Banner - Hide this banner





Author Topic: Anyone have Chondral Defect in Trochelear Groove, Help???  (Read 35766 times)

0 Members and 1 Guest are viewing this topic.

Offline Shine

  • Forum Faithful
  • ****
  • Posts: 238
  • Liked: 0
Anyone have Chondral Defect in Trochelear Groove, Help???
« on: May 17, 2008, 07:39:13 PM »
Hi All,
I have a chondrol defect in my Trochelear Groove in the area directly underneath the patella. I also have very very weak quad muscles because it has been about 1 1/2 year since I have been able to use them properly. (I had tons of scar tissue and like many others on this board have had to fight with this problem) I just tryed the Synvisc injections, which helped with the pain. However, if I sit in a chair at 90 degrees I get alot of pain still. My next option at this point is to try to strengthen my quads and see if that helps. If not the Dr. is suggesting a microfracture.

My question is has anyone had this type of defect and been able to conquer it with more muscle? Also do people have these defects and sometimes have no or little pain. Thanks for your help! Summer

Offline willp

  • Forum Faithful
  • ****
  • *
  • Posts: 196
  • Liked: 1
Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #1 on: June 05, 2008, 03:38:48 PM »
Hi Summer,

You might want to contact JoeW on the AF board. He has a chondral defect in the trochlea groove, and recently had surgery for scar tissue.

Good luck - hope this helps.

Will
Medial plica removal 4/12/06. Not referred to PT. Increasing pain and quad weakness. Diagnosed with scar tissue by Dr Steadman 10/12/06, LOA and AIR in Vail 12/15/06. Returned to high level activities 4 14 years.
2020 - flare up with medial joint line pain and occasional collapse. Currently baffled

Offline Shine

  • Forum Faithful
  • ****
  • Posts: 238
  • Liked: 0
Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #2 on: June 05, 2008, 08:22:49 PM »
Hi Will,
Thanks so much for the info. How are you doing? -Summer

Offline chrisMancini

  • Regular Poster
  • ***
  • Posts: 135
  • Liked: 0
Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #3 on: October 10, 2008, 06:07:28 AM »
Hi Summer,
I have a Trochlear defect underneath my patella. Mine is particuliarly painful after sitting for a peroiod of time and also when I clomb up and down the stairs. Unfortunately for my knee is the fact that I have little or no medial menisocus. So I am actually headed of to a knee replacement..this coming wenesday..15 oct. My OS offered me just the PFJ replacement, but I do not have enough confidence in my knee...apparently alot of folks who do the trochlea replacement are back for a TKA soon after.
I am not sure if build quads will help you overcome the pain, but more muscle never hurts. The patella see some pretty crazy forces when it is gliding over the femor...
I hope you are feeling better...
chris
Lt knee Meniscou  6/07
Lt Knee Plica rem 10/07
Rt Knee Meniscous  12/07
Lt TKA 5/08/2008
 Rt TKA 10/15/2008

Offline heather rae

  • SuperKNEEgeek
  • *****
  • Posts: 739
  • Liked: 0
  • Will power....tell the pomeranian to MUSH!
Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #4 on: October 10, 2008, 03:58:42 PM »
Hey all!!  ;D

Not sure how this ended up on a RA post but, that's ok. I have a question about that if anyone does have it. I'll post back with it, if so. It's about my teenage kid.

So, I've damaged my trochlear grove in the trauma that my knee sustained in fracturing the patella. Guess it was pretty nasty. Chris, what prompted your doc to do the PFJR? Mine said that would be a workable solution but, he feels I'm too young for it in my 30's. He's referred me to a soft tissue OS who specializes in PF problems. I also have lateral maltracking, too!  :P

I've been trying to rebuild this leg in PT since 7/07. UGH! That quads are quite difficult if I must say so. I guess you can only get so far with PT when things are screwed up inside.

