KNEEtalk

The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: papasmurf1978 on July 29, 2014, 07:04:30 PM

Title: Chondromalacia Patella + Patellar Tendinosis
Post by: papasmurf1978 on July 29, 2014, 07:04:30 PM
Hi guys,

I was wondering if the area of my pain in the knee is normal due to chondromalacia patella.
Picture is not of my knee but an example. I have indicated where the chondromalacia patella was diagnosed. This is my right knee and cartilage wear is on the medial facet. I have this irrititating pain all the time on the lateral side of the patella, it's like if it's rubbing against the trochelea or something. It's like if there's irritated nerve or something or could be that my patella is maltracking due to softening of the cartilage. Any ideas?
Title: Re: Chondromalacia Patella Pain
Post by: tinydinosaur on July 31, 2014, 07:11:41 AM
can you see a physio or something? they should be able to tell you if you are having tracking issues, you can - i suppose - just sit and flex your quads, if its way out of whack it will be easy for you to see. mine used to pull off way to the outside.

i get this same pain on my good leg due to having to compensate so much - (for me) it's caused by my outer quad muscles being too tight
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on July 31, 2014, 12:26:07 PM
Hi Tinydinosaur,

following MRI, it was found that I have 6 mm x 4 mm involving less than 50% of cartilage in the medial facet of the patella. It doesn't say if it's softening or fissure. Could that be reason for my patella tilting up lateraly and rubbing against femur?
Title: Re: Chondromalacia Patella Pain
Post by: tinydinosaur on July 31, 2014, 07:59:39 PM
as i understand it, yes. i had the back of my kneecap replaced and my surgeon showed me my before and after x-rays, with restored cartilage there is a nice space between the patella and the leg bones. i know everyone is different but my pain in the joint is very specific, before i had it i would get it right in the middle of my kneecap where i had no cartilage and now i am having pain on the inside.

i'm not sure if it would help you, due to the location of your lesion but look into unloader braces, see if you can try one out (without buying). they are made for unicompartmental wear (one side of the knee) and they offload it to another side which buys you time. again, i don't know if that would work for you.

they also might recommend hyaluronic acid injections, have you had those? they can be expensive if your insurance doesn't cover it. my surgeon explained that for some people they work wonderfully and they just need to get them every 4-6 months, instead of reconstructive or other surgery.

cheers!
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on July 31, 2014, 08:27:29 PM
Hi Tinydinosaur,

I'll look into the injections. In my case, the pain is really on the lateral outer edge of the patella, it's that tip of the bone that's on the outside of the patella, it's very sensitive, and it hurts when I touch it. I don't know if one of the nerves is causing it but the pain comes and goes but mostly it's painful. On scale of 10, the pain is constant 4 or 5. I ice it and rub it gently and it doesn't seem to go away. The pain is there already for about 2 months. You said you had knee cap cartilage replaced. Did they replace all of it or some and what procedure they used? So you had chondromalacia patella?
Title: Re: Chondromalacia Patella Pain
Post by: vickster on July 31, 2014, 08:35:36 PM
Given the MRI showed medial damage to the kneecap (the articular cartilage is only on the back of the kneecap) and you are experiencing lateral pain above and to the side of the kneecap, have you discussed the possibility of this being due to a tight ITB rather than the kneecap, or tendon/ligament inflammation (which would also tie in with the overuse you have described in other posts)?  Maybe discuss with the physio/specialist - a steroid injection or PRP may help if inflammation to another structure is the issue

You assume the pain is due to the chondromalacia as that's what the MRI showed, but it could be unconnected.  I have been having lateral knee twinges which I assumed was due to the meniscus tear and osteochondral defect, but the medics I have seen attribute it to ITB and LCL, not the other things on the MRI, and the treatment of these seems to be helping.  Knees can be really weird like that!!
Title: Re: Chondromalacia Patella Pain
Post by: tinydinosaur on August 01, 2014, 01:09:00 AM
yes, as Vickster says, it could be unrelated. i have the same pain on my good knee because of severe muscle tightness (having to compensate for my bad knee). your physio would be able to tell you if you have excessive muscle or IT band tightness, though there is a debate on whether foam rolling your IT band is good or not now.

i had a portion of the back of my kneecap replaced, they called it an osteochondral allograft. they use 'live cartilage' from a donor knee with very similar shape and size, and it's done within 30 days of receiving the donor part, so you're on a wait list. they use a jig to cut into the the bone on both kneecaps so the plug can fit it without any fixation. with my knee i had tracking problems that caused wearing of the cartilage on the back of my kneecap, the first surgery i had (lateral release) exacerbated the issue by causing muscle weakness. eventually i got that fixed with an MPFL allograft surgery but by then it had progressed to a grade 4 lesion (bone on bone) and that's when i was referred for the osteochondral procedure.

definitely, definitely look into everything else before looking towards surgery as a solution, as sometimes a combination of rigorous PT programs, bracing, etc can be a lot more effective and prevent or postpone any type of surgery. i wish i had known that before my first surgery, but my surgeon was certain it was a 100% fix and i had been at a (bad) physio for 3 months by that time  :-\
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 01, 2014, 10:25:19 AM
Thanks guys for your comments / suggestions. My PT did say that I have muscle imbalance and that is causing maltracking of the patella. He said that my pelvic is not aligned properly so that's causing muscle spasms in my good knee and chondromalacia in the other. He put me on regime of front squats and stretching. He said that this is fixable as long muscles fire in harmony and without any tightness. I did a second MRI yesterday so I will tell you what the second opinion said about it. I did MRI on both knees.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 01, 2014, 10:46:48 AM
He also said not to roll IT band as it doesn't do anything. Best solution is to roll the glutes, hamstrings, quads as once the muscles start firing properly by removing the knots, IT band will relax and not pull as much.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on August 01, 2014, 10:58:18 AM
My hips are also weak and being knock kneed, the knees tend to roll in.  I now have orthotics to help, as well as exercises.  No squats, but lunges ensuring control of hips and knees, ITB stretches (no foam rolling) and stretches and strengthening of rest of leg muscles.  My bad leg is clearly weaker and skinnier than the right following injury and surgery, trying to use leg press and do single legged calf raises to bulk back.  It's an extremely slow process though

You need to work on core too, I am now rowing at the gym to help that
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 01, 2014, 12:16:48 PM
By the way, I was like a crepitus sound when I bend my knee when in vertical position or when I knee up from ass to grass to standing position. Is that bad?
Title: Re: Chondromalacia Patella Pain
Post by: vickster on August 01, 2014, 12:24:18 PM
Knees crackle all the time.  Is there pain or poor movement with it..  I have no clear idea of what movement you are describing though!
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 01, 2014, 12:46:15 PM
No pain, and knee tracks well but there's the cracking sound. Example: lie on your back, lift your leg up but keep it bend at 180 degree so heel to ass, then when I raise the foot to 90 degrees it cracks, no pain at all.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on August 01, 2014, 12:55:52 PM
Sounds like nothing to worry about.  Chill :)
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 01, 2014, 01:06:38 PM
Thanks but I do associate it with the knee injury since I didn't have it before.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on August 01, 2014, 03:34:55 PM
If concerned, check with your specialist :)  No one online can diagnose the issue.  A hyaluronic acid injection would help to lubricate the joint and perhaps alleviate the creaking
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 02, 2014, 01:25:15 AM
Just got my MRI results for both knees. It states that I have mild chondromalacia patella Grade I in both knees. So that would mean signs of softening. So this means it's not fissure or damage. I will post full results once I have them in english cause test was done in french. I was told that everyone will have chondromalacia patella in their lifetime, some will get faster as per accident or injury and some with regular wear and tear. I guess at my 36 years of age, getting it as grade I would be normal no?
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 02, 2014, 03:45:05 PM
Here's my MRI in french. If anyone can translate what it means:

IRM GENOU DROIT


Renseignements cliniques:

Syndrome fémoro-patellaire. Chondromalacie.

Technique:

Examen effectué selon le protocole standard.

Constatations:

1. Cartilages (classification de Outerbridge) :

Le cartilage patellaire est légèrement hétérogène centralement compatible avec une légère chondromalacie (grade I/IV) avec préservation d'une épaisseur normale. Le cartilage de la gorge trochléenne est dans les limites de la normale. Pas d'anomalie cartilagineuse fémoro-tibiale.

2. Ménisques :

Normaux. Pas d'évidence de déchirure.


3. Ligaments croisés et collatéraux :

Intacts.

4. Tendons et retinaculum patellaire :

Normaux.

5. Structures osseuses :

Normales.

6. Autres :

Pas d'épanchement. Pas de kyste poplité.

Opinion:

Légère chondromalacie patellaire.





IRM GENOU GAUCHE


Technique:

Examen effectué selon le protocole standard.

Constatations:

1. Cartilages (classification de Outerbridge) :

Légère hétérogénéité du cartilage patellaire médialement représentant de légers signes de chondromalacie (grade I/IV). Le cartilage rotulien conserve une épaisseur normale. Le cartilage de la gorge trochléenne est normale. Comme pour le genou droit, la gorge trochléenne a une morphologie normale sans dysplasie. Il n'y a pas de patella alta. Pas de séquelle d'ancienne luxation de la rotule. Le cartilage fémoro-tibial est normal.

2. Ménisques :

Normaux. Pas d'évidence de déchirure.

3. Ligaments croisés et collatéraux :

Intacts.

4. Tendons et retinaculum patellaire :

Aspect légèrement hétérogène et discrètement épaissi du tendon patellaire distal à son insertion sur la tubérosité tibiale antérieure. Les autres tendons sont sans particularité. Le retinaculum patellaire est normal.

5. Structures osseuses :

Normales.

6. Autres :

Pas d'épanchement. Pas de kyste poplité. Petite plica médio-patellaire.

Opinion:

Signe compatible avec une légère chondromalacie patellaire.
Légère tendinose patellaire distale. À corréler avec la clinique.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on August 02, 2014, 07:21:47 PM
Mild patella chondromalacia in both knees. Mild patella tendinitis in the right. I'd be considering rest and prp, there's nothing surgical to be done. Good news :)
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 03, 2014, 03:09:01 PM
thanks Vickster,

What is prp? Ill stop doind squats for a while as the lateral side of my right patella hurts all the time
Title: Re: Chondromalacia Patella Pain
Post by: vickster on August 03, 2014, 04:54:49 PM
Platelet Rich Plasma

I wouldn't squat with patella issues, indeed I'd find another physio for a patella friendly rehab.  Maybe try swimming as a long impact activity, brawl, backstroke, no frog kick

Supported lunges, glute bridges, wall slides with go, all with good form might help your weak hip muscles too
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 03, 2014, 09:21:27 PM
Vickster,

I have a question. my left leg which has patellar tendinosis feels weird when i walk. Its like the patellar tendon is stiff and its compressing my patella a little and it just doesnt feel normal when i bend my knee backwards. Its like its stiff in the tendon. Any idesa?
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 03, 2014, 09:32:30 PM
Also does CP lead to arthritis?
Title: Re: Chondromalacia Patella Pain
Post by: vickster on August 03, 2014, 09:48:48 PM
Not necessarily no, arthritis is grade 4 bone on bone.  Age, wear and tear is the most common cause of arthritis,  not a lot any of us can do about that.   Being active (nourishing the cartilage with synovial fluid) and keeping weight optimal are good too

Have a read of the relevant primers in the info hub (arthritis and patella).  There are 4 grades of articular cartilage damage, 1 softening is the first but there is no guarantee it will progress or indeed not progress

http://www.kneeguru.co.uk/KNEEnotes/primers

http://www.kneeguru.co.uk/KNEEnotes/primers/patella-primer/what-chondromalacia

Reading about overuse injuries like patellar tendinitis may help too

Some supplements can help
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 03, 2014, 09:55:20 PM
Thanks ill check it out. Whats your opinion on sissy squats?
Title: Re: Chondromalacia Patella Pain
Post by: vickster on August 03, 2014, 10:01:54 PM
Don't know what they are.  I don't do any squatting, not suggested by physio or surgeon
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 06, 2014, 03:22:05 PM
Thanks Vickster,

Im wondering why my physio told me to continue with squats (with profer form) of course. I read few articles that encourage squatting for chondromalacia patella as it provides necessary pressure to get the bad stuff out and nourish cartilage with good stuff. Right now I stopped and am doing only wall sits with ball between legs to get my quads stronger. Also lots of stretching and icing the knee.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on August 06, 2014, 04:09:16 PM
I can't say, maybe it is the right thing for you to do.  But didn't part of the issue come from doing squats, wrongly?  Unless you are being watched, I don't think you can ever be sure they are being done right, like a lot of physio exercises

What is the 'bad stuff' you refer to?  Activity is indeed important for synovial fluid as I understand it, but the right activity given the condition.  Cartilage starts to wear regardless as we age (probably from about age 30) and partly as there is lower lubrication in the joints, hence the use of the hyaluroic acid in arthritic knees, to mimic/encourage synovial fluid production.  Seems to work for me anyhow
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 06, 2014, 04:45:58 PM
I have to assume that my poor form lead me to my condition and when I did squats something went wrong. Then again everyone or almost everyone will get chondromalacia patella in their lifetime. Softening of the cartilage is something that will come with wear and tear. Unless you never move, you are prone to daily cartilage degeneration. Now that I was doing squats with proper form, my knee responded well. But i got freaked out when reading that squats are a big no no for chondromalacia patients. I will definitely get another physio to look at me and my situation. Weird thing is that I barely get any pain behind the knee cap like many of you out here but only lateral pain which is a sign of maltracking. And I do agree with what you said that there's no guarantee that it might or might not progress. I truly believe in reinforcing knees, especially quads will keep the knees in healthy state for years to come.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on August 06, 2014, 05:03:17 PM
I had grade 3 crabmeat on my lateral patella that was tidied when I had my menisectomy, I was unaware of it, I don't believe it showed on MRI, although I didn't see the full report.  I don't know if it was caused in the accident or was already there.  I was 37 then (42 now).  I think my last MRI showed other wear to the patella but it still doesn't bother me specifically

