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What causes a chondral ulcer in the patellar ridge?

Orthopaedic Surgery
DOCTOR’S ANSWER (1)

Hi, Sorry to hear that you are suffering from a chondral ulcer in the patella (the knee cap). "Chondral" means cartilage, it is meant to absorb shock and allow our joints to glide smoothly without any pain. So chondral ulcer means that you have a "hole" in your supposedly smooth and shinny cartilage, and hence it will cause a "clicking" sensation, swelling and pain in the knee.

In simple terms, there are 2 main causes of chondral ulcers:

1. Major injury to the knee cap that the cartilage was damaged directly by a physical force - you might have sustained a bad twisting injury to the knee when you were tackled badly in a soccer match or you might have tumbled down the stairs. The impact is usually very high and there might be concomitant injury to the meniscus or ligaments to the knee at the same time.

2. Numerous small injuries to the knee cap that "scrap off the cartilage bit by bit" - typically the pain is more insidious and worsen gradually. You might have some misalignment of the knee cap, predisposing one side of the knee cap to be under more pressure. Or your lifestyle or work requires a lot of stairs/ squatting.

And the most important issue for the treatment of chondral ulcers do not heal by itself. It is still a challenge today to manage this condition.

In the past, we have very limited treatment option for chondral ulcers. We can only resort to glucosamine (I am sure everybody have heard of it) or lubricant injection (hyaluronic acid), however, the results had been rather disappointing as they cannot really solve the problem, the ulcer is still there! 

Recently, there is a lot of breakthrough in the treatment of chondral ulcers, we can now unlock the amazing healing potentials of our own bodies by utilising our own stem cells. If the chondral ulcer is rather small, we can use this technique called "mircofracture" which we create tiny holes in the bone underneath the damaged cartilage, releasing the mesenchymal stem cells, and we will supplement the repair with cartilage scaffold injection. (It's almost like us rebuilding the house for the cartilage cells to stay there and grow new cartilage) 

If the ulcer is bigger or when there are multiple ulcers, we may have to add on bone marrow stem cells to increase the successful rate. (BMAC - Bone Marrow Aspirate stem cell Concentrate) During the surgery, we will do a small injection in the pelvis to extract the stem cells and then adding them onto the cartilage repair site. (Rest assured that the injection is very small!). 

These few repair techniques can be summarised and called Mesenchumal cell-induced chondrogenesis (MCIC). These techniques are only being developed in the last few years and they are showing rather good and promising results. All of these techniques are done via arthroscopic techniques (keyhole surgeries) as we aim to repair the damaged cartilage in a safe and minimally invasive way. The surgery can be done as a day surgery procedure or some patients may prefer one night of hospital stay. 

I hope I did clear some doubts for you.

Cheers,

Dr. Henry Chan

168 views 21 Jan 2019
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