2017 ISAKOS Biennial Congress Paper #119

 

Grade 3 (T1rho+) Chondromalacia Patella (CMP) Can be Persistently Asymptomatic if Joint Homeostasis is Achieved and Maintained: Clinical Implications

Scott F. Dye, MD, San Francisco, CA UNITED STATES
Mailene Chew, MD, San Francisco, CA UNITED STATES

California Pacific Medical Center, San Francisco, California, UNITED STATES

FDA Status Not Applicable

Summary

We have shown that even T1rho+ CMP can be persistently Asymptomatic, and therefore such a cartilage lesion May Not be the source of symptoms, but,in fact, an incidental finding.

Abstract

Purpose

This is a unique long-term (17 yr) follow up report on bilateral, persistently asymptomatic Grade 3 CMP that is non-progressive and metabolically stable, And Yet, T1 rho+.

Methods

and Materials: This is a 17year follow up study (the author, currently age 67,) who underwent arthroscopic inspection of both asymptomatic knees at time zero without intra-articular anesthesia (in which bilateral grade 3 CMP was incidentally discovered to be present without sensation even to direct probing) At 15 years post-op, a T1 rho MRI study was performed, and at 16 years post-op, a repeat Tc bone scan was performed. Reports of his subjective sensation throughout the 16 year time span were documented.

Results

The subject reported no PF Pain At ANY Time, during the 17 years. The Tc99m- MDP bone scan studies performed at time zero and at 16 years post-op were completely normal (indicating the presence of Osseous/Joint Homeostasis) The T1 rho study performed at 15 years post-op was 3+ abnormal (indicating substantial diminishment in proteoglycan content) in the geographic region of the bilateral Grade 3, but Asymptomatic, CMP.

Conclusions

Even advanced Grade 3 CMP can exist Asymptomatically without progression and be metabolically stable (bone scan negative - an objective,metabolic marker of Joint Homeostasis) for extended periods of time. The + T1 rho study does not likely represent pathology, but rather, Normal, asymptomatic, age-related changes (diminished proteoglycan content) - that probably exists in Vast numbers in this advanced middle-aged population.

Clinical Implications:The results of this study have potentially profound implications for orthopedic surgeons,researchers, radiologists, and physical therapists to be Extremely Cautious to Not “Over-interpret” the MRI finding of a + T1 rho lesion in this clinical setting (Middle-Aged) as necessarily “pathological” and therefore serving as a rationale for aggressive cartilage-oriented operative procedures in a symptomatic patient - Where the Actual Etiology of the perceived PF pain may well be due to factors completely unrelated to the articular cartilage: (e.g.: transient synovial soft-tissue impingement, and/or intra-osseous hyper-pressure, etc.).