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Author Topic: patella lesion repair, microfracture & stem cell implant  (Read 4208 times)

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Offline Brandon123

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Re: patella lesion repair, microfracture & stem cell implant
« Reply #15 on: September 03, 2017, 09:28:38 AM »
Now I actually see in your first post that you mention "scaffold augmented microfracture", sorry, don't know why I missed it :)

I think it is a good idea to vent both the ups and downs of your recovery, so keep us posted independent of your mood :)

I too have some other health issues going on, besides my knee problems...so I know that sometimes it just becomes too much to deal with it all. But it helps to just take it one day at a time. 
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline reflex_nl

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Re: patella lesion repair, microfracture & stem cell implant
« Reply #16 on: September 20, 2017, 08:41:36 PM »
Hi Dreamrunner,

I also have a 2 CM by 1.5 CM defect grade 4 on the patellla and will meet Shetty in early october. I'm curious to learn if he can help me as well. I spoke to Ian on the forum who recovery very well, but it took 12 mths.

Please update us on how you're doing, i may need to go to the same steps as you.

BTW: How did your damage happen? and to which age group do you belong?

Thanks, Reflex,
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline DreamRunner

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Re: patella lesion repair, microfracture & stem cell implant
« Reply #17 on: October 03, 2017, 02:46:56 PM »
Hi Reflex_nl,
Great to hear you are seeing Professor Shetty, hope it all goes well - please keep us posted, I am really keen to hear how you get on. You mention you spoke to someone called Ian, do you know his user name? I would like to read his posts to see how his treatment progressed for him.

I am 50, by the way, so certainly wasn't ready for any type of knee replacement yet if can be avoided. Also, I am female, which I understand makes a difference with kneecaps as they tend to be smaller on women so the load is relatively higher. I have no idea how I did mine, how did you do yours? Was it from the patella dislocating? Mine may have partially dislocated five years ago when the knee suddenly and forcefully gave out as I was going up a step, it felt at the time like the knee buckled medially as well as forwards. Afterwards it was very, very painful and a MRI report said it was "osteochondritis", but I had deteriorating knee pain for many years before that, starting when I was 15. I banged it really badly on a concrete step when I was a child, so that may have been the start of it. My other patella is ok (touch wood!), so doesn't seem to be standard chondromalacia, which I would expect to affect both knees.

Currently, my repaired knee is very up and down, and it's hard not to worry - but I am worried in case the repair has failed. A few weeks ago it really felt as if it was starting to heal, it was hardly painful at all to touch or to move, and it was getting easier to walk around on, but this last week it has been markedly worse. I have been getting my old bone pain (you know, that horrible raw, gnawing feeling?) when bending the knee, also it has felt hot and is redder than the other knee, and currently my quads inhibition (and instability) is quite bad, making it really rather shakey as I try to walk. I am really hoping it was just caused by overdoing things, although I have to say I have really hardly been doing anything at all, due to health problems. still doing exercises though, and the muscle strength is still progressing, but really slowly. It's still only less than 4 months since having it done though, so early days I suppose.  :)

Offline reflex_nl

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Re: patella lesion repair, microfracture & stem cell implant
« Reply #18 on: October 08, 2017, 06:34:55 PM »
Hi Dreamrunner,

Indeed I met Shetty last week, a kind an knowledgeable OS, a lot different from those in the Netherlands. He indeed suggested to use a procedure like cartifill (sort of fibrin glue, collagen, stem cell, scaffolding technique) to restore the cartilage behind the patella and maybe reconstruct the MFPL. My injury was caused by subluxation of the patella.

(you can read more here: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=68466.0)

The road to recovery is long and he gave it a 80% chance of success in my case. It seems that if you do nothing to treat these lesions, they get bigger and worse over time... (he confirmed this). I will have to go back for a scan (CT+MRI) before he can really conclude what needs to be done. He did approx 200 of these surgeries. It is pretty expensive and all out of pocket cost for me... but to be honest I have little choice. And from all options considered this isn't too invasive...

In your case, be patient, I had serious up/downs from my initial surgery, and if unsure, make a call, request a scan if pain presits.

Ian's name on the form is: IMF73 you can look for his posts.

Good luck,

Reflex
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline IMF73

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Re: patella lesion repair, microfracture & stem cell implant
« Reply #19 on: November 05, 2017, 09:28:33 PM »
Hi There, I recently spoke to reflex_nl as I also had similar surgery by Shetty 2 years ago at the same hospital as you.
How's things going now? Its a long slow recovery but touch wood, 2 years later I am doing v well.
I hope you're doing well & recovering well.
Happy to help answer any of your questions if you have any as we have had very similar procedures by the sounds of it

