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Author Topic: Osteoarthritis in Back of Patella  (Read 978 times)

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Offline Sbh77

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Osteoarthritis in Back of Patella
« on: July 21, 2021, 05:24:51 PM »
My knee went bone on bone after multiple dislocations, leading to tubrecal osteotomy surgery a few years back.  The doctor who did the operation on me also said I had kissing lesions.  Now I'm starting to have soreness and pain again.  One orthopedic surgeon told me the next option is partial knee replacement. 

Are their any options you're aware of or doctor has performed on you that isn't a knee replacement? 

Offline vickster

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Re: Osteoarthritis in Back of Patella
« Reply #1 on: July 21, 2021, 10:49:51 PM »
How old are you?
Unfortunately the cartilage repair options available aren’t reliable for the patella and especially not where you have wear on patella and trochlea, which is presumably the source of the kissing defect? (Due to shearing forces in the knee between patella and groove the repairs often don’t heal or take well).

There is also wide variation on what options might be accessible depending on your location and access to funds to pay privately if required.

Have you tried injections to see if they alleviate inflammation and pain, hyaluronic acid, platelet rich plasma, stem cells? (Again cost and access variable). Or bracing?

There are plenty of resources in the learning portfolio to look through.

https://www.kneeguru.co.uk/KNEEnotes/learning-portfolio

Long term however, a replacement may be the only option likely to offer relief.

Good luck
« Last Edit: July 21, 2021, 10:51:39 PM by vickster »
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline Sbh77

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Re: Osteoarthritis in Back of Patella
« Reply #2 on: July 23, 2021, 02:40:03 PM »
How old are you?
Unfortunately the cartilage repair options available aren’t reliable for the patella and especially not where you have wear on patella and trochlea, which is presumably the source of the kissing defect? (Due to shearing forces in the knee between patella and groove the repairs often don’t heal or take well).

There is also wide variation on what options might be accessible depending on your location and access to funds to pay privately if required.

Have you tried injections to see if they alleviate inflammation and pain, hyaluronic acid, platelet rich plasma, stem cells? (Again cost and access variable). Or bracing?

There are plenty of resources in the learning portfolio to look through.

https://www.kneeguru.co.uk/KNEEnotes/learning-portfolio

Long term however, a replacement may be the only option likely to offer relief.

Good luck

I'm 32 years old living in the U.S.  As far as injections go, I've tried synvisc a couple of times but didn't notice a difference.  No bracing.

Offline vickster

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Re: Osteoarthritis in Back of Patella
« Reply #3 on: July 23, 2021, 02:47:44 PM »
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline Sbh77

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Offline A_sure_sky

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Re: Osteoarthritis in Back of Patella
« Reply #5 on: July 23, 2021, 05:12:54 PM »
My knee went bone on bone after multiple dislocations, leading to tubrecal osteotomy surgery a few years back.  The doctor who did the operation on me also said I had kissing lesions.  Now I'm starting to have soreness and pain again.  One orthopedic surgeon told me the next option is partial knee replacement. 

Are there any options you're aware of or doctor has performed on you that isn't a knee replacement?

I had some of the same knee issues you have had though not the tubrecal osteotomy surgery. I also was recommended partial knee replacement by several doctors.  I found a doctor who thought I would be a good candidate for an Osteochondral Allograft Transplant Surgery (OATS for short) and I ended up doing this.  I would suggest reading up on this surgery to see if you might a candidate. If so, see if you can find a doctor who has knowledge about this surgery in your area (I am also in the US). I wrote up my experiences in the Post-op Dairies section of this site so you might want to check that out if OATS is a viable option for you. Good luck.

Offline Sbh77

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Re: Osteoarthritis in Back of Patella
« Reply #6 on: July 23, 2021, 11:41:37 PM »
My knee went bone on bone after multiple dislocations, leading to tubrecal osteotomy surgery a few years back.  The doctor who did the operation on me also said I had kissing lesions.  Now I'm starting to have soreness and pain again.  One orthopedic surgeon told me the next option is partial knee replacement. 

Are there any options you're aware of or doctor has performed on you that isn't a knee replacement?

I had some of the same knee issues you have had though not the tubrecal osteotomy surgery. I also was recommended partial knee replacement by several doctors.  I found a doctor who thought I would be a good candidate for an Osteochondral Allograft Transplant Surgery (OATS for short) and I ended up doing this.  I would suggest reading up on this surgery to see if you might a candidate. If so, see if you can find a doctor who has knowledge about this surgery in your area (I am also in the US). I wrote up my experiences in the Post-op Dairies section of this site so you might want to check that out if OATS is a viable option for you. Good luck.

Thanks for the response.  Looking through your post-op diary, we indeed do have similar issues.  I had lateral release after the 3rd dislocation but it didn't work as my knee started feeling instability a year later and went bone on bone shortly thereafter.  This what led to the tubrecal surgery. 

