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Author Topic: Grade 4 Chondromalacia to the Patellofemoral Compartment  (Read 17929 times)

Offline rossometer

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Grade 4 Chondromalacia to the Patellofemoral Compartment
« on: January 19, 2010, 02:11:45 AM »
Hi

I was just diagnosed by MRI with Grade 4 Chondromalacia to the Patellofemoral Compartment.  Everything I have read online and the reaction of my PT leave me feeling depressed.  I am very active; cycling, downhill and X-country skiing, windsurfing, kitesurfing and hiking.  I would like to try to maintain my participation in all or some of these sports since I am only 48 years old.  Can anyone with similar experience provide some advise on what to expect and what my best options are.

I have also just had two ACL reconstructions, plus a cleanup on my "bad" knee so I understand rehab and a lot of what goes on with surgery and the knee joint....I just didn't think that I would need to start worrying about arthritis for a few more years.....especially at what seems to be a very intense level.

Thanks,

R.

Offline snorunner

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Re: Grade 4 Chondromalacia to the Patellofemoral Compartment
« Reply #1 on: January 20, 2010, 07:37:46 PM »
Hi R:
I was diagnosed the same-chondromalacia that turned into Grade 4 osteoarthritis--almost exactly a year ago, both knees. No other issues though. Like you very active downhill and XC skier, backpacker and cyclcist. I've had CP my whole life and worked around the pain forever. I'm only a little older than you. When it goes bone on bone it messes up what you can acheive. I was cycling last summer and had the patella actually get stuck on the femur; had to dismount and knock it back in place every 1/2 mile or so. Not fun. Downhill skiing last spring the bones actually started ratcheting and skidding off one another, then the quads cut out and I became an expert at double eject face plants! At the end I couldn't even stand up off the chair--the knees would not do it. At one point I downhill skied 40 days a year plus a ton of XC if that gives you any perspective.

I opted for a patello-femoral  replacement last summer after conservative treatment; PT and hyalgan injections. Knee #1was done in August, and I am still healing that one up. Knee #2 is scheduled for this February-6 months after the first. At 3 months I did my first XC outing and here at 5 months iI am skiing more and it is better; knee is still needing a little more strengthening and I am struggling w/some scar tissue issues. If my right knee wasn't also toast I would give downhill a try at this point.

Happy to answer any questions or whatever...when you're active it is VERY VERY hard to deal wtih this. It is disabling; I tried so hard for so many years to beat the monster, but it came down to replacement for me. I don't intend to stop doing what I do, so robo parts will have to work! You can go a long time  and perservere through the discomfort but when it goes, it goes in a big way. Don't mean to bum you out at all--I made my choice for me. Happy to share any cheats and tricks I learned along the way if that would help!
Chondromalacia dx age 14
1987 dx: malalignment, condromalacia, maltracking
2/2008 Gr. 2/3 OA L&R knees
3/2009 Gr. 4 severe isolated patellofemoral OA L&R
4/09 Hyalgan injections
8/24/09 PFJR and LR left knee
2/5/10 Left scope/debridement
2/22/10 PFJR and LR right knee

Offline gr8fit

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Re: Grade 4 Chondromalacia to the Patellofemoral Compartment
« Reply #2 on: January 21, 2010, 01:36:13 AM »
Hi Rossometer,
I was diagnosed with Grade 4 Chondromalacia when I was 38 years old in my R knee.  I was able to beat the odds for 8 years...participating in my activities of running, hiking, biking, in-line skating, working out, weight training, personal training, teaching fitness classes, etc. I did something every day and during peak season would put in about 80-100 miles a week of training.  (My husband and I usually hike about 15 miles in a day...it's our passion.....it's NO LONGER and it SUCKS).  Then at age 45...BOOM my entire life took a complete 180.  My R knee would lock up on me about 20 times a day.  I almost got hit by a semi while biking b/c my knee locked up.   I have end-stage PFJ arthrits and I literally can only walk about 30 minutes B4 the pain seizes up my joint. The only cardiovascular workout I can do is deep water skiing (can't do the deep water jogging b/c my knees can't handle the force from the semi flexed position to the semi extended position...the skiing offers me a more "fixed knee position" that I can endure for a 45 minute workout).   

I recently had 2 scopes to access my situation (in Sept and Nov of 2009). OS removed a 1/2 " X 1/2" calcium floater from my R knee  that was lodged under my patella.  It's HUGE...I still have it to show everyone.  I'm having a very difficult time "recovering" from the L knee scope (November) and I'm now consulting with PFJR specialists in my area.  My medial and lateral compartments are pristine. My PFJ is end-stage. I want my life back....not looking forward to another surgery after having 3 th is year....but this is just INSANE....totally INSANE!

