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RF thermal Shaving Chondroplasty: My experience with Dr. J.Toft (Munich, Germany) - an un-discussed, undisclosed procedure performed on a perfectly healthy knee according to the official investigation by BLÄK org (Bavarian national physician chamber) and per every doctor we talked to. All studies show RF thermal Shaving Chondroplastys causes Chondral Necrosis. (cartilage death)

http://www.shaving-chondroplasty.com/sitebuilder/preview/KNEE/Toft_11JAN06_files/image037.jpg  http://www.shaving-chondroplasty.com/sitebuilder/preview/KNEE/Toft_11JAN06_files/image039.jpg  http://www.shaving-chondroplasty.com/NastyasFamily_files/image048.jpg
    EXAMPLE: NORMAL                   EXAMPLE: GRADE III            ANASTASIA’S (NORMAL!!!).
CHONDOMALASIA

DR. TOFT: "WHEN YOU SEE 2nd and 3rd -DEGREE DAMAGED CARTILAGE THROUGH AN ARTHROSCOPE, IT LOOKS LIKE ANGEL HAIR WAVING GENTLY UNDER WATER." 

DR.TOFT CLAIMS AFTER THE SURGERY, THAT I HAD CHONDROMALASIA GRADE III !
(Compare Above Example Grade III vs MY IMAGE-ANASTASIA (NORMAL!!!)
-ALL OTHER ORTHOPEDIC DOCTORS SAY THERE WAS NOTHING WRONG WITH MY PATELLA-

In 2010, a German independent investigation by BLÄK (Bavarian National Physician Chamber)
presented a 30 page report determining that the Knee Surgery which occurred on Jan 10th
at the Alpha Klinik in Munich with Dr. J.Toft:
  • was not indicated - (the only problem was weakness, of which the AK was well aware of, as my prior spine surgery was done there 3 months earlier, and it was clear that I could not even sit in the examination room due to spine pain)
  • was incorrectly diagnosed - (nothing could be seen wrong with my knee in the video or MRI's)
  • that all 5 procedures performed during the surgery were done on a healthy knee, as seen intraoperatively: 
    • No meniscal tear could be seen in the video
    • No panus formation was seen in the video - although Toft claimed there was
    • No sinovitis was seen in the video - although Toft claimed there was
    • No patella misalignment was seen in imagery, to warrant a lateral release
    • No grade 2-3 chondromalasia to warrant a shaving chondroplasty
  • That the Shaving Chondroplasty procedure was never discussed, nor mentioned in any documentation
  • That the Shaving Chondroplasty procedure was never consented to - since we had never heard of it
In summary, it was officially confirmed by BLÄK investigation that all facts and evidence prove the shaving chondroplasty procedure was never mentioned to us before the surgery in any form (emails, reports, cost plans), and thus never documented, not consented to, and not indicated.  Besides the fact that I am permanently handicapped now, this is also a serious finding, as performing a procedure without a patient's consent and education is apparently a criminal offense  in Germany.  Furthermore, shaving chondroplasty is considered highly controversial, and even experimental according to some.  That this surgeon is seen in the media lamenting that most surgeons reject the idea, and that he has irrefutable proof that it works, makes one wonder whether he was looking for more 'irrefutable' proof.  Interestingly, he says in his book, that he discovered the technique accidentally, when he performed an incomplete procedure on a patient 'in the interest of time' and then went back in several months later to finish up.  I thus cant help but wonder if I was the result of another 'accident'.  MRI's were taken of both of my knees.  They both look exactly the same before the surgery.  Now one knee has lesions under the patella, the other is perfectly healthy.  Sounds like irrefutable 'evidence' to me:  Shaving Chondroplasty on a healthy patella leads to progressive chondral necrosis and secondary inflammatory.

----------------OVERVIEW----------------------

BEFORE THE SURGERY, I LIVED ON THE 3rd FLOOR WITH NO ELEVATOR AND COULD WALK 3 FLIGHTS OF STAIRS.

I STARTED HAVING AND ODD PAIN IN BOTH KNEES.  OUR LOCAL DOCTORS 'SUSPECTED' A POSSIBLE MENISCUS TEAR. BUT I HAD NO KNEE INJURY.