A couple of questions: How many dislocations did you have before the lateral release?  If you don't mind me asking, who did your OATS surgery?  Was the OATS taken from a deceased donor or healthy section of your joint.

Offline Brandon123

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Re: Osteoarthritis in Back of Patella
« Reply #7 on: July 24, 2021, 10:39:42 AM »
I found a doctor who thought I would be a good candidate for an Osteochondral Allograft Transplant Surgery (OATS for short) and I ended up doing this. 

Can I also add a question :) : as I assume we talk about donor tissue, how much was transplanted? Just a plug/smaller graft or the entire underside of the patella and/or trochlea? If the patella and trochlear lesions are large enough, I've read somewhere that the entire surface areas can be replaced with large donor grafts, if you understand what I mean.   
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline vickster

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Re: Osteoarthritis in Back of Patella
« Reply #8 on: July 24, 2021, 11:12:04 AM »
@Sbh77 Allograft = donor (autograft=from own body)

Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline A_sure_sky

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Re: Osteoarthritis in Back of Patella
« Reply #9 on: July 24, 2021, 04:39:35 PM »
My knee went bone on bone after multiple dislocations, leading to tubrecal osteotomy surgery a few years back.  The doctor who did the operation on me also said I had kissing lesions.  Now I'm starting to have soreness and pain again.  One orthopedic surgeon told me the next option is partial knee replacement. 

Are there any options you're aware of or doctor has performed on you that isn't a knee replacement?

I had some of the same knee issues you have had though not the tubrecal osteotomy surgery. I also was recommended partial knee replacement by several doctors.  I found a doctor who thought I would be a good candidate for an Osteochondral Allograft Transplant Surgery (OATS for short) and I ended up doing this.  I would suggest reading up on this surgery to see if you might a candidate. If so, see if you can find a doctor who has knowledge about this surgery in your area (I am also in the US). I wrote up my experiences in the Post-op Dairies section of this site so you might want to check that out if OATS is a viable option for you. Good luck.

Thanks for the response.  Looking through your post-op diary, we indeed do have similar issues.  I had lateral release after the 3rd dislocation but it didn't work as my knee started feeling instability a year later and went bone on bone shortly thereafter.  This what led to the tubrecal surgery. 

A couple of questions: How many dislocations did you have before the lateral release?  If you don't mind me asking, who did your OATS surgery?  Was the OATS taken from a deceased donor or healthy section of your joint.

I dislocated my left knee the first time when I was 14. Within probably six months I dislocated my knee again and this happened pretty frequently for the next several years.  I finally had the lateral release done when I was 20. Most of the dislocations didn't cause any real damage (meaning like after a few minutes or so I could return to normal activities but the knee was sore) but as you know they are usually incredibly painful when they happen. Sometimes however one of these dislocations would cause my knee to swell up like balloon and it would take weeks for the knee to return to normal.  Doctors would just tell me to get my quads stronger.  The final time my knee dislocated I was doing a leg extension machine exercise.  My guess is I probably suffered at least 20 dislocations in total in that six year period.

I am sorry to hear your lateral release surgery didn't fix the problem.  My lateral release surgeries (I had this to both knees) have been much more successful.

I had donor tissue that, I believe, replaced the cartilage behind my entire patella and in the trochlear groove.

Dr. James Stannard at the University of Missouri Columbia BioJoint Center did my surgery. I recommend him and the team there.  Here is a link to their webpage.

Let me know if you have any additional questions.


Offline Sbh77

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Re: Osteoarthritis in Back of Patella
« Reply #10 on: July 26, 2021, 12:53:13 AM »
My knee went bone on bone after multiple dislocations, leading to tubrecal osteotomy surgery a few years back.  The doctor who did the operation on me also said I had kissing lesions.  Now I'm starting to have soreness and pain again.  One orthopedic surgeon told me the next option is partial knee replacement. 

Are there any options you're aware of or doctor has performed on you that isn't a knee replacement?

I had some of the same knee issues you have had though not the tubrecal osteotomy surgery. I also was recommended partial knee replacement by several doctors.  I found a doctor who thought I would be a good candidate for an Osteochondral Allograft Transplant Surgery (OATS for short) and I ended up doing this.  I would suggest reading up on this surgery to see if you might a candidate. If so, see if you can find a doctor who has knowledge about this surgery in your area (I am also in the US). I wrote up my experiences in the Post-op Dairies section of this site so you might want to check that out if OATS is a viable option for you. Good luck.

Thanks for the response.  Looking through your post-op diary, we indeed do have similar issues.  I had lateral release after the 3rd dislocation but it didn't work as my knee started feeling instability a year later and went bone on bone shortly thereafter.  This what led to the tubrecal surgery. 

A couple of questions: How many dislocations did you have before the lateral release?  If you don't mind me asking, who did your OATS surgery?  Was the OATS taken from a deceased donor or healthy section of your joint.

