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Author Topic: Chondromalacia patellae worse post ACL repair  (Read 5330 times)

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Offline pleasenofatgut

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Chondromalacia patellae worse post ACL repair
« on: July 31, 2005, 02:34:04 PM »
Hope someone can give me some advice. I'm a 32 yr old male and at the start of last year started getting some discomfort in my kneecap while playing competitive basketball. This didn't stop me playing the following week but did prevent me playing every week. With a week rest it would let me play the next. During the season I started to develop a click at the front of my knee under the kneecap, which was at the point of discomfort. This effectively prevented me playing basketball since. I went and saw an orthopaedic surgeon who confirmed I had a ruptured ACL which to my knowledge was torn 10 years earlier. This tear however wasn't my main concern as the kneecap continued to cause some discomfort. I was booked in for a ACL reconstruction which I had in April and had some small damage to my patellas articular cartilage confirmed. This was shaved clean however 4 months post op have shooting pain far worse than pre-op in my kneecap when leg is flexed beyond 15 degrees whilst weight bearing. This has hindered my rehab post op in my quad development which I am aware is very important in stabilising the knee and I'm working on that as much as I can with no result in response to the pain. I have no discomfort while walking, however have difficulty going down hill and tend to compensate be favoring my good leg. This is the same going down stairs, however dont have pain going up stairs If I take it easy. I have no discomfort in the knee when sitting, laying down, or when pressure is placed on my kneecap by my hand, only during the mentioned activities.
Can anyone give me information in regards to how long  it may take for this discomfort to subside and why is it so much worse than preop, as its been four months since the op. Any suggestions or professional advice would be greatly appreciated. I'm finding it difficult not being able to get around as well as I should.  Thanks, Chris.

Offline Nick_Knack

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Re: Chondromalacia patellae worse post ACL repair
« Reply #1 on: July 31, 2005, 04:08:20 PM »
One explanation is that when your muscles weaken (inevitable after surgery), a greater force is carried by your knee.  When your muscle is built up, it takes a huge load off your knee.  So by working on your quad and hamstring strength this may alleviate your symptoms. 


Did you surgeon tell you why he thinks you devleloped patellar lesions?  Is there some time of mal-tracking going on in your knee or is the patella sitting too close to femur?



-Nick
Age: 35
1989 rt ACL (+25 degrees ext loss)
1994 rt ACL resection (+ 10 deg)
2001 rt ACL revision (+ 10 deg)
2003 rt med meniscus repair (+10 deg)
2004 rt LOA and post capsulotmy (zero degrees)
2005 rt LOA and tib bone plug removal (even w/ other leg)
2006 rt Fulkerson TTT & ACI Carticel

Offline pleasenofatgut

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Re: Chondromalacia patellae worse post ACL repair
« Reply #2 on: August 01, 2005, 05:42:39 AM »
Thanks Nick for the reply. I saw my os 3 weeks ago and he thinks that a ct of my knee may be necessary to see if the alignment is correct. I did have my medial and lateral meniscus trimmed during my op and I wondered if any inflamation still present from the meniscus or from the surgical trauma could cause the chondromalacia to play up? Its only a stab in the dark, but by now I'm getting a bit annoyed with the bloody thing. I dont fancy lateral releases or any surgical intervention that seems to rarely have a happy outcome. Any explanation or suggestion is appreciated. Would icing it help and if so how often? I'd do it twice a day if I new it would help. I've also just started taking glucosamine supplements in an effort to help it subside. We'll see how that goes. Anyway any suggestions Nick, or anyone else, would be hugely appreciated. Thanks, Chris

Offline RN2BNVA

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Re: Chondromalacia patellae worse post ACL repair
« Reply #3 on: August 01, 2005, 01:41:40 PM »
Let's see if I can do this without making it sound like I am bearer of bad news... just remember each case is different just as each person is different...

I had ACL reconstruction 9/04. Everything was going pretty well. I had some pretty severe medial knee pain that was present to a degree pre-op but the post-op pain was different. PT was going right on track and I was progressing at a steady pace. As more activity was added I found that I could do less of it without being in severe pain. Back to the OS who told me to back off PT and try to calm the knee down. Fast forward 3 mos of not being able to do anything and I had another scope performed because the MRI showed an ACL impingement.

Scope showed considerable amount of damage to the kneecap (chondromalacia) so my surgeon smoothed it out and cleaned up everything else in the knee. He assured me that this would fix my medial knee pain and told me that in MANY cases of ACL reconstruction people experience chondromalacia because the knee is pushed so hard in PT to redevelop the muscle. He basically told me that now that the joint surfaces were once again smooth life would be grand. WRONG... the medial knee pain continued. I finally sought out another OS and saphenous nerve damage was discovered. The treatment of that greatly decreased the medial knee pain but I still could not bend, do stairs, etc without wanting to cry. I honestly did stairs with my "good" leg and dragged the other one behind me because it was that painful. Thankfully, this surgeon has worked with knees for years and was not scared to make the diganoses of a subluxing patella (I had the problem previously corrected)... Tried PT in a modified version to try to not to mess with the PFS but was not successful in helping the subluxing... so tomorrow morning I will have a TTT done.

In my case it was pretty severe and had gone undiagnosed for a while (even after I asked the first OS about the problem... I was told "that has already been corrected" and nothing more.) Reconstructing the ACL tightened the joint up just enough for the problem to really bug me again (I had partially <75% tear of my ACL less than 6 mos after my first patellar realignment) and hence the minimal joint damage in the almost 10 years between the surgeries. The ACL rehab then brought the problem even more into focus.

On the plus side I now have an OS that is awesome with knees and has an outstanding reputation and success rate. He is confident enough to attempt to do the TTT tomorrow even though he has warned me that this may not be a pretty surgery and is considered a revision even though nothing has been done to the TT previously.

Hopefully, your knee is just reacting to the intense PT and muscle weakness of the quads. From what I have read and learned a vast majority of people who experience misalignment are able to correct it with adequate muscle development and the pain will resolve over time.

Good luck with your recovery!
Alnee
*May 95-- Roux-Goldthwait & lateral release
*Dec 95-- Chondroplasty, Synovial tissue removal,partial ACL tear
*Sept 04-ACL reconstruction w/allograft
*Mar 05-Chondroplasty of kneecap/Chondromalacia
*Saphenous neuroma
*Chronic PFS
*Aug 2nd 2005 Fulkerson TTT

Offline pleasenofatgut

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Re: Chondromalacia patellae worse post ACL repair
« Reply #4 on: August 02, 2005, 02:24:11 PM »
Thanks Alnee, I'll keep working on the quads and hammies and fingers crossed. Thanks, Chris.