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Author Topic: MRI & Chondromalacia Patella  (Read 8625 times)

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Offline Fruffy

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MRI & Chondromalacia Patella
« on: March 20, 2010, 01:25:05 PM »
Hi All,

I am a 30 year old female who sustained a knee injury (left knee pain > right knee) in September 2009 from running. The injury was accompanied by sharp pain at the back of my patellas, swelling followed by consistent popping, grinding and clicking. i could no longer squat, stoop, ascend or descend the stairs... so I saw my GP who, having examined my knees assured me that I was fine, too young to have knee problems and the pain would pass. Also x-rays showed knees healthy with "no action". I asked for an MRI to be done but was told that wouldn't necessarily show any other abnormalities.

The pain seemed to decrease after a few weeks but every time I did any medium to high impact activity the sharp pain would return (plus the grinding hurt too). I also noticed some stiffness and throbbing pain in the joints of my fingers. I went back to my GP and was referred to a podiatrist/biomechanics specialist, physiotherapist and rheumatologist. The biomechanics specialist diagnosed hypermobility in my knees as well as unequal limb length (left leg longer than right) and over-pronated feet. I was given a pair of orthotics which seemed to help a little but the knee pain persisted...Rheumatologist gave me the all clear and seemed confused as to why I had been referred to him!

I was dissatisfied with the treatment I was getting and insisted an MRI exam. I finally got one done in Feb 2010 - 5 months after my injury and these are the consultant orthopaedic surgeon's comments:

"The MRI scan of both knees showed some chondromalacia patella involving the articular cartilage on both sides which accounts for the knee pain. There is not any remedial surgery that will help her. Sensible non-impact exercise such as rowing, gentle cycling is probably better than any impact work and being patient. I think it will certainly improve. I do not think that it will resolve completely. The knees will always be vulnerable to flare-ups with sudden stressful movement, but I do not think it is going to deteriorate significantly or rapidly".

I would like to get a second opinion as 6 months since my injury my right knee still hurts considerable, gets swollen on the inner side when even when I walk for about 4-5 km at once. I cannot even run for a bus, go up the stairs, squat or stoop without experiencing noticeable pain... I am also not satisfied with (probably unwilling to accept) the above underlined comments of the COS. I gave up running since last September but can't seem to do much else except walking. My quads are wasting as I cannot do any weight-bearing exercises w/out experiencing pain, so I do straight leg lifts which seem insufficient to build and strengthen my quads and hamstrings.

Can anyone advise what other options I have to resolve this problem which is negatively impacting on my daily active lifestyle.


Offline weirdknees

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Re: MRI & Chondromalacia Patella
« Reply #1 on: March 20, 2010, 04:19:22 PM »
Did you try the physiotherapy?  Was anything said about the alignment of your kneecaps?  Chondromalacia does take quite a while to heal, and needs a good few months of rest and intensive physiotherapy.  A special support (one with a hole for the kneecap) and a good pair of shoes might help when exercising.  If you are very worried about this, I would try to get a second opinion.  If there is no problem with the alignment or tracking of your kneecap, surgery would most likely involve shaving some of the cartilage behind your kneecap.
knee pain since very young
2008 - diagnosed with patella tilt
2010 - partial meniscectomy

Offline Fruffy

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Re: MRI & Chondromalacia Patella
« Reply #2 on: March 20, 2010, 07:29:32 PM »
Yes, I saw the physiotherapist (Oct - Dec 2009) and she confirmed that my kneecaps were tracking properly. She insisted that my quads were wasting and I needed to progress to weight-bearing exercises to build and strengthen them. The problem was (and is) that my knees cannot bear any weight! The slightest squat, bend or extra pressure and the pain returns with swelling. I don't know what sort of "intense physio" I can engage in (except from what I do now - straight leg raises) without causing further damage.

I have had this condition for 6 months now and would have thought it enough time to heal. I do rest but also need to keep active (just long distance walking) to keep my joints, muscles strong. I also wear proper trainers with orthotics every time I go walking. I try taking the stairs from time to time but the pain eventually resurfaces.

I am seeing my GP in a week to request a 2nd referral to a COS or OS to consider other options. I fear that there is loose, rough cartilage lying around the joint which exacerbates my condition and may be eventually erode my femur joint with the constant grinding. I also worry that at my age I can now do so little because of the vulnerability of my knees.

Do you or anyone know (by experience, profession or 3rd party contact) how successful surgery might be?

