articular cartilage damage in knee

[melissafox]

re:  full thickness articular cartilage damage .9cm right knee weight bearing area

30 year old very active athletic female

want a LONG TERM solution!  should i microfracture, aci, oats . . .

[Michael L Gross, MD]

viscosupplementation will give you symptomatic relief, but will not fix the problem,  since your lesion is small, I dont think I would delay and risk making it larger

[melissafox]

will viscosupplementation prevent further damage to my knee or is it better to undergo surgery as soon as possible?

thank you again.  your answers are so concise.  

[melissafox]

can't possibly find the words to thank you enough.  finally, clarity.  

[Michael L Gross, MD]

I think your confusion lies in  not understanding the statistics.  All of the tthe surgical procedures have a reasonable success rate.  I fyour surgery is successful, you may never need anything more,

[melissafox]

Therein lies my confusion.  
microfracture - is it fair to say that i'll definitely need another surgery in 3 years max?
oats - isn't there a high chance of complications with the donor site?  isn't there a high chance of the plug not fitting properly into the lesion?  won't i need another surgery in 6 years max?
aci - after all that, couldn't the cartilage grow in as fiborous anyway?  won't i need another surgery in a few years with this option too?

frankly, the feeling i get from the doctors is that it's hopeless.  no matter what i do, i'm going to need surgery for the rest of my life.  i'm only 30, yet it's over.  i can't even walk let alone run like i used to.  vicodin is the only thing that takes the edge off the pain.  i'm discouaraged and extremely confused.  thank you for your help.  

[Michael L Gross, MD]

Each has its own advantages and disadvantages.  While microfracture has the quickest and easiest recovery period, it is the least preictable in the long term.  OATS is usually used for lesions less than 2.5 cm and ACi for bigger lesions.
Many surgeons recommend starting with microfx, and then trying oats or ACI if needed.