Author Topic: chondromalacia patella  (Read 245 times)

Offline azgirl1973

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chondromalacia patella
« on: August 11, 2017, 05:00:08 PM »
Good morning,
I am new to the forum but have read some posts when googling.  Back in February I got injured at work.  I was walking down some steps and rolled my ankle which caused me to twist my knee and fall down the stairs.  It was about 3-4 steps.  I landed on the ground but honestly can't remember how since it happened so fast and I was in the middle of teaching a class.  Initially I thought I just sprained my ankle which was obvious.  A couple of days later I noticed my knee was swollen as well but didn't  have any major pain yet.  I admit I was bad and was walking but not much.  Crutches were causing my wrist to hurt.  Anyway I went to the workmans comp doctor on Monday (accident happened on Friday).  He didn't seem too concerned about the knee at the time and just sent me to get ankle X rays.  When I was getting the X rays the tech asked me to turn my ankle a certain way and I wasn't able to.  So she then turned my ankle.  Not sure what happened when she did that but that night my knee swelled up bad and was extremely painful.  I could barely move it.  I went back the next day to the clinic and they took X rays.  Doctor then gave me new crutches (the ones I had were a friends and were falling apart) and said to stay off my leg.  I used the crutches for a few days and then gradually moved to one and then moved to a walking stick.  I went to the clinic every week but was basically getting nowhere.  A month after the accident I was finally starting to feel pretty good.  I went into the clinic and one of the doctors was checking my range of motion and pushed my knee in too far.  That night the swelling came back and the pain was intense again.  I was so mad!  I went back to the clinic the next day and finally got a referral for an MRI.  By the time I got my MRI it was 6 weeks after the accident.  The only thing that showed on the MRI was grade 2-3 chondromalacia patella.  Well the doctors then tried to say that was a chronic condition and was there before the injury.  I don't understand how they can say that.  From what I have read it can be brought on by an injury.  I feel like they are using that because I am in my 40's.  I have an extremely active job as I am a PE teacher who works with kids with special needs.  Prior to my injury I have had no knee pain whatsoever.  I was on my feet all day everyday, running, galloping, jumping, squatting, kneeling, etc. and never had any swelling or pain.  What are your thoughts on this?  Do you think the doctors are just saying this so they didn't have to treat me?  They finally approved PT 4 months later and I had 6 weeks of it over the summer.  Honestly it didn't help me that much because he didn't address my soft tissue issues.  I was released from workmans comp recently.  It makes me mad but they were no help at all.  I am currently seeing a sports chiropractor who is doing ART on me and that has been helping.  I have also received 3 treatments of prolotherapy and waiting a few weeks to see if I will need more.  The most frustrating part is my "good" knee also hurts as a result of overcompensating for so long.  That appears to be from my IT band tightening up on me.  Anyways would love to hear what you all think and mostly just wanted to vent.

Offline Brandon123

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Re: chondromalacia patella
« Reply #1 on: August 12, 2017, 09:37:11 AM »
Hi azgirl,

Chondromalacia patella (grade 2-3 is not uncommon among people in their 40s) is a chronic condition (basically wear and tear) and was probably there before the injury. I think the accident, along with the rough examination by the docs, is the cause of your current problems. However, you may have been more susceptible to knee injury/inflammation because of your existing chondromalacia. Hopefully, your current knee issues will settle down with time (be gentle with it and apply the RICE regime).

That is my take on it at least :) Maybe somebody else has a different idea?   
« Last Edit: August 12, 2017, 09:39:46 AM by Brandon123 »

Offline azgirl1973

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Re: chondromalacia patella
« Reply #2 on: August 12, 2017, 04:59:46 PM »
Thank you for your reply.  I guess I just can't comprehend how I would have never had any symptoms at all prior to my injury.  If I had a normal job I could see, but not with the activity level my job requires.  The day before my injury I ran 5 miles at work pushing kids in wheelchairs in grass for 3 of those miles.  It was a fun run fundraiser day. 

