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Author Topic: No change after patella chondroplasty at all?  (Read 1942 times)

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Offline Geronimo

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No change after patella chondroplasty at all?
« on: June 29, 2017, 04:57:32 AM »
Hi all,

My knee swollen and after X-rays/MRI, 12 months of PT and 4 doctors I decided to go in for patella chondroplasty, I've found a VERY reputable surgeon in my area who's focused on patellofemoral issues. Doctor said I have a small lesion on my patella which he shaved (less than 1cm, not bone deep). I went out from surgery on my feet, didn't take a single painkiller. My ROM is 100%. I have no pain, rather dull ache.

But what makes me angry is my symptoms are 100% the same as before surgery, it's like I never had a surgery at all. My knee is swollen (exactly the same shape as before) + I had certain moves which would cause grinding sensation (no sound) which I specifically mentioned to the doctor: first is when I straighten my leg from 80% to 100% at the very tip. another one when I put pressure on my knee and bent it a bit at a certain point, and the third one is when I hike uphill. Those are probably the same reason though. He told me he would shave those things.

But know I checked the symptoms and they are exactly the same. like 100% same. I assume if something was shaved I would at least feel it less, right? That's the main goal of chondroplasty? I thought the whole point of that surgery was to make my joint act more smooth, but it's not happening obviously.

Is it possible that doctor missed something? is it possible that he actually shaved something but I don't really feel the difference? Maybe he didn't do anything at all?

I'm still to have my follow up appointment but I expected at least some relief, I already cried a river and found a hobby which will take place of my love to basketball, but I at least want to be able to walk smoothly without feeling like my knee is full of sand and rocks.

Any opinions appreciated. Thank you.


Offline Brandon123

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Re: No change after patella chondroplasty at all?
« Reply #1 on: June 29, 2017, 08:45:12 AM »
I had a patella chondroplasty back in 2009. Before surgery, I had all these grinding, catching, and popping sensations going on under the knee cap. After surgery, it all disappeared and the knee worked quite well up until 2015, when it all came back with a vengeance. The OS, however, shaved off quite much of the cartilage I believe, which according to my latest OS, is what set me up for the current problems. I guess it is always a balancing act between getting the cartilage smooth and nice, and preserving it. However, I think it took a while for me to notice the difference (a few weeks or so), when was your surgery? Ask your OS during the follow up how much he shaved, if there is any chance that there might be some damaged cartilage still causing this grinding sensation, and if it might still improve after surgery?
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 Geronimo

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Re: No change after patella chondroplasty at all?
« Reply #2 on: June 29, 2017, 07:19:45 PM »
hi Brandon,

My surgery was a little more than a week ago. Maybe you are right and I should give it a little more time but I don't believe there will be any dramatic changes as now my knee feels 100% the same as before (except of pain from soft tissues). It seems that nothing has happened except of 2500$ out of pocket expenses. 

Offline vickster

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Re: No change after patella chondroplasty at all?
« Reply #3 on: June 29, 2017, 08:19:21 PM »
See how you are in 3 months, the knee needs to recover from the trauma of the arthroscopy.
Unfortunately, chondroplasty isn't guaranteed to help chondromalacia patella. Try to find a physio who has expertise in patella issues to work with you and develop an exercise programme. Maybe look into hyaluronic acid injections in a few months to help with lubrication and reduction of inflammation.

Good luck with the recovery :)
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 Geronimo

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Re: No change after patella chondroplasty at all?
« Reply #4 on: June 30, 2017, 01:05:04 AM »
Thanks. I really need luck. I'm very depressed. Surgery was my last hope and I see no improvement post it :(

I visited rheumatologist today to exclude some other staff and also showed her my knees. She said my knee is not swollen. This is the second time doctor tells me my knee is not swollen. Maybe I'm going crazy? Maybe my knee is actually not swollen? Can you take a look at the picture and let me know what you think? This bump on top of my knee appeared exactly the same day when I was injured. It wasn't there before, at a certain point when I iced my knee for 3-4 days in a row without any activity the bump gets smaller. What do you think guys?

Also, question #2: I just played with my knee and I figured that at least partially my grinding/catching feeling (no pain) is coming from the back of my knee, not from the patella. I also played with my patella (patella mobilization) and it feels perfectly smooth. I don't feel any catching at all. I have catching on my right knee and when I rub my patella I can definitely feel that something is rough behind, but that knee is not causing me any issues.

Is it possible that I have some other tear which was missed by my doctor? Doctor said I have small patella lesion and he would shave it, maybe he shaved it and didn't pay attention to other parts of my knee? Maybe he was in hurry? is this even possible? I definitely have chondromalacia on my other knee and the symptoms are 99% different.

Offline Brandon123

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Re: No change after patella chondroplasty at all?
« Reply #5 on: June 30, 2017, 11:17:34 AM »
I don't see any obvious swelling, and would not think there was anything wrong if you didn't mention it. However, everybody's knees are different and only you would know if there now is a bump or swelling that wasn't there before. The good news is, of course, that there is no obvious swelling or bump, and even if there is one that hasn't been there before, it may not be a big issue and go away with time.

Also good news I think that your patella now feels perfectly smooth! Maybe the surgery did do some good after all? Weird, however, that the catching/grinding now seems to  come from the back of the knee? I think you need to bring this up with your doctor, and ask what is possible going on in the back of the knee? If there was any major problem, however, they should have seen it during MRI/arthroscopy I guess. Usually I think doctors correct other possible damages they discover during arthroscopy. You should ask him about all these things.
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 Geronimo

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Re: No change after patella chondroplasty at all?
« Reply #6 on: June 30, 2017, 06:13:37 PM »
thanks for replies. I have a follow up appointment this will and will ask doc what's going on. I assume somebody with 30years of experience should now his staff. Although, he's patellafemoral specialist so maybe he doesn't care about the rest?  :-\

Offline Geronimo

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Re: No change after patella chondroplasty at all?
« Reply #7 on: July 06, 2017, 08:51:55 PM »
today had a follow up appointment. Doctor doesn't seem to care anymore.  :-\ The money is paid so he's not interested anymore. So far for $$$ motivated medicine, I had a job where my salary was partially (50%) dependent on the number or issues (patients for him) I process so I partially understand him but this is human life, not a piece of hardware.

Anyway, I took a picture of the inside of my knee. Can you take a look and let me know if somebody can tell me anything based on that?

Offline Brandon123

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Re: No change after patella chondroplasty at all?
« Reply #8 on: July 07, 2017, 09:08:20 AM »
Sorry to hear about the doc...profit-driven health care has both its pros and cons indeed. I am not qualified to interpret the pictures, but there seems to be (was?) some damaged cartilage, maybe somebody else can tell you more?
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: No change after patella chondroplasty at all?
« Reply #9 on: August 06, 2017, 08:33:39 PM »
chondroplasty didn't help me either, I needed 5 mths after the scope to recover from my RK minor cartilage damage. You do have some mild focal grade 2 or 3 cartilage damage which they "shaved", meniscus and other knee structures look all ok to me.

Give it more time :-), you'll recover.

Nb: I'm no specialist, but I've seen a lot of knee pictures by now.
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 SuspectDevice

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Re: No change after patella chondroplasty at all?
« Reply #10 on: August 08, 2017, 02:00:49 AM »
My research indicates patella shaving is a mostly load of OS money-making crap.

But it's very early days for you get - give it at least 6-12mths, and with the right activity levels (i.e. avoid what makes it hurt), hopefully the cartilage will slowly heal itself.
L Medial menisectomy 2012
PFPS both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2020 - ride 3x/week, swim 2x/week, gym 2x/week, aiming to get back to short triathlons

Offline Geronimo

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Re: No change after patella chondroplasty at all?
« Reply #11 on: August 10, 2017, 06:33:22 AM »
thanks guys, i really appreciate your kind words. i actually got a bit better and stopped taking pain pills until i became over-optimistic and squatted a few times...i can't believe it happens to be the second time...as soon as i start feeling better i totally forget about my issues and aggravate them right away.  >:(
















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