Anyone ever have a "full-thickness fissure" in their cartilage?

I had a knee injury with bone and cartiliage damage that ended my college-level basketball play in the second year of my scholarship.

How well you recover will depend on lots of physical factors, but the outcome is also at least partly determined by your own expectations. So the most important questions may be the ones you ask yourself.

What level of activity do you want to regain ? How long are you willing to work on rehab? Can you live with any degree of permanent, ongoing pain ?

My own experience with regenerative medicine was mixed. Most important was that I was fully covered for any and all treatment & therapy with almost no restrictictions. And I eliminated almost all chronic injury related pain. But I never regained full strength and range of motion, and I’ll never play at an elite level again.

@JLoon

I have an arthritic right knee that was first injured awhile back. So now I have some missing cartilage and probably some bone-on-bone contact. So Mitch Kupchak and I can probably relate.

I guess the only Dunkin’ we’ll be doing is at the Doughnut shop! ;-p

Need more info. What exactly is the injury, and how exactly is it bothering you?

@Caravanfan I had a knee injury back in January. We tried conservative therapy, but after a couple of months the PCP said it was time for an orthopedic consult. Met him very briefly. I’m sure he’s extremely competent, but he’s one of these obnoxiously arrogant Ortho dudes that didn’t bother to read the nurse’s notes, cut me off when I was explaining the accident. Anyways, he ordered an MRI, and I just got the results in the patient portal. I have an appointment to discuss them with him on Wed. and I wanted to get the most from the visit with him, because I know it’s going to be lightning fast. I’m hoping people can provide suggestions for things to consider and discuss that may not be obvious or that they wish they had known to ask.

The interpretation of the MRI read: “There is a full-thickness fissure in the deep femoral trochlea with an underlying subchondral cyst.”

OK, here are your questions:

1) Is this operable?
2) If I get an operation will I improve?
3) If I get an operation, what level of activity can I expect to achieve after therapy?
4) Is there any indication for not doing surgery and just doing conservative therapy with PT and occasional steroid injections for symptoms?

This is not an emergency, and if you’re not happy with the surgeon, find another surgeon, preferably a sports medicine physician who does knees all the time.

In terms of regenerative medicine I have no experience with it and can’t comment on it. Seems a little wooey to me but it might work.

@Caravanfan Thanks for taking the time for your response.

” if you’re not happy with the surgeon, find another surgeon, preferably a sports medicine physician who does knees all the time.”

He’s the diagnostician for a large Ortho/sports medicine group with a fantastic reputation. The name-dropping of celebrities and other stuff was obnoxious, but I’m sure he’s great at sending people for the correct treatment, and that’s ultimately what I care about.

Any insights into regenerative medicine? It’s my understanding that it’s pretty new and showing great promise but it’s not magic and can’t perform miracles. Is that a reasonable assessment?

@gorillapaws As I said, I don’t have any experience with it, sorry. I’m wary of the concept. I won’t be seeing any orthopedists this week as I am in the hospital. Next week I will be doing a clinic next to an orthopedist and I can ask him about your injury and treatment options.

@Caravanfan I very much appreciate it.

I’m no expert, but an orthopedic surgeon friend of mine was doing some sort of regenerative medicine back 10 years ago and charging a fortune and I remember at the time he said insurance wouldn’t pay, because it wasn’t a proven treatment or something like that. It made me very suspicious of how effective whatever he was doing really was.

I know he also complained about Medicare not paying well for other procedures he did, and making less money compared to years before. He was known to be a very skilled surgeon, and I believe he was.

Regenerative medicine might have some great advances in the last ten years, it certainly would be great if it achieves what people hope for, I would say just do your research if it is offered. I have no doubt that you would.

Just a general advice, write the questions down because you’re likely to feel rushed and flustered. Write the answers down. Hopefully he’s not so rushed that he can’t spare you 30 seconds per q to write his responses.

I hate when doctors are so rushed they can’t spare a few minutes for something which, to the patient, is extremely important, especially since he’s getting paid a decent amount from insurance. Even if not paid a good amount per patient, when he’s stacking up 15 appointments per hour, it adds up.

