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

[Brandon123]

Cartiflex seems to be some kind of supplement...do you take this, Geronimo?

http://qualityoflife.net/product/211/Cartiflex%C2%AE.html

Regarding supplements, I have tried glucosamine and chondroitin over long periods of time with minimal results.

[Geronimo]

lol...too many words... i meant cartiform.

[Brandon123]

OK

[reflex_nl]

Just got feedback on my new MRI (and x-rays) this new MRI is taken 10 mth post operation. The only thing they did was debridement aka shaving the cartilage under the knee cap in Nov'16.

The conclusions were as follows:
1) limited to no cartilage regrowth in the lesion (as expected )
2) 2 small osteophytes formed in the lesion (bad news)
3) No more bone bruises at the ligaments (ok news)
4) slight patella alta (already known)
5) very slight mall-tracking (lateral) (already known)
6) Some MPFL avulsion (new for me)
7) Other knee items intact (e.g ACL, Meniscus, MCL) (already known)

The big question is what to do next.... here in the Netherlands they cannot do anything (except for Microfacture or a new knee replacement), both awful solutions to my problem. They strongly advice against OATS (autograft) on the patella, and from most studies that I read, they are right as it has a low change of success and is very invasive.

Some others also mentioned MPFL reconstruction to increase stability but this doesn't remove the pain; the pain is for 99% coming from the damaged cartilage. Hence, the cartilage has to be fixed one way or they other. I willing to travel aboard but I need a local OS to sponsor and support me... (haven't found one yet... what they don't know they consider "experimental"...

Any ideas...?

[Brandon123]

Thanks for the update!

The only way to "restore" cartilage in the patellofemoral joint that you haven't mentioned, and that I know of, is ACI/MACI. They do repair patella cartilage damages (often larger) with those techniques, but it comes with the same problem as microfracture (and OATS): patella cartilage is the most difficult place to conduct the procedures. It is also quite expensive procedures from what I have read, and hence, many prefer microfracture as a cheaper and simpler alternative. It is also questionable whether at least ACI is much more successful than a traditional microfracture.

See for example: http://savingmyknees.blogspot.fi/2011/07/microfracture-vs-aci-which-makes-more.html 

But it might still be worth checking out? Have you seen Sune's story? His story reminds a bit of yours, I just found it the other day:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=56991.0

 http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=60875.0

Maybe someone else know of any other cartilage restoration techniques?

Then we have stem cells of course, which I have been thinking of myself. Unfortunately, there is little solid scientific support for these procedures and they usually cost a lot. I guess that is why they aren't used in non-profit driven healthcare practice, and many European docs refer to such treatments as "experimental". I am not saying that it doesn't work, only that is seems to be (from what I have read) an expensive gamble.

I think it all comes down to 1) how much money you can spend, and 2) what procedure you are willing to try in terms of risk of failure. Just taking it easy and wait and hope it gets better with time is also a (maybe viable) alternative. In the end of the day, the only treatment with a rather predictable outcome, I guess, is knee replacement (maybe PF-joint only), but I understand of course that you don't want to go that route in your age (me neither).
 

[vickster]

Look at DreamRunner's diary of her fairly recent experience of patella repair+stem cells in Kent UK (Prof Sherry team, he's been having some success with patella cartilage for 5+ years going on feedback on this forum) Should be pretty accessible geographically from Europe (via Eurostar)

Don't know if you can get a referral and pay for private consult with your imaging, guessing around £300-500 if not UK resident. You'll likely need to get CT scanning too which isn't cheap (he orders this for full detail of anatomy etc)

[reflex_nl]

@brandon, thanks for your reply. Indeed options are limited, but I'm happy to share my experiences so others can learn as well.

I did indeed contact Sune already via PM and had chat about MACI/ACI, the result were ok, not good, and literature hardly shows successful outcomes on the patella, although it is received better feedback compared to OATS. However, for me this is not available here (or in nearby countries) and as you mentioned really expensive...

Even so... I need a OS to help and "support" me if I chose for surgery aboard, and these OS's are hard to find.

[reflex_nl]

Hi Vickster,

Based on your other comment I contacted dr. Shetty and I'm planning to visit him in October - keep you posted. I'll look into DreamRunner's dairy.

thx. Reflex

Look at DreamRunner's diary of her fairly recent experience of patella repair+stem cells in Kent UK (Prof Sherry team, he's been having some success with patella cartilage for 5+ years going on feedback on this forum) Should be pretty accessible geographically from Europe (via Eurostar)

Don't know if you can get a referral and pay for private consult with your imaging, guessing around £300-500 if not UK resident. You'll likely need to get CT scanning too which isn't cheap (he orders this for full detail of anatomy etc)

[Brandon123]

I did indeed contact Sune already via PM and had chat about MACI/ACI, the result were ok, not good, and literature hardly shows successful outcomes on the patella, although it is received better feedback compared to OATS.

Ok, thanks for the info! I was actually rather curious about his outcome.

[Brandon123]

Hi Vickster,
Based on your other comment I contacted dr. Shetty and I'm planning to visit him in October - keep you posted. I'll look into DreamRunner's dairy.
thx. Reflex

Please keep us updated on what he says, I am always interested in possible patella cartilage restoration procedures. Good luck with the visit!

[reflex_nl]

Hi all!

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.

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...

Keep you posted on the next steps!

[Brandon123]

Great that you met with him and the procedure sounds promising!

Did he mention any specific challenges when it comes to patella cartilage lesions?

Also, can I ask what type of costs we are talking about for this kind of surgery? 5, 10, 15K?

[reflex_nl]

No clue yet, as I also need the MPFL reconstruction, but my guess it will be on the upper end of your range.

Are you planning any other steps?

[vickster]

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)

[Brandon123]

No clue yet, as I also need the MPFL reconstruction, but my guess it will be on the upper end of your range.

Are you planning any other steps?

Ok, I understand. Well, I must do something in the near future as the situation is not improving. However, as my patella cartilage damage is more of a wear and tear arthritis type than focal lesions, any cartilage repair surgery would probably be a long shot

I had a chondroplasty in 2009 that worked really well for 6 years or so, but as we know, a new one would be a real gamble. One OS wants to do just that, a new chondroplasty with a lateral release and possible microfracture if he finds any deep focal lesions. I'm quite skeptic towards this, especially the LR and MF parts...two other OS want to do nothing (only conservative treatment), and eventually a patellofemoral joint replacement as last option.

So, it feels like I'm kind of stuck without any good reasonable options. As my next step, I will probably try to get a fourth opinion from a PF joint expert.