 I WENT TO THE FAMOUS ALPHAKLINIK, FOR A SECOND OPINION.  THEY WERE THE 'EXPERTS'.

I WAS TOLD: AN ARTHROSCOPIC CHECK OF THE MENISCUS IS URGENT! I WAS TOLD, IT WAS TINY, QUICK OPERATION.

I WOULD BE ON MY FEET WITHOUT CRUTCHES IN TWO WEEKS ONLY!

Dr.TOFT SHAVED MY PATELLA CARTILAGE WITHOUT MY CONSENT OR KNOWLEDGE.

Dr. TOFT WRITES THAT THIS PROCEDURE IS REJECTED BY MAINSTREAM ORTHOPEDICS - BUT THAT HE HAS IRREFUTABLE PROOF THAT GRADE III CHONDRAL LESIONS CAN BE REPAIRED!!!

4.5 YEARS AFTER THE SURGERY, I CANT PUT ANY PRESSURE ON MY KNEE.

NOW I WALK WITH A LIMP. I CANT STEP UP OR DOWN EVEN ONE STAIR. I CANT KNEEL OR CROUCH.

NOW ... MRI' IMAGES SHOW I HAVE A LARGE LESION (HOLE) IN MY PATELLA CARTILAGE - WHERE IT WAS SHAVED!

Dr. TOFT (66 y/o), TORE HIS MENISCUS IN 2007.  DID HE SHAVE HIS PATELLA?  NO!

"chondromalacia patellae often begins during the second decade, and by the age of thirty nearly everyone is affected."
 - Outerbridge, the etiology of chondromalacia patella. 


We learned two years later that Alpha Klinik was sued by a number of German citizens (26 civil complaints) for inappropriate procedures and collapsed into insolvency (merkur-online.de)  According to German news media, some of these surgeons, including Dr. Toft, were being investigated for embezzlement (Spiegel Online). 

-
http://www.spiegel.de/spiegel/print/d-55508051.html
Ein starkes Dutzend Fälle", so der Sprecher der Kammer, Tobias Pichlmaier, seien derzeit gegen ihn anhängig.
A strong dozen of lawsuits, according to the speaker of the chamber, Tobias Pichlmaier, are at present pending against it.
http://www.tz-online.de/aktuelles/muenchen/schlammschlacht-in-der-promi-klinik-30686.html
26 zivilrechtliche Klagen sind seit 2003 beim Landgericht München I, bestätigte Gerichtssprecher Tobias Pichlmaier.
26 civil complaints are since 2003 at the regional court Munich I, confirmed court speakers Tobias Pichlmaier.
http://www.merkur-online.de/lokales/nachrichten/alphaklinik-staatsanwaltschaft-ermittelt-gegen-exchefs-69276.html
Die Staatsanwaltschaft ermittelt gegen Professor Jürgen Toft, Dr. Thomas Hoogland und Drs. Horst Dekkers, unter anderem wegen Unterschlagung und Insolvenzverschleppung
The public prosecutor's office determines against professor Jürgen Toft, Dr. Thomas Hoogland and Drs. Refuge Dekkers, among other things because of embezzlement and insolvency
http://www.middleeasthealthmag.com/cgi-bin/index.cgi?http://www.middleeasthealthmag.com/sep2007/feature3.htm
Knee surgery for the Elite, including Billionaire Weapons dealers
http://www.tz-online.de/aktuelles/muenchen/darum-ging-die-alpha-klinik-pleite-63608.html
Ich werde den Kollegen Horst D. jetzt auf drei Millionen Euro Schadenersatz verklagen.“
Toft will jedoch noch fünf Jahre weitermachen
I will sue the colleague Horst D. now. for three million euro compensation. “Toft wants to continue however still five years

LATEST NEWS:  Toft disappears from Germany, AFTER court order insolvency!!!

"Allegedly Toft is in London or Moscow.  Whether his attractive Indian wife Sveta accompanies him, is unknown. A neighbour of Tofts Penthouse dwelling  „We did not see both since July. Their garage is empty. “ 06 Sep 2010
"Bei uns meldet er sich gelegentlich, aber wo er genau steckt, wissen wir auch nicht."
"To us he announces himself occasionally, but where he is exactly, we do not know also." - Toft's lawyer
  tz-online.de article
 
-

 ----------------OVERVIEW----------------------

From other doctors emails:

 Dr. M_rk_n      I am horrified by your story. All I can say is that, in my experience, shaving the back of the patella is a worthless procedure...often causes more harm than good.