Talk to your physio about your concerns (you evidently are worried if looking at surgical solutions overseas), your goals etc
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 06, 2014, 05:55:39 PM
I would've never known that I have cartilage softening if I didn't get lateral pain cause I would not have done MRI. I'm looking into anything available since if there will be something available one day to fix the soft cartilage defect then I will do it. Of course this would be my last resoft. Right now I'm focused on physiotherapy. What is strange is that one knee has some crepitul in it and other don't. I will look into the acid injections you mentioned. Might be good idea to lubricate them as a precaution. By the way, are you still 100% mobile or have limitations?
Title: Re: Chondromalacia Patella Pain
Post by: vickster on August 06, 2014, 06:06:28 PM
Pretty mobile, not necessarily pain free but all complicated by the injury to my shin in February on the same leg as my knee and then trying to train too soon for a 100 mile bike event which annoyed my back and LCL/ITB...not clear cut

In the last 2 weeks I have cycled over 200 miles (including 52 on Sunday) and been to the gym half a dozen times (mainly rowing, recumbent cycle, resistance work and stretching)

My main limitations are that I can't kneel comfortably nor sit back on my heels - partly due to flexibility which is improving but also due to the 1.5cm2 hole in the cartilage on my femur...which has now been there for nearly 5 years.  Doesn't really get better or worse, the injections every 18 months seem to help as my surgeon reckons I'd be much worse off without them.  I also have two meniscus tears, but pretty full ROM

Try to just get on with it, two arthroscopies, really don't want more.  There are risks, it hurts after, means time off work, off life, off the bike, leaves swelling and scars :)

The limitations don't specifically limit, I can't jog or run but have no need nor want to.  Get a bit stiff sitting for long times, can get twinges and niggles but nothing unmanageable.  Try not to think to much about it if I can.  I've stopped formal physio for now as my insurers won't pay for any more, just doing the gym, stretching, limiting cycling to some degree (I had to pull out of my ride on the strong advice of the specialist as training adequately would have caused me worse issues)
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 06, 2014, 06:29:39 PM
I also got used to the pain which at worse would be 6 or 7 at times but usually it's at 3 or 4. When I wake up, the first couple of minutes are painless and then the pain kicks in. It's like my system knows when to let me know that pain will be there. I try not to take any pain killers, would on occasions.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on August 06, 2014, 06:51:15 PM
I sent you a message
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 07, 2014, 01:44:01 PM
Here's the english version of my MRI done last week:

Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 07, 2014, 01:46:55 PM
MRI RIGHT KNEE
Clinical information :

Femoropatellar syndrome. Chondromalacia.

Protocol :

The examination was done utilizing the routine knee protocol.

Findings:

1. Cartilages (Outerbridge classification) :

The patellar cartilage is mildly heterogeneous centrally compatible with a mild chondromalacia (grade I/IV) with a normal thickness. The cartilage of the trochlear groove is within normal limits. No femorotibial cartilaginous abnormality.

2. Menisci : Normal. No tear identified.

3. Cruciate and collateral ligaments : Intact.

4. Tendons and patellar retinaculum: Normal.

5. Osseous structures : Normal, without contusions, fractures or other lesions.

6. Other : No joint effusion. No popliteal cyst present.

Opinion:

Mild patellar chondromalacia.




MRI LEFT KNEE

Protocol :

The examination was done utilizing the routine knee protocol.

Findings:

1. Cartilages (Outerbridge classification) :

Mild patellar cartilage heterogeneity medially consistent with mild signs of chondromalacia (grade I/IV). The patellar cartilage maintains a normal thickness. The trochlear cartilage is normal. As for the right knee, the trochlear groove has a normal morphology without dysplasia. There is no patella alta. No sequela of an old patellar subluxation. The femorotibial cartilage is normal.

2. Menisci : Normal. No tear identified.

3. Cruciate and collateral ligaments : Intact.

4. Tendons and patellar retinaculum:

Mild heterogeneity and discreet thickening of the distal patellar tendon at its attachment at the anterior tibial tuberosity. The other tendons are normal. The patellar retinaculum is normal.

5. Osseous structures : Normal without contusions, fractures or other lesions.

6. Other : No joint effusion. No popliteal cyst present. Small mediopatellar plica.

Opinion:

Signs compatible with a mild patellar chondromalacia.
Mild distal patellar tendinosis. To correlate with clinical findings.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 12, 2014, 01:59:13 PM
I was looking into PRP treatments and got this info from India's Orthopedic Surgeon:


Patient needs arthroscopic coblation condroplasty with PRP injection both knees



Stay in hospital 2 days

Stay in India 7 days

Can anyone comment on the PRP procedure. What is the success rate of getting cartilage regenerated?
Title: Re: Chondromalacia Patella Pain
Post by: MDAL on August 12, 2014, 02:48:37 PM
Papasmurf:

We need to go slow with these kind of things. I had both those procedures separately (different points in time).

Chondroplasty means the surgeon will shave off cartilage that is breaking apart smoothing edges and so on. This is simply a clean up that is done in order to remove the inflammated part that is signalling the trouble as well as smoothing the rough edges in order to allow better mechanical motion.

This is highly controversial to do because:

1) Cartilage won't grow back, degeneration will continue where the doctor stopped.

2) You may trigger and inflammatory reaction with surgery that will lead your own immune system to "eat" the cartilage further.

3) There is no guarantees that the mechanical properties that are left will be useful (for instance if some zones are left too thin, the mechanical forces might lead them to break down faster leaving it bone on bone in a short time.

4) There are always risks of infection, formation of scar tissue etc.


This is the part without PRP, now with PRP:

PRP is great, I had 12 shots of it so far this year alone and I couldn't be more happy. Yet this was not related the previous procedure but far after it.

PRP as you described is highly unlikely to grow you any cartilage especially if it's just a few shots.

Properties of PRP are (take this with a grain of salt because nothing is written on stone):

- Anti-inflammatory properties that contribute to symptomatic relief.

- Healing of the superficial damaged layer that is signalling trouble, which leads to synovial inflammation and all the symptomatic mess.

- Eventually and without any proof, it may lead to regeneration if applied for long term with large number of injections.

In the context of the procedure you mentioned that is offered in India (7 days), all I see is the use of PRP post-surgery in order to heal the superficial layer and help you deal with inflammation post surgery. It's a good idea, that in my opinion should actually be standard with any knee surgery, but that is not a procedure designed to grow anything back unless you stay there for months taking shots and even so there is no scientific evidence that it will. I have a good experience with it though.

If I understand correctly you are in US and traveling to India for this? If so this may be a rush move since you may have hundreds of options at home with lower costs.

I have compared many options of traveling to India, and most turn out to be more expensive than doing them at home in Europe.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 12, 2014, 03:37:54 PM
Hi MDAL,

I live in Canada. Thanks for your very thorough explanation. I'm interested in getting a treatment that will grow back the layer of cartilage they will shave off.

I looked into couple of options:

1. Chondrofiller (already in use in Europe) producing hyaline-like cartilage
2. Agili-C (currently in clinical trials) producing hyaline cartilage according to studies

Do you have any info on one or both if any?
Title: Re: Chondromalacia Patella Pain
Post by: vickster on August 12, 2014, 03:40:17 PM
Right now, once it's gone it's gone...only cartilage transplantation like ACI really.  Maybe in 15-20 years according to my OS
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 12, 2014, 03:51:32 PM
Hi Vickster,

no disrespect to your OS but mine said the same thing. He didn't even know there are procedures available already to treat cartilage damage. Oh well, I guess mine was a bozo.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on August 12, 2014, 03:55:26 PM
Mine certainly does, it's one of his areas of interest, involved with ICRS, trials etc.  the UK system makes things less accessible if there's no trial. Canada sounds similar.  If no private insurance here, some stuff is just not available, and even then, they often refuse to cover if experimental as they follow NHS guidance.  We aren't used to paying large sums out of pocket
Title: Re: Chondromalacia Patella Pain
Post by: MDAL on August 12, 2014, 04:16:04 PM
Hi MDAL,

I live in Canada. Thanks for your very thorough explanation. I'm interested in getting a treatment that will grow back the layer of cartilage they will shave off.

I looked into couple of options:

1. Chondrofiller (already in use in Europe) producing hyaline-like cartilage
2. Agili-C (currently in clinical trials) producing hyaline cartilage according to studies

Do you have any info on one or both if any?

PapaSmurf:

I may need to sound a bit negative regarding these Chondrofillers and Agili-Cs...

So what are they? They are the "new kids in the block" from something that has been in market for over 20 years, and for which I have came across more than 20 brands of it, which are rarely used in clinical practice because they don't have much acceptance between surgeons (and with plenty of valid reasons). Among those reasons I can state one, because there is better in the market, with enough clinical practice and expertise built on it, namely ACIs, where they collect a tiny sample of your own cartilage, multiply it in lab, re-create cartilage that is hyaline alike, and re-implant. Since there are real cells on it, it is far more than scaffold structure, it is already cartilage.

The difference is that those products you mention are just scaffold materials, with a lot of limitations, for which in real practice obtain a huge failure rate and very low durability, independently of all the great things that are mentioned in the box, which are never demonstrated in long term studies with decent design.

The actual results are way beyond success rates of ACIs, and success rate is something important, if someone is going to cut your patella, flip it upside down and then reconnect all the structures. It will never be the same again mechanically, so at least it's better to use the effort on something with more reliability.

Implants and scaffolds aside, if you want to achieve some level of regeneration without having your knee disassembled to parts and attached back together, you have some options in Canada:

One a controversial doctor (but who does seem to get the job done): Anthony Galea
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=62143.msg618123#msg618123

And for a probably more affordable cost there is a doctor in Utah who is very well regarded in the articular cartilage repair forums using stem cells as well. Docere clinics, you can read a lot about it there.

Note that there are no magic treatments for cartilage repair. I have had stem cells from fat plus PRP and I am doing really good...
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 12, 2014, 06:12:08 PM
So when you had PRP injections, did they need to shave off part of your patella cartilage? So the purpose of PRP is to control inflammation and pain or rather that and help cartilage regeneration? I'm in Canada and there's not much available here yet. Europe and Israel seem to be dominating the market on cartilage regeneration.
Title: Re: Chondromalacia Patella Pain
Post by: MDAL on August 12, 2014, 06:33:07 PM
Nope. Debridment and PRP are not related in any way. In fact this is the first time I ever heard of it being used together.

PRP simply consists of extracting blood, spin it in a centrifuge to remove red blood cells which is most of the blood and something you don't really want in the joint, and concentrate the platelets and the growth factors (hormones), contained in the blood. Note that cartilage does not regenerate on it's own (or at least rarely successfully), because it has no blood supply to it. The theory is that if you supply the blood good stuff there is a potential for healing similar to any other body part which is vascularized. Several hormones in it, such as IGF and TGF-B1 have been show to help regenerate cartilage by multiplying cells, capturing stem cells, transforming them and induce collagen formation.

This is no magic wand though, evidence is limited, and most studies usually focus on very few shots. So what can be reliably said at this point is that it does have a demonstrated anti-inflammatory properties with symptomatic relief but there is no proof that regeneration is achieved. Note that cartilage is constituted by less that 5% cells, the rest is collagen (inorganic), collagen production is very slow and can take months or years to take proper effect. Results evaluation by MRI for example, are very faulty, it is only able to see large defects, often even big defects skipping MRI analysis being found later by surgery.

So given this slow regeneration and poor methodology, no study has been conducted to really measure it. Most studies are based in simply asking questionnaires to patients to see how they are going, conducted by single doctors or small centers... there is no big pharma or big money involved in this, because any doctor can choose between hundreds of kits and centrifuges in market to do so. Patents are useless in this field.

All together, it is a possibility, but no one has firm evidence. Same with stem cell treatments. There is mounting evidence of very positive effect and individual cases (anecdotal evidence, well such as mine).

It's not true at all that Europe or Israel are leading the way. Most research and early clinical application are being done in the US, Europe has been mostly importing methods and equipment for it, although there are some studies going on in Europe which are based on US developed methods. Other zones of heavy research are Asia, (China, South Korea, Malaysia and even Vietnam) mostly because they don't have the same legal limitations or time stalling bureaucracy that conducting studies in the west have.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 12, 2014, 07:05:15 PM
MDAL,

little of topic, would you be able to give me an idea if I have patellar tilt. I feel I do in the right knee, or could be that my lateral patellar retinaculum tendon is tight as I'm getting lateral patella pain, feels like it's in the tissue or something.

I posted my MRI's in:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=64591.15

Thanks
Title: Re: Chondromalacia Patella Pain
Post by: MDAL on August 12, 2014, 07:13:12 PM
If you want we can trade, I will keep yours and you keep mine :)

MRIs need to be analysed by the entire range not just a single section, and obviously by an actual medical expert.

