Patella Cartilage damage - what is next? (MRI Pictures - page 2)

[Brandon123]

Private cartilage repair will typically run GBP 10-15k. That's based on numbers I was given 6-7 years ago (e.g. For AMIC, a single scope procedure)

Many thanks for the info!

[reflex_nl]

Hi Guys,

Quick update: I decided to go ahead with Shetty's proposal and get CT scans and MRI's and X-yas. The third MRI within a year. Hence, I traveled back to the UK - see below the results. His conclusion was that I do have tracking issues. Patella tilt and patella shift. Hence he recommended to perform an MPFL reconstruction, a lateral release and the MCIC cartilage repair. A bit of a shock to me; but without addressing the bio mechanics the cartilage repair would not hold. He gave it a 80% chance of success.

If you look at the pictures, you notice a few things

• You can see the left knee patella is not in the same spot compared to the right
• You can see that some (fibro) cartilage has grown back in the hole
• The trochlear groove is flat, hence a risk of dislocating the knee cap
• Their is a bony avulsion on the MPFL patella attachment area
• Meniscus and other ligaments intact
• The patella is clearly tilted laterally

Strangely enough...  sometimes when the knee cap sits "ok" I don't have much pain; but when it tracks wrong, simple walking already hurts (luckly this happens once twice/each month). However, after a year, I still cannot do any sports and I'm at risk for further damage...

Hence, I have to go to surgery to improve the situation.

[reflex_nl]

and the MRI pictures...

[Brandon123]

You do really have a flat trochlear groove, no wonder you have suffered multiple dislocations :/

When will you have your surgery with Dr. Shetty?

[reflex_nl]

Yeah, surgery was done a week ago by Mr Shetty himself. He was quite pleased with the surgery it self. I stayed in the UK for 4 days. Currently in a brace locked to 20 degrees and on pain meds. So far so good... the stemcells need to do their job in the comming months :-)

It’s already the third time - getting used to it.

[Brandon123]

Sounds good! Keep us updated on how you are doing :-)

[reflex_nl]

A update after a knee surgery: MCIC + Lateral release + MPFL reefing all on LK

Week 1:
Surgery completed; stayed one day in the hospital and got some pain killers for @ home. Knee swelled a lot, as usual, but so far so good. Pain levels quite acceptable. No complications and I even got a pictures from the surgery itself. Shetty is as kind as ever and explained all the steps. I stayed 5 days in the UK for recovery and followup. I was in a CPM machine for 2 hours after surgery and the next morning the physio gave me a brace. I can bear full weight on the knee, but the flex is limited to 20 degrees. I can slow walk a bit with the brace and crutches. ROM w/o brace, not weight bearing: 20 degrees

Week 2:
At home. I can move around the house without crutches, just the brace. Pain is minimal, and wounds are healing nicely. The advantage of a swollen knee is that you hardly feel any cartilage or bone related pain. I do limit my movements around the home and ice the knee 3x a day. I do some light physio to keep the leg active. I stopped taking pain killers. ROM w/o brace, not weight bearing: 30 degrees

Week 3:
Enjoying my time off, the knee is a bit slimmer now. Increased the flex to 30 degrees per OS advice. I'm still amazed by how well the recovery is progressing compared to my two other knee key hole surgeries. These were far simpler, but both times I had for weeks a lot of "pain", "redness", "soreness" post surgery. Of course it will take at least 6 to 12 months before I know if the last surgery was successful, but a smooth recovery does help to stay positive :-). ROM w/o brace, not weight bearing: 60 degrees

Keep you updated - any questions, let me know!

[Brandon123]

I'm still amazed by how well the recovery is progressing compared to my two other knee key hole surgeries. These were far simpler, but both times I had for weeks a lot of "pain", "redness", "soreness" post surgery. Of course it will take at least 6 to 12 months before I know if the last surgery was successful, but a smooth recovery does help to stay positive :-)

Quite amazing, based on my own key hole surgery, I have always assumed that a "real" knee surgery would be a rather horrible experience :-)

Btw, is the patellofemoral joint (and PF surgeries) Shetty's key area of expertise?

[Vickster]

Knees, especially PF and cartilage repair (and hips which isn't unusual for a knee surgeon here)

https://www.spirehealthcare.com/consultant-profiles/professor-anan-shetty-c3444306/

A UK NHS surgeon will generally treat whatever is referred to him by GPs in the area in addition to tertiary referrals for any special interest

[reflex_nl]

To me it seems his main interest is helping people with cartilage issues. He is in favor of less invasive methods. If you still have knee pain, you can always visit him to talk about your concern.