You are the patient and should be able to ask as many questions as possible with the Orthopedic DR. I have been there many times over the years being an athlete.
My knees are my area of issue from overuse. I had a full medial meniscus tear many years ago that hampered my ability to teach Fitness classes, play competitive volleyball and competitive Racquetball.

Make sure you trust your DR and the procedure.
Make sure you understand exactly where your tear is and how much they will remove.
Ensure you understand the length of time for recovery and for Therapy.
Listen to recommendations on how you may need to modify your activities.
Listen to your body.
Question what medications they plan to give you and for how long.
Ask if it is significant enough to wear a brace or compression as time goes on.

Good luck.

Thank you for the helpful answers!

@jca2 I think it’s pretty common for Ortho to be double/triple booked. My understanding is the MD I saw was the diagnostician for a large group, so he’s feeding an entire team of surgeons. He’s not the one doing the procedure (if there will be one) and being a little full of yourself won’t materially affect the outcome of my treatment. I’m sure the guy is more than qualified to look at the images and know exactly which surgeon (if any) in the group to send me to for my injury.

In principle, I do agree that face time with an MD is important. I wouldn’t tolerate it from my PCP (she’s amazing). In this case, I think it’s less of an issue, but it is frustrating how our system is set up that this is how healthcare is done now. My father who is a retired surgeon had knee surgery with this group and he was complaining about how short his visit was (and he was good friends with the MD). I think it’s a sign of the times.

@Forever_Free Thank you for your excellent advice and points to go over.

I’ll be sure to keep everyone in the loop.

What are your symptoms?

@Caravanfan The knee is unstable so I can walk in a limited fashion, without pain. Stairs are sometimes problematic (if I take them one at a time, I’m ok), and right/left stability is questionable. I occasionally get shooting pain in the knee triggered by the position of the joint. I would also say there’s a constant very mild inflammation. Running, jumping, long walks or short walks over rougher terrain like on a nature path or lateral maneuvers are all not viable right now and will trigger shooting pain and inflammation.

@gorillapaws Got it. As I said I won’t be ablt to talk to an orthopedists until next week but I’ll get his opinion for you.

Update: I got a steroid injection and we’re going to pursue PT for a while to see if we can resolve it that way. He seemed to think long term I’ll be able to resume normal activities. He also seemed to appreciate the Barbera d“Alba Superiore 2018.

That sounds like a reasonable treatment course.

@Caravanfan I agree. The least amount of intervention necessary to achieve a good outcome is ideal. We didn’t get into regenerative options, because if PT solves the issue, there’s no need.

@gorillapaws I’ll ask my guy next week if he knows of anything about the regenerative things. I’m guessing that it’s all just very expensive bullshit therapy, but there may be something to it. The problem is that it’s something that’s very difficult to study well.

@Caravanfan “The problem is that it’s something that’s very difficult to study well.”

I 100% believe you know what you’re talking about but I’m surprised to hear it. Couldn’t you inject stem cells or whatever the regenerative therapy the treatment group is receiving and then also inject saline into the control groups and then measure the outcomes at various intervals? Blind the patients and the physicians? Your response leads me to believe that my high school science fair experimental design may not hold up to other factors.

@gorillapaws It’s a bit more complicated than that. Sure, you could high school science fair that, but generally the better test is to compare with surgery, or steroids, or combination of the above plus physical therapy. Confounding that is that the people who are studying it have a financial interest in getting positive results.

I’m not saying they don’t work. I really don’t know. I actually considered it myself for some bad tennis elbow I had last year but I was talked out of it by an orthopedic surgeon who said the data was shit and it was really expensive. With time it got better on its own.

@Caravanfan That all makes sense. I remember when we were considering participation in a human trial study for our vein center with a therapy, the protocol would likely have lead to some pretty miserable superficial thrombophlebitis that would have to be managed conservatively with warm compresses for our patients instead of how we were handling the treatment at the time in a manner that minimized such outcomes.

We decided to decline that one.