The patello-femoral joint :
Chondromalacia Patellae - - Posted by ProfLiebstrom (ProfLiebstrom), 17 December 2004
I'm 17 and i've had knee problems for somewhere between 8-10 years. I have done high impact sports all my life. Rugby, football, martial arts, climbing. You name it i've probably had a go at it.
First went to the doctors 4 years ago and had a knee exam done then where the doctor couldn't find nothing wrong and because I was a really shy child when asked about the pain it was usually answers of "mmm...yes". So the doctor must have found it difficult to diagnose
Recently I broke my arm so while at the doctor's I decided to ask about my knee. Was quickly asked where it hurts and what it feels like. After describing the clicking, grinding sensation, pain while sitting, going up and downstairs etc. Pretty much anytime when my knee moves or isnt straight like when sleeping really. She diagnosed it there as chondromalacia patellae (CMP from now on cause it's too long to type out). I was stuck on prescription ibuprofen (400mg, about the size of a small marble and appear to be doing little for the pain. It has reduced the frequency of excrutiating pan though ) and I am to go back first week of the new year for a full knee examination.
I have pain in both knee's definately worse in my right, the pain in my left has only begun relatively recently. (last 2-3 years)
After reading around the internet and comparing them with my full symptoms (Some aching that is constant, worse when doing above activities, knee giving way randomly causing me to fall to the floor and be laughed at, stiffness, sometimes (every few weeks at least) sharp pains where the aching isnt normally and not being able to move my leg completely straight until I forget I can't move it without pain and do it by accident causing an audible clicking sound to everyone around and half the time shouting obscenities. I'm starting to think that the cartilidge has begun to break away and start floating about in my joint.
Someone with more knowledge from those described symptoms can they confirm this or disprove it?
From what i've read if this is the case I will require surgery (also can someone confirm this please) . What sort of time will I spend in hospital if it is surgery? How long will I have to go around on crutches for? How long before I can walk properly? And because I go to sixth form with lots of little children about who seem to have no respect or anything these days....how long until I can handle the occasional knock without hitting someone for doing so?
Any other advice you may have would be great too and muchly appreciated.
Thank you in advance
Posted by ProfLiebstrom (ProfLiebstrom), 18 December 2004
awwww come someone has to post and help me!
I wanna know if im just being a hypochondriac or not!
Posted by hmaxwell (Heather M.), 18 December 2004
This question has been asked and answered so many times, there is really a good deal of information archived in this section. Just use the search feature and look up keywords. Also, don't forget to click on the link that says "general info" at the top of the page, then go to Step 5, which is all about the patella.
Finally, here are some other great resources:
http://www.steadman-hawkins.com/knee_chondral/overview.asp (be sure to click through all of the links for overview, symptoms, treatment, rehabilitation, etc.).
http://www.steadman-hawkins.com/pate/overview.asp An overview of poor patellar mechanics, which is a leading cause of softened/damaged articular cartilage.
http://www.kneehippain.com/patient/pain/pain_causes.html
http://www.kneehippain.com/patient/pain/chondromalacia.html
This last is taken from a book that you should DEFINITELY order--What Your Doctor May Not Tell You About Knee Pain and Surgery. You really need to read this book, or find out much more detailed information.
A diagnosis of 'chondromalacia' is actually pretty crummy, as the chondromalacia is a symptom of an underlying problem. It's like saying "You have a cough" when in fact the patient has a cold, and one of the symptoms is a cough. Make sense?
Once you read through these very easy to understand links above, you will be ready to tackle the problem with the understanding that a) 85% or more of patients with chondromalacia DO NOT NEED SURGERY, and can get significant relief from PT. b) you need a thorough knee exam by a skilled doctor to pinpoint your problem. c) if a doctor says you need surgery (especially a dreaded lateral release) then you should get more opinions from doctors who only operate on knees. That's my take, anyway, and what I wish I had done!
