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Author Topic: Anyone have Chondral Defect in Trochelear Groove, Help???  (Read 35765 times)

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Offline Shine

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

Offline Shine

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #15 on: October 13, 2008, 08:42:55 PM »
Hey Heather,
As far as the Synvisc and the 6 wks strength thing. The Synvisc was still in the period where you have to wait for it to start working. So it could be a combo of the Synvisc and the strength that worked. That is the thought of the pt's.  Yeah probably cause of the two open surgeries it is taking so long for you. Also, it could be if your knee is in pain and has alot of debride floating around. Also, you had a pretty bad patella break.:(

The day after my debridement/scar tissue surgery I started pt and started off course with easy things like straight leg raises. Guess what? I was exercise, the good kind of sore on my quads for the first time in the whole year. I could feel the quads working and the next morning I was exercise sore.  Ironic that I was sore with such an easy thing, when I had been doing squats the week before. Also, I would feel my quad working when doing something easy like riding the bike on 0 resistence. The quads started progressing alot quicker after the debridement/scar tissue removal so hopefully this will happen for you. There is a strength discrepency on quad, hamstring, calf, and glute strength on both sides. With the biggest discrepency being in the quad and calf. The calf because I haven't been able to work it cause of pain. Also, I am still very hamstring dominant and can't feel my quad as much on the badside. i guess I picked up really bad behaviors last year and started compensating with my hamstring. But it is getting better with time. The leg press hurts me when I do it. Does it hurt you? Which one are you doing? The sittiing or laying down one?

 I wanted to start a walking regimen on the treadmill but don't do it that much cause it makes my calf hurt. What I am doing is walking forward, backward, and sideways on the treadmill 5 mins each direction. Backward walking is good for the quad without the impact of squats. The sideways is good for the glutes.  Oh yeah I forgot to mention I had a lateral release done with the orginal surgery. Hopefully, my knee wont dislocate.  Hows your IT band? My IT band on the bad side is sore. Uh the calf is still really bad. What to do who knows? But it hurts right at the hamstring attachments on the calf. Have a good day! Summer

Offline heather rae

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #16 on: October 14, 2008, 03:11:31 AM »
Summer:  :)

Wow! I have that same muscle mass/tone/strength deficit from the glutes to the ankle. The entire thing was nothing but skin hanging around the bone when I started, though. It was pretty disgusting. Sounds like you and I share the same PT, LOL!  ;D My land-based regimen included the treadmill in all directions, too. I walk backwards on an incline. I do hold on but, the PT said that's ok. Now I just walk backwards in the pool. Think it's even more of a challenge!   :P

So, I KNEW it! It's possible for the rest of the leg to compensate for the quads. I've been saying that for months. The PT has never outright agreed with it, though. When he had me doing the board push exercise, I only felt the muscles in my good leg working. He did say I was compensating on that one, though. Nonetheless, I can't MAKE my other muscles stop working for the quads. It most likely is the pain that hinders them. You're right about that!!  ;) Thanks, I do hope the clean-up is offered to help move mine along, too. The leg press is the Cybex reclining one. Yes, it does hurt. Sometimes I haven't been able to even do it.  :(

Well, as a general rule, the PT has me withold any exercise that causes pain over a 5 on the scale. Short arc quads and heel touches off a 2 inch board have been the WORST by far. For the most part, I have pain to some degree with everything, though. Even standing still in the pool, while the joint forces are unloaded, I have some pain. It's better than 6 months ago, I'll agree. Mild at rest (unless I've over-done it) and moderate with increasing intensity, it can still get quite bad, with exercise.

So, I have a few questions for you. Do you still have REALLY bad end-range pain with flexion? How about while doing a SLR sitting in a chair? I'm not sure how significant this is but, it's not getting better with time. How would a LR work on someone with a really tight kneecap that maltracks? The PT and OS have both said I need it so, I hope it works. Fingers crossed for you on success with yours, too!! Did it hurt?

About the calf pain you're having, is it stemming from the popliteal tendon? Has the PT said it's tendonitis? If so, I did have that, too. I just kept icing the heck out of it and working those hamstrings. Another thing you may want to consider for calf strength is the Baps Board. My quad tendon stays in a constant state of inflammation. Maybe cold laser treatments would help as an adjuvant. Skinnycats says it's great!!  ;D

They have stretched me into a pretzel in loosening up the IT band. It's not sore unless I've been exercising anymore but, it's still tight. It hurts from cycling yesterday, Ew!! The rectus femoris is even more tight!! Stretching/bending the knee while face down, it feels like the hip's gonna pull out of the socket. You, too?