Just for the record, note that the lateral side is always smaller in space than the medial. That is how it is supposed to be, and often people panic when they see it.

Either way, compared to mine and many others I have seen around here, looks like you don't have much of an issue.

Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 12, 2014, 07:40:09 PM
Thanks MDAL,

appreciate your humor :) MRI report didn't state patellar tilt so I think it's probably just the tight tendon, will work on that. Just want go get grand scale of your knee damage? wanna share your story?
Title: Re: Chondromalacia Patella Pain
Post by: MDAL on August 12, 2014, 08:14:45 PM
I could, but that would keep me writing until Xmas...  ;)
Title: Re: Chondromalacia Patella Pain
Post by: vickster on August 13, 2014, 09:05:53 AM
MDAL is right about the MRI, the report is generated by looking at the hundreds of images, not just one in isolation.  You have the full report I think.  If you want more information, best to ask the specialist :)

My most recent MRI report referenced several images specifically for the items commented upon.  Anything that was fine (tendons and ligaments) was also noted
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 13, 2014, 10:29:44 AM
My question is, say a tendon is tight and putting pressure laterally on the patella, will that come up on the MRI? If there's no damage to the tendon only tightness.
Title: Re: Chondromalacia Patella Pain
Post by: MDAL on August 13, 2014, 10:40:08 AM
Hardly...

MRIs are very imprecise and results are done with a fair share of "interpretation". It may be possible to observe an inflammatory process that is causing that tendon or ligament to be tight, but no one in their right minds would put their hands on fire on an assumption.

The mechanical evaluation of such thing is always an opinion based formula. You go to 10 OSs and don't be surprised to obtain 10 distinct opinions, and so are the surgeries performed under such assumptions such as lateral releases or osteotomies which are calibrated by the eye and the results of such procedures are a bit like flipping a coin... work for some and create a big mess for others.

It's all an "opinion" based methodology.


Title: Re: Chondromalacia Patella Pain
Post by: vickster on August 13, 2014, 11:22:15 AM
An ultrasound might show up issues with a tendon, the damage to the one in my elbow was clear to see for the OS, and then able to injection steroid into it and later PRP using the ultrasound to guide the needle

If the tendon isn't torn or badly damaged, with proper rest (no squats etc), ice, anti inflammatories and potentially a support, you might be able to get it to settle.  An inflamed tendon/other soft tissue could well be the culprit rather than the grade 1 cartilage softening
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 13, 2014, 03:43:55 PM
I agree with you Vickster

I might have had the pain from the beginning from the tendon. It`s like a sore, sensitive and painful feeling I have in it. Since it`s on the lateral patella side, I don`t have pain in the knee cap but on the side since tendon is attached to it. Also, it`s quite stiff, I started to push the knee cap up laterally by pushing the medial side of it to get the tendon to stretch out a bit, it might`ve got tight when I was doing squats. Let`s see how it goes. I`m also icing religiously my knee.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on August 13, 2014, 04:10:18 PM
Ask your doctor about steroid or PRP, may just give you the required anti inflammatory benefit.  Could also try slapping voltaren gel (assuming not taking oral anti inflammatories)

I don't know how tendons get tight, the one in my elbow got inflamed then it got ragged and gritty, not stiff
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 13, 2014, 05:44:38 PM
Vickster,

you mentioned something about some acid injections. What are they. Did they do any good for you
Title: Re: Chondromalacia Patella Pain
Post by: vickster on August 13, 2014, 05:51:58 PM
Hyaluronic acid - you can Google the details further

http://www.arthritisresearchuk.org/arthritis-information/drugs/hyaluronan.aspx 

They are indicated for mild-moderate arthritis I believe.  Several different brands - Synvisc, Orthovisc, Durolane, Ostenil, Euflexaa, probably others

You have to be careful if allergic to eggs as some are derived from poultry

Yes, they do seem to help me.  I had one in Dec 2010, another course of 3 in May 2012 and a single 'plus' injection in December 2013

They aren't especially painful as long as you are relaxed, although the knee can feel full and stiff for a bit.  They take about a month to have an effect, but it seems only 50% benefit, the indication is quite narrow according to my OS

Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 22, 2014, 01:33:05 PM
Hi Vickster,

I'm thinking of getting Synvisc One injection in my knee. Do you think it's a good idea? Will it get rid of the little crunching I'm felling when bending knee sideways? I think it's crepitus or something.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on August 22, 2014, 02:57:38 PM
I've not had Synvisc, only Durolane and Ostenil

You need to ask your orthopaedic specialist if it would be indicated for you - did you already?  HA is for moderate osteoarthritis where replacement not required, grades 2-4 I believe.  I have no medical qualifications and could not say if it's appropriate or not.  They are not without risks, so your doctor and you need to decide whether it's something needed.  Is there pain and swelling with the crunching, most knees make noise sometimes

If it's a tendon issue though, steroid might be more suitable or PRP
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 22, 2014, 03:14:09 PM
I think crunching is due to cartilage softening. No pain associated with knee bending. Also, it might be air pockets making the crunching noise. It doesn't do it if I bend my knee left only right. What is the risk of the injection? Also, is chondromalacia Grade I softening a precursor to Osteoarthritis?
Title: Re: Chondromalacia Patella Pain
Post by: vickster on August 22, 2014, 03:55:54 PM
I don't know if soft cartilage crunches, you need to discuss the pathology and physiology with a doctor

Grade 1 doesn't necessarily progress to full OA (grade 4)  but it is the start of the process.  My surgeoon has never used the word arthritis with respect to my knee (fortunately as it would affect my insurance cover)

There's a good arthritis primer in the information hub ^^^

Injection risks, allergic reaction, infection, pain, inflammation, doesn't help...but as things go, pretty benign but it's still a pharmaceutical product being injected into the body through a decent sized needle.  PRP is natural but there are still risks
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on August 25, 2014, 10:50:26 PM
Can anyone comment on this:
Unlike the damage to cartilage caused by arthritis, damage caused by chondromalacia can often heal. Conservative treatment is usually recommended first since rest and physical therapy may eliminate the symptoms

I found it on:
http://www.cedars-sinai.edu/Patients/Health-Conditions/Chondromalacia.aspx

Is that possible?
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on September 10, 2014, 08:04:10 PM
Can anyone tell me what this sound is and is it serious? No pain associated with it.

https://onedrive.live.com/redir?resid=D014C516ECE065DC!133&authkey=!ALOu4P-EU7mGYB4&ithint=folder%2cmp4

Title: Re: Chondromalacia Patella Pain
Post by: vickster on September 10, 2014, 08:45:10 PM
Have you asked a knee specialist?  Probably more likely to give you an answer.  Joints creak, however if there are no symptoms, there's nothing usually to worry about or do
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on September 10, 2014, 09:39:33 PM
My pt said its the air escaping capsule. I will see orthopedic surgeon on friday and will ask. I have no pain or swelling associated with it.
Title: Re: Chondromalacia Patella Pain
Post by: thommo404 on September 26, 2014, 04:26:37 PM
I've read through the entire thread and I can't see why you would even be considering any kind of surgical options.  Maybe one of the injections at the most but even then I wouldn't think you need it.  To me it seems like all you have is a tight ITB or quads/hamstrings. 

I think you need to go and find yourself a good physio and follow whatever they decide for you.  Going by your MRI results you have very, very minor issues.


Yo me reading your posts it looks like you are trying to find a reason to have surgery.  It should be the last thing on your mind.  Once you have it you can't go back.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on September 26, 2014, 06:00:59 PM
Hi thommo404,

thanks for your reply.

You are right on the ball as well as others who wrote me. I finally accepted and understood that I do not need surgery. A simple case of patella maltracking leading to some wear and tear of the knee caps. My last orthopedist said the same thing. I have very tight IT band and quads and hamstrings tightness. Also, my glutes are extremely tight as well so I'm working on that. My PT said recently that my right VMO is completely shut off and does not fire and thus not providing patella with proper tracking. This is on the menu to fix.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on September 26, 2014, 06:07:16 PM
Here's what my knees look inside as of last MRI in end of July.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on September 28, 2014, 01:23:03 PM
Good to hear you have something to work with from your doctor :)  Listen to the physio and follow their instructions on form and frequency with the exercises and stretches :)
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on September 28, 2014, 01:56:35 PM
Thanks Vickster for your support. Ill be updating here on the progress. At this point stretching is the priority and right vmo activation.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on September 28, 2014, 03:24:48 PM
Maybe try a high quality sports massage too from a recommended practitioner to try to loosen everything up :)  You may need to do this regularly
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on September 28, 2014, 09:20:14 PM
I was wondering since i have pain in the tissue on lateral side of patella would femoral nerve block relieve pain forfew months? My pain is nagging and chronic
Title: Re: Chondromalacia Patella Pain
Post by: vickster on September 28, 2014, 09:30:43 PM
I wouldn't personally, too many risks, should be a last resort for nerve issues (someone posted about the risks earlier if you look through the recent posts).  It seems a very extreme solution to a relatively minor issue, even if uncomfortable.  Try steroid or PRP first (even a proper course of a decent NSAID).  What did your doctor suggest when you saw him?  Is the pain uncontrollable / unmanageable?  I would be very surprised if any doctor would do this - are you under the care of a pain specialist now?  I think here in the UK, that is something only an anaesthetist would do, possibly a neurologist/nerve specialist after every other option has been exhausted.  You could try a course of gapapentin or similar if it's nerve pain?  What sort of pain is it - achy, sharp, pinching, dull, burning?

You should really given the prescribed physiotherapy a proper go first - injections won't do anything for your tight muscles, could even make them worse
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on September 28, 2014, 10:58:54 PM
I was onnaproxen for two weeks which didnt calme the nerve. The pain is like a pinched nerve pain. 2 out of10 scale. Sometimes it stops hurting, sometimes its all the time. Orthopoedfic surgeon said its probably some tissue damage because of patella maltracking. I ice itbut it doesnt cool the pain at all.
Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on September 29, 2014, 11:10:31 AM
I also have been diagnosed with maltracking because of tight muscles.

What kind of stretches are you doing?
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on September 29, 2014, 01:18:10 PM
Hi ChelseaSoccer,

for glutes:
https://www.youtube.com/watch?v=Qby3ZsiidMY

for hamstrings:
https://www.youtube.com/watch?v=JZe9Iw2HwgQ

for quads:
https://www.youtube.com/watch?v=CZBKSOtyssM

It's working good but I'm still getting some inflammation and tenderness in the lateral patella area and just above it as well. I feel like the soft tissue there is inflammed. I'm icing after the exercises.

By the way, have you had MRI to see the condition of your cartilage behind knee cap?
Title: Re: Chondromalacia Patella Pain
Post by: vickster on September 29, 2014, 01:31:31 PM
I was onnaproxen for two weeks which didnt calme the nerve. The pain is like a pinched nerve pain. 2 out of10 scale. Sometimes it stops hurting, sometimes its all the time. Orthopoedfic surgeon said its probably some tissue damage because of patella maltracking. I ice itbut it doesnt cool the pain at all.

Depending on medical advice, you might need the NSAID for longer to have a cumulative effect and clear the inflammation.  Otherwise, a steroid or PRP injection offers a powerful anti-inflammatory effect.  If it's tendonitis, the tendon can be directly injected using ultrasound

Has your physio tried taping to shift the knee cap of the inflamed bit?

2 / 10 pain is annoying, but perhaps try to take your focus away from it and keep on with the physio and avoid things that aggravate
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on September 29, 2014, 01:46:34 PM
My PT didn't think it was necessary to tape the patella. He said with vmo activation, I should see better results. I do, it used to be worse.
I don't know about tendonitis cause my last MRI didn't find it there. It might just be a pulled tendon or some tissue damage.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on September 29, 2014, 01:53:35 PM
Damage to what tissue?  I don't think MRIs necessarily show low grade inflammation, like they don't always show small tears or minor damage or softening to articular cartilage
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on September 29, 2014, 01:56:12 PM
After doing squats last time about month and half ago, I think IT bad tissue that's attached to patella or retinaculum tendon hurts a little to the touch and also in general. PT said IT band very tight, could that be the reason why's it's pulling patella out of alignment?
Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on September 30, 2014, 11:07:47 AM
I got an MRI in July that showed some chondromalacia on the medial side. The first doctor I saw didn't think there was maltracking though; he thought I just had a sore knee and suggested a cortisone injection. I did not go back to him. I got a second opinion, and she said I have patella femoral syndrome. She put me on a different anti-inflammatory rx, told me to do PT, and come back in two months if it's not better. I did go to PT, where I learned different stretches, and I do these stretches every day (I did not go back to PT though as I did not like how rough he was with my leg). I also have been foam rolling, icing my knee, and using heat on the quads. It's been one month since I've seen the second doctor, so I'll be going back next month to see if they can do another MRI to determine if there is further damage.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on September 30, 2014, 12:24:04 PM
Did your MRI show any irregularities with patella cartilage in July?

By the way, do you have same symptom as me? Everyday when I wake up, the first few minutes on my knees, when I bend the knee and extend the knee cap pops, there's some snapping noise or popping noise or something and it feels weird. After few minutes of walking, it disappears and comes back from time to time.
Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on October 01, 2014, 11:13:01 AM
I don't think the July MRI showed irregularities with patella cartilage. It only mentioned chondromalacia on the medial side, and the first doctor didn't think it was an issue.

