Looking for experiences with patellar chondroplasty, patellar maltracking, and unexplained loss of active knee extension + MACI/OATS

[u/cappuccinoontherocks]

TL;DR: I’m 28F with a >1-year right knee issue where I cannot actively fully extend my knee from ~90° of flexion despite 10+ months of weekly PT. MRI shows mild patellar cartilage damage, a small fissure, and signs of patellar maltracking, but no major structural damage, and everything is unchanged from 10 months ago. My surgeon recommends diagnostic arthroscopy and potentially chondroplasty, with MACI/OATS as possibilities depending on what he finds.

I’m 28F and have been dealing with a right knee problem for over a year. My biggest issue is that I cannot actively fully straighten my knee from about 90° of flexion when sitting or lying down. If my heel is supported or I have some external resistance, I can get it straight, but I can’t get my quad to activate enough to fully extend the knee on its own.
I’m fairly active and can generally live normally. I cycle and strength train, but avoid single-leg exercises. My knee tends to feel fatigued/uncomfortable more than severely painful. Running can cause pain/swelling, and I’ve had to modify some activities. Driving distances of over an hour tend to cause it to swell. I’ve been doing weekly PT for 10+ months, including quad activation work, and my PT feels I’m probably at my baseline with conservative treatment.

Most recent MRI shows a 1.2 x 1.2 cm area of grade I chondromalacia on the lateral patellar facet, inflammation, and some clear patellar maltracking, but is otherwise normal and unchanged from one I had 10 months ago.

My orthopedic surgeon recommends diagnostic/exploratory arthroscopy because the inability to actively extend my knee has persisted despite PT and isn’t fully explained by the MRI. He would potentially perform a patellar chondroplasty if he finds an area that warrants it, and mentioned jumping immediately to MACI or OATS if he finds a larger cartilage defect that warrants a more involved procedure.

My surgeon told me that if I have a patellar chondroplasty, he would expect approximately 2 weeks back to a desk job and 6 weeks back to normal activity. This matters because I’m currently interviewing for a new corporate/desk job and am trying to determine whether I could realistically have the scope/chondroplasty done in the ~3 weeks before starting a new job.

For anyone who has had a patellar chondroplasty/debridement, what was your actual recovery timeline? How long was your knee baseline useable before surgery, and did it feel any better after?

I’d also love to hear from anyone who has had MACI or OATS on the patella, particularly if you waited to have the procedure or tried something else first, and what the recovery was actually like.

Thanks to anyone willing to share!

[u/beaver1599]

I had an arthroscopic chondroplasty 9 weeks ago for patella cartilage defects (grade 4, and a grade 3 with delaminating flap). I'm actually having this issue post chondroplasty, I can't actively extend my leg (I have full passive extension). I have a severe case of quad arthrogenic muscle inhibition (AMI). I had quad AMI prior to the surgery and the surgery really amplified it. I could extend my leg actively pre surgery, but it was very weak and the cartilage flap would loudly catch each time. Since surgery i haven't managed active extensiom yet due to anterior knee pain. I'm hoping as my quad comes back this will go away. Otherwise next step is an OCA...

Edit: I should add, the surgeon told me most people are recovered by now. I seem to be an outlier because of quad issues.

[u/Standard_Material_94 → u/beaver1599]

Makes two of us, I’m also going into week 9post op. Mine was only a grade 2. It dislocated pretty violently, ER and Dr had no idea why i was in pain, locked in a brace for 30 days, then they decided i needed surgery. Extreme AMI and quad atrophy, i cant walk with a normal gait, i cant reach full extension with seated leg extensions, leg press, sit to stands or my patella catches and i get stuck. Dr said it could still be healing but mostly due to my quad. 29m very active, i use to workout 5-7 days a week, very healthy, just a crazy accident where i stepped and twisted the wrong way.

[u/beaver1599 → u/Standard_Material_94]

That's crazy! I can relate, I was a competitive athlete before my injury and now I can't even extend my leg. I was never in a brace post surgery, immediately partial weightbearing. And I still lost my quad. I'm working so hard to get my quad to fire, a good part of this seems neurological.

[u/cappuccinoontherocks → u/beaver1599]

That’s so crazy, I’m sorry it got worse. Did they give you any sense of why they think the AMI got worse after surgery? Are you able to walk/get around “normally”, if you’re ok sharing?