 Poster: A snowHead
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Does anyone know if the articular cartilage can 'fully restore' itself?
Hubby had a knee op last year (tibial tubercle osteotomy and lateral release) but has ongoing symptoms, pain and not full function. So he was referred for another MRI. He has received a letter from his surgeon saying that the scan shows that 'the articular cartilage is fully restored and the patella malalignment is fully corrected' and so there is nothing further to be done surgically.
We were surprised as we didn't know that the articular cartilage could restore itself and this scan was to see if it would be worth trying to resurface it.
Hubby is now quite despondent.
Be grateful if anyone who might know has anything to suggest 
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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sarah, maybe get a second opinion from a different consultant? Can understand that the OH is despondent. You might get a local recommendation from Jonathan Bell but I think he's skiing at the moment.
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You need to Login to know who's really who.
You need to Login to know who's really who.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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sarah, I imagine that Jonathan Bell's secretary would be able to sort out an appointment. Knees are such a pain, aren't they?
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You'll need to Register first of course.
You'll need to Register first of course.
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sunnbuel, thanks, odd then that the letter states that the MRI report shows that the cartilage is 'fully restored' 
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pam w, any consultant's secretary will be more than happy to sort out a private appointment of course  at the moment we're with the Nash!
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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sarah, ask for a copy of scan report
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at the moment we're with the Nash!
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might be time for a change, by the sound of it...
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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sarah, that's a shame. I decided to join BUPA a year or so ago, as a priority in my old age! 12 years ago, when my OH needed a triple bypass, the waiting list was unacceptable - he was quite ill. We had no private health insurance and extended the mortgage on the house to pay for it - about £16K in all. The cost of a fairly ordinary family car. Never regretted it for a moment; there's nothing more important than health, is there?
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sarah, amazing what happens when you cross someones palm with gold isn't it?
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You know it makes sense.
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sarah,
That's a first for me , never heard of cartilage restoring itself.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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Poster: A snowHead
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sarah, I think he means 'restored' as in 'restored itself to its rightful position', rather than 'regenerated' which of course is impossible
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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red 27, thanks. I think we need the report and/or an appointment to get to the bottom of it.
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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sarah, where's the worn articular cartilage? On the tibia or inside the patella? Worn patella articular cartilage is my major knee issue. AFAIK it doesn't regenerate and is rarely helped by surgery. The only person I've met who's had an op for it said it made it considerably worse and a bit of googling suggests that's a common outcome. I was advised that only total rest would improve it. I've done that (for 2 years) and then worked on the muscles and I'm skiing pretty normally. I also have my own ultrasound massager which I use on it from time to time but I honestly can't decide whether it improves it or not.
The only treatment I've come across that seems to get generally positive reviews for restoring cartilage is prolotherapy but it's not very common in the UK. Assuming I go back to work abroad soon I shall try it out.
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You need to Login to know who's really who.
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Raceplate, pretty sure it is on the back of the patella. The op he had was to re-align the patella which was not tracking correctly in the groove and so was 'wearing' against the femur. I'm not sure what procedure was being proposed prior to this scan showing that there is now nothing to be done.
When you say total rest for two years what exactly do you mean?
He can ski relatively normally wearing a Mojo, that's not a big problem, it's day to day pain and limitations to his activities like not being able to ride his bike which are frustrating for him.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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sarah, yeah I googled the op so presumed it was the patella. I saw an Indian specialist (3rd opinion) in the ME who was adamant that only total rest would help it. First 2 specialists just complimented me on my muscle tone and said it would sort itself out in a few weeks. I saw the Indian 9 months later when it was worse, not better. He told me to buy a walking stick. No stairs, running, cycling, kneeling, jumping, sitting with bent knees etc. for an absolute minimum of 3 months but probably much longer.
I do also have a partially torn ACL, recovered medial meniscal tear, over-developed outer quads, weak hamstring and weak VMO (as a result of the meniscus tear) which have all contributed to patellar maltracking, though I have no recollection of any specific fall that caused these injuries - I suspect they may be shear injuries caused by my hamstring weakness that is a very old injury.
As it happens all my gym equipment is in storage so I really have done nothing other than walking for the last 2 years. I read somewhere that you shouldn't do any load bearing exercise unless you can hop pain free so every 3 months or so I 'test' the knee and if it fails I just carry on doing nothing but walking. I walk 2-3 miles most days and although I've lost about 2 inches of thigh muscle through doing no strength training I believe over time the walking has evened out the muscle co-ordination and therefore the skeletal alignment.
In recent times as it's started to improve I've been working daily on the VMO with ballet plies and full squats which seems to have taken the pressure off the kneecap somewhat and increased the joint stability. I can hop pain free now and have even run at full pace over 50m or so a few times. I don't think I'm ready to go jogging yet though. (Actually, despite all the other injuries I have a sneaking suspicion that switching my major exercise from cycling to jogging is what made it flare up in the first place so jogging is probably off the list forever). I don't think your husband should be cycling - the first specialist I saw told me cycling was ok so I was still doing it until I saw the Indian who told me categorically not to.
So, total rest and/or prolotherapy is my best recommendation to help.
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You'll need to Register first of course.