My knee pops throughout the day. I can feel my kneecap moving out of place when it does pops. When it's not doing a loud pop, I can feel the kneecap grinding (I guess that's an issue but it's odd because my other kneecap doesn't always seem like it is gliding smoothly but it has no pain).

I feel like things were getting slightly better at one point, and now it's worse that I added new stretches this week. It could be unrelated though.

What does your pain feel like throughout the day?
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on October 01, 2014, 12:51:52 PM
I think if you were diagnosed with chondromalacia patella then they found something in your cartilage, maybe just a little bit of wear that's it. If there's no fissure of broken piece, than you should be fine. Everyone on the planet will have chondromalacia patella in their lifetime, some more some less. It's just part of life. My pain is like a nerve pain and it's only on the lateral side of patella in one small spot, it's like the nerve of the tissue attached to the patella is inflammed or something cause it's just a nagging pain day in and day out. Sometimes I don't think about it and don't feel it and then it could be more annoying. How about you? do you have any pain right now?
Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on October 02, 2014, 11:10:57 AM
I have constant pain, although sometimes it's worse than others. Sometimes the pain is a sharper pain (on the medial side), and sometimes it's a burning pain under and around my entire kneecap.

My knee sometimes feels tight (like hard to bend it). The PT told me that my quad muscles are tight/knotted which has shortened them (making it difficult to bend). He said this is causing the femur to push against the patella, making them rub together in a way they should not.

I wish this would go away. I feel like I'm too young and healthy to be in constant knee pain. I'm 25 years of age and weight about 100 lbs.

I have stopped stretching and foam rolling for the past 2 days and things have gotten even worse, so maybe it was helping and I should start back up. I have another doctor appointment in two weeks with a doctor I have never seen before. It doesn't seem like the other doctors have taken my pain very seriously, so I am hoping this one does.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on October 02, 2014, 11:26:09 AM
What country are you in?  There are knee specialists (orthopaedics) who have a special interest in the patello-femoral joint.  It might be best to seek one out if you can

Good luck :)
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on October 02, 2014, 12:39:51 PM
Vickster is right. If one doctor doesn't take your case seriously, seek someone more specialized. I've also been through few doctors who were eager to prescribe pain medicine and not really advise of anything else. I also have constant pain as I have described it's more in the soft tissue attached to the tip of the top of lateral side of patella. I don't know if this is where IT band fibers connect to patella or simply my rectus femoris being tight and pulling vertically the patella but I do notice that my right patella is a little higher than left when my knees are fully flexed or bent. Don't give up on stretching and foam rolling. I have very tight left leg before which was extremely uncomfortable to walk since the muscles were pulling so hard that  it didn't feel natural to walk. After few months of stretching and foam rolling, i'm up to 90% normal again and I will continue to reach 100% of course and seems I'm not that far from reaching it. Now, my right knee is the troublesome one, still hurts (tissue not the patella). I've been doing this exercise to get the quads strenghten which I see seems to help slowly cause I feel that my knee tracks a little better now.

https://www.youtube.com/watch?v=lqmkmVG6q2E

Keep us posted on your status and don't give up on the knee. It's a very long process but knees do heal if there isn't any internal permanent damage. Soft tissue heals but it takes long time. Since you mention that your patella rubs on femur than it could be muscle imbalance, one is tight (lateral usually) and VMO is weak. We don't pay attention to the VMO until problems occur. After couple of weeks doing that exercise, I feel that the patella rubs less on the femur and VMO is getting stronger.

Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on October 03, 2014, 01:09:15 AM
I've been to two orthopedic doctors who specialize in the knee. The first one thought there was nothing wrong and thought the next step should be a cortisone shot, and the second one diagnosed me with patella-femur pain syndrome. I'm seeing a third orthopedic doctor in two weeks.

I'm going to start the stretching and foam rolling again. Today, I had very bad pain on my inner thigh, down to the medial side on my knee, and I don't think I've had my leg hurt this bad while I was stretching/rolling consistently.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on October 06, 2014, 08:34:44 PM
Try this and tell me if you have the same thing: when sitting on the floor with your legs fully extended, put on hand on the affected patella so you hold it in your hand. While holding, contract the affected knee so your patella presses against the grove. Then release the contraction and see if you feel the pastella rubbing against the femur onthe lateral side when going back to grove. Mine sdometimes does. What does that mean. Can cartilage be damaged there?
Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on October 14, 2014, 11:40:00 AM
I don't think mine does that.

I can feel my right knee tracking weird (or what I think is tracking weird). When I bend my leg then extend it, I can feel a small pop as it extends all the way.

But, sometimes my left knee does it too, and it feels no pain!

I've stopped all stretching and foam rolling for about a week now. I saw another doctor, and he just says to do PT. Have you gone to PT? I am scared to go back after a bad first experience.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on October 14, 2014, 01:06:25 PM
I just finished reading "Saving My Knees" book. Very interesting story. Author has also chondormalacia "mild" case as he mentioned. He tried everything from exercising to stretching. His knees were telling him what to do and what not to do. Eventually after couple of years, gradual walking saved his knees as he describes. He had lots of pain and burning after exercises, swimming, biking. So he just started to light walk and from what he describes it worked. Scientists demonstrated that knee joint as any other joint in the body needs movement and motion to heal. Author demonstrated through findings that knee cartilage does heal, very slowly even though it does not have any blood supply. What helps the healing process is movement. Cartilage needs to have right pressure applied to it to release toxins and right nutrients and lots of water to start healing process. He also said that in his case, sitting for prolong period of time, gave him knee pain so he alternated also the lifestyle at work and home.

To answer your questions: I am doing PT right now, stretching and strenghtening exercises shown in previous posts. I'm also doing some VMO strenghtening exercise as weak VMO is a culpit for patella maltracking (well one reason of it).

I also have some popping or snapping or something when I extend my knee, sometimes it will pop loud and there's no pain. Sometimes other knee will also pop loud once. I can tell you one thing, since I'm stretching, I feel less pressure on patella. I think tight muscles are also big problem. One pulls more than the other.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on October 14, 2014, 08:17:40 PM
I also have a question: Is it possible to damage or thin out lateral patella cartilage?
Title: Re: Chondromalacia Patella Pain
Post by: vickster on October 14, 2014, 08:44:11 PM
Presumably as mine was shaved during my first scope.  Don't know if the damage was due to the accident or wear and tear (as I'm a bit knock kneed) :)
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on October 15, 2014, 10:14:31 AM
but if it doesn't show on MRI, can the test miss the damage?
Title: Re: Chondromalacia Patella Pain
Post by: vickster on October 15, 2014, 11:20:21 AM
What test?  Maybe it was on the MRI, I never saw the report.  The focus of discussions with the OS was the meniscus and femoral defect than some presumably minor damage to the patella.  I never asked about it ultimately

The only truly reliable way to identify damage to the knee is to have a highly experienced knee surgeon do an exploratory scope - but you don't want to be doing that without a specific plan due to the trauma and risks of the surgery :)
Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on October 15, 2014, 11:35:10 AM
I have heard about the Saving My Knees book, but I have not read it. Exercising (high impact) hurt my knees, so I am reluctant to think that strengthening my quads will help. How did your knee problems come about?

I haven't been stretching or foam rolling, and my quads no longer intensely burn, but my knee pain is still full force.

Have you ever gotten a cortisone injection? I am thinking abut it.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on October 15, 2014, 12:45:00 PM
I feel like my right patella is a little higher than the left one just by observing it and also my PT said the same thing so it rubs on femur I thing because it's not in it's correct position. Could be patella alta? My MRI said there's no patella alta.

My problems started in July of 2013. I was walking a lot plus sitting at work tighnen up my muscles in left knee. so I went to pt and he gave me strenghtening exercises, mostly for quads. I did that and my knee got more tight. So then I started doing some squats thinking I have muscles imbalance. My left knee responsed well to the squats but right knee (weak knee) didn't. From Feb. of this year, my right knee is popping and I think I have crepitus and I feel that patella is not tracking properly anymore. MRI's revealed mild Chondro in both knees but the right knee is making this rice crispies or crunching chips noise when I bend it lying on my side. It only does it when I'm on my side and not on the other side. Weird! Plus I have this aching pain on the tip of the top of laterall patella side, it's like the tissue attached to the patella is irritated and every morning i have some mild burning sensation in that spot like I irritate it just by standing. Everyone I went to see said nothing to worry about, physio will fix it. Well my left knee is still feeling little weird, there's a pull on the lateral side of my patella still from time to time after all these months and my right knee is still aching a little. I'm doing a lot of stretching. Hopefully I can reprogram my nervous system to let go and get my muscles to fire properly. I didn't do any injections, I want to see if I can do this on my own. Regarding arthroscopy, I'm not keen on that.
Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on October 16, 2014, 11:05:28 AM
Thanks for sharing your story.

Mine started in April 2014. I was exercising a lot trying to gain muscle (Jillian Michaels videos mostly), but a lot of the exercises were high impact/jumping. I didn't think anything of it because I am healthy, young, and at a good weight, so didn't think jumping would do harm. I was so naïve. My right knee started hurting, but it returned to normal within a week. I was relieved. I continued exercising with caution, but I wasn't cautious enough. I was obsessed with exercising, and now I totally regret it. I wish I could go back in time and not exercise! My right knee started hurting again in May. I told myself I needed to be more careful, but I was hopefully things would be OK, since the month before, my knee felt better within one week.

I was wrong. My right knee hurt for a while, and then my left knee started acting up! My left knee hurt on and off for a short period of time. Then it got to a point where my left knee got better, but my right knee was persistent in the pain. The pain hasn't stopped in my right knee since May.

My right knee has an overall tightness feeling, and the sharp/dull/burning pain changes locations! My knee does popping/clicking/grinding too. The doctors all think I'm crazy- they look at me as a young, thin, healthy female and think there is no serious problem. My MRI and x-rays look fine, just mild chrondo on the medial side. Two of the doctors just tell me to do PT. But one doctor suggested a cortisone shot as the next step. At first I was very against it (in August when he first suggested it), but after seeing 2 other doctors who suggested PT (when PT seemed to make things worse!), I'm seriously considering the shot.

I wish the pain would go away! I do not want to be in pain for the rest of my life.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on October 16, 2014, 01:02:16 PM
How old are you? Is the pain behind the knee cap or around it? I never had pain behind the knee cap, only on the tissue or tendon or lateral side of it. By the way, everyone in the world will have some kind of degree of chondromalacia in their lifetime. This term is just to say that your cartilage is not perfect, there's something there. It could be regular wear and tear or something from injury. My ortheo said that if I didn't get the pain from the tissue, I would never known I have mild chondro in both knees. My MRI read mild chondro with normal preservation of cartilage. I would think that my knee pops from time to time because of muscle imbalance. Like I said I did squats and my muscles got really tight so there's some misalignment going on there. Chondro doesn't mean that you'll have arthritis. From doing lots of research on the web, I found that cartilage does have the potential to heal on it's own to some degree and very slowly. It does require balance of motion and pressure of the joint in order for the cartilage to release the bad stuff and get in the good stuff. Remember, cartilage is like a sponge, 80% made of water. So pressure releases the bad guys and sucks in the good stuff. There's so much stuff out there saying that cartilage does not heal ever, well I beg to differ. I'm a believer. I keep my knee in motion at work, I slide it on piece of paper to get rom throughout the day.

I'm sorry about your case, I know it's frustrating. Jumping can be harsh on the knees. I don't know anything about cortisone except that it weakens the tendons and muscles I believe from what I read. Do you have any maltracking in your knees? Has anyone examined them properly?
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on October 16, 2014, 07:59:26 PM
Here are my latest MRI images of my knees.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on October 16, 2014, 07:59:49 PM
Left knee
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on October 16, 2014, 08:00:11 PM
Right Knee
Title: Re: Chondromalacia Patella Pain
Post by: vickster on October 16, 2014, 08:23:44 PM
What are we looking at?  I can't read MRI - normally all of the images and report are needed :)
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on October 16, 2014, 08:28:01 PM
Will get report next monday. Will post then.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on October 16, 2014, 08:34:49 PM
How many MRIs have you now had?  I thought your knees were feeling better?

MRIs very costly in UK, only specialists can request and only do if there is doubt.  In 5 years, I've had 3 but that's quite unusual.  May have another on my good right knee though soon!
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on October 16, 2014, 09:56:54 PM
This is my 3rd MRI. First one didn't detect chondromalacia and the last one did so I'm waiting for the results on monday to see for sure what's going on. Knee is feeling better, less inflammation, less pain. I'm doing lots of stretching and exercises.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on October 16, 2014, 10:12:08 PM
Presumably it's being read by the same radiologist, they need to be compared by the same expert to detect any changes

Hope the MRI reflects the improvements :)
Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on October 17, 2014, 12:01:23 PM
I am 25 years old. This is what I have been through so far:

PCP: I saw her in June (pain started in May). She very briefly looked at my knees and thought it was the synovium was not fluid enough, which caused the cracking. She ran test for RA factor, Lyme's, vitamin deficiencies; everything came back normal.

1st Ortho (visit #1): I saw him in July. He did a thorough exam and xrays. He put me on meloxicam (anti-inflammatory). He said my exam and xray showed no problems. He thought my knee was just sore and it needed to calm down.

1st Ortho (visit #2): I saw him again in August. He very briefly looked at my knees again. He didn't think the cracking/popping was too abnormal. He did an MRI. A week later, he called me with the MRI results. He said they came back normal. He mentioned the chrondo on the medial side, but he didn't think it was a problem. He said he didn't know why my knee hurt, and his suggestion a cortisone shot to be the next step.