I dislocated my left knee the first time when I was 14. Within probably six months I dislocated my knee again and this happened pretty frequently for the next several years.  I finally had the lateral release done when I was 20. Most of the dislocations didn't cause any real damage (meaning like after a few minutes or so I could return to normal activities but the knee was sore) but as you know they are usually incredibly painful when they happen. Sometimes however one of these dislocations would cause my knee to swell up like balloon and it would take weeks for the knee to return to normal.  Doctors would just tell me to get my quads stronger.  The final time my knee dislocated I was doing a leg extension machine exercise.  My guess is I probably suffered at least 20 dislocations in total in that six year period.

I am sorry to hear your lateral release surgery didn't fix the problem.  My lateral release surgeries (I had this to both knees) have been much more successful.

I had donor tissue that, I believe, replaced the cartilage behind my entire patella and in the trochlear groove.

Dr. James Stannard at the University of Missouri Columbia BioJoint Center did my surgery. I recommend him and the team there.  Here is a link to their webpage.

Let me know if you have any additional questions.

Glad to see your surgery went well.  It sounds like I might be a candidate for this down the road.

Offline Sbh77

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Re: Osteoarthritis in Back of Patella
« Reply #11 on: August 02, 2021, 04:51:35 AM »
My knee went bone on bone after multiple dislocations, leading to tubrecal osteotomy surgery a few years back.  The doctor who did the operation on me also said I had kissing lesions.  Now I'm starting to have soreness and pain again.  One orthopedic surgeon told me the next option is partial knee replacement. 

Are there any options you're aware of or doctor has performed on you that isn't a knee replacement?

I had some of the same knee issues you have had though not the tubrecal osteotomy surgery. I also was recommended partial knee replacement by several doctors.  I found a doctor who thought I would be a good candidate for an Osteochondral Allograft Transplant Surgery (OATS for short) and I ended up doing this.  I would suggest reading up on this surgery to see if you might a candidate. If so, see if you can find a doctor who has knowledge about this surgery in your area (I am also in the US). I wrote up my experiences in the Post-op Dairies section of this site so you might want to check that out if OATS is a viable option for you. Good luck.

Thanks for the response.  Looking through your post-op diary, we indeed do have similar issues.  I had lateral release after the 3rd dislocation but it didn't work as my knee started feeling instability a year later and went bone on bone shortly thereafter.  This what led to the tubrecal surgery. 

A couple of questions: How many dislocations did you have before the lateral release?  If you don't mind me asking, who did your OATS surgery?  Was the OATS taken from a deceased donor or healthy section of your joint.

I dislocated my left knee the first time when I was 14. Within probably six months I dislocated my knee again and this happened pretty frequently for the next several years.  I finally had the lateral release done when I was 20. Most of the dislocations didn't cause any real damage (meaning like after a few minutes or so I could return to normal activities but the knee was sore) but as you know they are usually incredibly painful when they happen. Sometimes however one of these dislocations would cause my knee to swell up like balloon and it would take weeks for the knee to return to normal.  Doctors would just tell me to get my quads stronger.  The final time my knee dislocated I was doing a leg extension machine exercise.  My guess is I probably suffered at least 20 dislocations in total in that six year period.

I am sorry to hear your lateral release surgery didn't fix the problem.  My lateral release surgeries (I had this to both knees) have been much more successful.

I had donor tissue that, I believe, replaced the cartilage behind my entire patella and in the trochlear groove.

Dr. James Stannard at the University of Missouri Columbia BioJoint Center did my surgery. I recommend him and the team there.  Here is a link to their webpage.

Let me know if you have any additional questions.

Hi A_sure_sky,

How long did you doctor say Allograft will last?  Did your insurance cover this?

Offline A_sure_sky

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Re: Osteoarthritis in Back of Patella
« Reply #12 on: August 03, 2021, 01:35:35 AM »

Hi A_sure_sky,

How long did you doctor say Allograft will last?  Did your insurance cover this?

My insurance did cover it. The insurance company did originally send me a rejection letter for the procedure. The hospital where I had it done must have worked it out with them because a week or two later I received a letter saying the procedure was approved.  I know many insurance companies won't approve this surgery if you are older than 50 or 55 (depending on the company). Age shouldn't be an issue for you since you are much younger.  Some companies have a health advocate benefit you can utilize if you are having issues with an insurance company. If you are having issues getting the procedure approved you might see if this is available to you. 

The doctor gave me no promises on how long the allograft will last.  There are some stats out there for the longevity of the allografts so I would suggest looking into those. According to stats I have seen, some people have theirs fail in the first couple years while others have lasted over ten years.  The people at MU did tell me to absolutely stick to their rehab program (which is quite detailed and lengthy) for the best chance of success for the allograft to last.  I would try to find a doctor who has had high success rate with the surgery and a detailed recovery plan to go along with it. I think my doctor said if I follow the plan to the letter I should have a good chance for the allograft to last well over ten years.  I hope not to go in for another surgery again but time (and good luck) will tell. I still worry about doing something that will cause the allograft to fail (although not as often now).