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Author Topic: Loss of cartilage can cause patellar tilt?  (Read 930 times)

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Offline Lanterne Rouge

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Loss of cartilage can cause patellar tilt?
« on: July 22, 2014, 06:51:14 AM »
I was on the hospital yesterday for diagnose #42523452 and doctor was reviewing my latest MRI. I asked him it says lateral patella tilt on the report and what was the reason for that? I was hoping that he would say it is because of tight muscles or something but he said it is because of cartilage loss in that part of the joint. Since the cartilage is lessened there, patella was tilted laterally. I have never heard of this before. Do you think it is possible?

Online Vickster

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Re: Loss of cartilage can cause patellar tilt?
« Reply #1 on: July 22, 2014, 11:42:34 AM »
Have you had a good read of the patella primer?

It does make sense that if there is no articular cartilage on the patella that alignment of the bones may occur.  This certainly can occur where the femur/tibia are arthritic, and valgus/varus alignment occurs
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Offline MDAL

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Re: Loss of cartilage can cause patellar tilt?
« Reply #2 on: July 22, 2014, 10:05:27 PM »

This was the conversation we had in the very beginning... regarding alignment issues vs other factors.

The patella is one of the bones in the human body with higher cartilage height. If this cartilage starts getting lost, there will be extra space gap, and it will change the way it will fit into femur (not too normal).

We have even compared out MRIs, and it was obvious that on the lateral side I have huge space between bones there and you had almost none... I also have cartilage problems int he patella and throclea, but mine are in the middle of it while yours seem to be in the lateral side, this is consistent with root causes such as poor alignment, scar tissue (post surgical) which block the normal tracking, or years of consistent excessive wear due to sports or extreme physical activity.

You were a maniac cyclist for a long time, and this has forced the patella to rub against the femur time over time for years...

I am only saying this from a common sense and non-medical perspective. So from only an "amateur" exercise of common sense, there is no reasons to suspect you have an alignment issue at all which is in the root cause of your problems. Cycling makes your leg tilt by default, it is an healthy exercise in reasonable amounts, but brutal amounts of this exercise will always cause wear and tear over time in some zones more than others.

Based on my personal experience, I believe you could benefit a lot from stem cell treatments, the lateral patella side can be easily pierced with a needle to inject stem cells. By this I mean a doctor can inject stem cells right under the existing cartilage in order to make it expand and close or minimize the hole. My problem was right in the center (not so easily accessible) and I had great results.

There are no guarantees that it will work, and it is expensive. Furthermore you would have to travel because I don't believe you can find them in Turkey (not sure)... But still a 1 time treatment wouldn't cost you more than 2500 Euros including travel accommodation and stem cell treatment itself...

Other options you have down the line is micro-fracture (even though I am not sure how it could be managed in this zone) you would have to ask a doctor if its possible, and if it would hold there and it is just a time limited effect (not a perfect solution).

Down the line when things get tough, you can have a Patello-femoral replacement (replace the cartilage and throclea by metal prosthetic. But this should be a last resource....

Other options are alignment attempts. By alignment I mean more like dis-align in order to change the force into the other side, this could be achieved by lateral release (a surgery with a poor track of success and a big rate of worsening), or by bone, which means to cut the tybial bone where the patella tendon attaches and move it to the medial side. This alignment techniques won't fix your cartilage, it will simply attempt to move the forces to other side. No guarantees of success and these surgeries need a long recovery time and leave a lot of mess behind (scar tissues, and a series of functional problems).

For now, I would recommend if you can afford it, a non-invasive and non-destructive procedure, such as injecting your own stem cells into the existing cartilage adjacent to the defect in hope that the new cells will expand and start producing collagen that may fill or reduce the defect. PRP could also be helpful in your situation...