2nd Ortho: I was (and still am) nervous about the cortisone shot. I saw a second ortho at the end of August. I brought the MRI and report. She claimed to look at the MRI before coming into the patient room. She looked at my knees and said that I have patellarfemoral syndrome from a muscle imbalance. She said this is causing inflammation, which is causing the popping/clicking and pain. She prescribed me Voltaren (another anti-inflammatory), told me to do PT, and to come back in two months if I still had pain.

PT: I went to PT once. The therapist looked at my quads and told me I had very tight/knotted muscles, making my muscles shorter and causing the femur to rub against the kneecap in a way it should not be. He showed me stretches to do. I did those stretches (as well as foam rolling) for a month; however, the pain was so severe after PT, I did not go back for another session. I stopped the stretches/rolling because I believe it was causing my quads to burn, making my leg pain even worse.

3rd Ortho: I decided to see another ortho because things weren't improving, and I feel like the 2nd doctor didn't really examine me well or look at the MRI thoroughly (I didn't even see her do it!). This visit was a bust though. The doctor very briefly looked at me knee, and he sat down in his chair and proceeded to read the report (that I gave him along with the xray/mri disc) to me and my husband. I asked him if he could look at the MRI to see if he saw anything the other doctors missed, and he only glanced at it for a second and said I have chrondo, which will cause me pain for the rest of my life since cartilage does not come back once lost. He paid that PT will help though since my kneecap was sliding to the lateral side when I bend and extend my leg (he barely looked at my knee though, so I think he just assumed that since it's most common). I inquired about having plica (I seem to have some of these symptoms from what I read online), and he dismissed it, and said that it would definitely show up on on the MRI if I had it (although I have read otherwise online). All he said was to do PT and to get a brace.

I'm not sure what my next step should be. I am very scared of PT because it made things so much worse last time, but the cortisone also makes me nervous. I think that fi I see a 4th doctor though, I will not be bringing the MRI/xray disc or the report because I want to be seen with fresh eyes. I do not think any of the doctors properly examined my knees, except for Ortho #1 on my first visit.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on October 17, 2014, 06:25:31 PM
I honestly don't listen to anyone who says that cartilage doesn't have the ability to heal. There's lots of science on the net to prove that it does. In the book, Saving my knees, the author from the research mentions that with proper motion and pressure applied to the cartilage, this provides grounds for healing. Of course healing can differ from person to person but it is possible and to what extent that depends on the individual and the damage already done. Science does show also that sedentary person can develop chondromalacia patella without any exercise because his cartilage is weak and it does need movement to keep it healthy. I started walking again slowly since couple of days. The pain I had on lateral side of patella is pretty much gone. I feel that my tendons feel somewhat different (on the good side) since I started walking again. Also I do stretch religiously every day. I know that you cannot do much right now because of the pain but can you stretch lightly or that gives you automatic pain and inflammation?
Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on October 19, 2014, 08:05:38 PM
I haven't stretched/foam rolled in two weeks and haven't noticed any changes (good or bad) in my knee. My quads do not have the burning sensation that they use to when I was stretching/rolling though.

Do you ice? Or use heat? I was using ice on my kneecap and heat on my quads (to loosen the muscles).
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on October 19, 2014, 08:24:49 PM
I used to ice but not anymore. I'm letting my body to initiate the healing process. What are your exact symptons, you said you have some burning sensation around knee caps? Any dull pain behind the knee caps? Muscle soreness?
Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on October 20, 2014, 12:26:28 AM
I actually stopped icing as of today. I will see if things get worse without the ice as the week progresses. I am still taking the anti inflammatory though.

I have dull/burning pain around and behind the knee cap. The pain changes from hour to hour. This morning, the pain was on the lateral side. Later in the day, it was on the medial side. Another common paid site is on the lateral side, but below the kneecap (I found an image online and drew a circle around this part). Do you ever get pain there?
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on October 20, 2014, 10:19:53 AM
I don't have the pain in that area. If you look at the image on the first post here, I have some nagging pain in the top right corner of the patella. It could be the soft tissue or maybe that my patella is rubbing against femur there. I don't know myself. I was told I don't have patella alta so I can't understand why I have some pain there. I did do squats so that could be a tendon or muscle overworked. I also take right now some anti-inflammatory medication to see if that would help. So far the pain is down a bit but I still feel some discomfort. I do exercises for my glutes, been told that the weak glutes are responsible for many knee problems. My pain is pretty much isolated to that area. I don't have any pain behind the knee cap.
Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on October 20, 2014, 10:44:10 AM
I have pain on the top right corner of my patella too, where you showed in the picture. The pain there is not constant, but it is a common spot for me.

This morning, I feel  overall knee tightness, especially in that lower right corner spot.

I hope today is not too painful of a day (for either of us). Some days are worse than others for me.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on October 24, 2014, 08:58:36 PM
My latest MRI results:

IRM MUSCULO SQUELETTIQUE - GENOU DROIT (C-)
MRI MUSCULO-SKELETAL - RIGHT KNEE (C-)

Renseignements cliniques: Syndrome femoro-pateIlaire/chondropathie.

Technique:
L'examen a ete realise selon le protocole standard sans contraste intraveineux.
Resultats de ('examen:

Le cartilage articulaire demeure uniforme et normal en epaisseur et signal aux trois compartiments.
On note un petit foyer d'hypersignal a ('insertion du tendon patellaire avec un peu de liquide en profondeur du tendon, sans dechirure.
Petit volume de liquide intra-articulaire note.
L'alignement, les menisques, les ligaments croises et les ligaments collateraux sont d'aspect normal.

Aucune anomalie significative de la moelle osseuse, du tendon popliteus, des muscles périarticulaires, de la bandelette iliotibiale ou de l'articulation tibio-péronéenne proximale nest décelée. La partie distale/visualisée du tendon quadricipital est daspect normal.

Opinion: Pas de chondropathie significative décelée ni de lesion ostéochondrale. Les constatations a l'IRM sont compatibles avec tendinopathie patellaire légère sans déchirure franche.




IRM - MUSCULO SQUELETTIQUE - GENOU GAUCHE(C-)
MRI MUSCULO-SKELETAL - LEFT KNEE (C-)

Renseignements cliniques: Syndrome fémoro-patellaire/chondro path ie.

Technique:
Lexamen a été réalisé selon le protocole standard sans contraste intraveineux.
Résultats de l'examen:

Le cartilage articulaire demeure uniforme et normal en épaisseur et signal aux trois compartiments.
On note un petit foyer d'hypersignal a l'insertion du tendon patellaire avec un peu de liquide en profondeur du tendon, sans déchirure.
Petit volume de liquide intra-articulaire note.

Lalignement, les ménisques, les ligaments croisés et les ligaments collatéraux sont d'aspect normal.
Aucune anomalie significative de la moelle osseuse, du tendon popliteus, des muscles périarticulaires, de la bandelette iliotibiale ou de larticulation tibio-péronéenne proximale nest décelée. La partie distale/visualisée du tendon quadricipital est d'aspect normal.

Opinion: Pas de chondropathie significative décelée ni de lesion ostéochondrale. Les constatations a l'IRM sont compatibles avec tendinopathie patellaire légère sans déchirure franche.

Title: Re: Chondromalacia Patella Pain
Post by: vickster on October 24, 2014, 09:37:17 PM
All sounds good :)  Mild patellar tendinopathy should resolve with rest.  IF not did you ever discuss PRP with the specialist?
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on October 25, 2014, 01:06:00 AM
Hi Vickster,

I just find kind of weird that results for both knees are exactly same word by word but I guess tendinopathy can be cured with rest. The pain by the way is almost gone in the soft tissue so I think I have my answer now why I have pain because of the tendinosis in patellar tendon.
Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on October 31, 2014, 10:43:48 AM
How did you get so many MRIs? I have only had one, but I would like to get another one to see if anything different shows of it the chrondo looks worse. It's been almost 3 months from the first MRI. I don't know how to get the doctor to give me another MRI though. I hear they are usually reluctant to do another.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on October 31, 2014, 04:28:34 PM
I had 3 done this year, two said I have mild chondromalacia while the last one said that my cartilage is of normal thickness and signal and no significant chondropathy detected. I must say, the last one was read by a well renowned radiologist which I read about. I got two MRI requests by my GP and one from emergency in hospital. My work insurance covers the costs here. Are your knees feeling better?
Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on November 02, 2014, 02:42:55 PM
My insurance covers the cost too, but from what I have heard, doctors are usually reluctant to do multiple MRIs. Did you ask for another MRI or was it their idea?

My knee still hurts. I am seeing the doctor who gave me the MRI in August and who also suggested the cortisone shot after the MRI did not show much. I am wondering if he will be willing to do another MRI to see if there has been any change or if he will just want to do the shot (I did not do it after the MRI like he suggested a few months ago).
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on November 03, 2014, 10:06:30 AM
Did he say that the cortisone shot would remove the inflammation and swelling in your knee?
Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on November 03, 2014, 10:52:14 AM
Yes, he said I may have inflammation in my knee and the shot could calm it (I don't have any visual swelling).
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on November 03, 2014, 01:12:21 PM
I'm trying to get rid of the inflammation on my own, I do have less now. Icing and Voltaren Gel works great. I read that cortisone shot is very powerful stuff and it weakens tendons and ligaments but not sure if after one shot or multiple. Are you icing, elevating the knees? On scale of 10, how much is your constant pain? Mine went down to .5 or 1, I don't have it all the time anymore, sometimes. Also, I discovered huge painful knots in my hamstrings by sitting on baseball. I was told by my PT that knots shorten the muscles and mess up body alignment so I'm working on getting rid of them, altough very painful process.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on November 03, 2014, 01:13:26 PM
Also, do you feel after waking up and walking for couple of minutes that your knee or knees are filled with more fluid and when you bend them they snap or pop? it's a weird sensation I have in my right knee, could be accumulation of fluid as per my MRI.
Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on November 04, 2014, 10:57:21 AM
I tried icing for months, but nothing seemed to improve. I stopped icing last week. I was taking Valtaren orally, but I stopped that last week too to switch to Aleve. I haven't noticed much change though.

I am worried about the damages of cortisone. The doctor touched on it a few months ago, saying that it only happens with many injections. I plan on talking about it with him when I see him again, before the shot.

My pain level changes (as well as the pain location). It ranges from 6-9. I think I can tolerate pain better in some locations though. How did you improve so much?

The PT also told me that my muscles were knotted and shortened. I foam rolled for a while, but it caused burning in my quads throughout the day. I stopped and haven't noticed any change in my knee.

My knee does feel inflammed thoughout the day, but nothing seems to help (icing, medicine). Along with the pain in various locations, it feels heavy and tight. Could this be fluid?

Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on November 04, 2014, 02:02:40 PM
I'm not sure exactly what helped or is helping me. I did so much foam rolling, stretching, strenghtening, icing, voltaren gel cream and rest. I feel that the knee doesn't feel 100% yet but it's much better than it was few months ago. I think I still has some fluid in the knee cause it pops from time to time. You might have the same problem. I don't think I ever was at 6 or 9 pain so I really feel for you going through this hard time. Has anyone examined your body alignment? My problems started cause I was shifting more to left so my left knee is more developed muscle wise than right and put lot of strain on it. I'm still doing all of the above as I know that we must continue if we want to succeed. Knees are very tricky. I also will buy a stationary bike and start doing that slowly. I read that bicycling nourishes cartilage and that's a good thing. here's the article:
http://www.udel.edu/PT/PT%20Clinical%20Services/journalclub/caserounds/01_02/jan02/DOUCETTE.pdf

Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on November 05, 2014, 11:26:16 AM
I don't understand how my problem can stem form an alignment issue because I hurt it from high impact exercise. I was doing a JM workout video (Killer Abs Level 3), and did a jump in the video where I brought my knees to my arms and landed. I felt weird afterwards. I stopped doing the jumping, but my knee got worse over the next few days. I hate myself for exercising, since I was so much more healthy before!

I don't understand how that jump could have caused such long lasting pain.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on November 05, 2014, 01:27:19 PM
That is weird. Did you have any MRI done on the knees to see inside what's going on? When jumping, risk is to tear ACL or other ligaments or even do cartilage damage.
You are having pain for a reason.
Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on November 06, 2014, 11:51:01 AM
The MRI only showed some chrondo on the medial side, but the doctor didn't even think that was an issue. I am keeping my fingers crossed that he will want to do another MRI when I see him next week. It's only been 3 months since the first MRI though..
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on November 06, 2014, 12:36:44 PM
He`s right, Chondromalacia does not cause pain unless it`s in an advanced stage (OA). I was also diagnosed with mild chondromalacia patella (Grade 1) but that`s a general term since at my age, I`m expected to have some wear of the cartilage anyways. The reason why they found it is cause I had some tendon pain and MRIs were done. What people don`t realize is that everyone on the planet will have some kind of degree of chondromalacia in their life, some more severe. It`s just part of life. Your issue could be with the tendons, maybe you pulled them and now you have inflammation. I`m not a doctor so cannot say what it is. If it is indeed tendons, healing takes months depends on the severity of the damage. I have mild patellar tendinopathy in both knees and it`s been healing for couple of months now and it is getting better. One thing is for sure, patience is your best friend. I learned this the hard way by jumping too quickly into exercise and the pain came back.
Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on November 07, 2014, 11:24:31 AM
Would the MRI have shown problems with the tendons?