OK, 1 more question today, hope ya don't mind? Do you have pain that limits your ability to walk around with minimal sitting all day now? I just need to somehow be able to get back on my feet at work for 9+ hours 5 days/week and possible 12-16 hour shifts, too. I need a miracle!!  :-\ Take care and hope to hear from you 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

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #17 on: October 14, 2008, 05:54:00 AM »
Hi Heather,
Its funny that you ask about the pain when sitting. The thing is I don't know the answer to that question yet because sitting makes my calf hurt so bad. I have been trying to aviod it. At this point, the minutue I sit for over an hour it starts making the calf hurt more. However, from what I can tell I can sit without knee pain. I also, need the standing all day long and walking miracle too! Standing in a still position makes my calf hurt so i have been trying to avoid that. Especially if I am hyperextended. I can walk though all day as long as i am wearing comfy tennis shoes. i cannot walk all day with anything else not even flats. I have had to work up to that. In the beginning after surgery it hurt after walking around for a couple hours. So I just added time slowly and now i can go all day. And not even think about icing ;D I haven't been able to work cause of all of this and am applying for jobs that require walking now. I'm a little scared of how the knee will react if i do that much walking 5x a week. You can definately be compensating with other things. Everyone kept tellling me you can't last year but its true according to my new pt's. I think thats why i may have developed hamstring tendonitis. I also have pain in the popiteal sometimes. How do you know if it is the popiteal tendon vs. the hamstring tendons? what is a BAPS board? I do not have pain at end range flexion. When your asking about slr from chair do you mean sitting in a chair and donig a straight leg raise. If thats the case, i do not have pain with that. I wondering why your quad tendon is in a constant state of inflammation? Has your pt or dr said? I had a LR along time ago with the orginal surgeon who messed up my knee. and it did hurt. but i don't know if its cause he wasn't good a surgery. I have heard quite a few horror stories about my old OS. A question for you does your ankle and achilles tendon hurt sometimes. Mine has started to hurt. uhhh My calf pain was so bad today that it was hurting when riding the bike. i had to bump it down to 0 resistence when i have been using 6-7 resistence. Is your popiteal tendon pain all the time. Mine started off as sometimes and now it is almost constant.  Take care, Summer

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #18 on: October 14, 2008, 03:07:48 PM »
Hey Summer:

I HAVE to wear my tennis shoes when doing any kind of lengthy walking or exercising. I wear Shox, love em!! Flats, barefoot, flipflops, etc cause more knee pain. I'm relatively ok for about an hour in the store but, my home regimen is better in walking down the farmer's lane. Guess it's because dirt gives, ya know? This is the way it goes, it starts out as pressure (medial, at the base, and deep inside the knee) the minute I stand up. Then, the pressure becomes quite painful the longer I'm walking. It eventually just makes me sit right down where I'm at.

The tendon that runs over the popliteal space does come from the hamstrings. I believe it stems from semitendinosus. Tendons connect muscle to bone so, I'd have to review my anatomy a bit before I could elaborate more. The way the everything is interconnected, I'm not surprised that you have calf pain. Are there any surgical solutions in addition to the PRP injections? My ankle used to hurt alot back near the achilles tendon but, not anymore. The Baps Board, I'm conviced is what helped me the most. It's a flat round device that you step onto with the injured leg and rotate it in circles. There's a series of half balls that screw into the bottom of it and pegs on the top so weights can be added. It's pretty hard to do but, it gets better.

Well, now that you've mentioned it, I'm wondering if the pain I have in the front explains my shin pain. My calf is still quite a bit smaller than the other one and there's a dented in area on the lateral side. Surely the quad tendon had to have been damaged in how hard I hit my knee, the tendon runs right over the patella, too. My incision scar runs right over it, too. Thinking it's scar tissue around it, the tendon itself is really thick and cord-like. YUCK!!  :( 

The reason I asked about knee pain while sitting, standing still, and doing a SLR from the chair is because my OS asked me about it the day he referred me to the new one. He said it's PF arthirits and that's bad news if I have pain with those things. Propping it up still makes all the difference for me, hopefully for your calf pain, too!! Maybe backing off from some of the weighted exercise and doing more stretching might help it. Gosh, you've been through alot and it's terrible that the calf is hindering you!!

