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Author Topic: Grade 3 defect of Medial Femoral Condyle - advice for a runner!  (Read 5260 times)

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Offline bigbobbloggs

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Grade 3 defect of Medial Femoral Condyle - advice for a runner!
« on: February 11, 2010, 11:12:01 PM »
Hi

I'm a 39 year old man in UK and have been struggling with a knee problem for almost 3 years.
Stumbled across this board recently and am hoping that someone can relate to my story or offer sage advice because I really need it.

Can I briefly outline my story so far?

I was very sporty in my youth (Rugby, sprinting) but let it slip in my 20's. Around the age of 34 I caught the running bug and over the next couple of years did a handful of 10k's, a half marathon, and regularly ran 20 miles a week. Early in 2007 my inside left knee became increasingly sore but, like an idiot I ignored it until on April 1st that year something seemed to 'pop' on a run.

Not sure how many contributors on here are from the UK(?) but from then on I had an awful time on the NHS. After limping about for about a month (in the assumption that everything gets better in time) I went to see a private Physiotherapist who diagnosed a medial ligament strain and told me all would be ok. After another 6 weeks I went to see my GP, who confirmed the diagnosis, but thought it was taking a long time to heal so referred me to a specialist. From here I was 'triaged' to a GP with a Special Interest (3 months wait) who, after several appts sent me for an MRI scan (another 2 months wait). The MRI results were inconclusive but eventually I got to see an OS and almost a year after the initial injury I had an arthroscopy.

I never saw any notes but was told that I'd had a 'chondroplasty' (Over time I've also picked up that I have a grade 3 defect (2cm square I think) on my medial femoral condyle). Assuming this would be a cure I waited for the knee to get back to normal. After another 6 months, despite a slight improvement (I was now walking up steps one foot at a time) I still couldn't run a step without pain so went back to the OS. Now, being on the NHS, the OS appears to see aroung 10 patients in 30 mins, so I never got more than a few minutes with him. He sent me for another MRI and the results showed I had oedema in the knee which he took as evidence the knee had not properly healed, so told me to wait 6 months. After another MRI scan I was told the oedema had significantly reduced, and he was 'positive' I would return to my running in time. This was 6 months ago.

So - it is now > 30 months from the time of injury. My current status is that I am living everyday life pretty much normally. I'm always aware of my knee though (more a dull ache these days rather than sharp pain) so am limited to fairly gentle cycling. I'm an active guy though and being permanently injured in my 30's really gets me down. If I push the cycling or do very gentle treadmill jogging I find my knee is probably ok at the time, but is sore the day after and this gets gradually worse if I repeat the exercise. I've tried physio to strengthen my quads but found it made my knee very sore so gave it up.

Thanks for reading so far! My questions are:

1 - My OS clearly feels I should eventually be asymptomatic and that conservative treatment is the only way forward as  (I read) Grade 3 cartilage defects are not bone deep, therefore he would have to remove more good cartilage in order to stimulate the marrow (microfracture). Given the length of time I have been struggling with the injury, is this reasonable? Am I likely to see any further functional improvement, or should I just accept that 'gentle exercise' is all I'm able to do for the rest of my life? I find this really, really hard to swallow when I'm still in my thirties.

2 - Has anybody else had ongoing symptoms with a cartilage defect that is not full thickness?

3 - Lets say I did have a microfracure or similar procedure - would that not preclude running or semi-serious exercise anyway (as I read fibrocartilage is not as durable as hyaline - presumably one would be advised to abstain from impact activity completely)?

Apologies to anbody reading this who's knee woes make mine look pathetic, but any advice would be gratefully appreciated.

Thanks

Offline mmrocker13

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Re: Grade 3 defect of Medial Femoral Condyle - advice for a runner!
« Reply #1 on: February 12, 2010, 12:41:13 AM »
Yes, you can run after a microfracture. However, a generally accepted contraindicaton for the procedure is less than full thickness defect.

That being said... are you seeing a PT? I am not entirely sure how stuff works over there, but a running-specific PT might be able to give you a good set of core (quads, glutes, hams) exercises that can held distribute the load and help alleviate pain.

I'd also look into bracing solutions--perhaps an unloader?
89: Pat. dislocation, lat. meniscus tear, femoral OCD lesion
89: debridement, chondroplasty, lateral partial menisectomy
02: partial lat. menisc., debride
02: mfx
09: subtotal menisc., debride, c'plasty
10: scope/debride
10: varus DFO
13: HWR
15: total menisc., debride, c'plasty, notchplasty

Offline tad10301030

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Re: Grade 3 defect of Medial Femoral Condyle - advice for a runner!
« Reply #2 on: February 13, 2010, 12:29:10 AM »
Have you looked into an unloader brace?  (If you google, you'll find it.)  You can get a prescription for a custom made one and also buy one "off the shelf".  The brace will put pressure on the outside of knee opening up the inside of the joint, helping to relieve the pressure and pain. 

I have had a scope last month and the cartilage was all torn up.  My doctor is now giving me injections of Synvisc and an unloader brace.  If I get any pain relief from the brace it is a good indication that an osteotomy will help.

Anyway, the brace is designed to take the pressure of the medial or lateral, which ever is the bad side, of you knee.  I haven't done a great job explaining it here but there is a company Ossur which manufactures them, check their website -->  Ossur CTi brace

Good luck!

Offline bigbobbloggs

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Re: Grade 3 defect of Medial Femoral Condyle - advice for a runner!
« Reply #3 on: February 14, 2010, 01:15:09 PM »
Guys - thanks very much for the advice.

 I've never even considered the possibility of a brace - has anyone had good results with these? In my ignorance I thought they were purely to add stability to the knee joint, but if they can actually change the mechanics of he joint and take pressure away from damaged cartilage (medial femoral condyle in my case) then that could be exactly what I'm looking for.

Stupid question - wouldn't 'unloading' pressure from one side of the knee 'load' it on the other? And therefore make a second injury more likely (especially over medium to long term use)? Or is that just the risk you take? Are knee braces even designed for long term use for a chronic injury such as mine?

Injections are something else nobody has mentioned to me, anyone had success with these?

thanks again
bbb


Offline mmrocker13

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Re: Grade 3 defect of Medial Femoral Condyle - advice for a runner!
« Reply #4 on: February 14, 2010, 03:00:35 PM »
HI BBB...

I have never used injections, but I know many people who have had good luck with them.

I had an unloader brace, and found it to be quite helpful. You are correct, they are custom built (my insurance covered 85% of mine, which is good, as they can be expensive) and designed to off load the damaged compartment.

It does sound counter-intuitive, I know...but the unloading isn't enough to damage the healthy side, just enough to take the wear and tear off the damaged side. With proper alignment and without injury, normal joint space is remarkably robust.

I had a DFO, which is designed to do surgically what an unloader does mechanically. It's not something you'd do as a first line of treatment, but I am hoping it gives me a few more years out of my joint.
89: Pat. dislocation, lat. meniscus tear, femoral OCD lesion
89: debridement, chondroplasty, lateral partial menisectomy
02: partial lat. menisc., debride
02: mfx
09: subtotal menisc., debride, c'plasty
10: scope/debride
10: varus DFO
13: HWR
15: total menisc., debride, c'plasty, notchplasty

Offline kscope09

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Re: Grade 3 defect of Medial Femoral Condyle - advice for a runner!
« Reply #5 on: February 14, 2010, 06:39:01 PM »
My defect wqs grade 3 but not wide enough to need microfracture so i had a chrondoplasty, though before going in my OS said he might have to perform microfracture.  Also, mine is non-weightbearing, which probably why I was able to cope with my injury with pt for 18 months prior to surgery.  Os reckons I got the defect when my acl tore, this is very common.

The biggest problem i've had with the cplasty is constantly worrying everytime I have a bit of pain in the region where it was performed as sometiems they fail even if you do everything right.  They will help protect against osteoarthritis for a few years which is a plus.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o