The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: walshsimon on October 18, 2005, 11:44:06 PM

Title: Chondromalacia advice
Post by: walshsimon on October 18, 2005, 11:44:06 PM
Hi all,

I am new to this board so I am not sure if this is the correct room.
I am a UK citizen who now lives in Sweden. I am 33 years old and since the age of 25 I have been a pretty active person (Swimming, Football, Squash, Running and Mountain Biking)
In the Autumn of 2004 I was working on my house and got a really strange pain in my left knee while going up a  ladder. I shook it off and tried to forget about it. We had just had twins and the weather was starting to get cold so my training was at a mimimum. The pain would show up every now and then but I could never really put my finger on what caused it.
In about Feb 2005 I decided to see a doctor. He did some checks and suggested that I see a physio. I did this but they could not find any problem with my knee. They gave me a course of exercise which I followed but I was very skeptical to their "diagnosis".
I got contact with a clinic that specialises in sports injuries and within 5 minutes of meeting this new physio she had diagnosed Chondromalacia. The symptons she described matched my pain exactly. After our meeting I went back home and read tons of stuff about Chondromalcia. Everything seemed to match. She had asked me if I could recall any impact on my knee in the last 6 motnhs. I remembered that during a mountian bike race I smashed my left knee into the handlebar and had to dismount the bike for a couple of minutes to recover. I just didn't make the connection earlier. I was pretty convinced that this had some influence on the injury.

Anyway she suggested a course of training which included weights, cycling, balance boards etc. This all worked really well. I also decided to try Glucosamine as I had read a lot about it on the Internet. The results were reallly good. I started to get real strength back in my knee but more importantly I felt more confident with my knee. Even with this confidence there would always be a day every now and then where I would get a slight twinge and then some negative thoughts start to creep in.

Since then I have basically only trained on a bike. I have a spinning bike at home and I ride a lot of mountain bike. During 2005 I rode several mountian bike races including some marathons over 100km. These have all gone really well and I have never had any issues druing a race, trainign or in the days after a race.

But still these twinges remain. It feels like they will always be there. I don't have the confidence to go out for a jog as it feels like I would be doing real damage to my knee. It does tend to get me down a little. The twinges seem to occur most when I am getting up from the floor or getting in/out of a car.

I am planning to talk to the clinic again to try and get an MRI scan. I am not sure if that will show anything. Sometimes I think that surgery would solve this but when I read on the Internet it seems that this is, more often than not, not the case.

If anyone has any advice I would be most grateful. COulod this be caused by an impact to my knee or is it a degenrative condition? If it is degenerative then why is my right knee ok. Can I expect the same in the right knee?
Will a scan help? What about surgery? Does anyone have any experiences they wish to share?

Many thanks
Title: Re: Chondromalacia advice
Post by: blackbeltgirl on October 19, 2005, 03:20:15 AM
Simon -

I have no solutions.  The answer to almost all of your quesitons is - YES.  It could be caused by impact, it could be degenerative, it could always be there, etc.  Personally, I blame my knee troubles on getting whacked with a golf club when I was 12.  (It was my little brother's mini-golf birthday party  Not sure if you guy shave mini-golf in Europe, but anyway...)  There are a few questions you may want answered before trying to decide how to care for your iknee.  Find out if you have any mis-alignment.  FInd out what grade they think the chondromalacia is.  Chondromalacia is just softening of the cartilage.  In many ways, it's pre-arthritis.  DOn't let the evil arthritis word scare you.  Find out if your OS thinks it's a focal lesion.  This is basically a pothole, in otherwise healthy cartilage.  If it's a focal lesion, there are surgical options to replace/regenerate cartilage.  The surgeries are microfracture, OATS, and ACI (or next generation technology of any of these).  They're all big surgeries, but may be worthwhile for you.  For what it's worth, MRIs don't show articular cartilage very well.  I've recently seen a lot of people mention using a contrast agent, which is supposed to show the articular cartilage better.  But it may not answer your questions.  Have you had x-rays?  Especially standing x-rays?  X-rays are a good tool for diagnosing arthritis (and it's variations and stages) because it shows the bone spurs that form as your knee tries to heal itself, and the narrowing joint space.

Either way, it sounds like you've been playing it smart.  Keep the muscles strong, and don't ask the knee to do more than it wants to.  YOu may want to get a good brace, so that you can try some other sports.  And just get educated.  Try  Go to the reference section, and the knee page.  There are a lot of articles about maintaining the health of yourr cartilage.

Good luck.
Title: Re: Chondromalacia advice
Post by: uneek_mike on October 19, 2005, 11:07:06 AM
My girlfriend have the same problem.  Her knee hurts intermittently while driving, squatting, or kneeling down.  The doctor said that it was due to imbalance of the thigh muscles where one side is over powering the other and is causing the patella to move abnormally.  The doctor recommended to do PT and do different exercises to strenghten the other muscles in the thigh. 

So far so good, I haven't heard that much complains from her now. 

Do try to have an MRI to check for some loose cartilages and also do an xray (top shot) to check for malalignment of the patella.
Title: Re: Chondromalacia advice
Post by: walshsimon on October 23, 2005, 08:36:52 AM
Many thanks for taking the time to answer my questions. I will look into a knee brace and will push my doctor for both an MRI and x-rays.

Thanks again
Title: Re: Chondromalacia advice
Post by: ClimbingGirl on October 24, 2005, 04:46:26 PM
Mountain biking has also been my main sport for many years and because of that I have very over-developed lateral quads in comparison to my VMOs - as suggested above this will certainly contribute to poor tracking of your kneecap. It is very difficult to strengthen the vmo specifically without some involvement of the lateral quad - a good sports physio should help you address this.
Title: Re: Chondromalacia advice
Post by: blessedkarma on October 25, 2005, 04:48:43 AM
I've had this condition since I was eleven years old and I can tell you, it's a pain to live with. There are a lot of cases where physical therapy can help a great deal to strengthen muscles and offer more support but unfortunantly that didn't work for me. I have found that a good brace does help me a great deal - I would suggest one with supportive rods in the sides that can be removed and patella support. For me, I am having a re-alignment and a lateral release surgery done - very much yuck! Also, even if nothing shows up on the MRI [with my first MRI nothing did] if the pain keeps persisting, you be just as persistant with your doc to get something done about it! Don't wait ten years like I did!  :o

Good Luck!