Advertisement - Hide this advert





Author Topic: Grade 3 chondromalacia  (Read 3052 times)

0 Members and 1 Guest are viewing this topic.

Offline walkinboss

  • MICROgeek (<20 posts)
  • *
  • Posts: 4
  • Liked: 0
Grade 3 chondromalacia
« on: May 18, 2005, 09:34:47 PM »
52 y/o male. 24+ years in U.S. Army.  Thousands (and I mean thousands) of miles running in formation on asphalt with steel shanked jungle boots.  More than one too many slides into second base I'd imagine too.

Have had 2 orthos on each knee and both diagnosed with grade 3 chondromalacia.  That was in 1990 and I've got several thousand more miles on them by now. 

Which is worse, grade 1,2, 3 or 4?  Not sure what "grade" I would be in/at right now, but I know both knees are definitely worse now than in 1990.

Have bi-lateral MRI's scheduled for tomorrow.  Any thing I should ask my doctor when I go back after the readings?  Any"buzz words" I should be listening for or asking about?

Any/all help or advise is greatly appreciated.

tks,
Lee



Offline blackbeltgirl

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1372
  • Liked: 0
Re: Grade 3 chondromalacia
« Reply #1 on: May 18, 2005, 09:42:04 PM »
Chondromalacia is graded on a 1-4 scale.  1 means softening of cartilage, 2 means some frayed edges, 3 is "crabmeat", 4 is down to bone.  If you were at grade 3 in 1990, you've probably hit bone by now, and may even have started to wear on the bone itself.

Depending on how widespread the damage is, your options go from a series of injections to total knee replacement.  There are several stops in between. 

Questions/comments to think about: is it focal damage (meaning a pothole, vs. the entire surface is damaged)?  If it's focal, the options include microfracture, OATS, cadaver allograft, and ACI.  If the entire surface is damaged the options may include synvisc injections and tkr.  Probably some others, but I'm less familiar with that situation.

What can you do, without surgery, to help the knees?  Any supplements (glucoasmine condroitin, msm)?  Will strengthening specific muscles help?  Lots of people have strong muscles, but if they're not balanced, they could actually be pulling things off track.  Do you have any alignment issues?  PT sometimes can help (if there's a muscle imbalance).  Otherwise, if they're talking surgery, they need to do a re-alignment procedure along with a cartilage repair procedure.

That's all I can think of at the moment.  There is a reference on the home page of this website to a book by Dr. Gresalmer.  The book  basically says that MRIs are notoriously ineffective.  They are particularly bad at viewing/diagnosing articular cartilage issues.  Be sure your OS looks at the films himself and doesn't just read the report from radiology.

Good luck.
Jess
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline walkinboss

  • MICROgeek (<20 posts)
  • *
  • Posts: 4
  • Liked: 0
Re: Grade 3 chondromalacia
« Reply #2 on: May 18, 2005, 09:54:58 PM »
Been sitting here trying to remember all the medical terms in the surgical reports. I remember words like "debrided" and meniscus flaps/tears.  Doc told me I was pretty much bone on bone back then.  Don't remember any tracking issues though.  They (both knees) pop like bubble wrap when I squat.  If I sit in/on the floor I have to go to my knees and then pull up to get off the floor they hurt so bad.

I broke my right ankle realy bad (11 places) 6 years ago and wound up having it fused in July of '03. Because I don't have much flex in my right ankle my left leg/knee winds up doing most of the step ups/downs.

Took the glucosamine(s) and most other supplements without success.  Had several injections in each about 4 years ago.  Not real happy with the results I got when I had the "syn-visc" injected into my right ankle.  That was an expensive and painfull 6 weeks.

Any idea which (if any) of the prosthetics are the best and recovery time?  I can't go back to work on crutches.  I work at a prison and have to be "medically cleared" to go back to work.

Lee


Offline blackbeltgirl

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1372
  • Liked: 0
Re: Grade 3 chondromalacia
« Reply #3 on: May 19, 2005, 12:54:25 PM »
I haven't got a clue about the prosthetics.  I'm trying my best to avoid needing such a thing.  There is a board at the bottom of the arthritis section for total knee replacements, and another for partial knee replacements.  You may want to check out some of the threads there.

From what you do know, it sounds like a tkr may be in your future.  The good news is that the tkr is often a more rapid recovery than some of the cartilage replacement procedures, and many people are thrilled to have made the decision.

Good luck with everything.
Jess
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline walkinboss

  • MICROgeek (<20 posts)
  • *
  • Posts: 4
  • Liked: 0
Re: Grade 3 chondromalacia
« Reply #4 on: May 20, 2005, 02:20:20 AM »
Thanks Jess.

I was able to take a look at a few of the "still shots" of my left knee before I left the MRI Center this evening.  Not sure what I was looking at, but the tech said it was "less than good"!

will know the final "reading" next Wed afternoon.

Lee




Offline blackbeltgirl

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1372
  • Liked: 0
Re: Grade 3 chondromalacia
« Reply #5 on: May 22, 2005, 11:19:40 PM »
Lee-

Good luck with your follow-up appointment.  I actually carried my MRI films out of the center, and sat down for at least an hour pretending i had a clue what I was looking at.  I had done some research online, and "knew" what it was supposed to look like, but it's pretty hard for us novices to draw anything from those pictures.  And again - the MRI is pretty useless for diagnosing the issues with articular cartilage.  Did your OS take any X-rays?  Considering the level of damage you had in 1990, I would expect standing x-rays to be the first order of business.  It's the preferred way to identify "narrowing of joint space" or really bad arthritis.

The synvisc injections seem to get a pretty mixed review on the boards.  I guess if they work for you, the pain and cost of the injections are well worth it.  But not everyone gets releif.  But apparently not everyone responds to cortizone shots, and they have saved my sanity on more than 1 occasion.  I get full releif within hours... The glucoasimine also seems to  be a tricky thing.  Since it's supposed to strengthen the cartilage, if you don't have any, it won't be able to help you.  I've never found any pain releif from it, but I keep on taking it.  I tell myself I would be deteriorating at a faster rate without it.  Don't know if it's true, but since it can't hurt, and it can help, I 'll keep popping the pills.

ANy chance you can get ahold of your medical records from 1990?  You seemed tor emember a lot, but previous work can also look like new damage on MRIs.  I actually had to call my mother, to get the name of the OS I saw as a teenager, and ended up calling the hospital where I'd had knee surgery at 17, to get records for my current OS.  I remembered what had been done, but I didn't remember which meniscus had been trimmed, etc.  It took a couple of weeks, but he claimed it helped him read the MRI with more accuracy.  (That said, the MRI barely hinted at the damage to the articular cartilage, and it was pretty significant.)

Anway, wishing you luck.
Jess
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)















support