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Author Topic: Patellar debridement for chondromalacia--experience, and results?  (Read 2141 times)

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Offline wturri78

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Like so many whose posts I keep reading here, I've been "diagnosed" with "intermediate" chondromalacia on both knees. I've tried various PT routines and am still experimenting. The "Patellofemoral Solutions" ebook exercises seem to have helped...some...maybe...

MRI and x-ray haven't revealed any other problem in the knee besides the cartilage behind the patella.

Cortisone shots two weeks ago...some relief, but I don't expect it to last long. At any rate it certainly won't fix things.

Also like many, my problems seem to have curiously worsened during my periods of rest! I was running a lot of miles over the last couple years, backed off when things started to hurt, and then somehow both knees seem to have degraded all by themselves? 

Two different docs (one general, one ortho surgeon) have talked about the option of debridement, "cleaning up" the cartilage. It seems somehow counterintuitive, that if I'm having a problem of losing cartilage, that I should remove more of it. Advocates of regenerative techniqes consistently point to studies showing how ineffective such surgeries are at relieving pain. But then, many of their proposed techniques are so recent that there really aren't any major studies about them.

I was hoping some of the "Knee Geeks" here could answer from personal experience or medical knowledge, the following:

1. Have you personally had debridement performed, and did it help? How long was the recovery, and what level of activity could you resume after you healed?

2. Is the cartilage removed by this procedure actually doing me any good currently? I've seen videos from arthroscopic debridement procedures, and the frayed cartilage looks like dryer lint, so I wonder whether there really is harm in removing something that isn't serving a purpose anymore.

3. Has anyone been harmed by this surgery? Or been worse off because of it?

4. Does thi surgery preclude other options later? Like, if you have such a procedure, does that mean that you can't later try regenerative techniques?

I find that opinions and experience with knee problems are all over the map. One guy will tell me to avoid debridement at any cost...oh, and try an experimental stem cell procedure that costs $12,000 and may not work at all. 

Offline JOW_103

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Re: Patellar debridement for chondromalacia--experience, and results?
« Reply #1 on: March 25, 2014, 04:18:52 PM »
I have had this done.  However, the surgery was done in conjunction with a medial meniscus repair.  As this was done arthroscopically it was a day surgery and I was full weight bearing the afternoon of surgery.  I think how much you can do and whether or not you are weight bearing is up to the preferences of your surgeon.  Recovery was pretty quick though.  I was back playing recreational ice hockey in four weeks and really didn't have any problems. 

However, I ultimately had a PKR done in that same knee 6 months later due to bone on bone condition that developed in the medial portion of my knee. 

If it were me, I would want to know the underlying causes of the cartilage damage. Is it maltracking of your patella? It is muscle or tendon related (i.e. too tight, too loose) so that the knee cap is not sliding smoothly.  My surgeon suggested the cause of my condition was that my quad muscles were too tight and the patella was tracking slightly off line and the pressure on the knee cap was causing the deterioration.

I don't believe this will effect any future procedures, however, once you remove articular cartilage it can't be regrown. 

If you have it done it should help as the inflammation the condition is causing should subside.  I can't speak to other's experiences but this is a pretty low risk surgery and I would seriously consider it.

Good luck

Offline wturri78

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Re: Patellar debridement for chondromalacia--experience, and results?
« Reply #2 on: March 25, 2014, 04:46:42 PM »
I have had this done.  However, the surgery was done in conjunction with a medial meniscus repair.  As this was done arthroscopically it was a day surgery and I was full weight bearing the afternoon of surgery.  I think how much you can do and whether or not you are weight bearing is up to the preferences of your surgeon.  Recovery was pretty quick though.  I was back playing recreational ice hockey in four weeks and really didn't have any problems. 

Wow! I didn't realize it could be that fast.

Quote
However, I ultimately had a PKR done in that same knee 6 months later due to bone on bone condition that developed in the medial portion of my knee.
 

Did the bone-on-bone condition happen, in any way, as a result of the debridement procedure? Or do you know it to have been unrelated? Obviously my intentions are to avoid getting to the point of bone-on-bone. Did the removal of the rough cartilage allow the degeneration to progress faster, in your opinion (or your doc's)?

Quote
If it were me, I would want to know the underlying causes of the cartilage damage. Is it maltracking of your patella? It is muscle or tendon related (i.e. too tight, too loose) so that the knee cap is not sliding smoothly.  My surgeon suggested the cause of my condition was that my quad muscles were too tight and the patella was tracking slightly off line and the pressure on the knee cap was causing the deterioration.