Offline DreamRunner

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Re: patella lesion repair, microfracture & stem cell implant
« Reply #20 on: December 08, 2017, 10:35:55 PM »
Hi IMF73,
sorry, only just seen your post, I think my notifications must be going straight to junkmail!!
Thanks for getting in touch. So glad to hear you are doing well, that's fantastic.
I've had no change in function as yet and in fact I have had an increase in pain the last couple of months - the knee became a bit hot and inflamed out of the blue in September and has not improved much since then.
I have quadriceps inhibition, which causes instability of the knee, and that's been a bit worse too, probably because of the pain. I am wondering, did you ever get instability or quads inhibition? It seems to be my main problem functionally. Also, did you get clicking within the joint? I get it a lot, actually I call it a 'clonk' as it's quite marked. of late mine's been accompanied by pain at times, particularly after the physio got me doing leg curls, I think it put too much pressure on the cartilage around the defect area, anyway I've stopped doing those for now. My muscle building has plateaued and the bad leg is still so much thinner than the good one, I am hoping once the healing is complete it might all settle down and I can build more strength.
My physio seems as much in the dark as I am about what to expect and what's normal and to be expected or not. I don't think he's treated this kind of issue before, I have had to educate him about what I had done, as best I can.
It's six months almost since my op, I was expecting to have been able to do more by now. What level of exercise were you at by this stage? were you able to do stairs ok? I can go up stairs, though it doesn't support my weight properly and locks out on each step. I still can't go down steps forward as it would give out on me if I did, but I am finding that occasionally I feel as though I want to step down normally but then falter and am unable to unless it is a really tiny, single step onto flat ground - maybe that's a sign of progress, eh?! literally, one small step for woman!!!  :D

Offline DreamRunner

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Re: patella lesion repair, microfracture & stem cell implant
« Reply #21 on: December 19, 2018, 04:16:32 PM »
Hi Everyone,

Just an update on how my knee is going.  Itís exactly 18 months today since I had my knee op. so that's the end of the cartilage healing stage, and from now on I should be allowed to run, jump, and participate in sports etc. but unfortunately, I still am unable to do any of those things.

I donít think the procedure has been a failure as such though, as the pain in my knee is generally very much reduced, and I can move my leg in ways that I just couldnít before Ė for example extensions, which I couldnít do before, and itís much less painful going down stairs, so it must have healed to some extent, but it is still unstable, prone to giving way, and wonít take my weight. It still wonít take my weight properly when walking and remains quite straight or gives out either forwards or backwards Ė which causes strain and pain at the back of the knee after only short distances, and my quads are still weaker in that leg.

I am very pleased to have had it done though, as it has taken the misery out of the knee condition, though I still am getting pain and aching in the patella and around (but not nearly as bad as before) and I am wondering if thatís why Iím still getting the instability Ė that the proprioceptors are still sensing pain and so are not engaging the quadriceps, as the doctor explained to me before. I really ought to go back and have a chat with them about it, maybe get another MRI to see where itís at, but Iíve had a lot of other stuff going on recently so I havenít been able to get round to arranging that, perhaps I will do that sometime early next year.

I will update again, it will be interesting to see if there will be any further progress even after the 18 months healing time Ė I hope so!

Best wishes to all fellow knee-pain sufferers, hope you are all managing to make some progress.  :)

Offline DreamRunner

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Re: patella lesion repair, microfracture & stem cell implant
« Reply #22 on: August 04, 2019, 03:09:56 PM »
Hello Everyone,

This will be my final post on this topic as I now have a conclusive outcome to the procedure. It's just over 2 years since I had it done.
For me it didn't work, unfortunately.

I recently got referred back to Kims Hospital, but I didn't see Professor Shetty this time, perhaps he's not there anymore, I don't know. I saw a knee surgeon called Mr Paul Gill. He did the 'Clarke's test' and it was really painful so he sent me for a MRI scan.
I got the scan results this week and it shows a large area on the back of the patella where there is no cartilage at all - just bare bone. this area is the same area I had the microfracture and stem cells implanted so it appears that no cartilage has grown back at all, or if it did it has gone now. There's the full thickness of cartilage around the area where it is normal, then it drops like a 'cliff edge' into the bare bone area of the lesion.

Mr Gill has offered two options - one is just to live with it, the other is to have standard microfracture on the area. He doesn't, himself, believe stem cells to work so he's not offering that to me.
I can't see that microfracture alone on a 2 x 1.5 cm patella lesion is going to be successful, it's dubious even on a small area on a young person, so I just can't see it being worth all the trouble.
My knee is less painful generally than before - possibly due to the area being tidied up of lose cartilage, but the giving way is still persistent and I can't put weight into the joint at all, the muscles are still weak and the patella hot and achy at times.
I've got 8 weeks before I go back to see him, so I have that time to decide if I want to try the microfracture.

I find it interesting that no cartilage has grown back at all, I would have thought there'd be at least a little in places. There has to be a reason why.
So that's it, that's my story, it wasn't successful for me, but I know for others it has worked brilliantly, so I still would consider it's worth trying. It hasn't made my condition worse, and my pain levels have been reduced somewhat, so not a total disaster.
If I decide to go for the microfracture I will start a new diary for that journey.
Thanks for everyone's interest and input, it's been good to share. All the very best to you with your own progress.
 :)

Offline Brandon123

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Re: patella lesion repair, microfracture & stem cell implant
« Reply #23 on: August 05, 2019, 12:57:21 PM »
Thanks for the update! Sorry to hear that your procedure didn't work :( I agree that your lesion sounds too large for microfracture. Maybe you should try to consult another doctor? Please keep us updated on how things develop. Good luck finding a solution! 
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment















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