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Patient #4 - 51 year old man for whom knee replacement had been recommended.

About the Patient

This 51 year-old man had damaged the lateral meniscus in his left knee as the result of an accident as a teenager and had had the entire meniscus surgically removed. Without the meniscus in place, the bones on the lateral (outside) part of the knee rubbed together. Over the years, this caused damage to the cartilage. The patient began to have increasing pain in the knee. Before coming to our office, he had seen three other doctors, all who recommended knee replacement.

When he was seen in our office, he complained of severe pain in the lateral part of his knee. He walked with a pronounced limp and could not bend his knee fully. X-rays showed a marked decrease in the space on the lateral side of the knee. A mechanical axis film showed 4.5 degrees of valgus (knock-kneed).

Treatment

Because the pain was only in one area (compartment) of the knee, it was felt that performing a DFO to remove pressure from this compartment would help to relieve the pain. After a discussion of options, the patient elected to have a distal femoral osteotomy along with microfracture. During this surgery, video was taken of the inside of his knee joint. This video shows that the cartilage covering on both the tibia and femur in the lateral compartment were almost completely devoid of cartilage in the areas where they rubbed together.

Results

Six and a half months after the surgery, the patient had good relief of the lateral pain. However, he developed a lot of scar tissue in the joint as a result of the surgery. Because of this, his ability to move his leg (range of motion) was limited. He had an additional surgery at this point to remove the scar tissue. This gave us a chance to take a second look at the cartilage on the inside of the lateral compartment of his knee. The video of this look showed that cartilage now covered the areas that were previously bare. Even the large hole where there was previously a cyst had regrown both the bone and cartilage and now was almost indistinguishable from the surrounding areas.

The video below shows these before and after images. The inside of the knee is shown in two different orientations. First the before and after in one alignment is shown, then a different view and alignment before and after is shown.