The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: RBCLTT on April 13, 2011, 01:56:29 AM

Title: Any info on a grade 3 chondral defect, classified as severe?
Post by: RBCLTT on April 13, 2011, 01:56:29 AM
I've been having a lot of right knee pain, swelling, etc...Besides the pain, my biggest complaint is that I feel as though my knee cap could just pop off at any minute, it's such a weird sensation.

I had an MRI yesterday, yet have to wait 10 days before my follow up appointment.  I received my report today and it states "severe chondromalacia patella with osteochondral erosions involving the patellar apex and medial patellar facet.  Plus, chondromalacia with osteochondral erosions involving the medial femoral condyle."  In some of the notes it said there were several grade 3 chondral defects.

Will physical therapy help this?  Or, am I destined for some sort of surgrey?  I just can't digest all the info on Dr. Google and would appreciate some more basic understanding of what is going on with my knee.

Thanks in advance!
Title: Re: Any info on a grade 3 chondral defect, classified as severe?
Post by: knee always hurts on April 13, 2011, 02:20:51 AM
It's impossible to say if you'll eventually need surgery or not. A good PT will certainly be able to reduce your pain, but you won't know if you can be pain free until a few months pass.

I think it's better that you have some cartilage left (grade III) as opposed to none (grade IV). I certainly believe that it's possible to strengthen cartilage. Once it's gone, the consensus is that it isn't coming back, but there is at least some limited evidence that cartilage regeneration is possible under the right circumstances. I'd suggest a couple of things:

1. Most PT for knees is going to put a lot of emphasis on strengthening the quads. While this is a good idea in the long run, you don't want to damage your knees further in the process. I'd suggest that looking at how your ankles and hips are tracking is far more important than the quads. You shouldn't do any heavy exercise before your quads are up to par, though. The reason the hips and ankles are particularly important is that any rotation of these joints is going to introduce a lot of torquing force to the knees as you walk. This is going to cause pain and cartilage degeneration.

2. If something is causing you increased pain, you are overloading your knees. You need to find as close to a pain free level of activity as possible and slowly build up to greater activities. If you continue to ignore the signals your knee is sending you, you are guaranteed to eventually need surgery, and certainly sooner than you would have otherwise. If you come across a PT that tells you "No pain, no gain", I'd run away as fast as possible. A good rehab protocol would be to find an exercise that you can do for high reps but that puts a low load on your knees. Consider a lot of walking at a moderate pace or light cycling. Resting periodically during these sessions is a good idea.

This article actually sums up these principles nicely:

The good news is that cartilage therapies are more advanced than ever before. If performed soon enough, treatments can sometimes help you avoid knee replacement. But surgery should never be undertaken lightly, and if you can get to a satisfactory level of pain, I'd advise against it.
Title: Re: Any info on a grade 3 chondral defect, classified as severe?
Post by: Kimberly 77 on April 13, 2011, 03:14:32 PM
All I can say is my experience with chondral defects haven't been so good. I have the same thing as you Grade 3 defects, one on my Tibia, top of patella and medial femoral condyle. I have had 2 scopes with little to no relief and done lots of theraphy. I seen doc yesterday he tried another crtizone shot, just makes me swell more, he said we will also do hylagan shots in 6 weeks and if no relief we will then replace. But, all that said I think it depends on many factors, how bad is the defect, the location of the defect, its also best to have full flexion and extention,(I didn't and still don't)ect. Also your age will also be a deciding factor in what your treatment options are. In older people they are willing to replace, in younger people they are much more conservative. Problem with this is that cartilage never re grows so once its gone it is gone. Sometimes if the defect is not too large they can do a cartilage transplant or micro fracture and some people do really well with that. I have large defects so none of that is a option for me.
Title: Re: Any info on a grade 3 chondral defect, classified as severe?
Post by: kscope09 on April 13, 2011, 05:39:08 PM
Hard to say if you would need surgery or not but a scope might be able to tidy things up, since you've got grade 3and not 4, so if you did have the knee tidied up and there are no complications then it would slow down the wear and tear because you would have smooth surfaces instead of rough ones rubbing over one another.

Hower, you shouldn't conisder surgery until you have gone through a pt program to strengthen the knee and got enough advice on how you can manage with minimal pain for the time being/  If things persist despite the pt only then would a scope be suggestd.
Title: Re: Any info on a grade 3 chondral defect, classified as severe?
Post by: vickster on April 13, 2011, 05:57:15 PM
There is some good information in the Information Hub on cartilage damage / arthritic changes which should be more digestible than random Google links

Click through to different pages, e.g. ...

Title: Re: Any info on a grade 3 chondral defect, classified as severe?
Post by: smillie on April 13, 2011, 06:03:52 PM
You said you have the feeling that your knee cap could pop off--have you been checked for instability? If you are having cartilage wear, the first question shouldn't be how to fix the wear. The first question should be why is it wearing? An MRI won't show they why, only the what. Do some more reading around here, especially in the patella area if your patella is feeling unstable. Learn more about the anatomy and instability and start asking your OS Why? And if your OS can't or won't do the right kinds of testing and imaging to answer the Why? then find one who can.
Title: Re: Any info on a grade 3 chondral defect, classified as severe?
Post by: RBCLTT on April 13, 2011, 06:43:05 PM
Thanks everyone for your responses.   :)

I've only seen the ortho once, he examined me, took some x-rays and told me the x-rays were fine and everything looked good.  Then, he said I should get an MRI in case I had a torn meniscus.  The MRI report shows that there is no tear in the meniscus, but the other issues that the OS never mentioned could be a possibility. 

My follow up isn't until next week, but I'm having a lot of weakness and pain.  Going up and down stairs is really hard.  I'm 41, so I don't think it should be total arthritis causing it yet, should it? 

I definately don't want to have surgery if I can avoid it.  I guess my question about that was because most of what I've read (on google, etc.!) says that cartiledge can't fix itself and at a stage 3, would PT make a difference?  But, like the last poster suggested, the bigger issue is finding out WHY this is happening to avoid any further damage.
Title: Re: Any info on a grade 3 chondral defect, classified as severe?
Post by: knee always hurts on April 13, 2011, 07:13:10 PM
If the joint space on the x-rays was OK then you don't have arthritis. By definition, you would have to have a diminished joint space for this to be the case.

What you have is a focal chondral defect, which is an area of damage. Whether or not your body can repair lost cartilage is less important than whether you can improve what cartilage you have left. That is what PT is about, as well as preventing further deterioration of what is left. If you eliminate the rotational forces in your knee that is leading to the deterioration, as well as strengthen the cartilage that you do have, you may find that you're in significantly less pain. But nobody can say if it will be good enough for you in the end. Since most surgery is ineffective for this sort of problem, or has a protracted recovery time, it is worth it to try perhaps 6 months of PT before you give up and head off to the surgeon.