Good luck with your upcoming surgery!! Hope it goes well and you can get some relief now. Don't feel bad, I have the same problems with sitting, standing still, stairs, exercises, walking more than 20 min. or so, etc, etc. Not sure if deep squats, kneeling, jumping, or running will ever be back. Please post back when you get a minute ok? I'm very curious about how you ended up needing this and what other options may be available. My OS think OATS or equiv. will be offered but, I don't think that's successful in the PF compartment. Take care!!  ;D

Heather
5/10/07- Comminuted-20 frag., displaced L patella Fx
5/15/07- ORIF L patella, Bledsoe brace, crutches
7/07- PT 3X/week
8/07- Brace off, ambulate without crutches
9/27/07- Hardware removal, MUA, crutches x 8 wks 
6/08- J-brace for lateral maltracking, Cont. PT
8/08- Referred to soft tissue OS

Offline chrisMancini

  • Regular Poster
  • ***
  • Posts: 135
  • Liked: 0
Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #5 on: October 10, 2008, 05:54:36 PM »
Hi Heather,

My OS first recomended a Trochleaplasty, replacement of the PFJ. But after my research here on this board and others, I have discovered that rehabbing from the PFJ Replacement is lengthy and painful. Not that TKA isn't. Alot of the people I spoke to had to have their Knee replaced withing a short peirod of time anywhow. I am sick of surgeries and felt with meniscous problems I would be headed there soon anyway, so why waste the $$ on doing it partially and then 6 mos down the line doing it fully. My PFJ has no articuliar carltidge left and it is patella on femor, bone to bone. TKA is accepted as treatment for a abnormal PFJ. Ultimatley it will be your choice Heather, and I say if you quality of life is diminished, than it does not matter how old you are...of course 20's and below I would think seriously about the whole thing. But for me, tommorow is not a guarantee....so why live todayn with such pain that I cannot think about today....:)
Hope this helps, if you need to chat some more, I have a pre op/post op diary started..or you can message me...

Thanks

chris
Lt knee Meniscou  6/07
Lt Knee Plica rem 10/07
Rt Knee Meniscous  12/07
Lt TKA 5/08/2008
 Rt TKA 10/15/2008

Offline Shine

  • Forum Faithful
  • ****
  • Posts: 238
  • Liked: 0
Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #6 on: October 10, 2008, 09:23:37 PM »
Hi Chris and Heather,
Thank you for your response Chris. Good luck on the knee replacement. I've actually met quite of few people lately that say that they feel so much better afterward. I hope you get this kind of relief. Heather, have you tried the Synvisc? For me a combination of the Synvisc and building up my quads has worked. The only thing I can't do yet is climbing downstairs. I have been working on building up my quads since May of 08. Still, I cannot do deep squats and the OS has forbid me from doing this, says its bad for the knee. But for the most part I can walk, stand and sit without pain. I'm telling you gaining my strength made me go from really bad pain to almost no pain.

I am also in my 30's so I think for us its about prolonging our knee. The bike has helped build up my quad as well as limited range squats, wallsits. Getting my glutes more strong has seemed to help me alot too.  I would have to agree with you that it is tough to build  up quads especially when you can't do alot of exercises. Take Care, Summer

Offline Shine

  • Forum Faithful
  • ****
  • Posts: 238
  • Liked: 0
Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #7 on: October 10, 2008, 09:27:30 PM »
Oh yeah, I forgot to mention it really hurts before rain storms. My knee can predict the weather:(

Offline heather rae

  • SuperKNEEgeek
  • *****
  • Posts: 739
  • Liked: 0
  • Will power....tell the pomeranian to MUSH!
Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #8 on: October 11, 2008, 02:15:58 PM »
Summer:

My OS said he didn't think the injections would offer me much relief so, he is reluctant to do them. I have posted to folks about it and the answers I've received back said that if the lesions are deep, they injections won't work. He did say that it was chewed up pretty bad in the grove. Then, the patella shattering into so many fragments most likely shredded that cartilage to bits, too. It does feel like things as rubbing together back there. The grating is painfully sickening.

