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Author Topic: Patella cartilage loss  (Read 339 times)

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Offline Brankon

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Patella cartilage loss
« on: July 31, 2018, 11:41:07 PM »

Need some advice. Iím 28 year old male eith history of mild and at times severe knee pain for 10 years. Initially my issue was knee dislocations starting at 18. I had minor operation(canít remember what I had done), 3 years ago after on and off pain for some time I had tibia tubercle osteotomy. Initially it seemed this operation had gone well, alignment was better, swelling was way improved and was relatively pain free. This has all changed however in last 18 months with increased pain/stiffness. I went for mri recently and surgeon advised the mri shows full thickness loss on median facet of patella, full thickness loss on medial ridge. Full thickness loss superolatetal trochlea. Everything else seems fine in terms of menisci, ligaments. The surgeon has tried hyalurinic acid and steroid injections but I feel they are no good and waste of time. Itís difficult to meet with my surgeon but can anyone advise what options might be available ? Iíve heard of Microfracture, allograft but is it likely I would be good candidate for these considering the above ? Am I out of cartilage restoration options ? I just hate to think knee replacement is only thing left and even if it was that Iíll be told Iím too young. Any feedback be great

Offline Vickster

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Re: Patella cartilage loss
« Reply #1 on: July 31, 2018, 11:52:48 PM »
What country are you in as the potential options do vary between country (both in terms of availability and access through insurance/ the healthcare system). If your surgeon isnít a specialist in cartilage repairnaround the patella, it would be good to get further opinions from one or more who is (albeit youíll probably get different opinions about what can be done and what might be best). Unfortunately the PF joint cartilage is hard to repair successfully due to the shearing forces from bending and straightening

Thereís a list of PF surgeons in the primer section of the learning portfolio. Thereís also info on the patella and joint cartilage (as well other resources and articles )

Good luck.
« Last Edit: July 31, 2018, 11:56:52 PM by Vickster »
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
More tears and wear, scope planned in Jan 2019 to tidy up

Offline LisaWilliams38

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Re: Patella cartilage loss
« Reply #2 on: August 10, 2018, 06:55:22 AM »
In the past, I was told there wasn't much that could be done successfully for patella cartilage loss/lesions.

However, recently I was told by my OS that they're having much more success with ACI (autologous chondrocyte implantation) on the patella now---more so than with femoral/tibial condyle lesions. Mine just aren't big enough for insurance to pay for yet. I'm not sure if newer techniques are responsible, or why else, but I trust my OS immensely and have a long history with him.

I'm in the US though, and I know options/cost vary by location, but I wanted to at least mention it. I know insurance companies here used to deny all patella ACI procedures, but some insurances ARE paying for it now. I had good success with ACI on my right medial femoral condyle, and it's helped me put off a knee replacement a few more years. I was 43 at the time and am now almost 46. I hated the long recovery, and would definitely think twice before doing it AGAIN, but I would at least consider it if possible.

'98 R plica
'99 L resect discoid meniscus
'01 L  meniscus tear
'02 R  meniscus tear
'10, R meniscus tears, Bursectomy
'13, R 3 meniscus tears, Grd 3 Biocartilage fil
'15 R Oct-ACI harvest,
'15 R Dec-ACI implant
'16 R Mar-lysis of adhesions
'16 R Mar-MUA
'18 L 3 menis tears, Grade 4 Biocartilage fill