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Author Topic: Please advise if I require surgery from these MRI results  (Read 878 times)

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Offline skytom

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Please advise if I require surgery from these MRI results
« on: January 12, 2018, 02:25:28 PM »
Hello everyone, I was ice skating for the first time and my patella dislocated while I was skating.
I have massive pain now under the kneecap when I put any weight on it.
Please could you advise if I will need surgery or what options I should do.
Thank you

Here are my MRI results:

Findings: There is marked increased bone marrow oedema within the lateral femoral condyle with delamination of the the subchondral bone and articular cartilage at the most lateral border of the lateral femoral trochlea, just medial to this site there is osteochondral fragment measuring 1.5 cm (CC) x 8 mm (ML). There is a further osteochondral fragment measuring 7mm the donar site fragments represents the lateral femoral trochlea.

There is a further large osteochondral fragment within the lateral recess measuring at least 11 ml (CC) this is fragmented measures approximately 2.2 cm in width.
The donor site of this is the apex and medial facet of the patella where there is a focal osteochondral defect and extensive subchondral bone marrow oedema.

There is marked thickening intrinsic high signal within the medial patellofemoral ligament at its femoral attachment where there is a high grade partial tear. There is also associated oedema and thickening at the patella insertion consistent with at least a intermediate to high grade partial tear.
There is associated increased oedema within the vastus medialis and weakness muscle.
There is a large effusion with mild synovitis.

The medial and lateral menisci are intact.
The 30 inches in the lower ACL, PCL, MCL, lateral collateral ligamentous complex, quadriceps expansion patellar tendon are intact.
The medial tibiofemoral compartment articular cartilage is preserved.

Opinion: Transient lateral dislocation of the patella with large osteochondral fragment from the patellar apex and medial facet which is displaced within the lateral recess.
Osteochondral lesion lateral femoral trochlea with delamination of articular cartilage with osteochondral fragments adjacent to this site as described.
High grade partial tear femoral attachment of the medial patellofemoral ligament. Intermediate grade partial tear at the medial patellar facet.
Large effusion and synovitis.
« Last Edit: January 12, 2018, 02:27:12 PM by skytom »

Offline Vickster

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Re: Please advise if I require surgery from these MRI results
« Reply #1 on: January 12, 2018, 03:38:23 PM »
I would say itís likely given you have a very large piece of cartilage broken off and trapped underneath the kneecap

You would be well advised to find a surgeon specialised in patella issues and cartilage repair of  the kneecap. Itís probably going to be very difficult to fix well unfortunately so you need an expert to give you the best chance

How old are you? Where do you live?

Good luck :)
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 skytom

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Re: Please advise if I require surgery from these MRI results
« Reply #2 on: January 12, 2018, 04:18:17 PM »
Thank you for replying so fast. I am 26 and live in the UK.

It sounds like there are 3 separate pieces. Which is the one you mean that is trapped underneath the kneecap?

I don't really understand where each of the 3 pieces are.

One is under the kneecap, is one on the outer side of my leg?

Thanks so much

I would say itís likely given you have a very large piece of cartilage broken off and trapped underneath the kneecap

You would be well advised to find a surgeon specialised in patella issues and cartilage repair of  the kneecap. Itís probably going to be very difficult to fix well unfortunately so you need an expert to give you the best chance

How old are you? Where do you live?

Good luck :)

Offline Vickster

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Re: Please advise if I require surgery from these MRI results
« Reply #3 on: January 12, 2018, 05:04:02 PM »
Where in the UK are you? Have you seen an orthopaedic surgeon yet to discuss the MRI?

The trochlea is the groove the knee cap sits in. I assume thatís where the fragment is, under the kneecap? Iím not a medic though, you need to discuss with a specialist
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 reflex_nl

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Re: Please advise if I require surgery from these MRI results
« Reply #4 on: January 27, 2018, 04:00:21 PM »
Pieces are hard to identify on an MRI, but the damage you list is quite extensive. Get at least two good OS's to look at it.
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















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