So, an update two years after my lateral release.  Well, I've continued to investigate options - mostly with the doctors at the Rebound Clinic.  A couple MRIs and a handful of x-rays.  Lots of consultations about options.  A bit more PT, although I think I probably do just as well on my own without it.

The primary line of thinking in the last two years is that I've worn a groove in the cartilage of the femoral trochlea.  The MRI shows it clearly.  It's not huge; probably half a centimeter wide and a centimeter long.  And it's not full-thickness.  Up until recently the doctors have correlated this with my knee pain and dysfunction.  Their recommendation has been a Mickelson osteotomy to essentially relieve the pressure of the patella on the lateral chondral surface and provide more leverage for the knee.

I've hesitated (for two years obviously) hoping to find an alternative that's not so dramatic.  And, I've been hesitant to agree with the diagnosis because my pain is on the lateral side of the knee - not the center where the cartilage damage is located.

I've opted to have two of the doctors scope me next month in an effort to understand what's causing the dysfunction.

I do believe that my problem is the result of poor bio-mechanics and over-use.  Even in 2006, when training for  the Haute Route run, I noticed a tick, a twinge of pain at about 20 degrees of flexion when stepping up.  I also know that I have compensated for this secretly for a long time, letting the left knee go slack coming down stairs and using my right leg to push myself through a step up on a steep climb.  Looking back further, it is certainly that my knee pain in 2002 was symptomatic of something other than meniscus damage.  Some studies do suggest that meniscus/cartilage damage can often be asymptomatic, and that knee pain often has other root causes.

There is some promise in autologous (self-sourced) stem cell injections, I think. is one example.  In animal models, and anecdotal examples with humans, the procedure does seem to produce replacement cartilage and improve healing in bone.  In the procedure, stem cells are taken from the pelvis, cultured to increase their numbers, and reinjected at the injury site.  Unfortunately, there are no real scientific, randomized, double-blind trials to test this procedure.  Nonetheless, it does seem a likely early start at something that will someday be commonplace.  These procedures typically cost around $7,000, and seem like a relatively benign thing to try.  So...maybe.  Here's another, similar clinic doing the procedure in Europe: