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

[Brandon123]

Oh no, well mostly likely nothing is damaged from your "little jump" and the pain will get better. But good of course to check up with the local OS. Up until that thing at week 12, you recovery has been amazing!

[reflex_nl]

I hope so...  sometimes I over analyse the knee ;-).... but still it s*cks to feel the same pain as I had before the surgery.

Fingers crossed!

[Brandon123]

I hope so...  sometimes I over analyse the knee ;-).... but still it s*cks to feel the same pain as I had before the surgery.

Fingers crossed!

Yeah, of course, I can imagine that you freaked out a bit when that pain came back. But could the graft be so sensitive? Well, let's see what the OS says.

[reflex_nl]

I haven't posted in a while, but I'm still in the recovery phase.

Currently, it is 5 months ~ 23 week post my surgery in the UK (which was the 2nd surgery on the same knee). It is been a bit of a roller-coaster these last few months. I had days is which full pain/inflammation came back, the knee got swollen and I needed ice/NAIDS to get it back to normal. It is hard to link it to exercises, some times, just sitting at a desk at work, the pain flairs up. Despite the LR and MPFL reefing, the patella is not tracking right. I began to notice this around week 14 and it did improve a bit over time, but upon bending the knee the keep cap shifts to the inner side of the leg and you hear an audible click. I did not have this issue pre-op... which makes me worried.

On the positive side... I also have good days and began biking a bit. From 5 KM upto 20 KM/ride, without much pain. I have days in which the pain "mostly" stays away... ofcourse, squads, jogging etc are all out of the question, but I'm happy to have some good days as well. Compared to last re-hab from the previous surgery, I do feel I'm a bit ahead...  Each week I have once/week PT and go swimming/week, nothing fancy, just getting some movement. I take it slow as I'm worried to damage the patched up area.

Mid June I have to go back to Shetty and get an MRI scan... fingerscrossed...

[Brandon123]

Sounds good that you can bike that much without much pain, and that you also have more or less pain free days! Weird that the patella is not tracking right though...well, I guess you have to just wait and see what Shetty says at your follow-up. Let's hope everything is ok!

One thing that came to my mind, have TTO or TTT ever been considered in your case?

[reflex_nl]

Things are getting a bit better. I visited NYC and besides the long flight and subway in/outs it went relatively ok. Some pain, but given the average ~10.000 steps/day according to my iPhone, not bad. I took a NAIDS only twice in 5 days. I still wear a soft knee band just for the idea of it and providing some comfort.

This friday, I travel to the UK again I see Shetty again and will talk about the tracking issue...

[bluesea]

Good Morning -
I had similar damage I think. Traumatic kneecap dislocation with grade 4 cartilage lesion (1.3 x 1.5cm per MRI) under kneecap & torn MPFL. Had OATS procedure and MPFL reconstruction as well as removal of loose bodies on 5/15/18 (so this marks 4 weeks since surgery and 8 weeks since accident). I'm 36 female and was a recreational runner (completing 2nd half marathon 3/25 in 2:13), recreational volleyball player and also light weightlifter. So was very active before - running/exercise was kind of my solace. So anyway, I was basically non-weight bearing for 4 weeks before the procedure and now 4 weeks out am still in a lot of pain, reliant on crutches and physical therapist says I'm not trying hard enough and should be able to bend 90 degrees by now (I feel like pain becomes intolerable at 57 degrees when she is pushing it). I think I should quit PT until I have better ROM instead of feeling like I haven't been putting forth enough effort at home. I have to sleep in brace (which I haven't been doing so well at because sleeping is really difficult) and also wear anti-embolism sock because swelling is still high. Just looking for encouragement. When will this pain become bearable? I'm basically off pain medication unless I just can't sleep. Am I really that far off track? Thanks! Starting to think I should have looked at second opinions on the repair options for this injury.