I have been working at increasing my strength again.  I lost a lot of muscle mass in my leg after the injury.  I haven't been overdoing it though but do need to push myself now that I am back at work.  It is really hard to teach some of my students without modeling the skills for them. 

I am much better than I was.  I can now go up and down my stairs like a normal person.  But I really want to get back to being active like I was prior to my injury. 

Offline Brandon123

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Re: chondromalacia patella
« Reply #3 on: August 13, 2017, 09:51:57 AM »
I understand you are confused, the thing is that there is really no solid correlation between chondromalacia and knee symptoms. Some people have advanced chondromalacia and do not feel anything (even athletes and very active people), and others have only grade 1-2 and have much pain and knee problems.

In your case, I think you had chondromalacia without any symptom before the injury (as it is quite common). Then you had your accident and everything and got the symptoms from that stuff. The only thing turning up on the MRI, however, was the chondromalacia. Hence the docs telling you about it.

Anyhow, glad to hear you're doing better! 

Offline SuspectDevice

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Re: chondromalacia patella
« Reply #4 on: August 15, 2017, 11:30:22 PM »
I agree with Brandon - the chrondo would always have been there, and unless the fall caused a major new defect in the cartilage on the back of your patella, that is probably not the issue. Nearly everyone in their 40's would have some patella chondro.  Medicos jump all over this because they feel they have to find something wrong, but it is like noting that most Australians have some sun damage to their skin.

The critical piece of missing information in your post (like many posts on here) is where is the intense knee pain?  Directly under the kneecap.  Inside of knee on the joint line? Outside of knee on the joint line? Back of knee?

I'm wondering if the fall caused a meniscus tear which the MRI did not reveal - MRIs are quite poor at detecting tears, or more precisely the size of a tear.  And the medico twisting your knee aggravated it.

Regardless, it sounds like it is healing, and with careful management (i.e. don't overdo it), might be fine in a while.  Just don't let the knife-happy medicos convince you that you need surgery yet. Conservative treatment is always the #1 option....which means you may need to have the patience of a Saint with your activities.
L Medial menisectomy May 2012
PFPS in both knees ever since
Pre-CRPS diagnosed 2014
Also looking into Dr Scott Dye's Tissue Homeostasis & Envelope of Function work
2017 - 80+% cured thanks to Dr Dye's research
2017 - first small triathlon in 5yrs

Offline azgirl1973

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Re: chondromalacia patella
« Reply #5 on: August 17, 2017, 12:47:02 AM »
Good afternoon,
Initially my knee hurt quite a bit.  It got so swollen after the X ray of my ankle that I could barely move it at all for a few days.  I walked with a limp for quite awhile after the injury and was very uncomfortable standing for more than a few minutes.  I lost a lot of strength in that leg and my muscles got very tight.  The pain is pretty minimal in my knee but I have difficulty doing activities like jogging and other movements that I normally do with my students.  My "good" knee actually hurts worse than the knee I injured at this point.  Sports chiro I am seeing for "ART" says it is because of all the adhesions I developed from my muscles getting tight and not working properly.  My biggest frustration at this point is dealing with my tight muscles and knee stiffness that comes on at times. 

I stretch everyday and do the leg exercises my chiro has recommended daily also.  I foam roll and he does ART twice a week right now.  I also use Acuknee on both knees every night.  I don't have any issues with swelling, or at least none that I can see.  I just want the muscle tightness to go away.  I am on my feet all day at work and have to do a ton of walking (I go to about 3-4 schools a day).  I have done pretty good with this but really want to get back to being more active with my students.  They do so much better when I can model the skills for them. 

Oh and I should note I had an ultra sound done of my knee about a month ago.  It didn't note any tears but did say some deep medial edema most likely due to sprain.  It said my patella compartment was unremarkable. 

Offline SuspectDevice

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Re: chondromalacia patella
« Reply #6 on: August 17, 2017, 02:42:10 AM »
You still haven't said exactly where it hurts?