I am wondering if it's plica? None of the doctors have suggested it though. One of them said it would definitely show up on the MRI, but I have read different things online.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on November 07, 2014, 12:05:44 PM
If the tendons are inflamed or thickened or even torn, they should be noted as abnormal in an MRI report
Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on November 09, 2014, 02:31:46 PM
The MRI results noted that the tendons are normal. The only thing not normal was the chrondo on the medial side.

Today, I have the most pain on the lateral upper corner. I wish this would go away!
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on November 12, 2014, 12:27:31 PM
are you able to stretch? It's possible that you might have tight quads, hamstrings, glutes which all contribute to PFPS since they pull hard on tendons.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on November 18, 2014, 08:30:35 PM
I have a general question, when someone has chondromalacia like me mild case. The kneecap rattles a little bit when slightly trying to move from side to side when knee is 45 degrees bent, (feels like sand paper) does that mean that the cartilage became hardened or because of fluid accumulation or another reason?
Title: Re: Chondromalacia Patella Pain
Post by: ChelseaSoccer on November 23, 2014, 08:02:47 PM
Stretching didn't help. Neither did the cortisone shot. :(

Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on December 10, 2014, 04:36:56 PM
Hi ChelseaSoccer,

how are your knees these days? I just came back from vacation, beach, and my patellar tendinosis acted up during vacation more than before. I did walk up lots of stairs so that is definitely a reason for worsening it. Now seems to be much better, I avoid stairs at all costs and only do some light walking. However, I've been seriously foam rolling my knees and the pain at the corner of the top outside of patella where the tendon meets the patella is completely gone. I feel like there's nothing pulling it hard anymore so I think rolling does help trumendously. Now I only get some mild discomfort there from time to time but not constant so I'll continue foam rolling. I do feel i had huge knots in my rectus femoris muscle which could contribute to shortening of that muscle and pulling harder on the tendon and knee cap.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on January 08, 2015, 06:25:06 PM
Does anyone know if there's a nerve running outside of the knee close to knee cap? Let me explain, when I lie down with knees fully extended, and rotate my right knee towards outside, I would get this sharp nerve pain right on the lateral side the patella. Left knee does not do that. Any ideas what it is?
Title: Re: Chondromalacia Patella Pain
Post by: Stuart56 on January 11, 2015, 09:09:24 PM
papasmurf,

Where are you actually based? I live in the UK and been reading your post with interest.  My main issue is bilateral tendinopathy but recent inactivity for 6 weeks has atrophied the right VMO and what has historically been an on/off mild pain on the outside of my right patella has developed into very painful patellar maltracking.

As it really came to a head this last 4 weeks, I have taken matters into my own hands and self diagnosed, ahead of seeing my physiotherapist next week. I have almost identical pain to you - outside of patellar seems to rub on lower end of femur. Pain when walking and only drops to 2/10 when I lie flat. Also, there is a small spot, right on the lower end of the femur, where if I touch it it sends a shooting pain 10/10 around the area. I am certain it is maltracking but want my Physio to confirm.

Anyway here is what has SIGNIFICANTLY helped me in the last 2 weeks:

1) I have had 4x 90min deep tissue massages from a Sports Massage Association Grade 5 therapist. Prior to this my RH hip flexors (TFL) were so tight it was hurting to walk. Since then we have done 2 sessions on the TFL and 2 sessions on the quads. I have gone from pain levels of 6 or 7/10 when walking to almost zero pain when walking. My RH quads were ridiculously tight and had been probably for over 1 year as even though I foam roll and see my therapist once per week, we only really focused on back, shoulders, neck, hams and calfs. Not had a quad release for literally, years.  I go back for another session tomorrow.

2) I got my massage therapist to KT tape me using rock tape. A simple half moon shaped 50% stretch tape, anchored on the VMO then 50% stretch around outside of knee, covering 50% of patella, then re anchoring on the inside of the top part of the shinbone, partly covering lower end of RH patellar tendon.  This helps for daily re education and does actually help with the maltracking. Tape has been on for 5 days now and I have noticed a daily improvement.

Today, I started VMO activation as I can see I am pronating inwards on the RH knee. I did:
3x10 - Single leg pressbacks - Using green band tied to stairwell banister, pressing against back of knee. 20% bend then press back to extend leg. http://youtu.be/lqmkmVG6q2E (http://youtu.be/lqmkmVG6q2E)
3x12 - Seated leg extension with pilates ball between knees. https://www.youtube.com/watch?v=NEU3QXbXE8U (https://www.youtube.com/watch?v=NEU3QXbXE8U)

I am no able to do any more VMO stuff as all the other exercises are a little more dynamic and I am unable to do them due to my patellar tendinopathy. I started low weight eccentric 1 leg squats just last week as part of my recovery from PT.

I am seeing my PT next week so can report back on the details. My Patellar Tendinopathy has been dominating all thoughts in my head and spare time for the last 3 months so it has taken time for the maltracking to be isolated and rear its ugly head. I saw a specialist just before christmas re tendinopathy. I want to get this maltracking pain properly assessed now and will push for an x-ray at least ideally an MRI as I want to understand if there is any cartilage damage.

Stuart
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on January 12, 2015, 01:27:06 PM
Hi Stuart,

How old are you?

I live in Canada. I did 4 MRIs last year all showing mild chondromalacia patella in both knees but that doesn't cause my pain cause everyone will have some kind of CP in their lifetime, that's just part of life. I do feel that I have some maltracking in my right knee. First when I stand and tightness knee caps and then release, my right patella is rubbing against femur on lateral side so its like its being pushed more to the side when I tightness the knee. Also when I lie down and do same exercise it rubs on the side. I don't know if I have some lateral cartilage damage to lateral compartment, MRIs didn't show anything there. My knee would pop or make snapping noise from time to time when I bent it continuously mlike when doing knee bent exercises. Crepitus sound I had before when bending down is gone. Not sure how's that possible but its good news. Now to the pain I have. When I walk, lateral side of patella in the soft tissue hurts also the tendon attached to top lateral side of patella is irritated. I was diagnosed with mild patellar tendinopathy and its been lasting for 4 months now. I did do stretching and some knee raises exercises which made the situation worse as it irritated the pain atrea more. So now I'm off any exercise or stretch to see if it will heal. All the problems started in Feb 2014 when I started doing one knee squats and my knee is not the same since. I don't know if I need artroscopy to see inside the knee what's going on as the pain is like 2 or 3 on 10 at worse but its constant and and annoying ad hell. Right now I just foam roll the knee and its painful over it and so I must have scar tissue there. I read that sdome fibers from it and are attached to lateral side of patella and pull hard if it band is tight. Are you doing any exercises at this moment? You saw my MRI images, I can't tell if my lateral cartilage is fine and its sdimple maltracking issue.
Title: Re: Chondromalacia Patella Pain
Post by: Stuart56 on January 12, 2015, 08:20:24 PM
42yrs old.

Yes I am doing stretches, foam rolls, deep tissue massage (from a therapist) and exercises every day.  Commenting on your points:

Patellar Tendinopathy
Don't rest your knees for longer than 4-6 days tops. Muscles will atrophy and your larger - dominant muscles - like your quads - will take over from the smaller ones - like your VMO - and make your patellar maltracking worse.
Eccentric loading (progressing from flat floor to a slanted board) is the only proven (non surgical) protocol to heal patellar tendinopathy. My Tendinopathy is at it's worst however, after many false starts (too much too soon) I am now on the right rehab program. I started 1-leg eccentric squats on the leg press http://youtu.be/IZxyjW7MPJQ?t=1m11s (http://youtu.be/IZxyjW7MPJQ?t=1m11s) last week and did 3 sessions in a row with my pain returning to the baseline within 12 hours after each session. 
At the moment, bodyweight squats are too much, which is why I am starting on the leg press. I literally only have 5Kg loading on the leg at the moment but this is more than enough to stimulate the tendon. 2 sets of 6 reps on each leg to begin with. 
The added plus of the leg press is it teaches perfect form in terms of firing the glutes, which is why I actually contracted PT in the first place - they switched off. I am planning on the leg press for the next 4-6 weeks until the tendons have repaired to the point whereby they can withstand a 2-leg bodyweight squat and then progress onto the slanted board.

Patellar Maltracking
Due to the fact that the standard VMO activation exercises activate my tendons too much, I have bought a slendertone optimum machine to help activate my atrophied right leg VMO without engaging my tendon. It won't cure me but it means I can get ahead by doing a few sessions on the VMO each day whilst I focus on my eccentric loading.
What will tell you if you have cartilage damage or not? I understand x-rays will show this if taken from the top down?   I am seeing my PT tomorrow so will report back.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on January 12, 2015, 09:43:35 PM
My PT told me last year that I have pelvic tilt. Basically it shifts more to left and he said my right femur rotates more inward and patella rubs against it. And now I have soft tissue pain where I described. So difficult to fix something when in pain.
Title: Re: Chondromalacia Patella Pain
Post by: Stuart56 on January 13, 2015, 01:04:51 PM
You have to start somewhere.  Believe me you don't want patellar tendinopathy. This is all about overcoming pain in very small percentage gains.
Patellar maltracking is a muscular imbalance. "If" surgery is needed (and it should only be needed if there is a severe case) the single most important issue to address is the body mechanics. Re activating the glutes (which will help your pelvic tilt) and VMO and quads to ensure you don;t rotate inwards.
You should literally start with 5 reps per exercise per day. Muscles take 2 weeks to sign improvements. Really not long at all...
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on January 13, 2015, 01:45:46 PM
I have patellar tendinopathy according to MRI in both knees but the pain I feel is only in right knee, very strange. Also, when I do any type of knee exercise, I irritate the soft tissue in front of the patella and the side so I don't know how to tackle the exercise regime.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on January 15, 2015, 12:19:36 PM
Hey guys,

i'm thinking of going for artroscopy to see inside my right knee which is been giving me trouble. Any thoughts on it? anyone did it just to see inside what's going on?
Title: Re: Chondromalacia Patella Pain
Post by: vickster on January 15, 2015, 03:51:24 PM
I wouldn't myself, due to the risks and recovery required.  A knee is never the same once it's been operated on.  In my view, you'd be much better off trying a steroid or PRP injection first if non invasive physio and massage aren't helping.  Has a knee specialist agreed to do it.  Surgery is rarely if ever a solution for PFPS, arthritis and similar

That said I am having the first scope on my right knee in a few weeks to deal with a very painful anterior lateral meniscus tear, not enough improvement from steroid injection next week :(
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on January 15, 2015, 04:58:32 PM
Hi Vickster,

thanks for the suggestions. I don't know who to talk to about the injections. I don't know if they are available in Canada. Is it same as synvisc one?

My latest symptons are burning pain top lateral portion of patella, feels like it's rubbing on femur. I don't know if my cartilage is gone there, pain is also on lateral side of patella. I'm doing PT and seems to go nowhere. I added glutes exercises recently as well. My friend has arthroscopy to fix meniscus and she's doing extremely well like she didn't have any surgery done. I just want to see what's going on inside as I don't think it's something mild as described. I feel like there's more to it.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on January 15, 2015, 06:19:17 PM
No a steroid injection is different, used to treat inflammation. Hyaluronic acid, like synvisc, indicated to lubricate an arthritic joint. You have tendinitis you say and mild chondromalacia, so it seems something to reverse the inflammation might be more appropriate? Ask your orthopaedic specialist or a sports medicine physician

Not sure how a patella rubs on the femur unless it's dislocated out of the trochlear groove? Referred pain? My pain is about 3-4 inches below the knee but coming from the meniscus it seems

What has your physio said?  Talk to the medics about your concerns but it's still best to exhaust all non surgical options. Assume you ice and heat the knee etc to aid inflammation and healing?

However, you still sound like you want to try the surgery so you'll need to find a knee surgeon who agrees
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on January 15, 2015, 07:29:07 PM
the knee pops which I attribute to chondro and maltracking. Basically when I have my knee fully extended in front of me and contract the quads and then release by putting hand on the patella, when it releases the tension the lateral side of patella rubs against trochlear grove which is femur I think. The other knee doesn't do that. My sports doc said it's maltracking and tense lateral muscles, it band and vastus lateralis. I work hard on getting vmo strong and stretch and it still does that. I think that's what causing the inflammation cause the tendon in front of patella is on fire from time to time so I still ice a lot.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on January 15, 2015, 07:34:53 PM
And does the sports doc concur that surgery might be required?  They are often the ones who give the steroid, PRP etc, surgeons too, but ultimately they will operate if required
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on January 15, 2015, 07:39:07 PM
he said to continue exercises and stretches, nothing else. If I have so much cartilage under the knee cap why is it rubbing like if there was no lateral cartilage under knee cap and thus rubbing against the lateral side of the trochlear grove?
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on January 15, 2015, 07:40:05 PM
I started taking naproxen yesterday again to see if this will help with pain and inflammation.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on January 15, 2015, 07:52:02 PM
Does not a lot for me, been on it for 3 months.  Make sure you take it with meals, it's not great for your tummy.  How bad is the pain?  You might be better off with something milder like ibuprofen, talk to your pharmacist

It probably 'feels' like it's rubbing because it's inflamed, maybe it needs some lubrication.  What did the doctor say when you asked about other options like injections?