All I've heard to this point are very vague theories about what might be at play in my physiology, maybe. Some insist it's a weak VMO muscle, others that it's some combination of factors. Do you know what type of doc or therapist would actually do real, evidence-based examination of these factors to see what is actually happening?

Quote
I don't believe this will effect any future procedures, however, once you remove articular cartilage it can't be regrown. 

If you have it done it should help as the inflammation the condition is causing should subside.  I can't speak to other's experiences but this is a pretty low risk surgery and I would seriously consider it.

Good luck

Thank you for sharing your experience! It's much more helpful to talk to people with real experience, than to read piles of literature :)

ps. Have things improved for you since your PKR? Still able to play hockey, run, cycle, etc.? I hope I don't reach that point anytime soon (only 36!) but if it comes down to it, I'd rather be the Bionic Man than sit around on a sofa.

Offline Vickster

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Re: Patellar debridement for chondromalacia--experience, and results?
« Reply #3 on: March 25, 2014, 04:54:01 PM »
What country are you in?  There are specialists in patella-femoral problems around the place - if in the US, there are a couple of names that pop up often on here (Teitge and Sanders if you search)

I had debridement of a grade 3 lateral patella defect, along with a lateral menisectomy, other issues laterally too being knock kneed and having had a trauma to the knee
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline wturri78

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Re: Patellar debridement for chondromalacia--experience, and results?
« Reply #4 on: March 25, 2014, 05:10:19 PM »
What country are you in?  There are specialists in patella-femoral problems around the place - if in the US, there are a couple of names that pop up often on here (Teitge and Sanders if you search)

I had debridement of a grade 3 lateral patella defect, along with a lateral menisectomy, other issues laterally too being knock kneed and having had a trauma to the knee

I'm in the US...Ohio. There is an orthopedic surgery and rehab center near Cincinnati that performs various surgeries to the knees (with rehab and PT), and also performs nonsurgical procedures like PRP and the Regenerexx treatments.

Have you interacted with either of the specialists you mentioned?

What were the results of your debridement and lateral release?

Offline Vickster

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Re: Patellar debridement for chondromalacia--experience, and results?
« Reply #5 on: March 25, 2014, 05:21:08 PM »
No, as I am in the UK

My knee is crocked, but not due to the debridement.  It was done in Feb 2010, I had a subsequent arthroscopy in Dec 2010 and all was well then.  I had a further MRI in Dec 2013, don't recall what it said about the patella.  I have lateral compartment narrowing, but other things will have caused that.  I haven't had a lateral release, my patella doesn't maltrack nor is it tilted as far as I know but I am knock kneed and trauma caused lateral damage, presumably these contributed to the grade III wear on my patella (was debrided at the same time as menisectomy)

If it is causing pain, you need to know why.  A specialist should do a CT scan to check for alignment etc

Look for posts by an Australian chap called SuspectDevice, he posts often about his experiences with PFS.  Chondromalacia is a symptom, not a diagnosis

PRP is pretty unproven for articular cartilage issues, more useful for tendon inflammation. 
No point treating the symptom until the cause is known

Good luck :)
« Last Edit: March 25, 2014, 05:28:44 PM by Vickster »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline JOW_103

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Re: Patellar debridement for chondromalacia--experience, and results?
« Reply #6 on: March 26, 2014, 07:23:33 PM »
My bone-on-bone condition was more the result of being bow-legged and living 50 years with 80-90% of my weight on the medial part of the knee.  I did ultimately try Synvisc One and Eufelxxa injections wiht no effect.  The decision to go ahead with the PKR was done by having a needle arthroscopy to confirm what was happening inside my knee.  This procedure involves inserting a 18 gauge needle into the knee.  The needle has a camera in it and the OS can see exactly what's happening inside the knee.  It's done in the doctor's office so you can resume activity immediately after.  It was done by Dr. Thomas Gill who is the NE Patriots Team physician.  It's new technology he is working to develop.

After my PKR I regained full extension and full ROM and did resume playing recreational hockey.  However, I ended up with a TKR of my right knee that was performed in December of 2013.  So I am currently not playing hockey although I hope to in another three months or so.  My therapist wants me to wait 6 months before resuming play.

I would think a good PT therapist can check to see how your knee is tracking and whether or not you have weakness in the muscles or lose tendons that could be contributing to the knee issue.  I would also think you need to have an MRI and other scans to confirm the internal structures of you knees.















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