Regardless, if your 'bad' knee is better than your 'good' knee, you need to go conservative on both of them, and not rush back into activities which may put you out of action for years (ask me how I know this  :-\).
L Medial menisectomy May 2012
PFPS in both knees ever since
Pre-CRPS diagnosed 2014
Also looking into Dr Scott Dye's Tissue Homeostasis & Envelope of Function work
2017 - 80+% cured thanks to Dr Dye's research
2017 - first small triathlon in 5yrs

Offline azgirl1973

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Re: chondromalacia patella
« Reply #7 on: August 17, 2017, 03:51:51 AM »
It is actually difficult for me to describe the pain.  It is more that my knee feels weak and unstable.  It does get stiff sometimes when I have been sitting too long, but not always. Nothing hurts when pressed on.  I have had 3 sessions of prolotherapy and do feel like it has helped.  I can now go down my steps alternating feet and at a normal pace.  I was not able to do this prior to the injections. 

My good knee bothers me on the outside of my knee and occasionally pops along where the IT band crosses over.  It is not necessarily pain but annoying.  It kind of feels like a pull.  I have never had swelling in my right knee, have not lost any strength (other than maybe a little from being less active) and have full ROM.

I do feel like I have been conservative.  I don't run or do many of the activities I did prior to my injury.  I walk a lot but feel like that actually helps.  I ride my stationary bike.  Used to do that daily but got burned out so don't do as often anymore.  Although I did tonight and it felt good.  I do need to do leg strengthening exercises because I need to build back my strength.  My left leg was significantly smaller and weaker than my right. I am starting to gain strength and it isn't quite as obvious as it once was. 

How do you feel like you overdid it?  What helped you?  I appreciate your feedback!

Offline SuspectDevice

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Re: chondromalacia patella
« Reply #8 on: August 17, 2017, 08:04:38 AM »
It is actually difficult for me to describe the pain.  It is more that my knee feels weak and unstable.  It does get stiff sometimes when I have been sitting too long, but not always. Nothing hurts when pressed on.  I have had 3 sessions of prolotherapy and do feel like it has helped.  I can now go down my steps alternating feet and at a normal pace.  I was not able to do this prior to the injections. 

My good knee bothers me on the outside of my knee and occasionally pops along where the IT band crosses over.  It is not necessarily pain but annoying.  It kind of feels like a pull.  I have never had swelling in my right knee, have not lost any strength (other than maybe a little from being less active) and have full ROM.

I do feel like I have been conservative.  I don't run or do many of the activities I did prior to my injury.  I walk a lot but feel like that actually helps.  I ride my stationary bike.  Used to do that daily but got burned out so don't do as often anymore.  Although I did tonight and it felt good.  I do need to do leg strengthening exercises because I need to build back my strength.  My left leg was significantly smaller and weaker than my right. I am starting to gain strength and it isn't quite as obvious as it once was. 

How do you feel like you overdid it?  What helped you?  I appreciate your feedback!

It sounds like your problem is very different to my recent (current) one.  It was (is) patella femoral pain syndrome (PFPS), and the pain was very obvious with constant burning/aching/stiffness behind the kneecap.  I was a triathlete, and massively delayed my recovery by not stopping everything that aggravated it (triathlon, weights, kneeling, squatting, you name it - many many things).  What helped me was reading all Dr Scotts Dyes research, getting away from all the strengthening work and rugged household/gardening work, and just walking a little (20-30mins easy each day) plus swimming with no/minimal kicking. And the main thing (which took me 4yrs to discover) - 4-5 months on Celebrex to beat the chronic inflammation.  I'm sure this is the key to beating PFPS - knee strengthening attempts too early will just make it worse.

Yours sounds more like what happened to me in my 20's when I got a huge blow to my knee playing rugby and it got very unstable for 6mths, would sometimes seize going up/down stairs, but didn't really hurt. I had an exploratory arthroscopy which showed no damage other than a small Bakers cyst (not worth worrying about), and the cure was not doing too much on it for a while (6mths?) other than walking about.  I got back into rugby, but it always a bit problematic.  Then I quit rugby and took up cycling which really improved it.  I suspect you had a meniscus or ligament injury (tear? strain? bruising?), and with care and time it will get better, but if you rush it, you could do more damage.

