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Author Topic: Can a full thickness tear in articular cartilage heal....?  (Read 234 times)

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Offline gelnimbus19

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I had an injury last summer after about 2 decades of mild knee pain (not enough to slow me down, but had some intermittent discomfort before the injury.)

In the course of diagnosing the injury, I had an MRI that showed a full thickness tear in the articular cartilage. This was confirmed during arthoscopic surgery (surgeon provided photos and pointed out "here's the tear and here's where we trimmed the ragged edges of cartilage back.")  The surgery also included removing a lateral plica and a lateral release (not enough space under kneecap for scope to pass through.)

After several months of healing and physical therapy, I started to have problems with the knee locking/catching and more extreme pain. We tried a monovisc injection without much success and I recently had a cortisone shot because the entire joint was inflamed and painful. Shortly after the cortisone shot, my surgeon sent me for a new MRI and was discussing surgical options to transplant new cartilage.

I went back to get the results of the latest MRI and the surgeon says it showed no tear in the articular cartilage, at all, full stop. I was so surprised that I didn't do a very good job asking follow up questions. I was under the impression that we were talking about transplanting in donor cartilage because it was not possible for a tear like mine to heal. Has anyone had experience with this? I am still experiencing regular moderate to severe pain, especially following activity (walking, jogging, swimming, etc) but even without activity, as well.

(Surgeon has now referred me for 2 weeks of PT for 'patella tendinitis' and I am to report back if I don't feel better after those 2 weeks.)

Offline Vickster

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Re: Can a full thickness tear in articular cartilage heal....?
« Reply #1 on: May 23, 2019, 07:22:50 PM »
I have full thickness tears on both condyles. They are covered with fibrocartilage, so not healed exactly but not with exposed bone so left alone in recent scope. So yes, they can heal without intervention. Lateral defect has been like that for 9 years.
Also one in trochlear groove which needed Microfracture and will hopefully cover with fibro
Where is your knee is the defect? Did he rough up the surface before? Defectsbarentbakways clear on MRI although presumably he compared to previous?
« Last Edit: May 23, 2019, 07:26:34 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
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline gelnimbus19

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Re: Can a full thickness tear in articular cartilage heal....?
« Reply #2 on: May 23, 2019, 07:43:06 PM »
Thanks, Vickster.

The tear is on the patellar medial facet.

In your knees with fibrocartilage coverage, do you have any locking/catching or pain, or has that resolved for you? I am happy to be informed that the tear has potentially healed (surprised, but happy!) but if so, confused why I am still having pain and malfunction to this degree.

(If it helps, I am a 38 year old female, not overweight, and fairly active: exercising 4-6 days per week, and prior to the injury last year, a competitive equestrian (so galloping and jumping!)) I have had knee pain since school related to sports injuries, but as mentioned, it was intermittent/manageable.

Offline Vickster

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Re: Can a full thickness tear in articular cartilage heal....?
« Reply #3 on: May 23, 2019, 08:14:59 PM »
Yes, I have pain a lot of the time, I just live with it to be honest. See a rheumatologist as I have a lot of sore joints, take the meds, use anti inflammatory gel, see physio, get sports massages.

I can cycle (about 1200 miles this year, I was scoped on 10 Jan), can work (office job),canít run, canít kneel, canít squat.
My patella is grade 3 too.

Iíll need a knee replacement once I can no longer function well and cycle comfortably and at 46 iím too young anyhow



Are you seeing a patella specialist surgeon and physio (if you can access where you live? US?)
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 gelnimbus19

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Re: Can a full thickness tear in articular cartilage heal....?
« Reply #4 on: May 23, 2019, 08:25:08 PM »
Yes, in the US. My doctor is a knee and shoulder specialist, not patella specifically. I have been pretty happy with him but he's always in a tremendous hurry (not super helpful when I have questions, but otherwise he has been great.)

I can totally handle some pain - it is tougher when it's very severe (enough to distract me from work or wake me up from sleep) but randomly toppling over when my knee locks up is more of a problem. I am not sure the doctor has totally addressed that issue; and of course it's hard for him to see during an office visit.

I am actually happy to be starting physical therapy again - the doctor had me stop in December because I had a lot of inflammation/swelling and pain with the exercises, but I'm hoping it will go better this time. My surgery was last August so it just feels like this is dragging on a bit.

Offline Vickster

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Re: Can a full thickness tear in articular cartilage heal....?
« Reply #5 on: May 23, 2019, 08:30:33 PM »
I don't know if locking instability can be due to the lateral release, the surgery can have many adverse effects, not least ongoing pin. It won't be down to a patella defect I wouldn't think?
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 frustrated101

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Re: Can a full thickness tear in articular cartilage heal....?
« Reply #6 on: May 27, 2019, 12:44:29 AM »
Lateral plica removal and lateral release without your consent.  You should sue. 

Offline Vickster

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Re: Can a full thickness tear in articular cartilage heal....?
« Reply #7 on: May 27, 2019, 07:52:33 PM »
Where does it say no consent was given?
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

fullgallop

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Re: Can a full thickness tear in articular cartilage heal....?
« Reply #8 on: May 28, 2019, 09:42:22 PM »
(sorry about the confusion - apparently I have 2 screennames?!)
« Last Edit: May 28, 2019, 09:52:38 PM by fullgallop »

Offline gelnimbus19

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Re: Can a full thickness tear in articular cartilage heal....?
« Reply #9 on: May 28, 2019, 10:02:08 PM »
Hey frustrated101 - thanks for responding.

The lateral release was a 'game day decision' - my surgeon notified me immediately before my surgery that it might be necessary because my kneecap was so locked in place that he wasn't sure they would be able to pass the scope behind it. He expressed that it would not be his first choice due to possibility of bleeding, but that it might be necessary. So I guess that counts as informing me (although as I was already prepped for surgery, I certainly didn't have time to research the procedure or anything.)

Of course after the fact, I have read so much about the failure of lateral releases that I regret his choice to do it, even if he felt it was truly necessary (not meaning I plan to sue him, just wish there was an alternative or something.)

At this point I am just so confused that we went from "I'm putting you on the list for a cartilage transplant so we can do surgery" to "it's patella tendinitis, go do PT" when I really haven't had any change in symptoms or function. I don't want to sue anyone, I just want my normal level of activity back.

I re-start PT this week though, hoping they have some ideas to help me out. Also exploring the possibility of seeking a second opinion/second interpretation of the MRI.

(I somehow forgot that I signed up for this forum last year and had a screen name, so I made a new one. But my laptop remembered the old one for me?! I'll contact a moderator to delete the previous screen name and again, apologies for the confusion.)















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