Having the back of the patella shaved won't stop it feeling funny.  My left one was shaved 5 years ago and it pops oddly when straightened (doesn't hurt)
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on January 15, 2015, 07:58:30 PM
I saw my doc in oct 14 I think and we didn't talk about injections as the knee was feeling better. After that the pain very slowly came to be about 1 or 2 on 10 which is like a burning pain in the soft tissue just above lateral corner on patella and also on lateral side in front of patella. When I bent my knee and touch the knee there's some kind of rubbing on lateral top side corner of patella with femur. Don't know if it's bone on bone but feels like it's rubbing, maybe like you're saying could be inflamed tendon. This tendinosis doesn't seem to go away.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on January 15, 2015, 07:59:04 PM
doc gave me some stomach protection pill to take with naproxen as well.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on January 15, 2015, 08:10:23 PM
That's good

No tendons are a pain.  I've got tendonitis in my hand right now despite all the naproxen.  My elbow tendon never healed and needed surgery (I don't think they can do much with knee tendons unless properly ruptured and detached)

Best go back to the doctor if it's got worse, however 1-2 pain I'd be surprised if they would willingly operate unless it has a major impact on what you can do (that's coming from the UK where surgeons are rather conservative given the public health provision)

It is annoying though as you say.  Mine is probably a steady 4-5 and getting worse and affecting me generally, otherwise I wouldn't consider an op for a meniscus tear without mechanical issues (I have full ROM)

I have grade 2+ on my lateral patella but luckily it doesn't bother me there, although I expect the OS will tidy it if he deems it necessary

Hope you get sorted :)
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on January 16, 2015, 06:22:11 PM
I read that knots in the quad muscles especially in the vastus lateralis cause muscle shortening and thus fibers attaching to patella which are attached to lateral side get tense and are inflammed and painful since they are pulled too hard by the muscles. I will start foam rolling the quad muscles and try to get rid of any knots I have. I feel I do as there are few bumbs in the muscles I feel and they are hard and some painful. Let's see what this gives.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on January 16, 2015, 07:50:05 PM
Perhaps try a proper sports massage from a trained therapist too? You won't enjoy it but may help. If foam rolling be sure to check your technique if new to it :)
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on January 22, 2015, 02:31:23 PM
I'd like to share an interesting article with you all about knee pain and one of the main culpits of knee pain:

http://modernhealthmonk.com/ultimate-guide-to-chronic-knee-pain-runners-knee/

happy reading!

I relate to it cause I still all day at work and my glutes are pretty much non existant so I'll be working hard on getting them awaken and strong :)
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on January 30, 2015, 06:51:51 PM
Hey guys,

what's working for me at the moment is foam rolling my quads and getting rid of the knots which cause muscles to shorten and also get rid of pain trigger spots in the muscles and tendons. Been doing if for few days now and the knee bends much more smoothly without much popping or clicking, it's like it's gliding like it was meant to do so. I attribute that to getting rid of tight quads. I've been also working hard on getting my glutes strong so possibly a connection there too. Foam roller has become my best friend. And don't bother foam rolling IT band, it's been proven to be ineficient, concentrate on quads if you feel they are tight.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on January 30, 2015, 07:17:31 PM
Good news you have found something that is helping :)
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on January 30, 2015, 07:38:22 PM
I found a spot just at the insertion of the rectus femoris muscles below hip which has a knot very paintful to foam roll over. Immediately the pain the patelar tendon comes on, not sure if it's related but seems to provoke knee pain by rolling over the knot.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 13, 2015, 03:14:45 PM
My latest MRI results for both knees. Sorry it's in french:

RESONANCE MAGNETIQUE GENOU GAUCHE

Technique : Examen réalisé selon le protocole usuel.

Constatations :

Comparaison à décembre 2013.

Pas d'épanchement articulaire ni de kyste de Baker. Aspect normal du cartilage articulaire, des ménisques, des ligaments croisés et collatéraux ainsi que de l'articulation péronéo-tibiale supérieure.

Telle que documentée en 2013, légère tendinopathie quadricipitale distale sur 1cm de longueur cranio-caudale. En plus de l'hypersignal tendineux, on note un léger oedème du coussinet graisseux supra-patellaire. Cet oedème est secondaire à la tendinopathie adjacente. On revoit également un foyer d'hypersignal impliquant la partie distale et centrale du tendon rotulien sur 1.5cm de longueur avec un léger oedème devant et derrière cette partie distale du tendon rotulien. L'oedème s'étend même jusqu'au pôle inférieur de la rotule à la face antérieure du tendon rotulien, dans la graisse sous-cutanée profonde. Il n'y a pas de bursite pré-patellaire.

CONCLUSION :

Pas de changement significatif depuis 2013. Tendinopathie quadricipitale distale et tendinopathie rotulienne distale un peu plus étendue avec léger oedème péri-tendineux rotulien diffus. Pas de chondropathie ni de déchirure méniscale.




RESONANCE MAGNETIQUE GENOU DROIT

Renseignements cliniques : Gonalgie bilatérale persistante semble originer de la rotule.

Technique : Examen réalisé selon le protocole usuel.

Constatations :

Comparaison à mars et mai 2014.

Pas d'épanchement articulaire ni de kyste de Baker. On revoit une plage de chondropathie sur la facette médiale de la rotule au tiers moyen en hauteur. Cette zone de chondropathie a légèrement augmenté en dimension depuis l'examen antérieur puisqu'elle mesure 10mm de largeur comparativement à 6mm sur l'examen précédent. La hauteur de cette zone de chondropathie est inchangée à 4mm, impliquant un peu moins de 50% de l'épaisseur du cartilage. Le cartilage des deux autres compartiments est normal. Les ménisques intacts tout comme les ligaments croisés et collatéraux et l'articulation péronéo-tibiale supérieure.

On revoit un foyer d'hypersignal impliquant la partie médiale du tendon quadricipital distal sur 1cm de hauteur avec un très discret oedème au pourtour compatible avec un foyer de tendinose ou tendinite sans déchirure tendineuse. Tous les autres tendons sont normaux. Finalement, il est apparu un petit kyste mucoïde (ganglion cyst) d'environ 1.7 x 0.8 x 1.0cm derrière la racine postérieure du ménisque interne malgré l'absence de déchirure méniscale.

CONCLUSION :

Très peu de changements depuis mai 2014. Petit foyer de chondropathie de la facette médiale de la rotule ayant légèrement augmenté en dimension depuis l'examen antérieur. Apparition d'un petit kyste mucoïde derrière la racine postérieure du ménisque interne. Stabilité d'un foyer de tendinopathie quadricipitale distale impliquant le versant médial du tendon sur 1cm de hauteur.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on February 13, 2015, 05:24:06 PM
Not read all but good to read in summary that nothing's got worse :) did you ever speak to the specialist about prp for the tendinopathy? 

I'm recovering from a scope to deal with a torn lateral meniscus, impinged fat pad and grade 3 on a maltracking patella and its pretty sore so you don't want to do anything invasive if you can avoid it :)
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 13, 2015, 07:43:47 PM
Hey Vickster,

believe it or not, PRP is finally available in Canada. I'm thinking of scheduling appointment to discuss it. I read that it speeds up tendinosis healing, I hope it's true. My tendinosis in both knees is still haunting me, I'm avoiding stairs at all costs and am not doing any straining exercises at all. Any thoughts on PRP from your side?
Title: Re: Chondromalacia Patella Pain
Post by: vickster on February 13, 2015, 07:48:06 PM
I've never had it in a knee, but I did for tennis elbow,  It was done too late though and didn;t help.  When I had surgery a month or two later, the tendon was hanging on by a thread and nothing was going to help.


My knee OS believes it has value in tendon issues in knees but not cartilage issues (lack of proof, evidence), HA is better for that

If I was you, I'd certainly discuss it, but it can get expensive depending on insurance cover.  Be warned, if my elbow was anything to go by, the injection really hurts (no anaesthetic is used as it damages the platelets apparently). 

You could also try a steroid injection as a first try but it i usually temporary (didn't help with my recent issues unfortunately).
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 13, 2015, 07:52:30 PM
I checked out the clinic and it's about $850 CAD per injection. They don't really talk about cartilage regeneration from injections, mostly tendon healing. I don't care about the pain from the shot, if it will work, hopefully, I'm all for it. I will contact my private insurance to see if they cover it, I doubt it they will. My right knee IT Band is tangled with vastus lateralis and biceps femoris muscles, I feel it when I foam roll it, it's very painful and it shoots the pain down my knee and the patella is on fire after foam rolling sessions, it's getting better, as muscles are more knot free these days and they go back to normal state but it's a long process.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 13, 2015, 07:54:04 PM
by the way, the ganglion cyct they found on MRI behind the meniscus, is it serious? There's no tear in meniscus as per report.
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 13, 2015, 08:24:57 PM
Hey Vickster,

I just called a Montreal based company about:

"We are currently looking for individuals aged over 18 with a patellar tendinopathy for more than 3 months to participate in a comparative study of three treatments for this condition (randomized double-blind). We compare the effectiveness of the injection of platelet rich plasma, autologous blood injection and percutaneous tenotomy under ultrasound guidance. Following the initial treatment, the patient will be monitored four times over a period of one year."

Will get a call back on monday about this.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on February 14, 2015, 03:25:00 AM
Sounds promising, I don't know what the third option is and you'd want to fully understand th full study protocol, selection criteria, follow up etc

Good luck ;)
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 14, 2015, 11:24:57 AM
Thanks,

I'll be speaking with them on monday. What about my question on the ganglion cyct? What do you know about it?
Title: Re: Chondromalacia Patella Pain
Post by: vickster on February 14, 2015, 12:40:51 PM
If it doesn't bother you, leave it alone. Ask the specialist though if anything needs to be done. He's the doctor ;)

 I have a parameniscal cyst in my left knee associated with meniscus tears but it isn't a bother, so leaving well alone. I have lots of small findings on that MRI but none affect my function right now, which is the important thing. I don't seek any treatment unless my quality of life, ability to work etc are affected (this is the reason for last week's scope). Radiologists are paid to do a forensic review of an MRi and will report every tiny thing they see.  That doesn't mean that any action is needed. I expect everybody would have some finding or other on a knee MRi but they have no issues whatsoever, much less need any treatment of anything seen

It's all too easy to obsess about knees and any little niggle. Best just to get on with life if you can
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 14, 2015, 01:01:29 PM
the cyct doesn't bother me, just the quad and patellar tendinosis. Also my knee pops more these days when I extended it, I guess it's because of the chondromalacia getting little bigger in the knee.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on February 14, 2015, 02:10:31 PM
Not necessarily, I didn't think the MRI showed that? Why do you think it's getting worse?  It could just be inflammation from the tendinitis, do you still ice?

Popping and cracking can be quite normal
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 14, 2015, 02:51:37 PM
MRI report showed that zone of chondromalacia in the medial facet has slightly increased from 6 mm to 10 mm in lenght, however height remained at 4 mm with less than 50 % cartilage depth affected. I still don't understand if I have a hole or just softening of the cartilage in that area. No one can give me an answer.I ice from time to time, I still feel I have some inflammation in the joint.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on February 14, 2015, 02:59:44 PM
Cartilage damage/chondromalacia is a weird thing. I have just had grade 3 shaved and stabilised but I've never had any pain from it. The reason for the scope was an impinged fad pad and lateral meniscus tear

I wouldn't worry about it any more if I were you. Are you still only in minor discomfort from the tendonitis? When I had the elbow issue I was in agony when I did certain things and I've now got tendonitis in my wrist which can give me a 5 on the pain scale if I do certain things. I'm having some physio, or will be now the knee is done, I'm frictioning the tendon which I guess is like foam rolling or dry needling to stop the tendon shortening which is when the problems arise

If I were you, I'd foam roll, stretch and take up a non impact activity like swimming for fitness  :)
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 14, 2015, 03:28:59 PM
tendinosis pain is like 3 on 10, not all the time, mostly after walking or standing for some time. It used to be like 6 o worse. I know tendons take more time to heal than muscles so I must be patient. You still have tendinosis? how long now?
Title: Re: Chondromalacia Patella Pain
Post by: vickster on February 14, 2015, 03:47:21 PM
I have tendinitis (not tendinosis as its not chronic, refractory to treatment yet which I believe is the distinction) in my wrist which manifests as pain on the outside of my hand mostly. Started about 4 months ago I guess, no improvement even though I was taking naproxen for my knee. Saw physio a couple of weeks ago, after the prescribed couple of weeks rest from the GP, because I was concerned about how it might cope with crutch use after the impending knee scope.

No treatment since as the knee is the priority. She is reviewing it next Friday, along with my knee. It's tedious, unpredictable, odd things make it hurt. I did try a support but that made my arm and hand ache. I might need a bespoke splint from the specialist hand physio. Will see next week.

Historically, the tendinitis in my elbow was resolved by a surgical release, tidy up and reattachment of the tendon. Seems to be ok, touch wood, although the wrist issue is the same arm
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 24, 2015, 03:46:55 PM
Hi Vickster,

I got accepted for the Patellar Tendinopathy study. I will be meeting the doctor on March 9. I will get a blind treatment, basically I will not know which one I get but one thing is for sure, it should help me. I read about it and there's some very strong evidence that this stuff works on chronic tendinopathy.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on February 24, 2015, 04:09:10 PM
That's good news :)

What will they give if not PRP?  You will presumably know if you are on that protocol as they will have to take blood from you, same for the blood option?  Or will they take it, spin it and then discard if you are in the other arm and give you something else from an opaque syringe - PRP is pretty obvious as it's yellow, blood is red (or blue if a member of the Royal family :D ), not sure what the tenotomy option is?!
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 24, 2015, 04:50:18 PM
From what I was told and hope I can remember, I was just too excised about getting the call from them in the first place, one technique is PRP (pretty much self explanatory). The second is they draw your blod and insert it in the tendon to initiated healing process and third is where they poke the tendon and make it bleed to also start the inflammation process. I read that when the tendon is thickened (tendinopathy), it's not getting enough blood supply and nutrients to heal so it goes into dormant state and PRP actually awakens the tendon to start healing again so that should be good for me. I hope I get PRP but then again anyone could be beneficial. I just want a treatment, plus there's no cost involved and PRP is pretty expensive.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on February 24, 2015, 05:07:24 PM
Sounds good. Presumably they'll put you on a structured physio protocol too to give it all the best chance of working?

