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Author Topic: Lessons learned about patella cartilage  (Read 637 times)

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Offline JKG3

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Lessons learned about patella cartilage
« on: April 16, 2015, 08:14:03 PM »
A couple of weeks ago I posted a query asking for advice from anyone who was further along in dealing with a loss of patella cartilage than I am. Several people read the post but no one replied. I was curious what remedies people who had lost significant patella cartilage (so that they were now bone-on-bone) had tried to get back normal function in their knee. So, this is another attempt, but differs in that I'll offer what I've learned to this point, so that anyone who might be having a problem with their patella cartilage can factor in my experience to their own decision making.

My problem was first apparent after a mountainous hike... my knee was swollen and painful. After resting for a few days I tried riding my bike, and my knee had developed a pronounced catch in its rotation...not extremely painful, but worrisome. I happened to mention the problem to a friend who recommended an orthopedic surgeon at a well regarded local hospital. The surgeon explained that I had a "bump" in my patella cartilage and that with surgery he could "smooth it off" and I'd be back on the bike in a mere 6 weeks.  I had the surgery and my knee did not respond fact I was not able to ride a bike for over a year after the surgery.  I became frustrated with my surgeon's inability to explain what the problem was or to provide any solution, and sought out (4) other surgeons for advice. Here's what I learned:

First, not one of the surgeons, after seeing my pre-operative MRI, would have recommended surgery.  All said my best bet would have been to try a cortisone shot to address the inflammation and then do PT to see if my knee would improve without surgery.

Apparently patella cartilage surgery has a low rate of success..I was told that on average "scoping a patella" leads to an improvement in function about 1/3 of the time. 1/3 of the time there's no improvement, and 1/3 the knee actually gets worse.

The patella cartilage is not like meniscus cartilage..patella cartilage is fibrous and cannot really be "smoothed out". One surgeon, who at the time handled the orthopedic needs of the Bruins and Patriots, explained that cutting into the patella cartilage weakens the cartilage and causes the fibrous structure of the cartilage to come apart...not unlike cutting a chunk out of a rope. He predicted (correctly) that I might find that I would develop more problems with my knee over time as a result of the surgery.

Bottom line is always get a second and maybe even a third opinion before having any surgery. If a surgeon tells you he'll have you back at full capacity in 6 weeks he might be right, but the whole story might be that the surgery will also leave you debilitated in 6 years. I was able to get back riding for a few years but now cannot ride, hike, ski, or even climb stairs. My knee is in perfect shape I'm told except for the one spot under my patella where I had the surgery where there is a complete loss of cartilage. If anyone has had the same problem and has been able to regain normal (athletic) functioning, I'd be grateful to hear about it.