Full thickness chondral flap on medial femoral condyle

[kimberly584]

I am sorry if this is long but I think a little background is important. I am a 34 year old female and am a right leg amputee since I was 6  who has never been able to wear a prothesis. I have damaged my left knee from the stress of using this one leg always. I have had 2 scopes to clean up my knee, which at that time they found a 2.5 cm chondral defect on my medial femoral condyle and a smaller area on my patella. I still have severe pain when standing and walking. I am unable to bend or fully straighten my knee and sitting even is painful. I have done the shots and lots of theraphy. My OS did another MRI which has shown a full thickness chondral flap with kissing lesions on my medial femoral condyle. I don't know how large now but it was 2.5 cm in my last surgery. Because I am 34 and a amputee my os says I am too high risk for a replacement.  So instead he wants to preform a microfracture and if it fails move onto knee replacement. He also feels I am not a canidate for any cartilage repair surgery because of the kissing lesions. I feel I have more damage on the tibia too because I have lots of pain below my knee cap and in my lower joint line behind my knee. My concern is that this surgery will fail for me because of the size of defect, the fact that this has been going on for 2 years, and the amount of other damage I have in other areas of my knee. I also fear it will fail because of the strict protocol you must follow after surgery being it will be near impossible for me to not bear weight, I am afraid I will over do it too early. Are there any options left for me? Is it possible the microfracture would work? I am at loss on what to do next, I know I can't just live unhappy and in pain for the rest of my life. I have 3 wondeful kids who depend on me.

[kimberly584]

Thank You so much for taking the time to answer my question. I am in a small town and there isn't lots of choices as for who I go and see. The ortho I am seeing now is supposedly the best in this area. He has been great at answering my questions and I think he really has tried to help me but I am getting nowhere. After my MRI came back he called me and said we need to talk about replacement. So I went for consultation and he seemed very reluctant at this point on rather replacement was the right thing to do. He then sent me to his fellow in the same clinic with him and he advised I not replace my knee due to age and "my current condition" as he put it. Next appointment with my Dr. and he sends me back to theraphy for 2 months for strengthening , extension and flexion. Then in 2 months he wants to try microfracture and if it fails replacement. I value your opinion and feel that it is spot on. My next question to you is should I continue to push my Ortho for replacement or just move on to another Ortho. I know that is a personal decision but any advice would help me make this decision as I like my ortho but feel I am not getting the treatment I need and can't travel far to see someone else.

[Michael L Gross, MD]

I agree with your concerns that maintaining non-weightbearing status on your left leg, after micro fracture surgery will be difficult.  In addition, I believe that the micro fracture will fail for the same reason as the chondral repair surgery. Although a total knee replacement will likely not last your entire lifetime, it seems like it may be the best alternative for you. You will have an immediate return to function, and it will have greater longevity than any of your alternatives.