Hope it all works out for you :)

I'm still in limbo with my hand, no clear diagnosis and sporadic physio (I've not had acupuncture, hasn't helped though it seems).  Wondering whether I need to see a specialist.  I have post op follow up with my knee surgeon on Thursday, will see if he can recommend anyone good with hands
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 24, 2015, 05:27:24 PM
how did you hurt your arm?
Title: Re: Chondromalacia Patella Pain
Post by: vickster on February 24, 2015, 05:29:53 PM
No idea, came on gradually, like these things often do.  It's the tendons in my wrist we think that are causing the pain in my lateral hand

Cycling, rowing in gym, typing, any of the other trappings of modern life I guess!

Although as usual it's the left hand, and I'm right handed (same as with the tennis elbow)  :-\
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 24, 2015, 05:43:36 PM
maybe you pulled the tendon too hard. Are you gonna get PRP for your arm?
Title: Re: Chondromalacia Patella Pain
Post by: vickster on February 24, 2015, 05:47:42 PM
Maybe.  I don't know, I need to see a specialist before I can even think about specific treatment.  The pain of it from when I had it unsuccessfully for my elbow doesn't fill me with enthusiasm, but need to get on top of this before it becomes properly chronic.  Depends if it's available here, covered by insurance etc

I expect a custom support would be the next step (there is a specialist hand physio I could see but she's on holiday)

It's quite unusual to have in lateral hand, most hand / wrist issues seem to be thumb side  :-\
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 24, 2015, 06:19:38 PM
I wish you lots of luck with that. Hopefully it`s a temporary thing. What`s been really helping me is working on the butt. Glutes (gluteus medius (VERY IMPORTANT) and glutes maximus. I feel that knee is tracking better and I have less inflammation. Also, I work on VMO and foam roll. I honestly don`t feel chondromalacia is responsible for the pain but rather the tendons, thus I have tendinopathy. I read that tendinopathy is also caused by faulty body alignment since tendons work extra hard to keep you stable thus work overtime. Fixing alignment should help tendons restore to proper strength and length.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on February 24, 2015, 06:23:40 PM
A friend did suggest a chiropractor but I'm sceptical and would rather a diagnosis from a medical specialist, seems to be plastic surgeons who deal with hands rather than orthos due to all the stringy bits! It's not a flare up of the tennis elbow but I do have sore shoulders. Otherwise, a rheumatologist with a musculoskeletal skeletal focus might be the way to go. I'll need to take advice from the physio I guess but she's off sick right now so it'll need to wait
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 24, 2015, 06:37:11 PM
what`s your pain level at the moment?
Title: Re: Chondromalacia Patella Pain
Post by: vickster on February 24, 2015, 07:02:48 PM
In my hand or knees? 

In my hand, it can be a 6 or 7 if I lift something heavy in the wrong way, it's a sharp pain that eases...last night it was the wok with my stir fry that made me go ouch! But it can be picking up a pillow, pulling up trousers, shaking the duvet, not having a proper grip on the iPad. It's odd!  It's also sort to rest on that side.  It hurts a lot if I pull my little finger up towards the back of my hand
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 24, 2015, 08:06:57 PM
have you had PRP shots in your knees?
Title: Re: Chondromalacia Patella Pain
Post by: vickster on February 24, 2015, 08:23:48 PM
No, my surgeon doesn't believe in them for cartilage damage as there's no evidence (it's unlikely to would be funded here outside a trial). . But he says there is good evidence for tendon issues. 

Which is where I tried it for my elbow, into a very poorly tendon which needed surgery a month later as the PRP had zero effect. It was very damaged and the tendon was barely attached. No number of injections would ever have helped

I've had a number of hyaluronic acid injections in my left knee (which helped) and a steroid jab in the right (which didn't)
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 24, 2015, 10:39:43 PM
Vickster,

what do you think about this:

http://cartiheal.com/cartilage-regeneration
Title: Re: Chondromalacia Patella Pain
Post by: vickster on February 24, 2015, 10:55:42 PM
It may have been discussed before for full thickness defects? Did you do a search? I'm too old for this stuff and luckily I seem to be free of grade 4 holes for now :)
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 25, 2015, 10:18:10 AM
not sure if it's only for Grade IV defects. They are talking about osteochondral and articular injuries. I emailed them and still waiting for reply.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on February 25, 2015, 10:30:12 AM
Yes precisely, that's what defects are.  It's an implant for focal defects in the cartilage down to the subchondral bone (the layer below the cartilage).  It's not for chondromalacia, but according to the site an alternative to microfracture which is for exposed bone

Agili-C is CE marked for the treatment of focal articular cartilage and osteochondral defects

This implant has shown to promote regeneration of true hyaline cartilage and its subchondral bone, simultaneously without the use of cells, growth factors or other exogenous agents. The cell-free implant is inserted arthroscopically or via a minimally-invasive approach

This implies that the cartilage is gone and the bone exposed, i.e. grade IV and that's where the trial is being done

http://cartiheal.com/clinical-evidence

Abstract

Osteochondral defects are often symptomatic and lead to deranged joint function. The spontaneous healing capacity of osteochondral defects is limited. In this case study, use of an acellular scaffold capable of induction of mesenchymal stem-cell migration is described. This scaffold was used on an Outerbridge grade IV medical condylar defect measuring ~2 cm². At 24 mo follow-up, the articular surface appeared restored by MRI, and the patient returned to sports.

(Not good to see a typo in the Abstract!)

Might once upon time been an option for the defect in my left knee had it not filled will fibrocartilage and been compromised by other dodgy cartilage and knock knees! And had it been available!
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 25, 2015, 01:42:05 PM
Maybe they posted those comments to show the worst case scenario where the bone is exposed and it worked to regenerate the bone and cartilage growth. I want to know from them if they can do a patching for chondromalacia, the hardened spot removed from cartilage and patched with their implant to regrow the hyaline cartilage. Since they claim to be able to do the cartilage defect to the bone, perhaps they can do also small defects like chondromalacia.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on February 25, 2015, 02:37:34 PM
That's where they've done the trials it seems, they couldn't offer it elsewhere without clinical evidence.  It's to fix holes in cartilage, chondromalacia is softening, not holes, ergo there's nothing to fix with this :) Doesn't look like it's available anywhere outside of small trials anyhow

Chondromalacia is softened hyaline cartilage not hard fibrocartilage?  Hard fibrocartilage fills holes to the bone.  They wouldn't clear away good cartilage even if it soft to create a hole that isn't there before.  Same with all the cartilage repair techniques, these are for fixing focal grade IV holes not large areas of damage (that's when replacements need to be considered)

http://www.kneeguru.co.uk/KNEEnotes/primers/patella-primer/what-chondromalacia

The best chance with chondromalacia is avoiding things that will cause more damage (squats, lunging, running), possibly PRP, hyaluronic acid, stems cells, etc...but none are well proven in big controlled trials as yet.  You can also have it tidied up and stabilised but that's not a conclusive fix either.  The medics haven't got there with cartilage yet, give it another 10-20 years (if the investment is there from the pharma companies which isn't guaranteed).  More likely to see better replacements which will last longer especially as the population continues to age and folks who have replacements in their 60s and 70s outlast the implants and need another

Was this the same technology you posted about ages ago?  (I think that was you who posted about some new cartilage technique somewhere)
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 25, 2015, 05:07:45 PM
For sure, I don't want them take out any cartilage that is still strong and valuable. I really don't know if I have softening or a fissure in the cartilage. No one ever told me. All is was said on MRI was 10 mm x 4 mm signal involving less than 50% of cartilage. Whatever that means!
Title: Re: Chondromalacia Patella Pain
Post by: vickster on February 25, 2015, 05:11:26 PM
Why not ask the doctor to clarify?  10mm x 4mm is really a very small area and presumably only through a small % of the cartilage which is reasonably thick (that must be grade 1 on the scale if that)  and given it doesn't affect you a lot, leave well alone.  I thought you'd determined the tendinitis is more like the cause for your issues

I've just had grade 3 shaved on my patella, before the op, I had no from that when bending and straightening.  More from the meniscus and fat pad
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on February 25, 2015, 05:21:33 PM
was willing to get that fixed so there's no more patella popping. Yes, Im focusing on tendinosis PRP treatments coming up very soon. Hopefully that will be done with eventually.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on February 25, 2015, 05:24:15 PM
You might find the PRP or other options help the joint more generally by reducing the inflammation

I certainly wouldn't have major experimental surgery for popping unless it's agony! :)
Title: Re: Chondromalacia Patella Pain
Post by: vickster on February 26, 2015, 09:49:50 PM
As I can't get to see a physio for a couple of weeks, I decided to bite the bullet and get a referral to see a hand specialist next week as it's not getting any better.  I'll let you know what she thinks
Title: Re: Chondromalacia Patella Pain
Post by: vickster on March 04, 2015, 04:29:33 PM
Hand specialist thinks the hand pain is due to ulnar nerve entrapment.  Need to have nerve tests and an MRI to confirm and then determine next steps
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on March 10, 2015, 02:45:48 PM
Hey Vickster,

went yesterday for my PRP meeting with the doc. He did the eco on both patellar tendons, no inflammation or damage detected so I was not accepted for the treatment. He was happy to tell me this as my body is healing well the tendinopathy. He does want to see my MRI results as I forgot to bring them with me to be 100% sure there`s nothing to do but from what he saw tendons look healthy. I will send him my results. I started walking again during lunch hour and he told me to start climbing stairs slowly too to put the tendons under pressure.
Title: Re: Chondromalacia Patella Pain
Post by: vickster on March 10, 2015, 06:14:22 PM
Good news that things are improving and that you've got some advice to keep moving forwards

I'm seeing a new physio tomorrow who specialises in cycling to get me back into proper training (I've done a couple of short runs out, a few weeks ahead of my Easter back on the bike schedule).  I need an all over check

I had the nerve tests on my arm, but still need to have the MRI as I missed my slot due to a hospital mess up  >:(  Then I see the hand specialist again next Wednesday

Onwards and upwards as they say :)
Title: Re: Chondromalacia Patella Pain
Post by: papasmurf1978 on March 20, 2015, 05:21:39 PM
An excellent article for Patellar Tendinosis sufferers:

http://www.runningwritings.com/2011/09/injury-series-tendon-remodeling-part-ii.html

I do have it in both knees and am currently very slowly working with this program. 15 reps once per day on slant board with both knees going down at the same time 60 degrees max down.

I'm wondering though if this is dangerous for chondromalacia knees. Since most of the force is put on patellar tendon can this damage further the patellar cartilage?
Title: Re: Chondromalacia Patella + Patellar Tendinosis
Post by: papasmurf1978 on April 10, 2015, 01:55:09 PM
Wanna give an update on the progress of my knee rehabilitation.

After few weeks of doing the eccentric squats on slant board, am happy to report that the tendinosis pain is practically gone. Science behind this exercise is that loading the tendon with downward motion will realign the fibers which are crosslinked in tendinosis patients. I also feel that knee is tracking better and the tendons are functioning better than before. Must say that my quads are also getting stronger and nicer looking :)

I have literally no more pain around the knee cap as I did before and also I've been removing scar tissues around the patella and above it with friction massage, must say this helps a lot to get rid of the scar tissues. Will continue with the eccentric exercise on daily basis as it only makes your knees stronger if you do it properly. I started really slow, just 5 per day per leg and now I can do easily 15 every day. Will slowly increase the rate.
Title: Re: Chondromalacia Patella + Patellar Tendinosis
Post by: papasmurf1978 on April 24, 2015, 04:54:00 PM
An interesting article about Glucosamine healing powers for damaged cartilage:

http://www.life-enhancement.com/magazine/article/71-glucosamine--an-arthritis-cure

Title: Re: Chondromalacia Patella + Patellar Tendinosis
Post by: vickster on April 24, 2015, 05:00:11 PM
I'd say it's worth a try if not sensitive/allergic to the ingredients but you need to make sure you take the optimal therapeutic dose,  Adding chondroitin  / MSM can also help in the right doses - avoid if problems with seafood (they made me feel sick and I don't usually).  Need to take long-term, but not proven and it's nothing new (that article is from 1997 :) )

Good to read your problems seem to be behind you :)
Title: Re: Chondromalacia Patella + Patellar Tendinosis
Post by: papasmurf1978 on April 24, 2015, 07:27:50 PM
knees are getting better week by week. Really what is hellping me is the eccentric squats for patellar tendinosis and also it's building muscles mass and getting the knees to track properly. Knee stopped popping completely since about a month. No more inflammation.

I'm taking glucosamine chondrontin and MSM every day for two months now and will do so from now on. I'm not allergic to seafood nor I feel discomfort taking it. Let's hope it works in long run.

How is your status these days Vickster?