I can't really say I'm a true barometer yet, LOL!~  ;D My knee hurts all the time so, it would be tough to decipher when rain is coming. I can say that over-use make it MUCH worse, though. Last winter, the brisk cold was like ice-picks hitting it. EW!!! That sucked.

I've finally been told what the hold up is in getting my quads back, though. The PT says the knee is the lever to the quads. If there are articulation problems then, everything is off. Makes sense because I can't FEEL anything working in the quad area on exercises, especially the leg press. I only feel knee pain. So, I tried a few reps with the uninjured leg, OK, so that's how it SHOULD feel. So, the PT says the problems need to be surgically corrected before I can do much more for the quads.

Well, my exercise regimen has become more of a workout over time. Until recently, it was about an hours worth of really difficult things. I've been in PT for 15 months straight now. I am now back to aquatics in a structured class. The pain is much better in the pool. I'll be seeing the new OS soon and we'll see what he has to say. I do think he'll continue with it, though.

I've had a few things banned because of the patellofemoral problems, too. The bike, leg extensions, deep squats, kneeling, jumping, running. The last 4 of those I couldn't do if you paid me to. Stairs are manageable with railings but painful and quite awkward, not very safe. Standing still and sitting for any length of time are VERY bad. Walking is ok for up to an hour in the store with the J brace on but, it hurts too. It's great to hear that you don't have difficulty with that.

So, I'm curious what happened to you to weaken your quads. Were you injured? Well, I can't kid ya and say I haven't made any progress. I had complete quad shut-down and couldn't even pick up my leg last summer. My leg had also atrophied to the size of my arm during immobilization so, I've come a long way. How long is the doc giving you in PT before any surgery? Take care and hope to hear from you soon!  ;D

Heather
5/10/07- Comminuted-20 frag., displaced L patella Fx
5/15/07- ORIF L patella, Bledsoe brace, crutches
7/07- PT 3X/week
8/07- Brace off, ambulate without crutches
9/27/07- Hardware removal, MUA, crutches x 8 wks 
6/08- J-brace for lateral maltracking, Cont. PT
8/08- Referred to soft tissue OS

Offline Shine

  • Forum Faithful
  • ****
  • Posts: 238
  • Liked: 0
Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #9 on: October 12, 2008, 01:20:58 AM »
Hi Heather,
I orginally had a patella break. Then couldnt bend so the Dr did an MUA. After a year of having alot of pain and trying to rehab with little muscle growth I decided to get another opinion. I flew to Dr. Steadman, an AF specialist. During the MUA the OS tore all the cartielede in the trochelear groove. i have grade 4 damage. He also caused a full thickness defect in the trochelear groove   and grade 4 damage behind the patella. My quads got so weak cause of the pain and swelling I had. no matter what I did they would not come back. I would never even get exercise soreness in the quad. However, after my surgery with the AF specialist I have been gaining back muscle. The AF speiciaslit said since my knee was in such bad condition thats why it wouldnt grow back.

After his surgery though i have had to work really hard to get my quads to work. One of the things that has worked for me is thinking about the quad working when doing everything. It was something one of the pts told me and it has worked. And by everything I mean everything. When walking around in the house to running errands to exercising. Also, have you tried tapping your quad when working out. It can get it firing better. I know exactly what you mean about not feeling you quad as much as the good side. Even though I feel my quad better than before it still is not the same. Do you have alot of swelling? This can inhibit quads as well.I can't believe you quad atrophied to the size of your arm. That is tiny. At this point the OS believes I have dodged a microfrature as long as I am not in pain. Hopefully, it will stay this way. What type of surgery does the Dr. want to do on you? Does your insurance cover the Synvisc? If so, it might be worth it. If it doesn't the shots are expensive. Mine covered it so it was worth a try. But I think what has helped me more than the shots has been gaining muscle. Gosh, I do know about being limited though in trying to gain it back. Makes it much harder when you can't squat deep. Talk to you soon! Summer