You'll need to Register first of course.
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Raceplate, interesting yhat you say "you shouldn't do any load bearing exercise unless you can hop pain free ".. I can't hop at all, not even a semblance of a hop..but I do have to do load bearing exercise, and hopping is an "end goal". Maybe that;s specific to your injury as opposed to mine.
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Raceplate,
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He told me to buy a walking stick. No stairs, running, cycling, kneeling, jumping, sitting with bent knees etc. for an absolute minimum of 3 months but probably much longer.
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That is just not practical at all, how did you manage to do that? No stairs? We have stairs in the house, pretty much anywhere you go you need to use stairs, you would need to kneel for something now and then, how can you sit at a desk without bending your knee?
He was told by the first consultant he saw that cycling was absolutely the best form of exercise anyone can do to preserve the health of the knee and this is what he likes to do but can't because of the pain, this is at odds with what your 3rd man was saying.
I don't know 
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holidayloverxx, I didn't say it, I said I read it somewhere that hopping was the best test of whether patellofemoral pain was in decline or not. I don't know what your knee injury is but it's been a good yardstick for me.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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sarah, I'm only relating my experience with a similar injury; don't castigate me for it! I had a similar reaction when he told me but a lot of googling suggests that total rest is the best cure - you have to take the pressure off the bone. Whether it's realistic or not for your circumstances depends on your views on work/life balance, I guess.
As an aside I came to the conclusion some years ago that any serious injury takes 3-4 years to fully heal; mine is in that timescale. Depressing, I know. I often ponder that as it takes 20 years for a human body to develop, why do people assume a serious musculo-skeletal injury will re-develop to the same strength in 6 weeks, or even 6 months?
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sarah, for stairs he would stop climbing and descending reciprocal. He would need to go one at a time using the strong leg first. I try not to bend my knee at the desk. I have a box of photocopier paper that I use as a leg rest.
Raceplate, thanks. My injury was TPF with meniscus rupture and stretched MCL. I don't have the dynamic strength to hop yet.
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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holidayloverxx, I was using a scanner box with some bubble wrap to cushion it
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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sarah,
If he is having pain on day to day activities then that is not sustainable. Two years rest is unlikely to make him better.
The question at the moment is whether there is likely to be any further improvement with longer recovery and , in particular, rehab.
If not then a rethink on whether situation acceptable: if not then a discussion about whether there are any other procedures that can help. However if the problem is patella femoral osteoarthritis it may have to be a discussion about some form of joint resurfacing.
Jonathan Bell
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You know it makes sense.
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Jonathan Bell, thanks a lot, much appreciated.
There was a brief discussion about resurfacing and a scan was ordered. I don't see why the scan should change that when the symptoms remain, surely the whole picture should be taken into account. Husband feels very 'fobbed off'.
In the 8 months after the op he went for around 4-5 consultant clinic follow-ups and did not see the consultant at any one of them but instead kept seeing the physio 'ESP', who just kept on saying 'early days'. Once his clinic form was marked consultant but he saw the ESP again. I was concerned as the procedure was a fairly unusual one and I wasn't even convinced that the ESP knew what she should expect from it anyway. Eventually the physios overseeing his rehab said he should go to his next appointment and ask to see the consultant, he did so and it didn't go down too well but I don't think it was unreasonable to actually want to speak to the boss once in 5 appointments. Now this letter has come, consultant seems unwilling to discuss further, just feel very let down.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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sarah,
Have you asked to see another consultant? It doesn't sound vey good.
In fairness to ESPs they aren't there to deal with problems post op, more to check on progress when things go to plan.
The consultant should have been involved.
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Poster: A snowHead
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Jonathan Bell, thanks again.
I would have expected the ESP to refer to the consultant but she did not and hubby didn't want to make a fuss. I gave up accompanying him as I was becoming so frustrated and he would not let me speak up. I had a huge problem with him seeing the ESP at every clinic appointment as he was also seeing an ESP for his rehab so it just seemed like duplication of effort without any consultant oversight.
We are waiting to hear from the secretary as to whether the consultant will see him or not. If not then he could pay to go and see him privately, doubt he will refuse that  Or go and see another consultant.
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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sarah,
The Nhs is frustrating in that time spent with patients s limited due to a large workload but the time spent ( however short) should at least be spent trying to address your concerns .
I would demand that he/ she see him because the outcome is not what was expected and that is unacceptable to be fobbed off.
You should not have to pay him to do his Nhs job.
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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Jonathan Bell, thanks, I will phone again on Monday. Very frustrating because the chap came highly recommended, is very well regarded in our area and was extremely good at the initial (private) consultation and then at the NHS one. It's just been the post-op period where it feels that hubby has been really fobbed off.
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You need to Login to know who's really who.
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Secretary off sick this week, no appointment showing in the system. Very frustrating 
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FAQ
) as they weren't really getting any further 
and wondering how on earth that would be practical. I can see that yes ideally total rest would be the best thing but that practically it would be severely limiting. With his condition anyway I'm not sure rest would be the key as it's not been an injury, it's been more of a wear/degenerative type condition and as we have established that damaged cartilage surface cannot regenerate anyway. I really don't know.
