Banner - Hide this banner





Author Topic: Grade 4 Chrondromalacia/patellofemoral compart-what does this mean?  (Read 10384 times)

0 Members and 1 Guest are viewing this topic.

Offline rossometer

  • MICROgeek (<20 posts)
  • *
  • Posts: 4
  • Liked: 0
Hi

I just joined this site since I was just diagnosed by MRI with "cartilage degeneratvie changes in the patellofemoral compartment equivalent to a grade 4 chondromalacia".  I have suchondral bone irregularity and marrow endema plus some other issues.

Everything I read online and the reponse from my PT do not instill any confidence.  I am very active, cycle extensively, downhill and skate ski and windsurf and kitesurf/ski....maybe that is why I have this problem but I am only 48yrs old and figure the knee then only lasted 60% of its duty life cycle...and would really like to maintain my activity in these sports.  Current pain varies but I have very little power in deeper squats.  I have a pretty good grasp of the mechanics involved and why the failure is happening. I also have had two ACL reconstructions (other knee...it used to be my "bad" knee...now I am not so sure) and some patella tracking issues that I was able to address with PT.

What I don't understand is why I rarely had any significant pain before this major episode...and then the cartilage is all gone?  Also my PT and GP both hedge around future activity and what I can expect...I am trying to get an appointment with my OS...but this being Canada it will take a while.

Has anyone else had similar experiences and if so any help understanding what the future holds for me and how to mitigate the problem to maintain a reasonable level of activity at the sports I enjoy would be appreciated?....since right now it seems like a tiny little bone in my right knee is set to cripple me from the sports I enjoy for life......I know its not fair to the patella.... :-\


Thanks

Offline thevoice

  • Regular Poster
  • ***
  • Posts: 132
  • Liked: 0
Re: Grade 4 Chrondromalacia/patellofemoral compart-what does this mean?
« Reply #1 on: January 19, 2010, 08:00:01 AM »
I might be wrong but with a partial knee replacement you can still do all the sports you curently do..its mostly things like impact sports/running which are advised against.

Offline TwoBadKneesUSA

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 3340
  • Liked: 0
  • No matter how bad it is, my dog still loves me!
Re: Grade 4 Chrondromalacia/patellofemoral compart-what does this mean?
« Reply #2 on: January 19, 2010, 03:56:52 PM »
Just had a PFJR this past August.  I don't really have any restrictions, but I did not ask about any.   :D  I think it sometimes depends on the OS what they decide is the best restrictions to get the longest life out of the replacement.  I can certainly do things I did before (except run, whiich I had not been able to do for a long while now).  Running is one of the big no-nos after a partial or total knee.  High impact stuff will likely shorten the life span of the hardware.  As for not much pain then bam no cartiage and pain.  Mine went that way too.  It ached once in a while, the I fell in the parking lot and it went down hill very fast.  Not sure if any of this helps, but there you go. 
'83 lt knee scope
'88 lt knee LR
'89 rt knee LR (6 mos. after left)
'05 rt knee scope (clean up)
7/5/07 - scope, LR left, right clean
3/19/08 - LR failed, Supartz failed
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=47974.0
8/21/08 - new OS apt
8/5/09 - TTT, LR, PFJR sched.

Offline Lottiefox

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • Posts: 2393
  • Liked: 16
Re: Grade 4 Chrondromalacia/patellofemoral compart-what does this mean?
« Reply #3 on: January 19, 2010, 09:33:36 PM »
Hi and welcome,