Dr. Shn__d_r: I use chondroplasty when indicated as part of the overall treatment of the knee.  Your wife’s pictures and video do not show a major surface problem, in fact, the surfaces look fairly healthy... 
I think the procedure has an extremely low success rate and never recommend it...

Dr. Juergen Toft, Born 1943. 64 y.o.
--------------------------

Suffered a ‘medial meniscus’ tear, August 2007. Surgery successful, no chondroplasty shaving noted, even though ...

"chondromalacia patellae often begins during the second decade, and by the age of thirty nearly everyone is affected."
- Outerbridge, the etiology of chondromalacia patella.




============================
“Prof. Toft has made his name in two areas.
The  highlight in his work is abrasion arthroplasty...a very useful tool for "regeneration" of severely arthritic knee joints in order to prevent knee replacement surgery.”
Book: “Knee Arthritis? How to avoid an Artificial Knee.” (Mentions ‘shaving’ 50 times)
  ===========================
ARTICLES FOUND TO BE PROMOTING SHAVING CHONDROPLASTY & ABRASION ARTHROPLASTRY
=================

All sites and sources found are, surprisingly, authored by Dr. Juergen Toft.

"chondroplasty - can it prevent knee arthroplasty ?" .. Even the staunchest critics of his technique admitted to have been impressed by the series of radiologic and arthroscopic images of patients healed by abrasion.  
When you look at the literature, most of the reports on abrasion arthroplasty are negative. … I feel that this is unjust and unfair to the procedure because it can do much better than is written in the literature. ...we feel that it is time to take a new and unprejudiced look at abrasion arthroplasty

Although this concept is largely rejected by the mainstream of orthopaedic surgeons, there is irrefutible proof that grade III chondral lesions that underwent shaving-chondroplasty will recover themselves with a reparative tissue consisting of fibrocartilage. "...the resurfacing of the damaged areas is achieved by a combination of shaving, microfracture and abrasion arthroplasty … the damaged surfaces will recover themselves with a new tissue consisting of fibrocartilage. "You are referring to the trimming (shaving) of degenerative and frayed articular cartilage on the back surface of the knee-cap… It was certainly a good idea to shave such a defect, provided of course that the technique was performed competently." Toft performed abrasion arthroplasty and corrective osteotomy on her to save her knee from replacement surgery.

With over 5.000 such interventions, Dr. Toft looks back on the world´s largest series of joint-preserving knee surgeries as an alternative to an artificial knee joint.  (note, the study had 486 in its cohort, but he admits to having done over 5000?)

When the MRI revealed the meniscal tear, it was clear that he had to undergo surgery. (did not include abrasion/shaving arthroplasty)

Prof. Toft has made his name in two areas … The other highlight in his work is abrasion arthroplasty, … which Prof. Toft has developed into a very useful tool for "regeneration" of severely arthritic knee joints in order to prevent knee replacement surgery.

Many of the orthopedic community … argue that the new cartilage is of a quality inferior to that of the original hyaline

If your MRI indicates 2nd to 3rd degree damage, shaving is the recommended procedure.”

“Rehabilitation for shaving and abrasion patients requires up to three months of restricted activity,”

And to this day there is a very critical stance among the orthopaedic community towards abrasion arthroplasty.”
When looking at the agenda of most conferences organized by such societies it becomes evident that little or no space is given to time-tested techniques such as abrasion arthroplasty, microfracture and and other bone-marrow-based methods of stimulating cartilage repair. 

Anastasia: 31 y/o, Born 1974
-------------------------------------      http://shaving-chondroplasty.com/index_files/image003.jpg
Suffered no knee injury. Bed-ridden 6 months with disc prolapse. Extremely weak. Pain in both knees w/ suspected  ‘medial meniscus’ tear but no injury. Nov 2006. Surgery by J. Toft: Meniscal RF probing, Lateral Release, Chondroplasty Shaving for claimed grade II/III Chondromalacia. 
Chondroplasty Shaving Was Never Mentioned Before The Surgery.
============================

Completed two degrees before 1999 (Computer & Accounting). In U.S.A.- a B.S. in Business, an A.S. in Accounting, A.S. in Circuit CAD. Made the Dean’s list as a senior in Computer Science at the University of Arizona 2003 with 158 hours completed and transferred. CAD engineer at Texas Instruments.

