dislocated patella, cartilage damage

[jamesp]

so the long story.... Dislocated patella ~8 years ago & I knocked a finger nail size piece of cartilge off the inside of said patella. Meniscus is ok, only other damage was a fairly minor (I think) partial tear of the interior crucial ligament.

Since then I've always had a weak point that I could never weight properly. Straight leg is ok, bent is ok, in between is bad. Pain, weakness has varied over the years, but has never really stopped me from doing anything. I bike lots, hiking (climbing approaches), alpine mountaineering routes etc. I've never been able to run though, the impact was always too much.

I've skied LOTS since 2007. 100+ days for ~4 years. Tele, alpine, lots of touring days, lots of days walking into ice climbs. My knees were best since the dislocation during this period. I put it down to my legs being strong, lots of exercise & a variety of exercise also.

Had 2 winters off (travelling, riding motorbikes, ocean sailing trips). I've been back in the mountains now since last summer. I was definitely out of shape compared to previously. But I've been biking lots, skiing again this winter, touring, classic XC.

My knee FKING hurts this winter. I've stopped tele, it just hurt too much. But now even alpine skiing is hurting almost as much. Pretty sure I'm using my good leg to compensate from my sore leg. Is it just taking a while to get my legs used to skiing again? The only thing I'm not doing is climbing, so I'm probably walking/hiking less now.

Any suggestions other than 'suck it up princess'? Am I a reconstruction candidate?

If you can be bothered responding with any suggestions / feedback / experience / heckling it would be appreciated.

[Orthoski]

James...sorry to hear about your injury. The decision making regarding being a "reconstruction candidate" is quite nuanced and unfortunately it'll be impossible to get enough information over a forum. You didn't specify your age (which influences things), but you should probably speak to a sports medicine surgeon who specializes in your types of injury (i.e., a surgeon that not only does knee scopes and ACLs, but also realignment procedures, cartilage implantation, etc). Depending on where you are, this may mean traveling to a major medical center. The obvious first step is to rehab the knee again, get stronger, and see if you can get to the point that you were during your four years of 100+ ski days. Otherwise, whether something can be done (and there's a significant likelihood that there won't be a surgical solution) depends on why you're having pain (is it the knee cap vs. something else), the type of cartilage damage in your knee (a localized, punched-out defect vs. early arthritis), your knee's overall alignment, the status of your ACL, etc. Best of luck with this - I can easily understand your frustration given how active your lifestyle sounds, but I sincerely hope you'll return to that lifestyle given that you were able to do so for all these years post-injury with the only change being two years off from skiing. And I've heard it said that waist-deep powder cures everything...

[jamesp]

ok totally realise that I won't get close to all the info I need from the 'net. I was really asking to see if anyone else here had similar experiences...

FWIW, I'm early 30s. The pain is localized to the knee cap. I mentioned I am missing a finger nail size piece of cartilage from my patella - this was removed via arthroscopic surgery at the time. I'll likely just suck it & do what I can for now. If it gets worse or doesn't improve I'll try go see someone about it.

[Orthoski]

Sounds good, James. You're considered a young guy, and the reason I bring out the "nuanced" component of decision-making is that were you to have just a punched-out, nail-sized defect in your cartilage and your knee is otherwise perfect, at the cutting edge of sports medicine are things like cartilage implantation, etc. Some of the things I brought up steer that decision. The vast majority of people with knee cartilage injuries are NOT candidates for these procedures (and the patella doesn't necessary do as well as other areas of the knee), but given that you are young and active, it may be worth at least talking to someone who is familiar with these procedures about various options. Best of luck to you and keep us posted!

[lrc]

Hi James, I came across your thread during a long and mostly fruitless search for information about small areas of missing cartilage on the inside of the patella. Seems like you and I might be part of a very select group of folks with this kind of condition...

My "spot" of missing cartilage flaked off about 1 month into recovery from a pretty standard arthroscopic surgery to repair a small meniscus tear and general clean-up. I think a combination of perhaps too much clean-up and enthusiasm for a few PT exercises on my part were at fault. Suddenly one day I had lots of pain trying to stand up from seated position, can't squat down very far (ie: skiing position out of the question), etc. My surgeon had no idea what was going on so we waited about 6 months for it to subside - which it never really did. 2nd surgery found the piece of cartilage floating around and cyst of fibrous material had formed where it flaked off. My surgeon removed the cyst and performed microfracture (small holes into the marrow to release stem cells to "hopefully" create a cartilage-like material). It's been a year since the 2nd surgery and "the spot" is still there (painful to squat, etc.) , so the microfracture didn't really solve the problem (microfracture doesn't always work).

Will be having a discussion with my surgeon about next steps soon, and I'm wondering how your situation turned out. Any attempts made to repair the missing cartilage? What method(s), what results?

I hope your situation is better no matter what path you took - thanks for whatever you care to share.