Offline heather rae

  • SuperKNEEgeek
  • *****
  • Posts: 739
  • Liked: 0
  • Will power....tell the pomeranian to MUSH!
Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #10 on: October 12, 2008, 03:51:59 PM »
Summer:

Ahh, so you're another one of us fracture folks, I get it now!  ;) Good golly it sure is nasty rehabbing, isn't it?  >:( Did ya check out how many fragments I busted mine into? My OR reports about the OS cutting the medial retinaculum open and fishing around the knee for pieces of bone was just gross!! It really was a hit or miss save and, thankfully my OS's skill saved it. He was sure nervous until we finally got the x-ray that said "healed". Whew! So, what was yours like? You're really lucky to have so little pain now, too!!  ;D

I'm glad you went to Dr. Steadman, he's recommended on this website!! Fortunately, the one I'll be seeing soon is too. My OS mainly does knee/hip replacements and fracture repairs. Dr. Wojtys, he says, is the soft tissue guru and is better equiped to deal with the problems at hand now. My doc told me exactly what to expect so, I'm not in the dark about it and trying to psych myself up for this. He said not to expect an MRI, it won't give enough info behind the patella. And to expect 2 surgeries. 1- scoping to get a view of how the cartilage looks, debridement, and a LR. 2- cartilage repair. He said the PFJR would be a good solution but, I'm too young. With grade 4 damage, I'm kinda surprised that hasn't been mentioned for you.

How's your swelling now? Mine has finally settled from a constant bowling ball status to an odd shaped knee now. It's definitely bigger than the other one. The swelling comes and goes and is mainly just above the knee. It's poufy up there. The medial condyle is quite a bit bigger than normal, too.

Well, the quads are a little better than they were. I can still feel the femur from the hip down to my knee, though. They've never taped my thigh. Maybe I'll try that and see what happens. How do you place the tape? I'm going to ask about wearing ankle weights for the water PT, too. It might help.  ;)

So, do you have alot of coarse grating behind your kneecap, too? Happens everytime I bend mine. It's NASTY and it really hurts. That achy pressure keeps me up at night quite a bit, too. I still sleep with a pillow under it and if I lose it the pain wakes me up. I am going to ask the new OS about Synvisc and see what he thinks. My insurance has been wonderful to cover everything at 100%. I'm lucky on that one. Actually, my auto insurance will pay for a lifetime on my knee now. So, I'm curious if your kneecap jumps the track, too? Mine maltracks to the lateral side all the time and I just push it back in place. Fortunately, it doesn't completely dislocate!!  :o

Well, I hope you can continue to dodge surgery. Sounds like you've been lucky! If sawbones comes after me again, I'll be running in the other direction, too. LOL! I told my PT I would go to summer school PT, do extra-credit and make up days to avoid the scalpel again. He said, Keep dreamin' you don't have a choice, if you want the pain to get better!! Think I'd take the shots without question and be on my merry way, though. Take care and I'll chat with ya later!  ;D

Heather
5/10/07- Comminuted-20 frag., displaced L patella Fx
5/15/07- ORIF L patella, Bledsoe brace, crutches
7/07- PT 3X/week
8/07- Brace off, ambulate without crutches
9/27/07- Hardware removal, MUA, crutches x 8 wks 
6/08- J-brace for lateral maltracking, Cont. PT
8/08- Referred to soft tissue OS

