What are my options to treat a chondral ulcer after twisting my knee?Orthopaedic Surgery Sport Medicine
I am 39 years old. I have been experiencing knee pain after accidentally twisting my knee. An MRI report showed a chondral ulcer. I have tried physio for about 6 months. Each time, the exercise just causes my knee to swell up and become more painful. May I know what are my treatment options? Are there any alternatives to surgery?
I think Dr Dinesh has summarised it quite well. Full thickness Chondral ulcers on the patella are quite difficult to manage. Failed conservative management , would usually mean a patient has to consider surgical intervention. Intra-articular visco-supplementation can definitely be considered. It helps in the lubrication of the knee and offers some pain relief. This would most probably be temporary.
Based on the scan, you have 2 problems. The lateral tilt is an anatomical problem that can be solved by an arthroscopic (keyhole) release. The chondral ulcer would be abit more tricky. A chondroplasty to try patch back the full thickness ulcer Would be the best thing. Some patients may even need to have bigger multi-step procedures if the ulcers do not heal.
I think the more important thing to consider is, how much is this affecting you and your lifestyle. It doesn’t seem that whatever you’ve been trying has worked so far. Of course you can choose to continue trying physiotherapy and medication, but if the symptoms continue and get worse, there is definitely a role for surgery. Unfortunately full thickness ulcers do not heal themselves.
Hope this helps
Dr Sean Ng
Welcome to the over 30's club! I say this with personal experience of knee pain and a story similar to yours.
Cartilage injury around the front of the knee can be quite painful and limit activity, particularly if you enjoy running and jumping sports.
Seeing a physiotherapist is important in such situations as they can help identify specific muscle weaknesses. In addition a Sports Physician can help by providing various treatments such as visco-supplementation, where a synthetic form of hyaluronic acid is injected into the knee for pain symptoms, and also a sports podiatrist can help assess your gait, particularly if you are a keen runner.
Having spoken to a sports knee surgeon, options for cartilage injuries such as this include a lateral release, if you have tilting of the patella, trimming away of the injured cartilage or trying to promote healing through other interventions. The main issue with surgical intervention is the post-op period (trust me) it takes ages to get back to normality!
This give you a number of options to start with - I hope it helps.
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