So two very different injuries for me, with very different paths to cure (though I'm def not fully cured from the PFPS).
L Medial menisectomy May 2012
PFPS in both knees ever since
Pre-CRPS diagnosed 2014
Also looking into Dr Scott Dye's Tissue Homeostasis & Envelope of Function work
2017 - 80+% cured thanks to Dr Dye's research
2017 - first small triathlon in 5yrs

Offline azgirl1973

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Re: chondromalacia patella
« Reply #9 on: August 17, 2017, 02:41:58 PM »
I do think I may have strained my menicus or ligament when I fell.  That would explain why the prolotherapy has helped my knee feel more stable.  My doctor did a treatment, then a week later another one and for the third we waited 2 weeks.  Now he plans on emailing me in a few weeks to see if I need another one. 

I don't plan on returning to jogging and such with my students until my knees feel great for awhile. But I am now modeling the exercises for my students which feels great to do.  Was very frustrating for me at the end of last school year. 

Offline reflex_nl

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Re: chondromalacia patella
« Reply #10 on: August 17, 2017, 09:03:32 PM »
I fully share your pain and frustration. My RK grade 2/3 did heal over time... be patient and don't over do it like the others mentioned as when. BTW: you can also try some taping
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope grade 4 damage to patella Nov'16
LK PT ongoing... in a lot of pain...

Offline azgirl1973

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Re: chondromalacia patella
« Reply #11 on: August 18, 2017, 03:01:10 PM »
That is good to know yours healed.  I am going to have the sports chiropractor try taping my "good" knee today.  It drives me bonkers.  It is not really pain but more like a pulling sensation on the outside of my knee and pops there as well.  I may have him tape my injured knee as well just to see how it feels.  My biggest obstacle right now appears to be my muscles tightening up.  It is getting better but taking longer to resolve than I would like. I am also trying to decide whether or not to have another prolotherapy treatment.  I have had 3 so far, last one was August 5th. 

I am moving in 2 weeks and will have a pool in my backyard.  I plan on using the pool often until it gets too cold to use.  I also want to try and find a used eliptical to buy. 

Offline Brandon123

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Re: chondromalacia patella
« Reply #12 on: August 18, 2017, 09:00:07 PM »
My biggest obstacle right now appears to be my muscles tightening up.

I also have problems with tight muscles around the knee, mainly on the outside pulling as you describe. My OS and PT say the muscles tighten up as a result of the irritation and pain in the knee. Have you tried stretching? My PT gave me a few stretching exercises that I think helps a bit at least. 

Offline azgirl1973

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Re: chondromalacia patella
« Reply #13 on: August 19, 2017, 12:05:59 AM »
Happy Friday!  Yes I stretch every night.  I also foam roll, do the exercises my sports chiro suggested and a few others.  The knee that I feel the pulling in is my "good" knee.  I have been seeing a sports chiro for about 4 weeks, 2 X per week for Active Release Technique.  I feel like he is really helping me but it is getting really expensive.  Part of me wants to reduce to once a week but worry that will slow down my progress. 

What are your thoughts on my recent ultrasound report:
The retropatellar joint compartment is unremarkable with intra-articular fluid being present.  There is minimal suprapatellar fluid echo.  The medial and lateral collateral ligaments are intact. Medial and lateral compartment height appear well-maintained.  Mild fluid signal is identified deep to the medial collateral ligament.  The quadracps and patellar tendons are of normal caliber and echo quality.  Mass lesion is not featured within the popliteal fossa.

Impressions:
1. Patellofemoral joint fluid and small suprapatellar effusion.
2. Fluid echo deep to the medial collateral ligament compatible with a low grade sprain injury.  MRI examination of the left knee should be a consideration to exclude internal derangement of the medial meniscus.  (this was in July, I had an MRI in April). Wouldn't chondromalacia show on an ultrasound?

Offline Geronimo

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Re: chondromalacia patella
« Reply #14 on: August 19, 2017, 05:23:11 AM »
even if it would show it doesn't necessarily mean it would be seen.

 

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