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