[Brandon123]

Knees, especially PF and cartilage repair (and hips which isn't unusual for a knee surgeon here)
https://www.spirehealthcare.com/consultant-profiles/professor-anan-shetty-c3444306/
 

Many thanks for the info and link, Dr. Shetty has a very impressive resume indeed! I suppose he is one of UK's leading PF/cartilage repair knee surgeons?

To me it seems his main interest is helping people with cartilage issues. He is in favor of less invasive methods. If you still have knee pain, you can always visit him to talk about your concern.

Yup, I still struggle with my PF cartilage damage…Dr. Shetty seems to be a world-class expert on this area, so I will definitely keep him in mind for the future.

[reflex_nl]

Week 4:
ROM is improving and I'm a bit more mobile. Still super carefull not to damage the graft and every step I take is with help of the brace. Pain is acceptable although I do get occasionally some minor "cartilage pain shoots" in the knee. The knee is somewhat slimmer and hence the surfaces can rub agains one and other occasionally. I'm working full time from home and take it easy. Also made some short trips to friends/supermarkets and a dinner. ROM w/o brace, not weight bearing: 80 degrees

Week 5:
The knee behaving quite ok; I expected worse. I did a first 10 min cycling on a stationary sit-bike, which went well. I will now try to do this daily. The pain on the side of the latteral release is increasing a bit and when touching it, it does feel sore. However, still manageble. After week six I have a call with Shetty to discuss the status and to find out if I can drop the brace and start PT. ROM w/o brace, not weight bearing: 90 degrees

[reflex_nl]

Week 6: I had a chat with dr. Shetty, and he was pleased with the progress so far. Recovery is going well. the swelling is still there but that seems to be ok (I've send him some pictures). I can remove the brace at the end of this week and slowly start with PT. ROM w/o brace, not weight bearing: 110degrees

Week 7: First week without the brace; it feels weird as I got quite attached to it. I walk slowly with a limp, but the pain is level is ok. I need to work on recovery of the stability as the knee doesn't feel strong. The first PT session was walking in a swimming pool and this went fine. I also starting driving the car again. ROM w/o brace, not weight bearing: 120 degrees

Week 8: Being a bit more mobile increases the occasional sharp pain shoots in the knee. Maybe I should take it down a notch. Otherwise it is ok, I can stand for 30 min and walk for 15 min all without much problems. The skin is still sensitive to touch and the knee is still swollen and a bit warm, but not red.

[Brandon123]

Week 8: Being a bit more mobile increases the occasional sharp pain shoots in the knee. Maybe I should take it down a notch. Otherwise it is ok, I can stand for 30 min and walk for 15 min all without much problems. The skin is still sensitive to touch and the knee is still swollen and a bit warm, but not red.

Great that you can stand and walk rather normally (for short periods) without any major problems, and do not experience any redness.

[reflex_nl]

Week 9: Knee is getting less swollen and I can increase the walking time to 30+ min. Pleased with the result so far. I'm still walking in the pool once a week and doing some exercises at home. The knee is tender to touch but no major issues the recovery yet. I'm still careful not to overdo something.

Week 10: I cycled in the city for the first time since the surgery ~15 min. Felt a strange as the ROM is still a bit limited; but the constant pain I used to feel is absent. Pain shoots during walking are getting a bit less but the clicking noises in my knee increased. I still walk with a limb and swim once a week.

Week 11: I went on a short weekend trip with my wife to Germany (the first trip after >1 year full of knee problems). I do still wear a soft brace as it gives me some comfort. I drove a car for >3 hours and walked for about 2 hours in a city without much trouble. The recovery is much faster than I expected... until...

Week 12: Being a bit overconfident: I rode my bicycle to a friend who lives near by (~10 min) and "jumped" a bit too quickly of the bike (landing on my weak left leg)... which resulted in a sudden pain shoot in the knee. A bit more than normal; and my knee felt sore afterwards. No swelling or redness, but the pain is still there...

Not sure if I need to worry... but I felt a bit stupid afterwards. I hope the graft is not damaged, but the knee doesn't feel as it used to. I'll have a check-up with my local OS soon.