I was like you when I first found out...my OS advised me to give up running.  Looking back, I wish I did.  I think you could modify your lifestyle a little bit.  But, like Snorunner said..."when it goes...it goes in a big way..."  So I guess it's hard to say if conservative approaches to your lifestyle will prolong the obvious or not.  I don't mean to sound negative...but you may be able to prolong a replacement by modifying...but that is really hard to do when it's a part of who you are.  I hope my story helped a little bit.  Like I said...I really wish I would have listened to my OS and modified a bit.....
3/22/02: RKScope.Grade 4 Chondromalacia patella Microfracture.
09 & 11: L ankle Scope
9/17/09: RKScope.
Removal of 1/2" X 1/2" calcium floater. End Stage PFJ-OA
11/5/09: LKScope. End-Stage PFJ-OA.
2/24/10: Bilateral PFJR w/ LR!
12/13: L-spine Laminotomy
01/14:  bilateral patella subluxing

Offline snorunner

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Re: Grade 4 Chondromalacia to the Patellofemoral Compartment
« Reply #3 on: January 21, 2010, 03:07:03 AM »
Hi there gr8fit:

You can modify till the cows come home but if it's Gr. 4  it's history, ya know? I say go out with a bang! They had to tote my sobbing body off the ski hill last season when it was one double eject face plant after another cause the quads cut out. I was more worried about tearing up an ACL in the process! It sure is nice ranting and raving with other active folk because this is so very hard to live with. Nature will force you to modify at some point, and then the lovely decision making process must begin. Sorry Rossometer, this is probably not what you want to hear! But isolated PF OA is fixable if that's any good news.
Chondromalacia dx age 14
1987 dx: malalignment, condromalacia, maltracking
2/2008 Gr. 2/3 OA L&R knees
3/2009 Gr. 4 severe isolated patellofemoral OA L&R
4/09 Hyalgan injections
8/24/09 PFJR and LR left knee
2/5/10 Left scope/debridement
2/22/10 PFJR and LR right knee

Offline gr8fit

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Re: Grade 4 Chondromalacia to the Patellofemoral Compartment
« Reply #4 on: January 21, 2010, 12:13:53 PM »
Hi Snorunner,
I know...you are EXACTLY right and I love the way you put it...." Nature will force you to modify at some point." I was just trying to be as optomistic as I could be....but as you say...isolated PF OA is fixable...and yes...that is GREAT news!!!!!!!!!!  (Despite everything one has to endure to get to the other end...but it's worth it...at least that is what I'm learning as I investigate this surgery). So for Rossometer....I hope this doesn't freak you out.  For me...I've been taking meditation classes to help me deal with my lack of mobility.  It's been one year of extremely compromised mobility...and it hasn't been easy to deal with. THANKS Snorunner....you have a strong spirit!!    ;)
3/22/02: RKScope.Grade 4 Chondromalacia patella Microfracture.
09 & 11: L ankle Scope
9/17/09: RKScope.
Removal of 1/2" X 1/2" calcium floater. End Stage PFJ-OA
11/5/09: LKScope. End-Stage PFJ-OA.
2/24/10: Bilateral PFJR w/ LR!
12/13: L-spine Laminotomy
01/14:  bilateral patella subluxing

Offline rossometer

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Re: Grade 4 Chondromalacia to the Patellofemoral Compartment
« Reply #5 on: January 26, 2010, 06:31:44 AM »
Thanks gr8fit and snorunner.  You are right it is not really what I wanted to hear....but from my research I  already had a pretty good idea where this is going.....blah.

Worst part of it is that I just went through two surgeries on my left knee, a suspected ACL that turned out to be only partial where the OS cleaned up what I believed was the knee cap....waiting to find out....followed by a full ACL about 18 months later.  Here in Canada with delays between injury and surgery I have had to rehab my left knee for about 4 years of the past 6.....and now this!  I will blame it on my genes since the rest of the knee is in pretty good shape.

Did either of you try Synvisc or Synvisc one to help with mobility and if so did it help?

Ross

Offline Blaise

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Re: Grade 4 Chondromalacia to the Patellofemoral Compartment
« Reply #6 on: January 26, 2010, 04:56:20 PM »
Rossometer,

   Sorry to see how much your struggling...Like you I have been diagnosed with grade 4 changes in my  patellofemoral compartment, not to mention a shallow trochlear groove which did not help with my TTT from a year ago...