Offline Shine

  • Forum Faithful
  • ****
  • Posts: 238
  • Liked: 0
Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #11 on: October 13, 2008, 12:46:22 AM »
Hi Heather,
Seems as though we have similar knees. Mine grates alot, but it doesn't hurt. Mine used to track laterally and is very hypermobile to begin with. It is tracking better now that I have gotten some quads back. It used to totally move to the side but now it moves better.  My knee is still a little swollen and doesn't seem to get smaller as time goes on. Maybe its cause of the arthritis? The debridement might help you. When Dr. Steadman did my knee he removed all the scar tissue and also did a chondroplasty. Some other OS told me that provides relief for about 80% of patients. (but its another Dr. and not Dr. Steadman that said that) so I don't know how much I trust the opinion. Wow your break sounds really bad. Mine was only one piece that broke of medially underneath the patella. I haven't taped so not sure how to do it. Where is the speicalist you are going to see located? I guess I have been lucky but also not. After most of my knee issues have gone I have had continual calf pain which no one knows what it is. My nerve test normal. MRI's have been normal. So the guesstimated theory at this point is it is my tendons and it is an over use thing. I have been getting PRP injections and it seems to be helpful but it is still now where near a liveable situation. So who knows what next? Uhhhh, isn't it just so tiring to be in constant pain? When r u going to go see the specialist? Hope the speicalist can help. I'm sure they will figure something out for you. Take Care, Summer

Offline heather rae

  • SuperKNEEgeek
  • *****
  • Posts: 739
  • Liked: 0
  • Will power....tell the pomeranian to MUSH!
Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #12 on: October 13, 2008, 02:02:26 AM »
Summer:  ;D

It seems we do have similar co-injuries with our fractures, right down to the maltracking. That wasn't really an issue until I started to ditch some of the swelling and had more ROM back. I was injured in May 2007 and, the PT actually diagnosed the maltracking and put me in a lateral J brace in May 2008. Isn't that a strange sensation when it pops back in the grove? Feels almost like a fracture with bone fragments hitting together.

I think the only difference is that my kneecap barely moves in any direction with mobes. It's really tight but jumps to the side when I'm bent more than maybe 60 degrees or so. Was yours always that loose?
There is a big difference with how much the good one will go, though.

So, how did you break your patella? Did you have an ORIF, too? Mine kissed the dashboard and broke it, too. Think I won that battle, though.  ;) I was in some really nasty fog on my way to work. It wasn't even daylight yet and I missed the end of my road and nose dived into the grand canyon of all ditches around here.

I'm wondering if your calf pain is caused from the muscle itself. If you had any significant atrophy or even prolonged limping, trigger spots can build up. My PT showed me that, Ouch that did really smart!! He just likes to torture me, LOL! He also proved that it didn't hurt when he push on my good leg, though. I went to a LMT for about 6 weeks and I just couldn't take it any longer. Think I need some decent muscle mass back first. Hope the PRP injections start to kick in soon but, have you considered massage therapy? It might be a good addition to what you're already doing now.  ;)

So, you've already been in the direction I'm headed with the debridement and chondroplasty. Is that when you noticed the pain to start improving? Did the grating hurt before that? I've been diagnosed with patellofemoral arthritis ALREADY so, I'm hoping for a miracle.

The new OS (Dr. W) is thankfully only an hour from here at Univ. of Michigan hospital. I will see him on Oct. 21st. Yes, the daily pain is wearing my nerves thin at this point. I push it and I end up suffering for it. So, I really hope this doc has the ticket to get me out of this. I did try the bike again today. Shh! Don't tell my PT LOL! I did it!! Yay! Think I managed about a half a mile before I had to call it quits. The knee pain does stop me before the leg fatigue does now. Is that bad news? It's so good to hear someone having gone through this and able to walk without pain now. That's music to my ears!  ;D

Take care and I'll chat with ya soon!

Heather  ;D
5/10/07- Comminuted-20 frag., displaced L patella Fx
5/15/07- ORIF L patella, Bledsoe brace, crutches
7/07- PT 3X/week
8/07- Brace off, ambulate without crutches
9/27/07- Hardware removal, MUA, crutches x 8 wks 
6/08- J-brace for lateral maltracking, Cont. PT
8/08- Referred to soft tissue OS