FWIW, I was given the chondromalacia diagnosis at age 13, and with some adjustments to my working out routines (competitive swimmer) I was fine for the next 18 years. Yes, my knee would hurt occasionally, and yes, I wore a brace for things like hiking distances. But beyond that, I was doing great. I only had surgery for a torn meniscus, and the chondromalacia was discovered, and the can of worms was opened.....
Heather
Posted by ProfLiebstrom (ProfLiebstrom), 18 December 2004
im having a knee exam first week of the new year like i said 
My sister knows a knee surgeon so she is asking him and to him it sounds like it will need surgery. If just to remove bits of cartilidge which it sounds to him like that has just started to happen fairly recently.
Posted by brattkids2 (brattkids2), 18 December 2004
Its a good thing you are getting a full knee exam after the first of the year!! If you hurt its the bodys way of saying something is wrong.
Your symptoms sound a lot like mine. I have ostochondritis dissecans and condromalacia of the patella. My condromalacia is a grade 1 but the ostochondritis dissecans (damage to the cartilage covering the bone) are grade 4 lesions. The pain while sitting, going up and down stairs, the constant ache, and the knee giving out- oh yeah and my kids laughing hysterically because I fell in the street on the way to the bus stop sound oh so familiar. I also have a sharp throbbing pain that wakes me up at night if my knee is bent. These symptoms are caused by my OCD. Oh yeah I also have the clicking grinding noises too.
OCD is where the cartilage covering the bones is breaking down can be caused by a variety of reasons genetics, trauma, degeneration or broken due to injury. I dont know if this is what else you could have but the symptoms sound the same.
Not being able to straighten your leg without pain sounds like a loose body in the joint. I have had several due to the cartilage breaking off and it kind of sounds like a rubber band snapping in the joint and dangggggg it hurts like a well you know.
If you have loose bodies floating around they will need to do surgery to remove them. I was told for my condromalacia that may treatments available do not have a good success rate for repair of that cartilage. For the cartilage on the femur bone and OCD there are several treatments available that due have good to great success rates depending on the severity of damage. Your OS will be able to tell you the amount of damage and your treatment options. I have had the OATS proceedure and on my lateral femur had great success. My medial femur is a different story I had a full thickness lesion with bone damage. Im still having that worked on. I had bone grafting there and an OATS done in November. Time will tell if it was successful.
With bone the loose body removal and the OATS I was home that afternoon but wanting to hit people with my crutches about 4 to 6 weeks ith the OATS.
Please feel free to contact me with any questions you might have. I would be happy to help.
Hope this helps
Paulette
Posted by ProfLiebstrom (ProfLiebstrom), 18 December 2004
how long has your knee pain been going on? thats something I aint been able to find info on.
Mines been something like 8 - 10 years. I dont know if this is a lot or a little or what!
Posted by brattkids2 (brattkids2), 18 December 2004
5 to 6 years then i finally decided to get it looked into and that is what we found 
it started out just a little ache and over the past year it really got bad.
Happy holidays
Paulette
Posted by ProfLiebstrom (ProfLiebstrom), 18 December 2004
sounds like i have what you have then. maybe a bit worse.
the unable to move leg pat certain point every now and then + collapsing is what is worrying me the most
Posted by brattkids2 (brattkids2), 18 December 2004
My OS says that my leg was giving way because when walking I would hit the point where the lesions were and its like a huge gap with nothing for the bone to grab onto and whooopp down ya go.
Let me know how your doctor visit goes. IT will be interesting to see if that is what you have and what treatments are available to you!!
Paulette
Posted by hmaxwell (Heather M.), 18 December 2004
Buckling and locking are also symptoms of meniscal tears.
Heather
Posted by erinee (erinee), 18 December 2004
OK, here goes. This is from a PT perspective as well as a fellow knee patient perspective.
I too was diagnosed with "chondromalacia" (if you can even call that a diagnosis) in my teens, after knee pain for many years. My input to you is:
1) Don't accept "There's nothing that can be done"
2) Find a doctor that you understand and trust. Ask for referrals from friends and family as well as whats available through your insurance company.