I hear you on the going back/forth with exerces. I've bumped up and had to back off so many times, it's not even funny. Patellar fractures are just lovely rehabbing, aren't they?  :P Maybe you do better in just sticking with water PT, too? Do you have that option? I love it!! Take it easy there and hope ya get to feeling better. It's a therapy day for me AND it's raining, UH OH! No wonder I was up/down all night!! TTYL!  ;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

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #19 on: October 16, 2008, 07:05:10 AM »
Hi Heather,
Oh my gosh. I can't believe how much we are the same. My ankle and achillees tendon has started to hurt to. But I also, have a hypermobile which is contributing to my problems. I know exactly the pressure you are talking about. I used to get before my chondroplasy/scar tissue removal surgery. And even after I got that surgery until I gained more quad strength. Yeah propping it up does help my calf. In fact thats the only way I am not in pain with the calf. Yeah when looking at knee anatomy, it looks like the calf pain is coming exactly from the tendon. Uh those things take along time to heal from what I have heard. Are you excited that your  appt. with the  OS is coming up. Hopefully, he can come up with something to take away the pain. Hey did you have an MUA too? -Summer

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #20 on: October 16, 2008, 01:19:50 PM »
Howdy Summer:  ;D

I'm so glad to hear you had relief from this painful pressure after sugery!!! YAY! Maybe it will happen for me, too. I have HOPE now!!  ;D The pain behind the kneecap is the worst, knife-stabbing kind when tightening those mushy quads. Surely it took the procedure to help you get your muscle back, too. The PT said I need to have it done to continue progressing.

Was your kneecap REALLY tight, too? Mine barely moves in any direction. Seems to be a problem. My OS mentioned a medial/lateral release. So, I am convinced that's why my knee still feels really tight, even though I have decent ROM. Thought maybe I was hyperextending, too. The quads are sunken in and the knee protudes. Extension is still 0, though. Whew!! How is hypermobility fixed permanently? Would a stabilization technique work?

Yes, I had that nasty MUA the day my hardware was removed. Felt like I'd been beaten with a baseball bat. Bruising and swelling like I'd never seen before!!  :o It is strange how the doc can get soo much flexion with that but, it took me FOREVER to get it to go that far on my own... like 8 months.

Doesn't it just suck with all the co-injuries that patellar fractures causes? I think that healing a badly comminuted fracture was the easy part. The other things hang around and are so nasty to deal with. Have you been diagnosed with patellofemoral arthiritis too? Tendons are quite tricky to deal with, too. My quad tendon is STILL very tender to touch it. Have you had any iontophoresis treatments in the hamstring or achilles tendons? Hope they get better!!

I'm excited to hear what suggestions the new OS may have. I have a feeling that he'll most likely follow what my OS said he'd do. It's the same thing they've done for you. Guess it's going to depend on how deep those lesions are and what areas are involved now. I'm still scared, though. Feels like I'm facing doomsday, here we go again!! Ever feel like that?

Take care of that calf and don't push it too hard, ok? Thanks goodness propping and ice finally give me a little relief, too. Had a pretty tough night last night though. I think you're right about the rain!! UGH!

TTYL  ;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

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #21 on: October 17, 2008, 03:46:45 AM »
Hey There,
Yes my knee was tight, but it was because it was jammed full of scar tissue everywhere. You know my MUA cause all my cartiledge damage. Was yours caused by that or the bone break? Yeah I had to get the surgery to see any progress with my quad. I don't know how hypermobility is fixed, but really don't want surgery now if I can avoid it. I guess strenghtening would help from what I heard. Yes I agree the pain behind the kneecap is the worst. I hope you get relief with the surgery. Yeah tendons are hard to deal with. Hope you are having a pain free good day today! Summer

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #22 on: October 17, 2008, 11:50:59 AM »
Hi Summer:  ;D

Well, my OS mentioned the cartilage damage at my first visit after the ORIF. The MUA very well could have increased my damage, too. The OS has always said it was bad and he can't repair it so, I was just assuming it couldn't be. He just kept telling me to strengthen the quads and it might get better... until now. At the same time, he also mentioned a trial of Synvisc and a scar tissue clean-up. For some reason now, he doesn't think either will help much. So, he's referred me to someone else to get their opinion. It was then that he finally told me soft tissue repair is not his specialty, he's more of a "hardware" OS. The PFJR would be a workable solution... guess I'll know for sure in a few days. Have you ever heard of so much going back/forth with possibilities?