Offline Shine

  • Forum Faithful
  • ****
  • Posts: 238
  • Liked: 0
Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #13 on: October 13, 2008, 04:52:19 AM »
Hi Heather,
Yeah both my knees are hypermobile. The reason for my patella break was the fact that it dislocated and broke. I only started feeling better after the debridement/chondroplasty and scar tissue removal. Prior to that I was in hurendous pain for a year. Part of my issues were from the scar tissue and the other was from the cartiledge. I felt great immediately after surgery. However, that quickly went downhill. I thats when the Dr. decided to give me Synvisc. It was still hurting after that and he pretty much told me that he wants to see if I can strengthen it engough within 6 weeks and lessen then pain. If so, no microfrature. However, if that didn't work he said most likely I would have to get a microfrature. So I worked hard for 6 wks and within the first couple weeks of strength training I started noticing a difference in the pain. By the time the 6 wk mark came I barely had pain. But then thats when I started noticing the calf pain. After that point, I have been strengthening and I noticed the stronger I get the less it hurts. Yeah I have been doing message therapy as well. It seems the message does help for a 24hr period or so and then the pain comes back. I have so many trigger points in my calf. You are right I do think its partially from not walking properly before. I think the other half is a tendon thing. And the knots coupled with the tendon thing causes 24hr pain. UHH!  You are lucky he is only an hour away thats good. So are you going to go for the surgery if he says it will help?

Offline heather rae

  • SuperKNEEgeek
  • *****
  • Posts: 739
  • Liked: 0
  • Will power....tell the pomeranian to MUSH!
Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #14 on: October 13, 2008, 02:03:17 PM »
Hi Summer:  8)

Love your name, it's my fave season! I really wanted to name my daughter Summer but, my hubby didn't agree. So, we settled on Miranda instead.  ;)

So, is there is risk of dislocating and having yet another fracture with you now? Gosh, that's really scary!! Do you wear any kind of knee braces? Hopefully strengthening your quads will work and keep them in place better. Fingers crossed for you!  ;D PT is usually the first line of treatment after most injuries. How's your IT bands?

Not sure if it's because I've already had 2 open surgeries but, it seems to be taking me FOREVER to rebuild the leg. My doc is pretty pleased about the progress I've made in strength over 15 months. To me, it should be much better in working my guts out. I can push 95 lbs on the leg press with my good leg as opposed to about 25 lbs with the injured one. BTW: the leg curl and heel raises causes alot of calf pain for me, too. When all else fails, a soak in a hot bath can sooth those tight painful muscles. Yay! ;) I have a preference to the hot tub as long as I remember to ice my knee after it!!

Are you doing any kind of walking regimen? I've been at it for about 4 months now and can push about 1/2 mile before the knee pain sits me down. Got a bit overzealous one day and tried to go a bit further. Not good, I was down for 3 days and missed PT because of it.  :-\ It's a very s-l-o-w thing to advance, too!

Someone else with grade 4 lesions told me the same thing after her debridement/chondroplasty. I think the plan was to try annual cleanup procedures until she would eventually need a PFJR. I'm sooo sorry that you only had such short-lived relief. Why is that? Seems my doc may have been right about the Synvisc not working for deep lesions though. Glad the 6 wks of work seemed to pay off for you, though. Maybe the calf is just being a bit more stubborn? How's the muscle tone/strength, is it equal with the other leg yet? Keep up the good work in dodging that microfracture!!  ;)

Well, I am hoping that the new doc has some really good solutions for me. U of M has a great rep in being up with the best of care out there. I definitely don't want to be a trial/error patient so, if the doc has a surgical solution I'll want the %'s, ya know? Soo many people go in/out of surgery until they finally get it right. Less is more in my book. I'm not looking forward to the 21st, though! Yikes!!

Hope you stay on the "up" with things and the calf starts to improve very soon! Chat with ya later!!

Heather
5/10/07- Comminuted-20 frag., displaced L patella Fx
5/15/07- ORIF L patella, Bledsoe brace, crutches
7/07- PT 3X/week
8/07- Brace off, ambulate without crutches
9/27/07- Hardware removal, MUA, crutches x 8 wks 
6/08- J-brace for lateral maltracking, Cont. PT
8/08- Referred to soft tissue OS