Offline doublemom

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Re: MRI & Chondromalacia Patella
« Reply #3 on: March 20, 2010, 09:15:31 PM »
I think it's time for you to be seen by a knee specialist, particularly a patellofemoral specialist.   Chondromalacia patella is not a diagnosis in and of itself, though unfortunately lots of docs still use it as an official diagnosis.  CP is when the cartilage on the back of the patella and/or in the trochlear groove where the patella glides up and down is worn down.  Something is causing the cartilage to wear abnormally, and what ever that cause is should be your "real" diagnosis.  I hope that makes sense.  Basically, CP is the effect of something else going wrong with the tracking of your kneecaps.

Have you had a series of xrays done with your knees bent at different angles (called "merchant" or "sunrise" views)?  This is truly the best way to check for patellar tracking.  To be honest with you, and MRI is probably the least likely test to show patellar tracking problems.  It's good for showing soft tissue or cartilage injury, but there is physically no way that an MRI can show the true tracking of a kneecap.

If you're willing to post what area you live in, there are probably lots of other people on the forum who could recommend a good patellofemoral specialist.  Please don't take "there's nothing we can do" for an answer... there are a ton of things that can be done to help, you just have to find the right doctor to help you. 

Take a look at the Patellofemoral forum here at Knee Geeks and post there, chances are someone at that forum can recommend a good doctor for you.

Andi
2000 R patella dislocation
2004 - Soccer injury - LK medial and lateral meniscectomies
2007 - Dx patellar tilt, lateral subluxation, grade III chondromalacia
5/13/08 - RK medial/lateral meniscectomies & patellar chondroplasty
4/6/2010 - RK TTT/LR scheduled

Offline Fruffy

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Re: MRI & Chondromalacia Patella
« Reply #4 on: March 20, 2010, 10:58:54 PM »
Thanks for your input Andi.
I think it's time for you to be seen by a knee specialist, particularly a patellofemoral specialist.   Chondromalacia patella is not a diagnosis in and of itself, though unfortunately lots of docs still use it as an official diagnosis.  CP is when the cartilage on the back of the patella and/or in the trochlear groove where the patella glides up and down is worn down.  Something is causing the cartilage to wear abnormally, and what ever that cause is should be your "real" diagnosis.  I hope that makes sense.  Basically, CP is the effect of something else going wrong with the tracking of your kneecaps.
I understand. As I have over-pronated feet and hypermobile joints, this is the origin of the malfunctioning of my knees. Plus at the time I was running I didn't have proper support for my feet (orthotics and suitable running shoes) which is when the symptoms began. I wear my orthotics in all my shoes now (limited to trainers and my converse!) but still have this niggly sharp pain...

Quote
Have you had a series of xrays done with your knees bent at different angles (called "merchant" or "sunrise" views)?  This is truly the best way to check for patellar tracking.  To be honest with you, and MRI is probably the least likely test to show patellar tracking problems.  It's good for showing soft tissue or cartilage injury, but there is physically no way that an MRI can show the true tracking of a kneecap.
Yes, had such done and the result showed my knees as "normal with no action".

Quote
If you're willing to post what area you live in, there are probably lots of other people on the forum who could recommend a good patellofemoral specialist.  Please don't take "there's nothing we can do" for an answer... there are a ton of things that can be done to help, you just have to find the right doctor to help you.
 
I am in West London. I do not think I can afford to go private which is why I am currently seeking to be referred to a reputable specialist under the NHS.

Quote
Take a look at the Patellofemoral forum here at Knee Geeks and post there, chances are someone at that forum can recommend a good doctor for you.
Will do. in the mean time any more pointers would be much appreciated.


Offline Fruffy

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Re: MRI & Chondromalacia Patella
« Reply #5 on: March 20, 2010, 11:06:46 PM »
I can't seem to find the patellofemoral forum. Can someone please direct me? Thanks!

Offline KW

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Re: MRI & Chondromalacia Patella
« Reply #6 on: March 21, 2010, 12:26:00 AM »
Right Knee
2000 - 2002 - Scope,LR,TTT,Unscrewed
01-10-12 - PFJR

Left Knee
04/07 TTT/LR
08/07 Bone Grth Stim
10/07 Loose/Bent Screw
1/08 Unscrewed/MRI~NON-UNION
02/19/08 Lt  TTT Revision W/Graft
12/09/08 Scope
05/15/09 Scope
09/04/09 PFJR/Unscrewed