How many PRP treatments have you had? I'm wondering if it's something that takes a while before you  get some results. Have you ever had laser treatments? The ionto is a topical steroid that's fed into the tendon by an electric current. I've had 3 rounds of it and the tendon only hurts now when I touch it so, it's better. Has ultrasound been used of the calf? Might work, it would be worth trying. I've also used my Lidoderm patches for muscle pain. Works better on muscle than it does for the knee, too.  ;)

Hope you're able to continue stengthening and dodge that surgery. Fingers crossed for you!! Take care and hope you have a better day with your pain, too!! TTYL  ;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

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #23 on: October 17, 2008, 11:59:25 PM »
Hi Heather,
I believe you when u say going back n forth with so many possibilites. From my experiences, unfornatenely not good with OS, they don't seem to know exactly whats wrong. When it came to my knee I went for 4 different opinions and no one knew. And Dr. Steadman looked at the same MRI and my knee and he knew right away. My OS did a really aweful thing where he told me that he does MUA's all the time. And then when the cartiledge showed up damage he was like I don't do it that often. He was really unethical. And even when my pt told me that he thinks something is wrong my OS brushed it off as u need more muscle. I think cause u r so young they prob will do a chondroplasty with injections of synvisc after. They probably will wait to do PFJR till its a last resort. Do you know what grade your damage is?

I have had two PRP injections and it is definately something that takes time cause it stimulates the tendon to heal. I might get another one at the next appt. We will see. It is better than before. My pt did not want to do ultrasound on it cause he doesn't think it works. I have taken antiinflammatories and also ice/ionto to without success. Ice helps numb the pain but I am not allowed to use that now because of the PRP injections. The Lidoderm patches totally work on my tendon. Did they work on yours? But I'm afraid of using it too much and then overdoing it at pt and tearing the tendon or soemthing. Good luck on your upcoming appt. Let me know what he says.

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #24 on: October 18, 2008, 02:07:57 AM »
Hey Summer:

WOW! That really sucks that out of 4 opinions, no one knew what was wrong. Makes me wonder what the heck is wrong with them. I'm only a nurse but, I can guess that scar tissue would be a logical culprit just to start. Sorry, I'm venting but, it makes me mad for your sake and the frustration you must've had. Glad you gave it one more shot with Dr. Steadman! You even proved the PT wrong, atleast partially.

Well, I can atleast say my doc knows what's wrong. He's just not the expert in repairing it unless I need the PFJR. Then, I would go back to him for that. I asked what grade it was and if the bone was exposed. He pointed to the trochlear grove on his chart and said that's what you've smashed the kneecap against and the force it took to shatter the bone to bits. The cartilage is much softer than bone and was badly chewed up. So, he never did give me a grade on it. No wonder it maltracks and grates with all that gunk, right? The PT is also very suspicious of the cartilage on the medial condyle.

So, about the MUA. There are many complications that can happen with it. Were you fully informed? If not, have you considered a lawsuit? My ROM was sooo bad, I didn't have much of a choice. Honestly, the CPM would've been a kinder way to go. We fracture folks just don't get that lucky most of the time.

I was trying the Lidoderm patches when I had my last round of ionto treatments. I had it scheduled so the patch came off for 12 hours when the ionto patch was due to go on for 2 hours. Maybe it really was the combination of both that helped the constant tendon pain? Hey, I say whatever works, ya know? Jeans bother it more than anything now, though.  :P I have used them on the hamstrings and calf since then and they DO work on muscle pain!!  ;D

Hope you're able to keep up the injections. Sounds like they may be starting to work. I've also considered it for the quad tendon. I am going to ask the new OS about it, too. For now, I'm still icing. Sorry that's been banned for you, I'm FINALLY getting some relief with it for a little while. If you keep your patch on, just be careful. Atleast they work for something, right? Hope ya get some relief!! 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

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #25 on: October 19, 2008, 06:48:49 AM »
Hi Heather,
I am glad that your OS knows whats wrong and your cartiledge problems were not caused by the MUA. Oh my gosh, your break sounds so painful along with the cartiledge. Its no wonder you are still in pain. You appt. is very soon. Yeah! It's good you are a nurse, helps you understand everything that is going on better than most people. I was not informed of the consequences of the MUA, but I hear a lawsuit against Dr.'s is hard to win. And at his point, I just want to get better and not deal with anymore. You know what I mean. I read an article about how they are using prolotherapy for cartiledge issues. But it seems a little experimental still Actually read it on the plane ride to my Dr.'s appt. Also, there are some Dr.'s studying stem cells. Hopefully, there will be good options for us later on down the road. Guess what I am having a really good day. No calf pain. I'm wondering if the injections themselves are causing me bad pain for 3 weeks. Cause after my first round I felt the best at 3 1/2 weeks. And its the same case after the second round. I hope it stays this way.:) Jeans bother mine too, but its probably cause my jeans dont fit. I have gained weight:( UH! ha ha. Yeah the injections probably would help with your quad tendon issues. I would think. Good luck with your appt! Summer

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #26 on: October 19, 2008, 03:43:29 PM »
Hi Summer:

Glad you're having a better pain day!! YAY! Have you mentioned the 3 wk time frame to the doc? It may be normal, hope so! Are you going to continue with them? Sound like you've found something good!!!  ;D

I'm having a bad pain day. I was stupidly talked into going to a haunted house last night and whined in pain the whole time. Chainsaw even came running through the line and I didn't even flinch. My husband made sure I didn't fall but, it really messed with my balance. Today, I'm swollen and hurting. I even wore the J-brace, I'd hate to see how I'd feel if I hadn't!  :o It was funny to hear the monsters ask if I was ok as I limped through that mess! LOL!

Can you update me on prolotherapy? I've researched stem cell injections, though. Very interesting that they're having success with up to 30% cartilage regrowth!!! YAY! Hope it will be a solution for us, if joint replacement is in our future. It may very well be the key to eliminating the need. I had a quadraplagic pediatric patient who went to Portugal for stem cell injections. I saw her a few months later and she was regaining use of her hands/arms! Phenomenal!!  ;D

Yes, I know exactly what you mean about wanting to avoid the stress of lawsuits. I could've sued Ford's because of faulty airbags and the sealbelt didn't lock. I did tell them about it and they were supposed to check it out at the salvage yard. I would just like to see their products improved and... of course, recover from this dilemma myself, too!

Thanks for the well wishes with my upcoming appt. Think I'd be all good if the OS didn't HAVE to touch my knee, though. I really do hope he has all the answers. Guess my OS has been right in saying "Hey kid, you can't go around "smooshing" your kneecap on dashboards and expect to walk away from it easily".  I'll keep you posted after I get the scoop from the doc. Take care and try not to over-do it, there ok? Gets me in trouble every time. Hope your pain stays away!!! Chat with ya later...

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

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #27 on: October 19, 2008, 08:15:29 PM »
Hey Heather,
Oh no, sorry you are in pain. Ice, ice, ice! Do you still have to use pain meds sometimes? The prolotherapy article just said that they were having success injecting it into people knees to regrow cartiledge. Did not have percentages or studies on it. I wonder if that might be an option for us later? Wow that is amzaing about the pediatric patient! Good for them. Oh my gosh, I didn't realize your airbags or seatbelt didn't look. I'm sorry. That is so unfortunate. Good luck at the appt. Let me know what happens. -Summer

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #28 on: October 20, 2008, 02:27:26 PM »
Hi Summer:

I went straight to icing after that little adventure. I alternate with warm water sometimes, too. It helps muscle fatigue and the ice helps the knee inflammation. You'll commonly find me with icecubes massaging around the knee while I'm still in the tub. Less mess!  ;)

Well, I've been afraid to try any of the pain meds with the meds I take now. These still cause mental fogginess and make me tired so, narcotics would compound that. The doc did say I could try them together but, I'm scared to. NSAIDS don't help and just make me really nauseated so, it's best I stay away from them. Can you take them?

I hope your pain is still minimal today. My swelling is back down because I stayed off the leg yesterday. Wierd how that puffiness right above the kneecap just blows back up so fast!! I did a little bit of walking and stretching yesterday afternoon to work on the tightness. Even that was enough to make it get hot and painful again so, I'm still down today. Chewing off my nails thinking about tomorrow... yikes!! I'll let ya know what the boss says. Really hope he doesn't push it too badly. Take care and TTYL!!

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

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #29 on: October 23, 2008, 06:04:51 PM »
Hi Summer:  ;D

How are you? I'm a bit frustrated but, my PT is even more so. Here's the scoop. Well, I saw the new doc.. ummm this is interesting, I have good and bad news.

The good news is that I've dodged surgery for now. Absolutely nothing he can do until my quads get better, even injections won't work. Despite having had continuous PT since July 2007, he wants me to see his PT there 1x/week and give it a shot. Also, the only compartment that looks to be trashed, according to the x-ray, is the PF one. So, I'm still spinning my wheels with PT.

The bad news is I will likely not be returning to my previous nursing position. No more pushing med carts and assisting with patient transfers etc. for me. I was encouraged to begin exploring other avenues, I'll still off until I'm fully rehabbed, though. The snapping is scar tissue around the fat pad and the painful grinding is what it is. My other patella jumps the track, too. Those quads, however, are already like rocks!! Not sure how that'll be improved. That knee hurts on a random basis off/on.

So, I've updated my PT today about the appt and his exact words were "Does this new PT walk on water?" He's very upset because his intelligence/experience and diligent efforts to successfully rehab me have proven what results I'm going to have. He doesn't feel the quads will get any better until the knee is repaired. I guess it makes sense because the rest of the leg/hip/ankle is coming along fine. He's asked to see the dictation from this appt so, maybe he has a plan. Not sure? Good grief, I AM at my wits end.

If I have one determination still about me, it's the fact that I refuse to be told to just live with the pain. I will keep trying until a solution works for me.

I hope you're still doing as well as you can be and, I hope to hear back from you really soon! 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

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #30 on: October 24, 2008, 04:51:27 AM »
Hi Heather,
I was thinking of you and was going to email u to see what happened but you beat me to the chase. I'm sorry that you can't return to your old job. That must be really hard to take. So what the OS plan after you get your quads back. Does he think that will be enough for you not to be in pain or does he think that he will do another surgery on you? It will be interesting to see what his pt does differently. I guess from personal experience I can tell u that I have worked with a couple of pts and a good pt actually helped me get my muscle bad. I think if I would have stuck with the regular pt I would not have gotten as far as I have gotten. Yeah, I bet your pt is frustrated. That sucks if he has worked really hard and you have progressed. Just give the new pt a shot though. You never know he might have some new tricks up his sleeve. I have the same thing on the PF compartment is not good. Don't worry you will find a solution that works for you. You are too young to live with pain. Thats what I keep telling myself to. Take Care and talk to you soon! Summer

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #31 on: October 24, 2008, 01:15:55 PM »
Hi Summer:

Ya know what's perplexing? The new doc didn't even bother to ask what I've been doing for the past 15 months of PT. I have had about a million exercises and have done both aquatics and land-based.  Until recently going back to the water class, it's been ALL work hardening stuff. For example, the quad slide board, stair master, treadmill (all directions), abductor machine, ball squeezes, board push, theraband exercise including squats, short arc quads, leg-press and curl machines, just to name a few. I also walk all the time, too.

My PT thinks pain will continue to hinder my quads, I tend to agree. Maybe the new one will figure that one out relatively soon, if he's that good. Mine has had me to keep the weights to my comfort level. Anything that causes pain over a 5 on the scale is avoided. The only thing I can figure is that I'll just have to push through ALOT of mind-blowing pain to work the heck out of it and see what happens. Did you? I'm also convinced that other muscle groups are compensating when I'm exercising.

I'm not sure what the new doc plans to do. He didn't even schedule me to return. He just said to make an appt if I needed to. My long term options on this if pain continues if/when the quads get better, would be to remove the kneecap or a joint replacement of some sort. UGH!! No way!  :-\

You're right about us being to young to have to live with pain everyday!!! Really, anybody is. It's unethical to be told that you HAVE to. I plan to go to pain managment if push comes to shove. Have you been to one? What exercise were you doing to get your quads back? Whatever is was, I think I need to be doing them, too!! Well, here's my theory... you work the quads like dogs  :P and push it as hard as you can. In the mean time, the cartilage (if there's any left by then) just wears out more and more. And then.... it's anybody's guess as to how we'll manage to get around.

So, here's my plan... I'll do what the doc says and then some. If the new PT along with my aquatic stuff and home regimen still doesn't help, there's a PF specialist 2.5 hours from here and I'll be at his door with bells on.  ;D He's on patella MD if you want to check it out. Lots of info!!! WOW! You're welcome to join me if you'd like!! Take care and hope that calf is having an ok day... hope to chat with ya soon!!

Heather 8)
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

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #32 on: October 24, 2008, 09:09:14 PM »
Hi Heather,
I pushed through alot of pain last year before Dr. Steadmans surgery. And no matter what I did the quads did NOT come back. So when I went to see Dr. Steadman I asked him if I did more pt if it would help. His answer was, you have been trying for a year and it hasn't worked so its not going to work. I think you should go get another opinion. Make an appt. with the guy 2.5hrs away. Because if you have been trying for 15 months and its not coming back then is it really going too? In the meantime, just see the new pt to see if they can help. After Dr. Steadman's surgery I have not been allowed to do exercises that cause pain. A little twinge now and then of level 1-2 pain is okay but anything past that is not okay. He and the vail pts do not believe in the theory no pain no gain. I think they think if I am getting pain I am probably doing more damage to the cartiledge. So for now, all I am doing is riding the bike with resistence, squats not too low on bosu, single leg squats not to low, wall sits not to low. Dr. told me last time it would be good for me to walk on the treadmill backwards too. The rest of the stuff I do is  all glute, hamsting and core. I do not have pain with these exercises and if I do they get modified or taken out. They told me to really listen to my body and not do things that cause pain. Its a different way of doing pt, cause I think pts down home just say work through the pain. But I think the Vail method works much better! Can you swim without pain? That might be an option too, or aqua jog. For me, swimming hurts so I don't do it. I also think its wierd that the new Dr. didn't say come back in a month so that he can follow up on your progress. I don't know, I feel like he might not know whats wrong. Remember I went to 4 local dr.'s and they didn't know whats wrong. I know it may seem crazy to fly out to see a Dr. But maybe you can make an appt. to see Dr. Steadman? I really think that my knee is much better only because he did my surgery and because I got good pt in Vail. I say don't wait too much longer to get other opinions too, cause you don't want to damage your knee anymore than it is. Sorry, if this may sound negative I just don't want to see anyone given the wrong advice by there OS and then suffer more damage. Take Care, Summer