[reflex_nl]

Good Morning -
I had similar damage I think. Traumatic kneecap dislocation with grade 4 cartilage lesion (1.3 x 1.5cm per MRI) under kneecap & torn MPFL. Had OATS procedure and MPFL reconstruction as well as removal of loose bodies on 5/15/18 (so this marks 4 weeks since surgery and 8 weeks since accident). I'm 36 female and was a recreational runner (completing 2nd half marathon 3/25 in 2:13), recreational volleyball player and also light weightlifter. So was very active before.....

At 4 weeks you cannot say much, OATS and MPFL are serious surgeries; I would wait at least 12 weeks before concluding on the initial healing phase. Take it slow especially with OATS; you don't want to damage the graft. To me, you don't seem to be off track.

You don't hear often about OATS on the patella; how did they decided to do this?

[Leeds, UK]

Hi,
Any news on status of knee? MRI? Tracking issue?
I followed your blog last year whilst waiting for surgery. I have same problem and have had identical procedure. Four weeks in.
Hope it worked out.

[punsikorn]

I'm also a bit afraid of this as I can see how my muscles, general health, and everything are slowly getting worse by this inactive lifestyle. The thing keeping me from having a surgery is of course that there are no really good surgical options for me. I would love if they could just go in and easily "fix" this bad cartilage

When will you have your new MRI? Please let us know what it said. I'm also considering doing a new one in a few months, it was over 2 years ago I had my last one done.
gclub

[reflex_nl]

Hi Guys.

Some update on the knee; unfortunately no good news. I'm 14 months post op and things are not good. The cartilage didn't grow and only the bone has grown fully in the hole of the cartilage (clearly visible on the MRI). They call this intralesional osteophytes, which is the likely cause of my constant pain. The pain is worse than prior to the surgery... I'm feeling really down at the moment. After 2.5 years of pain, surgeries no progress at all...

The OS in the UK mentioned that this is a "complication" that can occur. Dr. Shetty didn't have any suggestions on what to do next; except for some injections (Kenalog and HA) which I received in Nov'18 but didn't relieve the pain.

This whole knee drama really s*cks.... I'm fed up with the pain and huge impact it has on my life and those around me...

I can only swim a bit and cycle a bit... (but not without pain); secondly, the mall tracking introduced by the surgery is still there...

Even though he mentioned it wouldn't get worse if the surgery failed... it did.

I hope you have better results than me.

Reflex

[Brandon123]

Reflex,

Really sorry to hear the surgery didn't work out So no improvement at all pain-, cartilage- or patella tracking-wise?

In a rush, but I'll get back to you regarding "intralesional osteophytes", I think I have one too...

[RGB]

Do either of you see a PFJR in your future? Depends on your age I guess but it's not all bad. See posts by me and Dave33.

[Brandon123]

Yep, a PFJR is the only reliable solution I could see to my problem. However, I'm too young (37) by most standards. So still looking into alternative 'bridging procedures' such as TTT/TTO/cartilage repair. How old were you, RGB, when you got your PFJR?

[RGB]

Hi Brandon - yes age 37 does raise a whole lot more issues. I was 56 when I had the PFJR, after approx 10 years of problems and trying micro-fracture, stem cell injections and Dr Saw's treatment in Malaysia. I've posted the details elsewhere but, in summary, the initial micro-fracture made things worse and I'd classify everything subsequent as being a waste of time, effort and money for no material improvement.    TTO etc was not an option because the damage was central. I guess I'm in the honeymoon period with the PFJR - I haven't yet had to deal with it wearing out. I also want to make clear that this is not a recommendation - just a recording of my own experience. However, in hindsight I wish I'd been brave enough to insist on the PFJR earlier than I did. The 10 years of activity restriction was tough to endure and I never did learn to cope well with my restrictions - I was constantly railing against them and trying to improve, to the extent that I didn't give other areas of my life the focus they deserved. I feel like cartilage restoration technology is not yet sufficiently developed to be considered a reasonable alternative so in my opinion for my type of patello-femoral damage it's conservative (non-surgical) treatment or PFJR, with nothing useful in between. Sorry - a bit gloomy. Regards.