This story is about Gary - a middle aged man who I have been looking after for some time, and who had developed a fairly long cartilage flap in his trochlea - the groove of his femur within the knee joint.
Initial conservative management included physiotherapy and steroid injections, although I never thought this was going to be particularly successful as it really was quite a significant flap. Unfortunately we had to take this route because the insurance companies are insisting on surgeons ticking the boxes, crossing the t's and dotting the i's as per the current N.I.C.E. Guidelines on arthroscopy in the maturer patient.
Gary found this delay very frustrating, and eventually in May 2017 we agreed that I would perform an arthroscopy to tidy up the cartilage defect. During the procedure I microfractured the crater in an attempt to encourage the defect to cover over with new fibrocartilage. He was fully weight bearing from the word go, but in a brace set to a protected range of motion to protect the microfracture.
All of his pain went immediately and he is doing brilliantly well.
The post-operative MRI Scans demonstrate the problem well, and you may find them interesting -
I wanted to discuss this patient because of the current debate about the overuse of arthroscopy - particularly when we are talking of mechanical problems like this in middle aged or older patients.
Arthroscopy 'to tidy up a joint' in the older patient with wear and tear has developed a bad reputation. I agree that there has been an overuse but with the right indications it can be extremely effective as it has been with Gary.