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #33 on: October 25, 2008, 12:50:14 PM »
Hi Summer:

YES! I am exicted about something now. My PT has absolutely been correct in his way of rehabbing me. Anything that causes pain like that has been cut or modified for me, too. He did say that what you have after a year pain/strength wise is just about it, too. Are some docs just more trusting of their own PT's or something? The only way I can see getting these stubborn quads back is to try the old theory of pain and gain because we've proven this way isn't working for me. I don't want to do it, though. Yes, the cartilage damage will get worse, and then what?

I can swim with a floatation device but, MAN does it hurt!! I stay away from it, too. I really like the water PT class so, I do plan to stick with it along with 1x/week with the new guy. There's a couple of things they do that I can't, like the jumping exercise, but that's ok, I just skip it. Water is just better all around!  ;D

Well, I can't say that this doc doesn't see what's wrong. He agreed with my doc about patellofemoral arthritis. I even showed my PT my x-ray yesterday and he said that PF compartment looks bad as does the rest of the kneecap. There's also a PT assistant who works there and has currently been studying radiology. He checked it out and he said hmmm, looks like you don't have much cartilage left there. There's also a chipped out area on the top of the patella that's now rectangular shaped and it's mostly dark and shadowy looking, too.  ???

I am sincerely hoping this doc's PT is as good as mine. If so, he'll soon realize what my PT is saying about the pain and quad shutdown and relay the message to the doc. I will make another appt to see the doc if he advises me to. Then, if he says live with the pain or the patellectomy, I will go to Lansing to see Dr. Schneider. He only deals with patellofemoral problems only. No referral needed!!  ;D I shot him an e-mail explaining my situation and then mentioned the quad dilemma. I asked if he had any success with similar patients. If he mails back and says yes, I'm soooo there!! How far was your flight to Steadman?

Take care and hope you're having a good day. Tonight is my kid's 13th B-day bash... YIKES. It'll be kiddy city here and I'll be up in the barn rafters with a glass of wine... HELP!!  :o I have asked 10 other adults for help so, I DO hope they all keep their promises. That's ok, I'm sure they'll be asking me for help at some point, too!! Hope to talk with 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

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #34 on: October 25, 2008, 09:40:06 PM »
Hi Heather,
Ahh 13th birthday! How fun! Have a good time today. Yeah I hope this new pt is good and will realize and just tell the new Dr. What is a  patellectomy? My flight to Dr. Steadmans was about 2 1/2 hrs. Not too far. Yeah I think some Dr.'s do trust there own pts. I know in Vail the pts work really closely with the Dr.'s there. Hope you get some answers soon. Also, it would be nice if the new pt can help u get more quad back too. Try to really concentrate and tell yourself to make your quad work in your head. That has worked for me. Although it took me 6 wks of doing this for the quads to work all the time and my hamstrings to compensate less! Have a great weekend! -Summer

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #35 on: October 26, 2008, 05:41:35 PM »
Hi Summer:  ;D

I survived the party... lots of kids and parents here last night. My house is still full of girls who stayed over. They're driving my son crazy but, they're helping my hubby to clean up the barn now. Thank goodness, my knee hurts, ouch!! I must've worked the hamstrings in doing all this work, they're pretty sore, too. Nothing whatsoever in the quads though. I do try to focus really hard on the exercises but, more in doing them correctly. Make sense? I'll try the mind over matter technique on the quads next time at PT. Thanks for the tip... hope it helps me, too.

I'm glad your flight to Dr. Steadman wasn't too long. I've flown since I've been injured and the cabin pressure really bothered my knee. I'm not sure if that will get better or worse over time. Did that happen to you, too?

Well, a patellectomy is complete removal of the kneecap. That is an old procedure that's supposedly been replaced by the PFJR. Given the removal of the patella as the doc's solution to removing the pain, I'm not sure why he still uses an older technique. That's what he would do if I can't get better. I'm not very keen on that idea as he did say I may need a joint replacement down the road. Think I'm up a creek without a paddle? Does your x-rays look the way I've described mine? The machine used wasn't standard x-rays, it was pretty detailed almost like a sketch. Lots of black areas around the PF joint and white areas of cartilage on the medial/lateral sides.