3) Go through diagnostic testing BEFORE ANY SURGERY EVEN A SCOPE!!!!
4) Don't jump to conclusions. Take time to digest what the doctor had said and tests have shown before making any decisions. Research thoroughly. Unfortunately, this part of the anatomy and the biomechanics and physiology that go with it are not very well understood, and there are many many opinions on what to do.
5) Stay strong. Do whatever exercise you can do without or with minimal pain. Do straight leg raises until the cows come home if you can.
GOOD LUCK!!!
Posted by mike_bknee (mike_bknee), 18 December 2004
If your doctor recommends surgery, tie him down to what he will do, and what he might do, then only allow him to do what surgery you feel comfortable with in your own mind. If he says he might do a lateral release, that means he probably will do a lateral release. It is an easy procedure, and does help around 50% of the time. He will probably do a cleanout, which is probably a good thing.....maybe also some type of cartilage repair. It is your body, do the surgery ONLY if you feel comfortable doing it. I had CP in both knees and had a LR in both knees in April, two weeks apart. I was walking within hours after surgery, and walked two miles two days after each surgery, and 10 miles after 10 days. If you decide to have surgery, remember RICE for a few weeks whenever you are not exercising your knee (if your doctor decides you can). Rest, ice, compression, and elevation. Good Luck 
Posted by ProfLiebstrom (ProfLiebstrom), 18 December 2004
Well I do actually like this dr. The other GP I saw I didn't really like since he nearly killed me by prescribing me the wrong thing lol. Best thing about her is that she has actually acknowledged something is wrong. First doctor I saw 4 years ago didnt.
The doctor is doing the treatment and that in a few diffrent stages that I was talked through.
1) Ibuprofen and co-proxamol + rest. I had the co-proxamol for my wrist and it helped with that so I was kept on it for the pain. Ibuprofen to help with the inflammation. If it wasn't that bad these should get rid of it.
2) Full knee exam first week of the new year. I can tell you now that she will find something is wrong. I can't bend my leg completely straight if my foot is flat. Can feel the tightness behind the knee. This will either help in diagnosing how it actually start or be why it actually started
3) Physiotherapy to try and see if that helps. She said then that treatment can all be done at the doctor's if it isnt that bad and just requires physio to get everything back into working order. Im not expecting this to work. All the sports i've done we have had to do stretches and the legs were something they paid particular attention to because they were the main thing used in most of them. After years of constant stretching I still can't bend my leg fully straight while lying down (I normally sleep like a frog if im lying on my back if you can imagine that!) Not exactly the most promising thing based on the range of movement in the rest of my body.
4) Surgery if the physio does not sort it. At the moment it's looking like these will be some sort of release, cleaning out of cartilidge and trimming of the damaged cartilidge
When I have my knee exam I will probably be referred for x-rays as well. If i'm not I will ask to be sent for x-rays. If the cartilidge has worn away The femur and tibia will be closer together and if the patella isn't in the correct place this should show on it too. That's from what I have read at least.
Posted by brattkids2 (brattkids2), 18 December 2004
My X-rays showed nothing and the tibia and femur did not look closer together- at least not in my case as my meniscus is still intact- I have some degeneration of the meniscus but not enough to show on x-ray. My cartilage breakdown is on the articular cartilage covering the bone istelf.
Now the tibia and femur will look closer together if you have a meniscus degeneration. My husband's meniscus is worn away and he was bone on bone so his bones were almost touching in his x-ray.
erniee is right strengthen your leg as much as possible just in case there is surgery in your future you wont believe how fast the muscles waste. I have been off and on crutches since April and my Quad is toast. I was a pretty active person beforhand and did lots of strength training. I would hate to see how weak I would be had I been non-active!!!
Have a great weekend!!
Posted by ProfLiebstrom (ProfLiebstrom), 18 December 2004
yeh i know how fast it wastes away. I had my wrist in splints and casts for a total of 8 weeks not long ago. Put my arms together and you can see the difference between the two of them still!
