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Author Topic: What does the grade system mean?  (Read 6729 times)

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Offline eurofrenchie29

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What does the grade system mean?
« on: March 26, 2003, 07:50:05 AM »
I received a letter from my doctor that performed a scope on my knee.  On the letter he mentions phrases like 'Grade lV patellar femoral change' and Grade ll medial tibial plateau change'
He also says "In the patellofemoral joint the groove was normal but there was extensive grades 3 and 4 changes that were debrided down to stable margins.
My question is what does this all mean?
What does the grades mean? High good or bad? Low good or bad? HELP!
Doctor jargon is not my speciality can anyone help me?
From eurofrenchie29  :-[
Osmond Clark Aggravation Test Positive/Gr lV patellar femoral change/Gr ll medial tibial change/Scope in 2002/Future knee replace/Chondromalacia/Cronic Pain/All thanks to falling on some ice.

Offline Shazinoz

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Re: What does the grade system mean?
« Reply #1 on: March 26, 2003, 11:39:01 AM »
In ligaments it is low good high bad (a grade 3 ligament tear is a COMPLETE rupture/tear of the ligament).
I am not sure if the grading is the same for "changes" in bones and cartliage.
Sorry I couldn't be of more help. I am sure someone else will be able to help you.
Sharon
2 ACL 'reco's', 3 'scopes', Pain, JRA, EDS, RSD, CMP, osetochondral defect & #, synovitis, adhesions, nerve damage, foot drop, MCL damage, tendonitis, fibrosis, ligament damage AGAIN, dislocations +++

Offline Janet

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Re: What does the grade system mean?
« Reply #2 on: March 26, 2003, 04:02:10 PM »
I don't have an exact answer for you, but this is my understanding. With cartilege damage, it is graded from 1 to 4, with one being slight damage and four being bone on bone. It sounds like you have quite a bit of damage. I would contact the doctor and ask exactly what this means. It may not cause problems now, but could lead to problems in the future.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline eurofrenchie29

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Re: What does the grade system mean?
« Reply #3 on: March 26, 2003, 07:39:14 PM »
thank you for your input
The doctor basically told me that my knee is really messed up and that I can look forward to full knee replacement surgury in the future.  I asked him about the pain I am experiencing and he said to take advil for the pain but for now there is nothing he can do for me but wait.  My physiotherapist told me to use this ointment called Bells red pepper cream.  Does anyone know if this stuff really works, because I don't want to buy something that costs a lot of money if it won't help.  From Eurofrenchie29 TEXT
Osmond Clark Aggravation Test Positive/Gr lV patellar femoral change/Gr ll medial tibial change/Scope in 2002/Future knee replace/Chondromalacia/Cronic Pain/All thanks to falling on some ice.

Offline Heather M.

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Re: What does the grade system mean?
« Reply #4 on: March 26, 2003, 10:35:49 PM »
Here is an idea of the grading system of chondral damage (the chondral meaning pertaining to the articular cartilage).  Chondromalacia is rated at grades I - IV as Janet said.  After Grade IV, you get into bone, or osteochondral lesions.  It's my understanding these are also graded I-IV depending on how deep into the underlying bone the damage goes.  Once you have osteochondral lesions you are said to have arthritis; chondromalacia is 'pre-arthritic' or early arthritic or whatever.

Here's the scale:

Chondral damage is graded from mild to severe,
and all grades can have characteristics of osteoarthritis.

Grade I - The cartilage "blisters" and becomes soft in the earliest form of damage.

Grade II and III - As the condition worsens, the cartilage may become fibrillated (it has a shredded appearance). The grade of injury depends on the size of the involved area and how much of the cartilage thickness is worn down. Noise as the knee bends, called crepitus, may be present at this stage.

Grade IV - The cartilage may wear away completely, leaving the underlying bone exposed in small or widespread areas. When the involved areas are large, pain usually becomes more severe, causing a limitation in activity.

The good news is that you won't necessarily progress (unless you have mal-tracking that is wearing away the articular cartilage).  The bad news is that I have progressed from Grade IV chondral lesions to Grade II osteochondral lesions in less than 6 months...mechanics are everything!  You need to talk to your doctor about how to prevent further damage, because once you have the lesions the pain isn't going away until the underlying cause is addressed...and maybe not even then.

Heather
« Last Edit: March 26, 2003, 10:36:04 PM by hmaxwell »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline eurofrenchie29

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Re: What does the grade system mean?
« Reply #5 on: March 27, 2003, 04:38:43 PM »
Your letter was very informative, thank you so very much.  I think this web site is amazing.  So many things I have learned just in a few days.  My compliments to it's creator!  The people on this site is very kind.
Osmond Clark Aggravation Test Positive/Gr lV patellar femoral change/Gr ll medial tibial change/Scope in 2002/Future knee replace/Chondromalacia/Cronic Pain/All thanks to falling on some ice.

Offline neil

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Re: What does the grade system mean?
« Reply #6 on: March 28, 2003, 09:28:16 PM »
 i also can not skate any more. but i have hope for a chance. i will be having my cartilage harvested then implanted to replace what i have lost.  i also was told i would need a tkr and as a skater that is not totally bad news. i know some who have had them and gone back to skating.  always believe you will be able to do the things you used to do. good luck
9-13-02 - present, 4 surgeries to right knee. quad severed, piece of femoral condyle cut off, shaving of patella. had cartilage implant 9-22-03, fluid drain, cultures & manipulation10-21-03

Offline eurofrenchie29

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Re: What does the grade system mean?
« Reply #7 on: March 30, 2003, 03:27:49 AM »
Hi there Neil, thank you for your vote of confidence.  I do hope one day I will be able to skate.  It was a passion of mine ever since I was young.  The thing that frustrates me is the lack of activity and the feeling of being held back.  I have always been someone who likes to get up and go, not having anything stand in my way.  I had to quit the gym because I am to avoid too many machines making my membership not worth the money.  I can only walk for so long, cycle for so long before the pain kicks in. AHHHH it stinks!  I am 29 and I feel like I'm 50.  Sorry if I am comming off as someone who is complaining, but it upsets me so much.  I have read a lot of the articles in this forum and it seems like a lot of people share the grief.  In a way, its good to know I'm not alone and that feeling this way is perfectly normal.  I've been doing a lot of yoga to keep my muscles around the area strong, but dammit I miss running:'(
Osmond Clark Aggravation Test Positive/Gr lV patellar femoral change/Gr ll medial tibial change/Scope in 2002/Future knee replace/Chondromalacia/Cronic Pain/All thanks to falling on some ice.