Hope you're having a good day... I'm resting for a long while here. I've skipped my a.m. exercises and hope it is better by later on to do the p.m. stuff. Take care and I'll chat with 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

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #36 on: October 26, 2008, 10:27:20 PM »
Hi Heather,
Yes the cabin pressure bothers me. I always put ice in a ziplock bag and ice. It does get better. The last time I flew about 6 wks ago. I didn't need ice:) Yeah I can imagine with all the kids. I don't remember the x-rays. I had MRIs which I can't tell what is what on!:) Have a great day! Summer

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #37 on: October 27, 2008, 05:31:07 PM »
Hey Summer:

Hope you're having a good day, how's the calf holding up? My hamstrings are better today. Rest and a hot bath did the trick. YAY! The stupid knee still sucks, though.

I'm glad to hear the cabin pressure with flying gets better, too. That was nasty, I remember. It just added pressure to the painful pressure already in there. I did have an extra seat next to me to prop the leg on. Betcha icing would've helped, too. Smart move on that one!  ;D

Have you ever heard of Protronix (I think) PF bracing? My PT said that's the only thing we haven't tried. I'm going to shoot it past the new PT on Thurs. and see what he thinks. Gonna give it one last ditched effort to get my quads back and it may help. Guess it's big and rather bulky, though. Been wearing the lateral J since May and no results. I would surely think that this PT will tell me when he thinks he's gone far enough with this dilemma, too. Atleast he has easy access to talk with the doc all the time, they're in the same office.

Oh, BTW: If you're interested, as I was looking for this brace online, I happened across some really good advice on eorthopod.com. about patellar arthritis. Interesting stuff if you'd like to check it out, WOW! Hope to hear from you soon, I'd love to hear your opinion about the options on the website... it's pretty scary. TTYL...

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

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #38 on: November 06, 2008, 05:52:32 AM »
Hi Heather,
How's the rehab going w the new pt? I hope it going better and your quads r working:) I have never heard of that bracing. I've never tried bracing so don't know much about it. Sorry it has taken me so long to get back to you. Things have been very crazy in my world.  I couldn't get into the site. FYI, i just got another round of PRP injections. I talked to someone that works in the office and they said that some people are doing studies on it for growing cartiledge back. Hopefully, the results will be good. Another option for us, maybe. Let me know how things are going with you. Summer

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Re: Anyone have Chondral Defect in Trochelear Groove, Help???
« Reply #39 on: November 06, 2008, 11:20:39 PM »
Hi Summer:  ;D

Hope all is well with you and the PRP injections... fingers crossed. My quad tendon has been fussy again..sore, tender. The new PT doesn't want to do anymore modalities on it because ionto. has been used 3 times. I've just ben hitting the ice on it.

So, I've had 2 PT sessions with him, the first one nearly killed me, LOL! Seriously, the muscle strain was quite bad for 3 days from the hip to the knee. Everytime I tried to stand in it, it wobbled like it was gonna collapse and MAN! Did it ever hurt! It even hurt to sit on my hammys. So, today, he backed off and it's the usual cranky knee thing after PT. Still hitting the ice every couple of hours. I do have something new now.... gosh I'm excited. Is that bad? It's called the shuttle aka rocket science in my book, lol, kinda like leg-press without weights and it's unloaded as you are completely lying on your back. The objective is to do as many single leg push-ups as you can in 5 min. My leg ran out of gas at about 2.5 min but, I made it Yay!!  ;D

So, I've had an interesting offer by the doc on Patella MD. He's the closest PF guru to me. I e-mailed him to ask about quad strengthening as I've been stuggling with it for years now, lol and if he knew of better bracing option. I also mentioned the patellectomy as a last ditched effort to get rid of the pain. He told me to send all of my x-rays to him. He looked at them and his nurse called me back today. She said he can help me and thinks resurfacing would be a good option.  ??? I have an ASAP appt. next Tuesday. He doesn't mess around.  ;) ok, guess I'll go, would you?

I am very excited about technology for cartilage regrowth, aren't you? Are the studies being done in your doc's office, too? The PT assist. where I've been going has told me her bro-in-law lives in Florida and had it done there on both knees.... quite successful, too!! Take care and hope you're feeling back up to speed very soon. Keep me posted ok? TTYL...

Heather
5/07 Sev. comminuted,displaced L patella fx,ORIF,brace,crutches
7/07 PT
9/07 Hardware removal,MUA,crutches,PT
5/08 J brace,patellofemoral arthritis,PT
12/08 Appt w/ patella specialist: L-TTT,LR PFJR,scope,scar tissue debridement-1/26/09
8/09-RSD,PT
2/10-TTT screws removed,scar tissue debridement















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