  I had the Synvisc-1 shot 3 weeks ago..I guess my response to the shot thus far is blah...Has it made any changes yes & no...In my my medial portion of my knee along the joint line it has help with the tenderness, but I still get sharp pains..Under my knee cap it has not helped, I still have grinding, sharp pain, pressure with inclines/steps, and issues when sitting prone...My OS gave me the shot as an aid to help me strenghten my quad for my PFJR surgery knowing fully that patellofemoral arthitis is not the ideal setting for the Synvisc-1...

As for the shot itself, it was not painful but for the first 3-5 days I had increased pain and swelling.  The swelling was failry extreme, and radiated into my ankle and foot..Perhaps and allergic reaction...

I hope this helps & if you have any questions please give a shout...

Blaise
00-LK LR,chondroplasty
12/10/08-LK Chondroplasty,repair of mp-fem ligament,TTT
8/28/09-LK synovectomy, lysis of adhesions,chondroplasty
9/8/09-LK 100ml drain
10/8/09-LK cortisone
1/4/10-PFJR Consult
1/7/10-LK 15ml drain/synvsc-1
5/24/10- LK PFJR/TTT

Offline snorunner

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Re: Grade 4 Chondromalacia to the Patellofemoral Compartment
« Reply #7 on: January 26, 2010, 05:21:07 PM »
Hi Rossometer:
Don't blame genetics until you find out if maltracking or alignment triggered this. There is always a reason (usually mechanical) for isolated PF OA, especially in younger people.

On the shots...I did Hyalgan (another brand) last spring. It was a series of 5 shots given 1-week apart. I did both knees. The shots were pretty painful when administrered; the rooster juice is very thick and takes some push to get into the joint. I started noticing it after about 3 weeks--after a month and a half it was working nicely! It doesn't fix bone on bone, but it does make things a little more slippery in there. It let me sleep through the night without nsaids, I could sit at the dinner table w/o agony and I was able to at least keep up my 3-mile fitness walk-carefully. I had a pretty low chance of success due to end stage PF OA, but I have to say it was great. I am almost 8 months out on the hyalgan with the  non-surgical leg and it is now just starting to wear down. So yippee skippee I liked it. It's not a fix for Gr. 4, but it will buy you some time for a decision or a long waiting list.
Chondromalacia dx age 14
1987 dx: malalignment, condromalacia, maltracking
2/2008 Gr. 2/3 OA L&R knees
3/2009 Gr. 4 severe isolated patellofemoral OA L&R
4/09 Hyalgan injections
8/24/09 PFJR and LR left knee
2/5/10 Left scope/debridement
2/22/10 PFJR and LR right knee

Offline gr8fit

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Re: Grade 4 Chondromalacia to the Patellofemoral Compartment
« Reply #8 on: January 27, 2010, 12:40:00 AM »
Hi Ross,
I have NOT used the Synvisc or Synvisc One (yet).  I was recently told by my OS (the one who has been doing the scopes on me the past 9-years) that the injections probably would NOT do much for me b/c I am Grade 4.  He said something like "We'd be giving you a painful shot for nothing."  After reading Snorunners post (and she is Grade 4) and learning that she got some relief from it...I might try it. I met with a PFJR OS today (and didn't ask him this question).  I am meeting with another PFJR OS next week (the OS who will most likely do my surgery) and I'll ask him then.  I can't walk more than 20 minutes now and I really need to strengthen my legs with some land base leg loading B4 I have my PFJR.  So, like you...I am in the deciding mode....
Julie
3/22/02: RKScope.Grade 4 Chondromalacia patella Microfracture.
09 & 11: L ankle Scope
9/17/09: RKScope.
Removal of 1/2" X 1/2" calcium floater. End Stage PFJ-OA
11/5/09: LKScope. End-Stage PFJ-OA.
2/24/10: Bilateral PFJR w/ LR!
12/13: L-spine Laminotomy
01/14:  bilateral patella subluxing

Offline snorunner

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Re: Grade 4 Chondromalacia to the Patellofemoral Compartment
« Reply #9 on: January 27, 2010, 01:09:00 AM »
Hey Julie (and Ross):