Moved to Germany for T.I. in 2005.  Perfectly healthy.
==========================
THE MEDICAL COMMUNITY REPORTS REPEATEDLY  ABOUT SHAVING CHONDROPLASTY:
 "THE PROCEDURE LEADS TO ARTIFICIAL KNEE REPLACEMENT"
==================
  • Monopolar radiofrequency treatment of partial-thickness cartilage defects in the sheep knee joint leads to extended cartilage injury.
Kääb MJ, Bail HJ, Rotter A, Mainil-Varlet P, apGwynn I, Weiler A.
http://www.ncbi.nlm.nih.gov/pubmed/16009983
Am J Sports Med. 2005 Oct;33(10):1472-8. Epub 2005 Jul 11.
 At 24 weeks after surgery, grade IV cartilage defects were detected in all radiofrequency-treated samples

  • Thermal Energy in the Knee.Techniques in Knee Surgery. 3(3):180-186, September 2004.
Khan, Amir M MD 1; Fanton, Gary S MD 2
 confocal laser microscopy and cell viability staining have confirmed a zone of chondrocyte death after thermal chondroplasty

  • Effects of radiofrequency energy on human articular cartilage: an analysis of 5 systems.
Caffey S, McPherson E, Moore B, Hedman T, Vangsness CT Jr.
 Am J Sports Med. 2005 Jul;33(7):1035-9. Epub 2005 May 11.
 These results showed significant cellular death at these minimal conditions to the underlying chondrocytes with radiofrequency probes.

  • Thermal Chondroplasty with Radiofrequency Energy, An In Vitro Comparison of Bipolar and Monopolar Radiofrequency Devices
Yan Lu, MD*, Ryland B. Edwards, III, DVM*, Brian J. Cole, MD{dagger} and Mark D. Markel, DVM, PhD*,{ddagger}
 Radiofrequency energy should not be used for thermal chondroplasty until further work can establish consistent methods for limiting the depth of chondrocyte death

  • Radiofrequency Thermal Energy Application on Articular Cartilage.Sports Medicine & Arthroscopy Review. 13(4):206-213, December 2005.
Lu, Yan MD; Markel, Mark D DVM, PhD *
 Radiofrequency thermal chondroplasty has gained popularity over the past decade. The treatment of chondromalacia continues to be a great challenge because of cartilage's poor reparative capacity. ... These studies have highlighted potential safety concerns of thermal chondroplasty, particularly regarding chondrocyte death during the radiofrequency energy application.
  • Radiofrequency and Articular Cartilage.Techniques in Knee Surgery. 3(3):193-197, September 2004.
David, Tal S MD 1; Shields, Clarence L MD 2
 The use of radiofrequency energy to treat articular cartilage damage has become popular because of its cost and convenience. Current literature supports its role as a method of smoothing the surface and sealing the fissures in articular cartilage partial-thickness lesions...Exposure of chondrocytes to uncontrolled heat can cause cell death and alter the mechanical properties of its surrounding matrix.

  • The potential for regeneration of articular cartilage in defects created by chondral shaving … Do Not Heal.
Kim HK, Moran ME, Salter RB.
 We concluded that, in this model, partial-thickness defects created by chondral shaving do not heal; rather, the remaining underlying cartilage degenerates.
  • Mechanical and Biochemical Effect of Monopolar Radiofrequency Energy on Human Articular Cartilage, An In Vitro Study
Ko Yasura, MD*, Yasuaki Nakagawa, MD*,{dagger}, Masahiko Kobayashi, MD*, Hiroshi Kuroki, PT{ddagger} and Takashi Nakamura, MD*
 Background: There are growing concerns about thermal chondroplasty using radiofrequency energy to treat partial-thickness cartilage defects....Conclusion: Radiofrequency energy is able to create a smooth cartilage surface and reduce catabolic enzymes at the cost of collagen denaturation and chondrocyte death in the superficial layers.
  • The Role of Arthroscopy in the Treatment of Degenerative Joint Disease of the Knee.Current Controversies in Orthopaedic Surgery.
Dr. John R Duda
 “The long-term value of this [fibro]cartilage is dubious [3]. Laboratory studies have shown that this repair tissue---histologically distinct from the normal hyaline articular cartilage---cannot endure for long.”

  • Injury to articular cartilage joint surfaces. I. Chondral injury produced by patellar shaving: a histopathologic study of human tissue specimens.
Milgram J.W. , Northwestern Orthopaedic Associates, Chicago,
Five patella specimens from patients who had previously undergone elective shaving procedures for chondromalacia no significant repair arising from the articular chondrocytes
 Five months to two years prior to patellectomy were examined. There was

  • ARTICULAR CARTILAGE LESIONS (Book)
by Brian J Cole, M Mike Malek - 2004
 Currently, however, these potential advantages are outweighed by the significant chondrocyte death caused by all RFE devices

  • The surgical treatment of chondromalacia patellae.
Dr. Geonge Bentley
 A total of 140 operations had been performed in 98 patients. Overall, satisfactory results were achieved in 25 per cent after forty shavings of the patellar cartilage
  • The natural history of chondromalacia patellae. A 12-year follow-up.
Jensen DB, Albrektsen SB.  (pubmed)
Restraint is advised as regards operative treatment of chondromalacia patellae.
  • The KneeClinic, Patellofemoral Disorders
. Arthroscopic debridement and shaving of damaged articular cartilage is of unclear benefit. Although very attractive as an option, so-called electrothermal chondroplasty seems to cause significant thermal damage to articulating surfaces and unacceptable level of irreversible chondrocyte injury.

  • Dr. Warren D. King:
Almost all people have evidence of cartilage damage on kneecap cartilage when we perform arthroscopic surgery.
“Strengthening of the quadriceps muscle when done properly often results in approximately 90% cure rate for this condition.”
  • Dr. Alexander Sapega:
Many cases of mild to moderate chondromalacia patella can be treated with just oral anti-inflammatory medication, weight loss and the proper type of therapeutic exercise.
http://www.clinicalsportsmedicine.com/chapters/24c.htm
The need for surgery in patellofemoral syndrome has been almost eliminated due to the improved understanding of its etiology and the introduction of the vastus medialis obliquus strengthening and taping program. The only indication for surgery in this condition is failure of an appropriate conservative management program.

I would like to take a minute of your time to tell you about my experiences with Shaving Chondroplasty. 
This procedure considers to be highly 'controversial' in the literature if not outright rejected (above references).
In fact, there is a study by Dr. Max J. Kääb from Berlin specifically denouncing such procedures. 
He reported that 24 weeks after RF shaving of Grade II chondral defects:
"grade IV cartilage defects were detected in all radiofrequency-treated samples". 
He is not the only one with such reports and researches (see above & below references examples)
The medical community reports repeatedly that "the procedure leads to artificial knee replacement". 
Even for those few surgeons who do not reject it completely,
it is ONLY indicated for cartilage with Grade III-IV Chondromalacia (meaning, fissuring of the worn-out cartilage).

MY STORY
============================
I was on a job assignment in Germany with an American company Texas Instruments. I was 31 years-old, slim., healthy, and had never had an injury in my knees. I used to hike 10 miles in the mountains. Usually, 10 km walk was FUN-I loved walking...and dancing!
 
 I went to see Dr. Toft at AlphaKlinik to find out why my both knees had begun to have a sharp pain when I climbed stairs.
I had two endoscopic spine surgeries to treat a ruptured (prolapsed) disc and I had been bed-ridden for 6 months. 
I couldnt sit for more than 10 minutes due to my spine pain and spent most of the time in bed. I had grown extremely weak.
I was scheduled for an artificial disc replacement at the same clinic.

We had xrays and MRIs at the local orthopedic office in our town Freising and everything looked fine:
I didn't have any tears. I didn't have any signs of arthritis (as no one in my family). And the local Radiologist Dr. Rothmeier wrote in his report that I do not have chondromalasia. We didn't know what chondromalasia was but it was good to hear that I dont have it!

We saw AlphaKlinik advertisement about Dr. Toft. He was operating on sheiks, queens and famous. It was a private clinic, meaning our health insurance would not cover the costs, but we decided that money don't matter - we wanted to understand what was wrong with my knees. We wanted to have the best  care.
     I TRUSTED Dr.Toft.

My husband drove me 4 times to the AlphaKlinik to see Dr. Toft, but every time we came, he was busy doing surgeries and I only spoke with his assistant Dr. Zimmerer. Even though we made all appointment specifically to see Dr. Toft, every time we came in, he was not available. I had to lie down on the couch from my spine pain, while waiting to see yet again, his assistant. I guess, I was not a sheik, a queen or whatever to meet his criteria for "deserving" to be seen before a surgery.

His assistant  suggested that I might have a 'medial meniscus' tear, but that they could not see it on the MRI.
I received a medical diagnosis that an 'arthroscopic look' was URGENT!  I was told, if I have a meniscal tear and they didn't fix it now, it could be permanent.They said (in email) the procedure would be minimally invasive.
I wrote email to Dr.Toft explaining how weak I was with my excruciatingly painful disc; that I am scheduled in his clinic for the disc replacement; and that I absolutely need only minimum intervention for my knee in order to be on my feet asap.
Dr.Toft himself said in his email that the problem with meniscus is relatively minor and I would be on my feet in two to three weeks. The office suggested to do both knees, and took MRI's of both. One was enough for me to start with.
After the surgery, we read in the medical report that the Surgeon had shaved the cartilage under my Patella with a thermal RF-probe.
This procedure was NEVER discussed or even hinted at.
It was never mentioned on our meetings with the assistant.
It was never mentioned on our cost plan papers.
BUT the POST-OP report says that it [Shaving Chondroplasy] was the main purpose of the surgery!!!

When we read the Post-OP report, we had no idea what Shaving Chondroplasty meant. So, of course, we started researching.

We discovered that Shaving Chondroplasty creates a type of scar tissue called fibrocartilage. All researchers say this fibrocartilage is short-lived, wears out and creates inflammation - and thus triggers osteoarthritis.  The thermal probe initially damages the cartilage, and then the fibrocartilage wear-off particulates and inflammation contribute to further degradation of the cartilage. Most studies report that the thermal shaving chondroplasty results in a deep chondral lesion.  An idiopathic cascade of chondral death.  Apparently, RF probes kill the top, laminar layer, and expose the lower, weaker layers.  The inflammation kills it layer by layer.  This triggers more inflammation, and more cartilage destruction.  This is classic Osteo-arthritis vicious circle.

After 3 months my knee was still severely inflamed and not healing.  It was getting much worse. I still could'nt put any weight on it without severe sharp pain under the patella, and my quadriceps muscles were atrophying. 

After 6 months, I was still doing badly and we took the arthroscopic video to a local orthopedic doctor in Freising, our town.
Dr.W told us the Patella cartilage shown in the surgery video was perfectly healthy, and he had no idea why the surgeon was doing what he was doing. He also shook his head and said that I was not the only person from AlphaKlinik with the same complaint and the same devastating result after the same procedure.
My Physical Therapist said: "I would never let anyone to shave my knee!" Well, I wouldnt either! Except that no one asked ME!!!

We took the video to three other well respected orthopedic doctors in the Munich area. They each said the retro-patellar cartilage was perfectly healthy on the operating video and a simple softening of the cartilage, especially after 6 months in bed, doesn't warrant such a procedure! They said there was no sign of any medial meniscus tear in the surgery video.  We reviewed the MRI reports, and found that the pre-operative radiologist report (from a different hospital) specifically stated "No sign of Chondromalacia."

We have written statements from various surgeons world-wide confirming that
the procedure was totally inappropriate. 
As well, we have heard verbal confirmation from many Bayern Orthopedic doctors
stating that the procedure was done to a perfectly healthy knee (listed below).

Because of this surgery, I am now unable to use my left knee without severe pain. 

I can not climb even one step with the left knee (used to clime three flights right before the surgery), nor crouch to pick up things, and my left leg is clearly atrophied.  Because of this procedure, the cartilage under my left patella has a large 1cm square lesion (as described by Dr. Alyssa Watanabe, President Spine Radiology Society.)   It is clear from the Arthroscopic video that this lesion did not exist before the surgery.  It is also stated by all doctors, that the RF Thermal Shaving Chondroplasty was the cause of the Chondral lesion under my patella.

============================

 

SURGERY VIDEO – DOES THIS LOOK LIKE A GRADE III ARTHRITIC PATELLA?  NO!


http://www.spinesupport.org/as/Shaving_Chondroplasty_files/image007.jpghttp://www.shaving-chondroplasty.com/sitebuilder/preview/KNEE/Patellar_Chondral_Defect_files/image010.jpg

In the operation video, the surgeon digs until a piece tears out of the patella, and then declares:

                                                 “Oh, there is damage here!”

image012

  1. In the first image, the Patella sits to the side (significantly – like its being held there). This degree of subluxation is not evident in the above MRI’s. 
  2. After the patella is released, magically it fits perfectly into the groove again.                                                                       It is always so much better to cut ligaments than to strengthen muscles (ie, better for profits).
  3. Lateral Retinacular release of the alar ligament in order to allow the Patella to float.                                                        Patella stability from weak muscles is now even worse. Lateral release procedure along takes months to recover from !
  4. A probe presses into the Patella cartilage – demonstrating chondromalasia Grade 1 (softening).                                     It is claimed that this is Grade II/III. Here are examples of the various Grades of Chondromalacia 
 
http://shaving-chondroplasty.com/index_files/image004.jpg               http://shaving-chondroplasty.com/index_files/image006.jpg
   GRADE III (EXAMPLE)                              MY PATELLA - PERFECTLY HEALTHY!
                                                       “No Sign of Chondromalacia” – Dr. Rothmeier, Radiologist

Now, nearly 4 years later, I still have a swollen knee and I cant put any pressure on it. I used to be an athletic person who could walk all day, and now-I am crippled for life.
My only hope is to be able to walk with no limp, and to be able to step 2-3 stairs up or down.
I was told by doctors that it is NOT a realistic expectation with degree of damage that happened because of the thermal chondroplasty shaving surgery.

Before the knee surgery, I could walk up and down stairs (three floors to our apartment in Germany).
After the surgery, four years, I can not even step up ONE stair with my ruined knee! 

Before the knee surgery, I could walk with no problem.
After the surgery, 4.5 years, I am limping and walking on my straight leg. I can't kneel, can't crouch, can't do any activities that involve the usage of my left knee.

Before the surgery, the MRT on the knee showed no defects.
After four years, the latest MRT shows I have a large lesion under the patella ... just as Dr. Kaab's research
reported would happen.

             BEFORE                                                      AFTER

http://www.shaving-chondroplasty.com/sitebuilder/preview/KNEE/DVD/DIAGNOSTICS/Knee_MRI_Feb_2008_vs_Nov_2005_files/image001.jpg

http://www.shaving-chondroplasty.com/sitebuilder/preview/KNEE/DVD/DIAGNOSTICS/Knee_MRI_Feb_2008_vs_Nov_2005_files/image005.jpg

             28 NOV 2005                                  FEB 28 2008 – LEFT QUADS ATROPHIED


The 2 years-later Left-Knee MRI Radiologist' report reads:
  • “Partial chondral defect involves in the inferior aspect of the lateral facet of the patella which measures 10mm wide x 11mm long”
  • Heterogenous signal is present in the articular cartilage in the upper portion of the medial facet (series 5, image 14).
  Basically: The Shaving-Chondroplasty triggered Chondral Necrosis... just as the experiments on rabbits predicted.

Dozens and dozens of reports on Shaving Chondroplasty show negative to catastrophic results. 
Only one surgeon is seen in the media and literature repeatedly promoting the merits and miracles of Shaving Chondroplasty. 
Dr. Toft himself states: "Although this concept is largely rejected by the mainstream of orthopaedic surgeons, there is irrefutable proof that grade III chondral lesions that underwent shaving-chondroplasty will recover themselves with a reparative tissue consisting of fibrocartilage." Dr. Toft does not tell though, what happens to the cartilage of a healthy knee (chondral necrosis).

