words of my physio, it's just a matter of finding exactly the right kind of PT that the knee can handle, and keeping your faith that the inflammation will go away.   

Judging from my complete inability to walk stairs, my injury is in the middle of a weight-bearing surface (taping does not seem to help). While my OS was very reassuring, neither my OS or my physiotherapist were able to say that they've seen a young active person "come back" from this injury and recover full function. Hearing that waiting it out is working for you is very inspiring and reassuring, although I am not ready to give up on playing football again.

Thanks again!

Offline Kimberly 77

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Re: Full-thickness cartilage fissure on the patellar articular cartilage
« Reply #3 on: January 30, 2012, 09:17:14 PM »
I have a full thickness chondral flap on my medial femoral condyle show up on last mri and also have had 2 scopes to fix other defects one on my patella. I will tell you that my pain has never gone away but has gotten much worse over time. I am barely able to stand and walk or even sleep without pain. I am told I will need a replacement but am too young. I guess it depends on where the flap is and if it is catching or not and how much pressure is put on it when standing. The knee cap usually takes alot of pressure and being it also glides across the cartilage it can easily catch and tear more. This is what is happening to mine, it is on top of my thigh next to my patella and it is catching when I bend and straighten. It has actually torn to the bone and now has kissing lessons (meaning underneath bone is damaged). My advice would be to get a second opinion, especially being you want to play sports cartilage injuries don't heal, they get worse.
Right leg amputee.
Osteoarthritis in left knee.
Medial femoral condyle defect, arthoscopy 8-2-10
Grade 3 defects, patella, medial femoral condyle, tibia scoped1-12-2011
Physical theraphy and awaiting microfrature 2-1-12

Offline aisopous

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Re: Full-thickness cartilage fissure on the patellar articular cartilage
« Reply #4 on: January 30, 2012, 09:51:04 PM »
I'm sorry to hear about your cartilage troubles. Cartilage injuries getting worse over time is precisely why I'm so nervous. Did you feel pain when the knee was catching? My lesion looks from the MRI to be in the vertical direction (I can see it from the top-down view), which leads me to hope that the gliding and brushing of the patella against the femoral cartilage would not tear it open. Then I think, what kind of damage would another twisting injury do? Thank you for sharing your experience.

Offline Kimberly 77

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Re: Full-thickness cartilage fissure on the patellar articular cartilage
« Reply #5 on: February 01, 2012, 04:16:00 PM »
When I try to fully straighten my knee it will literally lock at the top of my knee cap and when I go to bend it, I get a loud pop and a burning sensation as it grinds back into place. Feels really weird and is slightly painful. The more times it catches during the day the more irritation I have and this causes me to swell. I seen my OS again yesterday, another wasted appointment. I need a replacement but he will not do it yet. He wants me to do 2 months of theraphy to try and strengthen my quads as they are totally wasted and then do microfracture. If microfracture doesn't work he then will talk about replacement. Same old story I keep getting"need replacement but too young and a amputee too high risk". I think location of the defect does play a role in how well you will do so maybe yours will be fine for many years. I am sure it will come a point to where something must be done. Good Luck and I know the fustration well.
Right leg amputee.
Osteoarthritis in left knee.
Medial femoral condyle defect, arthoscopy 8-2-10
Grade 3 defects, patella, medial femoral condyle, tibia scoped1-12-2011
Physical theraphy and awaiting microfrature 2-1-12















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