I was lucky with the hyalgan working; doc gave it a 50/50 chance. I think most docs would give it less a chance than that. Quick thought on the workout/strengthening--- land based type loading might be too much for the knee. PT has a bunch of exercises that strengthen without loading the joint. They can be done as pre-hab and re-hab; same stuff, different weights. If you're even considering surgery (or even if you're in the "conservative treatment" mode) your OS can write you up for some PT to learn the exercises. Remember to save enough PT though to get you through a surgery if that's maybe in the plan!
Chondromalacia dx age 14
1987 dx: malalignment, condromalacia, maltracking
2/2008 Gr. 2/3 OA L&R knees
3/2009 Gr. 4 severe isolated patellofemoral OA L&R
4/09 Hyalgan injections
8/24/09 PFJR and LR left knee
2/5/10 Left scope/debridement
2/22/10 PFJR and LR right knee

Offline tsanford07

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Re: Grade 4 Chondromalacia to the Patellofemoral Compartment
« Reply #10 on: July 16, 2010, 01:11:54 AM »
I was diagnosed with grade 3/4 in both knees when I 29 years old. I have had nine surgeries trying to stop the progress. I just had a patellofemoral replacement. I wish I had it done when after the first 2 surgeries didn't work. I have been disabled for 7 years. I am hoping to get the other knee done once this knee heals some more and then I hope to go back to working and living a normal life. I don't want to discourage you. My case was very odd because it happened in both knees at the same time with no warning and because of my age. The doctors didn't know what to do help me. The first doctor didn't tell me I had chondromalacia patella. It was until I wasn't getting better after surgery on each knee that the second doctor told me I had a form of osteoarthritis. Then when I requested my medical records be transferred to the new doctor that's when I found out about CP. I looked it up and I was stunned. The first doctor had removed the bad cartilage. The second doctor told me I would never work again because of the pain and where the OA was located there were no treatment options available. By time I saw the third doctor a year later I was back to stage 4 CP again. It has been a long process and I finally have some hope that this patellofemoral replacement will be the answer to give me my life back. If you want anymore details you can email me I am happy to answer questions. I wish you well

Offline runnergal

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Re: Grade 4 Chondromalacia to the Patellofemoral Compartment
« Reply #11 on: April 07, 2011, 07:29:35 PM »
Hi, there,

I'm an ultramarathon runner/soccer player, and I have Grade 4 chondromalacia too.  I just had my 4th Hyalgan injection today.  Whereas I'm finding I have better ROM in the knee now, it's not relieving the pain.  I'm not sure what my next step will be.  I'm willing to give up the soccer, but I can't imagine life without running.  But, from everything I've read, it appears that's where I'm headed.    :'(

I guess misery loves company, because it feels good to converse with other active individuals facing the same struggles. 

Offline Adobec

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Re: Grade 4 Chondromalacia to the Patellofemoral Compartment
« Reply #12 on: June 07, 2012, 05:07:35 AM »
Wondering I'd there are any updates to this thread?  I have enjoyed all of your responses.  I am struggling with a right knee that is very close to needing a full replacement and a left that may need a partial.  I've been told to limit my activity in the meantime, which breaks my heart-- but I'm 38 and need to make this body last for at least another 50 years!!!
1991 - R ACL patellar tendon, med. meniscus removed (50%)
2002 - R ACL revision, cadaver, lat. meniscus removed (50%)
2011 - L ACL patellar tendon, med. and lat. meniscus REPAIR. 
3/2012 - L Medial meniscectomy (didn't heal from 2011), microfracture
11/6/12  - L TTT (maquet). Micro fully healed

Offline Dave258

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Re: Grade 4 Chondromalacia to the Patellofemoral Compartment
« Reply #13 on: June 14, 2012, 12:50:32 AM »
Wondering I'd there are any updates to this thread?  I have enjoyed all of your responses.  I am struggling with a right knee that is very close to needing a full replacement and a left that may need a partial.  I've been told to limit my activity in the meantime, which breaks my heart-- but I'm 38 and need to make this body last for at least another 50 years!!!

Hey Adobec, I am glad I came across this post!  I just had my forth operation in a year last Thursday, and find out that I have been at grade 4 chondromalacia pattella since the first one which was April 2011.  I had a Fulkerson (TTT) in December (here is my post op diary http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=58292.0) and that helped with my kneecap dislocating, but didn't stop the pain.  When I had the hardware removed last week my OS also did a scope, and had to clean off the last spot of my kneecap that had cartilage.  The back of my kneecap looks like the surface of the moon!  Another OS said that I need to have a PFJR.  My OS wants me to wait two months as I heal from this op, and then see what we are going to do.  I am only 34 years old, and that is why the OS doesn't want to jump into the replacement, but I have no idea what will help the constant pain I am in everyday!
Dave