Posted by ProfLiebstrom (ProfLiebstrom), 6 January 2005
Just to update you all!
Been to the GP today and tomorrow im having an x-ray to see if that shows any loose bodys and other things that x-rays can show (please please tell me what they can show if you know)
Week later when she gets the report back no matter what it says im getting referred to the specialist orthopedics department. Hopefully it will show that something is wrong though that x-ray. That's all for now!
Posted by shadehawk (shadehawk), 6 January 2005
Hi, when they took my x-rays they showed nothing, you can only see the bones and unless you have certain conditions nothing will look out of the ordinary, this does not mean that nothing is wrong though.
You need to see a knee specialist and get checked out thoroughly, hips, feet and knees. The knee specialist will then pull the whole package together and might send you for a ct scan, bone scan, mri and sometimes want to do a diagnostic scope. It depends on what the specialists findings are.
You might have to go for PT for 2-6 months depending on what the problem is and then they might re-assess your progress. Every OS works a little different. It all depends on their findings. Just make sure you keep doing those straight leg raises and keep everything as mobile as possible.
I was also diagnosed with chondromalacia patellae and now I have found out that this is only a symptom of another condition like malalignment issues or soft tissue problems etc. My issues are bad malalignment and maltracking patellae.
Hope this helps some.
Posted by ProfLiebstrom (ProfLiebstrom), 7 January 2005
Well X-ray in a few hours. The joys of dropping trousers and having someone poking at my knee then zap it with radiation!
I have another question about waiting for a consultation.
As I said e arlier once my GP has the results of the x-ray she is referring me. But the waiting times for a consultation are nearly a year!.
Are consultations on a first come first served basis? Or will they get me in for a consultation quicker because I have been refered before but they had no time to actually see me (so this will be the second referral sent by a GP) or because of the time frame it has been going on ? (10 years)
I assume they will also speed it up if they see something on the x-ray. This assumption right?
And will I get sennt a copy of the x-ray report too? Or will I have to ask my GP for one ?
Posted by shadehawk (shadehawk), 12 January 2005
Hi there again, you will find that every place works differently and you might have to wait awhile to get into see an OS.
You usually have to have a prescription from your GP or the OS himself for you to get copies of the x-rays etc, but your GP will get a report from your OS on his findings.
It seems that every hospital & clinic have different views how they give out copies of x-rays, so all you can do is ask.
Good luck.
Posted by nmcbride (nmcbride), 13 January 2005
I recently had arthroscopic meniscectomy and a washout, I had the same sort of symptoms as you had and the OS said it was because of the cartlidge was breaking off and floating in the joint (I have grade IV chondro), I had A LOT of pain and trouble straightening the leg, loads of clicking and crunching and sticking, I'm now a couple of month on from my surgery and it is a whole lot better. The surgery was a breeze, I was in and out the same day, walked out of the hospital with no crutches and only a slight limp for a few days. Pain was minimal.
Just wanted to give you my experience in case you go in for same thing I had. Good luck
Natalie.
Posted by ProfLiebstrom (ProfLiebstrom), 13 January 2005
what you have sounds a lot what i think i have! I get my x-ray report next week. Will know tomorrow what day my GP is in.
Get my report monday morning first thing.
Posted by ProfLiebstrom (ProfLiebstrom), 17 January 2005
Oh well sat waiting in GPs for an hour just to find out they dont have my x-ray report yet! I now have to phone up wednesday to see if they have it and if they do go in thursday morning.
Posted by ProfLiebstrom (ProfLiebstrom), 20 January 2005
Got it back! Turn's out there was nothing wrong shown on the x-ray. So my GP has sent off a referral for orthopaedics and I assume they will send me for an MRI ? this correct?
Quick lok around says most people are seen for their first appointment withing 13 weeks. Just waiting for NHS site to work so I can see what the current waiting times are Be great if I get an appointment within a month though which the department of health site says about 1/4 do in sheffield!
Updated Mon Oct 6 2008