I'm a fellow member of the worn out patella club, in the early stages of diagnosis but it would appear in the later stages of cartilage wearing out! Like you, things were pretty much fine, the odd twinge, was very active and fit and then suddenly I couldn't squat properly, couldn't lunge and took to going downstairs like a crab. MRI shows similar issues, although mainly lateral side wear. I've been told that impact activity will not help with the pain or further degeneration. But, staying active especially keping quads as strong as possible, stretching, foam rolling, e-stim and so on might help manage the symptoms if not the rate of change. I'm also exploring cartilage transplant/regeneration techniques. Patella cartilage loss is one of the hardest to fix as the blood supply is low and the bone is under constant movement and shearing stresses. Anything like microfracture won't work, not enough blood flow to allow a scar to form and fibrocartilage to develop. So, you're left with a cartilage transplant option - I would do a LOT of reading about techniques - there are succeses on here for patella ACI/MACI I think, and they are also developing cartilage grafts in conjunction with your own stem cells and so on. Its very promising. All of these are pretty major open surgeries (the nature of the patella means that it needs open surgery rather than a scope to do anything more than a basic tidy up behind it) but they can give excellent results if your OS thinks you're a candidate. You'll get back to good activity if the op works, but high impact is probably not going to be recommended.....Alternatively there is PFJR - again a major op but with developing success rates.

Patellas are a pain in the knee!! Good luck with your appointment, I think you definitely need an OS view and ideally one with a focus on patella-femoral issues.

Lottie  :)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline rossometer

  • MICROgeek (<20 posts)
  • *
  • Posts: 4
  • Liked: 0
Re: Grade 4 Chrondromalacia/patellofemoral compart-what does this mean?
« Reply #4 on: January 20, 2010, 05:29:01 AM »
Hi

Thanks for the words of advice.  I am hoping to put of a partial knee replacement as long as possible.  Has anyone tried Synvisc-One?  An ultra runner that I know worked with a group of athletes (cross country skiers) that used it to minimize arthritic pain for a number of years prior to joint replacement.  I am hoping that it is suitable for this type of failure.

I am a bit fascinated by the dynamics of the failure of the cartildge since it seems like you have all had similar experiences.  An occassional bit of discomfort, no limit to activity and then bang...major failure.

I am off to my GP tomorrow and then starts the long waiting period to see the OS....the only reason that I recieved a prompt MRI is because I paid for it..... ::)

Ross

Offline TwoBadKneesUSA

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 3340
  • Liked: 0
  • No matter how bad it is, my dog still loves me!
Re: Grade 4 Chrondromalacia/patellofemoral compart-what does this mean?
« Reply #5 on: January 20, 2010, 02:53:20 PM »
Personally the synvisic did not do much for me.  It cannot hurt (much) to try it though.  Actually only the shot hurts a bit, like any shot.  I have read that it does not alway do much for patello-femoral arthritis.

I don't blame you for wanting to put off surgery as long as possible.  I finally decided it was time when I could not longer do daily activities without severe pain.  I had pain 24/7 and with anything I did and nothing less than narcotics took the edge off, so definately time to fix it up.  I am quite happy with the result.  I hope you can see the OS soon.  At least within a month or two.
'83 lt knee scope
'88 lt knee LR
'89 rt knee LR (6 mos. after left)
'05 rt knee scope (clean up)
7/5/07 - scope, LR left, right clean
3/19/08 - LR failed, Supartz failed
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=47974.0
8/21/08 - new OS apt
8/5/09 - TTT, LR, PFJR sched.

Offline Blaise

  • Regular Poster
  • ***
  • Posts: 84
  • Liked: 0
Re: Grade 4 Chrondromalacia/patellofemoral compart-what does this mean?
« Reply #6 on: January 20, 2010, 10:59:25 PM »
Rossometer,

I am sorry to hear what your going through...It seems these knee issues can pop up on almost anyone at any age...I am 31 looking at a PFJR in the next few months, so you never know...I had just the synvisc-1 shot and after two weeks it has done really nothing for me...Patellofemoral Arthritis from my understanding has had little success with the synvisc-1 as my OS told me, but wanted to give it a try to help me with the pain...Once that you lose that cartilage things can change very quickly....I wish you luck.



TwoBadKnees,

You would be correct in saying the Synvisc-1 does very little for patello-femoral arthritis.  That is what my OS told, but suggested the use for help with my medial pain...Two weeks thus far and no help, but more swelling and continued grinding...

LottieFox,

Patella ACI is a tricky endeavour as you mentioned, the shear forces are extreme as explained by many others.  In my case a shallow trochlear groove, too much damage, and continued maltracking due to a failed TTT have made me a poor canidate.
00-LK LR,chondroplasty
12/10/08-LK Chondroplasty,repair of mp-fem ligament,TTT
8/28/09-LK synovectomy, lysis of adhesions,chondroplasty
9/8/09-LK 100ml drain
10/8/09-LK cortisone
1/4/10-PFJR Consult
1/7/10-LK 15ml drain/synvsc-1
5/24/10- LK PFJR/TTT

Offline TwoBadKneesUSA

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 3340
  • Liked: 0
  • No matter how bad it is, my dog still loves me!
Re: Grade 4 Chrondromalacia/patellofemoral compart-what does this mean?
« Reply #7 on: January 21, 2010, 01:40:19 PM »
Well as my prior OS said about the Synvisic (I had the 5 shot course by the way), "It won't burn any bridges.".  So it was worth a try and it did help a bit, not a bunch, but did take some pain away.  I think my kneecap was just too toasted for it anyway.  I got a good look at the underside from my op pics.  More bone than cartilage.  I have shallow groves too, so can understant that issue.  If my current OS would have been doing PFJR 10 years ago, (when I was about your age), I would have jumped on it.  I am so much more comfortable.  I can take my kid to the mall and look at all the cool suff. (Not a shopper myself so don't know where the kid gets it, must be hubby's side of the family :)).

I hope the shot at least helps some.  If there is medial compartment involvement, it should help that some.

'83 lt knee scope
'88 lt knee LR
'89 rt knee LR (6 mos. after left)
'05 rt knee scope (clean up)
7/5/07 - scope, LR left, right clean
3/19/08 - LR failed, Supartz failed
http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=47974.0
8/21/08 - new OS apt
8/5/09 - TTT, LR, PFJR sched.

Offline Lottiefox

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • Posts: 2393
  • Liked: 16
Re: Grade 4 Chrondromalacia/patellofemoral compart-what does this mean?
« Reply #8 on: January 21, 2010, 02:44:42 PM »
Interestingly in terms of the way the cartilage loss suddenly becomes a "bamn there you go have some of that" type event, my OS was discussing me with WHY I have cartilage problems at all. He is a very forward thinking OS with new work using stem cells and collagen paste and has trained under Steadman and other cartilage gurus before coming to roost in the UK. I like his focus on the why/where/how to improve things. He said that research has now identified a gene that is responsible for cartilage management - if this gene is faulty then it lets too much of the water and proteins and stuff within the cartilage evaporate and it dries out, cracks and is prone to failure. He says that explains why I've had creaky crackly kneecaps since i was about 15 but recently, as the loss got too great at my advanced age of 40 it became symptomatic - aggravated usually by a trauma (fall etc) or increase in shearing stress (in my case deciding to train for a 10k - not the cleverest move!!). In the future they'll aim to identify the faulty gene and correct it before the damage is done - awesome! I think that was his explanation anyway, I might not be 100% technically accurate but you get the gist! It explains why some people, even with dodgy biomechanics manage to get by just fine, and others with the same imbalances have a failure at some part of the joint chain.

I'm very interested in ACI or Cartifill but have to get all of the CT scans, X-rays and better MRI images to show if I'm a candidate. I suspect I will need something else to help the alignment at the same time. Its a big gamble as with so much stress on the patella and ACI transplants being like water at first, then yoghurt etc etc and taking up to 3 years to harden I fear it might not get chance to even bed in! Cartifill (see my post in the general section) is a new technique using your stem cells and a collagen paste - hardens quickly, bonds strongly and is more resistant to the shearing. But no good if the lesion is > 3cm. I'd love to be able to flip my kneecap over and measure my defect!!  :o ;D  My other interest is direct stem cell injections.....perhaps they might buy time? If i were a betting gal though, I'd stake money on a PFJR being one of my presents to my knee(s) one day!

Lottie  ;D
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline smillie

  • SuperKNEEgeek
  • *****
  • Posts: 1438
  • Liked: 1
Re: Grade 4 Chrondromalacia/patellofemoral compart-what does this mean?
« Reply #9 on: March 29, 2010, 08:18:16 PM »
I'm also in the camp with sudden onset of symptoms.  I had a TTT etc. 15 years ago, but recent x-rays show that the patella tilt is still there or returned and it is sitting against the lateral side of the groove with no gap there where the cartilage should be.  I haven't had an MRI yet, but will at some point.  I'm working on quad strengthening and then will have to have my hardware removed before I have that MRI.  I thought I was just having a little flare-up in my knee when it started hurting, but after two months of major pain (now 3 months) I accepted the fact that this was more than a flare up and went to get checked.  My OS has mentioned injections but we haven't decided to do any yet.  It is interesting to read that it isn't all that effective with the pf area.

It's an interesting connundrum  when deciding to go with major options like pfjr.  I find myself wanting to be very conservative and wait before taking such a big step, but then I also look at my kids and think that I'd like to get rid of the pain and restrictions while they are still young enough to want to do things with Mom.  I don't want to get to my later years and finally have functioning knees, but look back and feel like these years were wasted dealing with the pain and limitations.
patella pain began early teens
'94 TTT/LR/VMO adv.
'94 MUA
'10 tried PT again
1/11 scope/hardware removal
4/11 (Finally!) dx medial instability due to LR
5/9/11 LPFL reconstruction scheduled

Offline natalyav

  • MICROgeek (<20 posts)
  • *
  • Posts: 1
  • Liked: 0
Hi everyone,  ::)

I have just joined this site and was wondering if anyone had some advice or personal experience in lateral release and arthroscopy operations for chronic chondromalacia. I have suffered from sever knee and hip pain for over 4 years now and am so limited in what I can do, even walking for more than 15 mins is painful! I also struggle to sit for long periods due to the pain in my hips. I am hoping to have these operations asap but would be grateful for any suggestions on whether they actually work as I wouldn’t want to make my condition even worse-if it could be lol. I am 23 so the surgeons are reluctant to operate but it is getting so critical, I am unable to work or much else really! I have tried everything under the sun, from intensive physio, herbal remedies and anti-inflammatories to acupuncture. It all makes it worse though. I do wear orthotics which help. My MRI scans just show inflammtion of the patella but everything else is normal so its hard to diagnose a particular problem.

Thanks to all

Natalya  :D

Offline NickiAnn

  • Regular Poster
  • ***
  • Posts: 97
  • Liked: 1
Re: Grade 4 Chrondromalacia/patellofemoral compart-what does this mean?
« Reply #11 on: July 22, 2010, 10:14:37 PM »
Hi Natalya,

The fact that your hips and knees hurt make me wonder if you have issues with the alignment of the bones in your legs.  I have a condition that is sometimes called miserable malalignment.  My femurs twist inwards, this is called femoral anteversion; and my tibias twist outwards.  Some people have the twist in the femurs only. 

My pain has always been in both my hips and knees.  Due to the twist in the bones, the knee is under excess stress and the hip doesn't sit in the socket exactly right.  People who have this condition can wear out their cartilage faster because the patella isn't tracking correctly in the knee. 

You seem very young to be having hip and knee pain from wear and tear alone.  I first had pain when I was in my early twenties.  I  have sharp pains under both knee caps, and I have a deep sharp pain centered right in front of my hip socket.  I was able to manage the pain for a long time by limiting my activity, but my alignment isn't as bad as some people's.

It's worth investigating before you seriously pursue any surgical options.  Some of the girls on this board have had various knee surgeries only to find that nothing helps much until their alignment if fixed.  The first doctor I visited diagnosed me, so I was lucky to understand what I was up against eary on.  However, it's my understanding from the posts of others that many doctors do not really understand the effects of femoral anteversion or miserable malalignment.

My malalignment is very apparent.  When I stand with my feet pointing forward, my knees go in. Not everyone's is quite so visible.

Sorry to pull this thread off its original topic of treating chondromalacia, but I think, Natalya, that it's worth looking into why you have such bad cartilage degeneration at such a young age. And the hip pain in conjunction raises concerns that this more than just a knee problem.

Nicole
1997 Diagnosed with miserable malalignment
Nov. 2011 Left leg femoral and tibial derotational osteotomies
July 2012 Right leg femoral and tibial derotational osteotomies