============================
SO, DO YOU THINK:
  •    It is acceptable to NOT discuss a procedure with a patient, even if that procedure is highly controversial - such as Shaving Chondroplasty on Grade I Chondromalacia - for a patient who expected a check for a torn medial meniscus?
  •   It is acceptable to do a Lateral Release on a slender 30 y.o. woman who was extremely weakened from being bed ridden for 6 months prior the surgery, who had a lumbar spine surgery 3 months earlier at the same clinic, who was scheduled for an Artificial Disc Replacement at the same clinic, and who could not even stand or sit (due to L4/5 prolapse) for 20 min during the FOUR extremely painful visits to the clinic prior to her knee surgery, and who did not have any patella tilting on MRIs. That is, it is better to re-center a patella by chopping tendons, than by strengthening weak muscles?
  •   It is acceptable to prescribe that a surgery on such a disabled patient is 'Urgent' - as claimed by the surgeon, rather than agree with the literature of 100's of his peers, that nothing should be done until the patient has successfully engaged in 6 months of physical therapy to strengthen the quadriceps and VMO?
  •   It is acceptable, knowing the patient had been bed-ridden 6 months, to not discuss the procedure but apply an RF   thermal Shaving Chondroplasty for 23 seconds on the Patella seen in the youtube video, rather than just leave it alone?
  • Does he believe that the cartilage seen in the Arthroscopic video shows Grade III Chondromalacia (i.e., showing fronds and fissuring), and disagrees with his ALL other colleagues, who say that the patella is quite healthy, but simply softening from disuse?  Note, these Colleagues are ALL respected German Orthopedic doctors - also in Munich.
  • That he disagrees with the President of the US Radiology Society, that the cutting pain I have from the pressure on my patella, is due to the lesion under the patella, and that he believes that the lesion can NOT possibly corroborate the findings of numerous studies revealing chondral necrosis post RF shaving chondroplasty?
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Here is the Pre-OP Diagnosis of my Patella not from the AlphaKlinik
28 Nov 2005 (Pre-Op) . Der retropatellare Gelenkknorpel normal dick, kein groesserer Defekt.
Fuer eine Chondromalazia patellae kein Anhalt. - Dr. Dr. Lothar Rothmeier
and the 2 year Post-Op result (i.e. Chondromalcia caused chondral necrosis)
28 Feb 2008: “Partial chondral defect involves in the inferior aspect of the lateral facet of the patella
which measures 10mm wide x 11mm long”  - Dr. Alyssa Watanabe (President, US Radiology Society)

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I cant believe that it is happened to ME...
It is even harder to accept that I lost a healthy knee at 31y.o. for no reason, no injury - and have to live with it for 50 years.
There is absolutely nothing I can do about it...except
TELL MY STORY EVERYWHERE AND WARN PEOPLE

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OUTERBRIDGE RE : the etiology of chondromalacia patella.
J. Bone Joint Surg (Br), 1961, 43 B : 752.

Wiles, Andrews and Devas (1956) stated that chondromalacia patellae “ often begins during the second decade, and by the age of thirty nearly everyone is affected.

Should EVERYONE'S knees be shaved in their late 20s then?

Owre (1936) examined 124 patellae at necropsy and found a high incidence of abnormal cartilage :
of subjects over twenty years of age, ninety-seven out of 106 showed pathological changes.
 
Thus it must be accepted that chondromalacia of the patella is far more common than is generally believed, because usually it does not cause symptoms.”

These macroscopic changes of chondromalacia of the patella can be classified into four grades: in grade
1 there are softening and swelling of the cartilage
2 there are fragmentation and fissuring in an area half an inch or less in diameter
3 is the same as grade 2 but an area more than half an inch in diameter is involved ;
4 there is erosion of cartilage down to bone

My video clearly shows healthy, white, smooth cartilage, which was softening - from 6 months of in bed!

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LESSON LEARNED...BUT TOO LATE: 
If you have been bed-ridden for awhile, and your knees start to hurt (and you had no injury), or lock -
don't ask a surgeon, GO SEE A PHYSIOTHERAPIST!

Sometimes the obstruction is from a misalignment of the bones and muscles around the knee. "Weakness of the muscles on the inside of the thigh or tightness of the outer muscle can throw off the alignment of the kneecap," says Lyle Micheli, M.D., director of the Sports Medicine Division at Boston Children's Hospital and associate clinical professor of orthopedic surgery at Harvard Medical School. "The kneecap comes out of groove with the thigh bone, derails and gets stuck, not allowing you to bend or extend. When the muscle returns to normal, the kneecap gets back on track and movement proceeds normally." http://www.mothernature.com/Library/Bookshelf/Books/16/127.cfm
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