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Author Topic: Patellar chondral injury w/deep chondral fissures  (Read 12959 times)

Offline tinkerbell76

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Patellar chondral injury w/deep chondral fissures
« on: December 28, 2004, 08:46:38 PM »
I hope that someone can help me with a recent problem that I have.  I am a 28-year-old female and started right knee pain, swelling and constant cracking.  I went to a local walk-in and the doctor there ordered an MRI.  The MRI report shows moderate effusion, patellar chondral injury with deep chondral fissures.  I tried to do a google search for this, but could not find any good websites with any good information.  It is my understanding that this is normally the result a trauma, but I never injured my knee and I am not athletic.  I have spoke to a few doctors about this issue, as I work in the medical field and everyone has something different to say, but they all agreed that I need to see an orthopedic surgeon.  I have scheduled an appointment with one, but it is not until the end of next week.  I am very concerned that I have been having the pain and swelling for two weeks now and the cracking has been going on for months.  I don&#8217;t know if this is something that is treated with medications or if it is a surgical issue.  Any help that you can give me would be great.  Thanks in advance!!!!!!!!

Offline Heather M.

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Re: Patellar chondral injury w/deep chondral fissu
« Reply #1 on: December 28, 2004, 11:09:37 PM »
There is quite a bit of information on the web, you just need to have the right keywords to plug into the search engines.  Try chondromalacia, chondral defect, chondral lesion, focal lesion, osteoarthritis, and crepitus (the crunchy noise).

It's not exactly true that you have to have some kind of trauma--my chondral damage came on slowly over many years.  This is because I have poor knee mechanics (lateral tracking of patella and chronic subluxation, which is like a mini-dislocation of the kneecap).  In general, this is called patello-femoral syndrome or PFS.  You can also look that up.

Start with the 'general info' tab at the top of this page, paying special attention to 'Step 5--Patellae."  Also, there is a whole section of this board dedicated to patello-femoral syndrome--it's down well below this 'general knee questions' section, called the 'patello-femoral joint.'  You will find lots of threads that deal with chondromalacia and cartilage damage there.

Another great source is this one, dealing with damaged articular cartilage/chondral defects:
http://www.steadman-hawkins.com/knee_chondral/overview.asp

And this, dealing with PFS in general:
http://www.steadman-hawkins.com/pate/overview.asp

Finally, this is a great resource on patella problems and PFS:  http://www.kneehippain.com  Go to the 'for patients' section and read through each of the multiple drop-down menus per topic, focusing on the patella and physical therapy & surgery sections.

PFS can be resolved 85% of the time without surgical intervention.  Specialized physical therapy, patellar bracing, even taping the patella can help reduce pain long enough for you to build up the muscles around the knee joint.  This in turn will help take pressure off the joint, and in most cases resolves the problem.

There is no need to panic that you have some dire knee emergency--chances are whatever condition your knee is in, the damage has been there for a long time.  So don't jump into anything, though it is necessary to see an orthopedic surgeon (preferrably one who specializes in PFS and only does knees) to get an appropriate diagnosis and physical therapy regimen.  There are surgeries that can be done, but I would certainly stay away from them until you are facing a disability or chronic pain.  The patellar realignment surgeries are far from a sure thing, and in some cases can leave the patient worse off.  That's why it's a good idea to exhaust every option with physical therapy, life-style modification, and all conservative measures FIRST.  I was diagnosed with PFS and chondromalacia at age 13 and managed to avoid surgery for over 18 years.  And even then I only had knee surgery because I tore my meniscus, which is a condition unrelated to the state of my articular cartilage--even though they are both called 'cartilage'!  That reminds me, bone up on your knee anatomy and terms.  The web sites I listed above are in easy to understand language and will help you understand exactly what you are dealing with.

Heather

« Last Edit: December 28, 2004, 11:14:25 PM by hmaxwell »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline Heather M.

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Re: Patellar chondral injury w/deep chondral fissu
« Reply #2 on: December 28, 2004, 11:14:35 PM »
PS I urge you to see the right kind of orthopedic surgeons.  There are doctors who specialize in knee problems and PFS--if you want to post the general region where you live, someone here can likely point you toward the right doctor.

Also, if you want to read medical journal articles and find the names of surgeons doing cutting edge work in the area of patello-femoral syndrome/issues, you can go to http://www.findarticles.com and look up the articles using the keywords above.  You will find there is a lot of controversy in how to treat this problem, and a lot of questions remain!  You can see 6 doctors and get 5 different treatment plans...you just have to educate yourself and find a doctor who specializes in the PFS sub-field--one who has a plan that you can live with.

Here's an example of the abstract/summary of a journal article on dealing with PFS through conservative (non-surgical means).  You can find the full text at the link above.

Quote
Patellofemoral disorders: a classification system and clinical guidelines for nonoperative rehabilitation.
Wilk KE, Davies GJ, Mangine RE, Malone TR
J Orthop Sports Phys Ther 1998 Nov 28:307-22

Abstract
Patellofemoral disorders are among the most common clinical conditions managed in the orthopaedic and sports medicine setting. Nonoperative intervention is typically the initial form of treatment for patellofemoral disorders; however, there is no consensus on the most effective method of treatment. Although numerous treatment options exist for patellofemoral patients, the indications and contraindications of each approach have not been well established. Additionally, there is no generally accepted classification scheme for patellofemoral disorders. In this paper, we will discuss a classification system to be used as the foundation for developing treatment strategies and interventions in the nonsurgical management of patients with patellofemoral pain and/or dysfunction. The classification system divides the patellofemoral disorders into eight groups, including: 1) patellar compression syndromes, 2) patellar instability, 3) biomechanical dysfunction, 4) direct patellar trauma, 5) soft tissue lesions, 6) overuse syndromes, 7) osteochondritis diseases, and 8) neurologic disorders. Treatment suggestions for each of the eight patellofemoral dysfunction categories will be briefly discussed.


Here is a journal article that gives an overview of the surgical measures that can be taken--but only after conservative treatments have failed.

Quote
Operative management of patellofemoral pain.
Fulkerson JP
Ann Chir Gynaecol 1991  80:224-9

Abstract
In short, the surgical treatment of patients with patellofemoral pain will depend on understanding each specific disorder and the pattern of articular degeneration. Tilt alone generally responds well to lateral release. Subluxation, particularly when more severe, may require medial imbrication and/or a distal (Trillat) procedure in addition to lateral release to achieve extensor mechanism balance. When there is significant patellar arthrosis, an oblique osteotomy deep to the tibial tubercle will permit unloading of the patellar articular surface in addition to realignment. A small amount of metaphyseal bone placed in this oblique osteotomy will permit straight anterior displacement of the tibial tubercle of 15-20 mm with minimal bone graft when necessary. These basic surgical procedures will permit adequate treatment of most patients with resistant patellofemoral pain (with or without arthrosis) when non-operative measures have failed and the appropriate procedure is selected for a specific mechanical disorder.
« Last Edit: December 28, 2004, 11:20:28 PM by hmaxwell »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell