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Author Topic: Chondromalacia Patella  (Read 1540 times)

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Offline skydiver91

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Chondromalacia Patella
« on: March 17, 2010, 08:53:00 PM »
Hey Everyone,
I'm new to this but have had serious knee complications throughout the last six years and thought it was time to get some other opinions. Does anyone know about the more serious effects of chondromalacia patella? I am a senior in a technical high school majoring in culinary arts and have been dealing with my chondromalacia patella since I was ten years old. In the fall of 2006 I had a lateral release done arthroscopically on my left knee done by my orthopedic surgeon, Dr. B. who said I would be able to play softball in the spring. Unfortunetly I was just starting to jog again by the spring of '07. I was also unable to participate in phys. ed. for the entrety of my freshman year. Since then I have always "taken it easy" and have limited myself from activities that hurt my knee. After I turned eighteen this last November I noticed a reoccurence in the pain of my knee. When I saw Dr. B. again he sent me back to physical therapy on a tri-weekly basis until further notice. Keep in mind I have been going to physical therapy on and off for the last six years. He also gave me a cortizone shot. Recently I went to another specialist, Dr. C. who, after reading my MRI, said I just had an excess of scar tissue and the problem would eventually resolve itself. I was told to do what I love to do, but limit my physical activity. I also have been wearing a brace on and off every day. I cannot limit myself anymore. I have given up everything. The pain is so reoccuring and spurratic that it is limiting my day to day activities. Dr. C. suggested getting a Fulkerson Osteromny if nothing else works. Does anybody know anything about this?
          The pain can best be desicribed as a sharp shooting stab usually around the lateral head of the quad. Other times it comes below the kneecap and more lately than not my entire quad muscle becomes inflamed and the kneecap itself won't stay on track. I feel it moving, catching, grinding, and slipping almost every time I walk, even when I'm sitting down. I cannot work a full day in culinary arts without having to "fix" it.
Does anyone have ideas what I can do to fix my knee? Is there an answer? Please, help.



Sincerely,
Skydiver91

Offline rsuddeth

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Re: Chondromalacia Patella
« Reply #1 on: March 18, 2010, 01:59:39 AM »
Well, you've tried everything short of that, so if the diagnosis is correct, having some kind of "tibial tubercle transfer" (Fulkerson is one type) is probably warranted. But... the pain you describe doesn't sound typical for "Chondromalacia Patella" from what I've heard (and certainly different from mine, which is highly typical.) So I wonder if that's really the main cause of your pain? Maybe it is common if you really dislocate a lot? I have heard that some people find other types of transfers better for stability (the Fulkerson, if I understand correctly, will lift your patella away from the other bones some, which is meant to help avoid arthritis -- so it doesn't rub as much, but this is not always the best thing for patella stability.)

Hopefully others will have some better info... maybe someone experiencing something more like what you are?
Feb 24th, 2010 TTT/LR (meniscus trim)

Offline crankerchick

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Re: Chondromalacia Patella
« Reply #2 on: March 18, 2010, 02:15:32 PM »
SkyDiver, I'm glad you decided to post. I think you are in the right place to get some help with sorting through and dealing with your knee problems.

First and foremost I want to encourage you to seek out a patello-femoral specialist to get to the root causes of your problem. Chondromalacia isn't a diagnosis. It just means wearing of the cartilage under the patella, so it is a symptom not a diagnosis. The key question that needs to be answered is why is your patella tracking improperly, and a good specialist will help you get to the root (or roots) of your problems and address as many of the real issues as possible. You really want to make sure you are good good opinions from the right doctors before making any surgical decisions.

The Fulkerson TTT moves the patella medially and anteriorly, so it is moved towards the middle of the knee and then also "out" of the knee. This is supposed to "correct" the position of the patella in the trochlear groove in the horizontal axis and relieve pressure on the patella. It, like any procedure, can be successful if done in the right situation.

Have you had x-rays with your leg in various degrees of flexion, lateral x-ray, and standing leg length x-ray? CT scan? MRI (although not all that useful for patella tracking issues)?

As rsuddeth said, there are a few different TTTs, and the CT scan seems to be the best tool for analysis of patella issues to rule out bony reasons for patella problems. It can reveal rotational issues like femoral anteversion, tibial torsion as well as provide insight into the terrain of the trochlear groove and the patella, along with revealing the displacement of the tibial tubercle from the trochlear groove, which will tell if the tibial tubercle is actually displaced and needs to be moved more medially.

What you want to avoid is being lumped into a group and treated like a number, where a doctor says, well, you've had conservative treatement, you've had a lateral release, now let's try a fulkerson. Do you really want to be a patient on an assembly line? That's how I felt with my treatment through all the years, like I was just being led along this path of, if this doesn't work try this, if that doesn't work try this, and after that we can't help you.

If you can find the right doctor to evaluate you for bony and soft tissue issues alike and suggest the proper course of treatement for you and your body mechanics, i think that will give you the best chance at improving your quality of life with respect to your knees.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline skydiver91

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Re: Chondromalacia Patella
« Reply #3 on: March 20, 2010, 12:46:17 PM »
Thank you everyone for your advice :)   I just wanted to post an update that on March 18 I got a cortisione shot injected by Dr. B.   this was my second one on four months. The first time it didn't hurt as bad, but this time he injected it right into the scar tissue. I was in pain for the whole day as well as the majority of the next day. On top of everything... the NSAID he orginionally perscribed me, Voltarin I found out is a depressent and after using it more frequently mrore or less as a crutch for the pain it's stopped working and just makes me depressed. Is there any other medicine alternative or holistic that would work without the side effects?
 
 
Ever since getting the shot my knee hurts even worse... its seems like a downhill slope as I am continually running out of options. I am scheduling an appointment with the orthopedic institure of new jersey sometime within the next few weeks; maybe they will have some answers.   As to the replies previously posted I have had an MRI done recently, but all it showed was an exceess of scar tissue. Dr. C. said that would work its's way out over time, but I have heard otherwise from various medical proffessionals. Is there any truth to this? Does anyone know of any other doctors in the new jersey area who can help me?

Sincerely,
kKydiver 91


Offline crankerchick

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Re: Chondromalacia Patella
« Reply #4 on: March 20, 2010, 12:53:28 PM »
Hmm how far are you willing to travel? A few hours by car?

Sorry the injection made things worse. I know the pain is probably bad but my pqth that I chose with my leg was to do nothing without having though and researched first. I'm not a fan of injections in gemeral though, so that may account for trigger shyness. I will round up the lists of docs I know.

The MRI is fine for assessing the cartilage but it won't tell much else. definitely think its time for a new doctor.
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline skydiver91

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Re: Chondromalacia Patella
« Reply #5 on: March 30, 2010, 09:14:51 PM »
Hello,
   I haven't been having much luck with my knee. Last week the entire quad gave out at once while my kneecap moved down to the left and stayed there. I had to do a quad contraction to get it to "pop" back in place. So much for not having a strong quad! Thank God my boyfriend was there to catch me as I fell because there was nothing keeping me up. Has anyone else experienced this? Recently it's been grinding and clicking and I just get random pains. I'm trying to live a "normal" life and do what I love, as advised by my OS, but even that's becoming difficult... I need to be able to walk. Yesterday my PT said she didn't even know what to do with me anymore. This situation sucks  :'(
In other news I made an appointment with a new OS because my second one didn't even call in my new perscripton... some help he is! I'm going to see Dr. Hurley in Morristown. Does anyone have experience with him? Ironically enough as I'm updating my resume' for college Simultaneously editing my "kneesume" for the next opinion.

Offline Silkncardcrafts

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Re: Chondromalacia Patella
« Reply #6 on: March 31, 2010, 07:12:52 AM »
Sorry to hear what you are going through.

You definitely need to see a surgeon that specialises in patella problems and won't just operate for the sake of it.

Having some plain x-rays and CT scans is really the key to working out what is going on. It definitely sounds more than just scar tissue.

Good luck with your next opinion. When is the appointment ?
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
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11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
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