Osteochondral Injury Knee

[heints25]

Hi Rip,

I tried the search function, and didnt get any info on this, but I wanted to hear your thoughts/opinion. Very interested if you have had any experience with this.

I injured my knee a few months back playing softball. I haven't squatted since (though I have tried a few times), as it is painful an causes swelling. I am able to deadlift at about 80% without pain or swelling. I went to the doctor and after an MRI was diagnosed with osteochondral injury to my right knee. The doc referred me to another doc in the office who is their leader in cartilage restoration. I have an appointment with him next week. From the MRI report:

"There is a shallow thin osteochondral defect inferior margin lateral trochlea extending into the anterior marin lateral femoral condyle over an anterior to posterior distance of about 2 cm. The overlying articular cartilage is thin and irregular and a bit blistered in appearance. There is some subtle cyst formation under cutting the defect and some patchy edema in the marrow deep to the defect. "

Also, Impression:

"Shallow osteochondral injury lateral condyle from distal trochlea through anterior atricular surface. Anterior to posterior dimension is about 2 cm and greatest width is about 4 to 5 cm. The overlying articular cartilage of the defect is irregular and thinned with some blistering. Underlying cyst, edema and sclerosis formation suggest it unstable"

Anything you can give me would be helpful. I want to have as much info going into the appt as possible. I have actually been pretty pleased with the doctor so far, which is surprising as I havent had much luck in the past. The doctor figured I would want to do something, as I am 28 years old, and cannot have my desired level of activity with this. She wanted me to talk to their "expert" before making a decision. The options she gave (but clarified it with the possiblility that the other doc might have more) were: nothing (again, probably not an option), lubrication injections (she said probably not for someone my age) and surgery to try and stimulate cartilage growth or transplant.

I am interested in what the short term and more important, long term outlook is. I would assume I will be more subject to arthritis. Is this something I will be able to squat with?

I dont have a great knowledge of anatomy, but the doc was impressed with how much I knew, which I have picked up from this site.


Thanks much in advance.

[Mark Rippetoe]

Are you a runner?

[heints25]

No. I run for the sports I play, and occaisonally will run some sprints, but long distance running really is not my thing.

[heints25]

"Shallow osteochondral injury lateral condyle from distal trochlea through anterior atricular surface. Anterior to posterior dimension is about 2 cm and greatest width is about 4 to 5 cm. The overlying articular cartilage of the defect is irregular and thinned with some blistering. Underlying cyst, edema and sclerosis formation suggest it unstable"

I should fix a mistake I made in typing this, as I belive the size of the injury is important. The 2nd sentence should read:

"Anterior to posterior dimension is about 2 cm and greatest width is about 4 to 5 mm."

[Mark Rippetoe]

I have no personal experience with this, but it looks like an overuse injury. And I have never heard the term "trochlea" applied to the knee, so I can't help you.

[John Petrizzo]

Hi All,

I have never posted before but I have been reading this forum for quite awhile. I hope you can find this info useful. The injury that you sustained to your knee could have occurred from either over-use or trauma. The surgery your doctor is suggesting is most likely microfracture surgery. My basic understanding of this surgery is that they drill a few small holes in the bone near the site of the injury to induce bleeding. From there the bone responds by building new cartilage in the area. Unfortunately the cartilage that regenerates is more like fibrocartilage and not quite the same as the articular cartilage that was originally injured. Several pro athletes have had similar procedures over the last few years with Amare Stoudemire and Kenny Philips being two off the top of my head. Besides that, my understanding is that it is a long rehab process. Good luck with your doc and keep us posted on what he/she says.

[heints25]

An update on this after my appt yesterday:

The injury is definetly a traumatic injury. I cannot recall a specific injury, but it had to happen while bearing weight on my knee and probably some sort of twisting. Microfracture surgery is not an option in my instance as my lesion is approx 5cm2. Microfracture is normally used for lesions 1.5cm2 or smaller. It does not hold up for larger lesions.

My options are 1 nothing, 2 "lubrication injections" (doc said wouldn't do much, but maybe reduce inflammation), 3 physical therapy (doc said is not effective and a waste of time/money), 4 a procedure called ACI (Autologous Chondrocyte Implantation) using Carticel. The procedure is two steps. First, a small amount of cartilage is removed from another part of the knee (non-weightbearing) sent to a lab where they grow more cartilage from my cells to make an implant large enough for the area of the lesion. The second surgery would obviously be to put the implant in. Cortizone injections are available for older patients with extreme arthritis, but doc said he would never give me one due to the negative effects on cartilage.

The rest of my knee is structuraly sound, and looks very good. There is no indication of arthritis.

The procedure would require 6-8 weeks of crutches, and about 6 months of rehab before returning to sports. It would probably take about 12 months to get back to 100% (or close). Long-term, the procedure tends to hold up very well. Often, the implanted cartilage will hold up better than the surrounding cartilage, as it is newer.

My doc and I were in agreement that the procedure is really the only option for someone who wants to be active and is only 28 years old. If I wanted to be a couch potato, or was 58, the conversation would be different. Really, the worst part of the procedure is the rehab. He said he will have me walking on a zero gravity treadmill in 2 weeks to encourage healing. He also said that being as I am strong (at least he thinks so ) it will help the recovery.

No question here. Just more of an FYI if anyone cares. If anyone has any info or questions for me or that they think I should ask, I would welcome them.

[Mark Rippetoe]

Sounds like you may have stumbled onto a good orthopedist. Keep us posted.

[heints25]

Sounds like you may have stumbled onto a good orthopedist. Keep us posted.

Yes, I have been very happy with both of them. The first I was referred to from a friend of the family that is a competitive oly lifter. She referred me to the second, who is one of 2 in the state that can perform the procedure. He is also one of the doctors for the professional baseball team here.

I learned my lesson in college a few years ago when I had 2 surgeries on my shoulder that really weren't needed. Knowing what I know now, some pressing would have probably done the trick (I didn't really know anything about training at that time). Of course, the orthopedist told me to rest for 2 months. When that didn't do the trick, he tried a couple cortizone injections. Finally, the MRI and surgery. Of course, some silly phyisical therapy on top of it. What a waste of money. Well, that is a different topic.

Bottom line, I don't see a doctor until I find one via referral, or I am close to death.