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Author Topic: Chondromalacia - In a dark place  (Read 2863 times)

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Offline Hersh

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Chondromalacia - In a dark place
« on: September 16, 2010, 06:57:57 AM »
Hello,

I have been diagnosed with Grade IV chondromalacia, owing I'm told to a dominant lateral tilt of my right knee cap as well as VMO muscles that aren't strong enough.  I also have a very tight ITB and biceps femoral tendonitis.  The grade IV area is 0.7 x 0.5mm, a relatively small amount I'm told.

I am taping and doing physio, which is helping, but I am not where I was prior to the diagnosis.  I can run 3 km or so without too much pain (not that I am doing it very frequently) but afterwards the knee gets sore and occasionally I get sharp pains just under the patella. 

My options are surgery (arthroscope and / or ITB release) or continue with my existing conservative treatments.  My physio and one of the sports physicians I have seen recommend this course of action and say that, given it is only a small grade IV, I should get to a level where I can do everything including running without pain.  The other two physicians recommended surgery. 

I would love to hear from anyone who has been in a similar situation, and what course of action they took, their outcome etc.

Particular questions I am interested in:

1.  Can/should I snowboard with my existing condition?
2.  People who have had positive ITB release experiences
3.  People who have remedied similar situations through conservative treatments like physio, acupuncture etc.
4.  Is running (say once a week, 10k) a pipe dream? 

Thank you to anyone who takes the time to help me. 

Hersh

Offline kscope09

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Re: Chondromalacia - In a dark place
« Reply #1 on: September 16, 2010, 12:40:28 PM »
Wow!  I'm impressed that you can run with that.  I had my defect (with as so small it didn't even show up on mri) fixed and there is a cosntant worry that it has failed.  The OS said I could go back to Karate and th pt said I could run for short distances on soft ground but I can't see either of these happening even if my left knee didn't start flaring up and giving me a whole heap of trouble without any diagnosis.  Before surgery i hadn'ta clue what wa wrong with my knee only that it felt weird and was driving me round the bend.  You can see on my signiture what I had wrong with it so I needed it fixing but worrying about the patchiup that was done is sheer purgatory.  If you don't ave surgery then the defect could get bigger and cause you more trouble and result in OA later one but if you do get it fixed it culd fail after 5 or 10 eyars and leave you with OA so your dammed if you do and dammed if you don't.  Certainly having th defect fixed is a conservative treaetment itself and if successful is worth it as long as it works but you ahve to weigh up wether you want it doing because it sounds like you have good function now.  Having a scope could as with me open up a whole pandora's box of problems, but on the other hand it might work smoothly and go well.
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

Offline Lottiefox

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Re: Chondromalacia - In a dark place
« Reply #2 on: September 16, 2010, 01:14:09 PM »
Hi

I too have Grade 3-4 chondromalacia, in far larger areas than you currently have and due largely to a tilted kneecap and also slight rotation issues with the bones in my legs. Like you, I probably started with a smaller defect but unfortunately I didn't listen to my body and things progressed. PT has helped me a lot but I don't run anymore. I prefer to keep what I have got left functional. Impact activity is just too hard for my kneecaps now.

How long have you been doing PT? Is this focusing on all of the lower limb mucles not just your under functioning VMO? Have you tried foam rolling for the tight ITB? This can have good effects if you do it regularly and combine it with proper stretching and PT exercises. On a personal note I am avoiding surgery - but my damage is more extensive and I also have a cheeky grade 4 lesion on my femur gained through some manic military fitness type sprints last summer (I felt it sheer off ouch) but again, I am functional and active and not prepared to risk what I have for a surgery that may not help. cartilage repair is a very imprecise science. There are developments happening all the time, but many of the simpler techniques such as chondroplasty, microfracture and so on might bring relief for a shortish period of time and might not even help. If you're able to be active, are pain free and seeing progress with PT I would probably say wait a while longer. A scope brings no guarantee of improved function, but clearly if someone is in regular pain and restricted then it is a sensible option.

What I would say is do anything you can to protect your kneecaps now. How old are you? The hard fact is that with knee issues, high impact activity often isn't the best thing to do. I'm not saying don't run, but get your legs as strong as possible first and build up gradually if you want to. I train at the gym with a guy who is late 40s, and has bone on bone OA in both knees from years of rugby playing. He is super fit, strong and has built up to running when he wants to - he probably does manage 10k once a week but the rest of the time he sticks to non impact training. He also skies 3 times a year.

This is only my view and as said, I am allergic to people with medical instruments probing in my knee!!

Good luck

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 Hersh

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Re: Chondromalacia - In a dark place
« Reply #3 on: September 19, 2010, 12:38:38 PM »
kscope09 - Thanks for sharing your experiences and good luck.  Hope you are back to karate soon.

Lottiefox - I'm 35 and this has been going on (or at least I've been aware of it) for about 12 months now.  I originally did some PT for about 5 months which did not help at all, but I'm about 1 month into a new regime with a different physio.  My current PT focuses in particular on the VMO and glutes.  In between I tried a lot of different things - massage, anti inflamms, ITB rolling etc.  I'm still doing all but anti inflamms.

Overall, I'm better than where I was, but I'm sure that is partly if not largely due to me being much less active than I would like.  So I'm not sure if my progress is just a false dawn and when I start being more active it will all come back again.  I also find it hard not being able to attribute one pain or another to cartilege, ITB or tendonitis problems.  Aaaargh...! 

Thanks again to you both for taking the time to write, any further insights gladly received!!


Offline Silkncardcrafts

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Re: Chondromalacia - In a dark place
« Reply #4 on: September 19, 2010, 01:04:57 PM »
Hersh,

Whereabouts are you located ?

Your rehab should also include calf, hamstring and hip strengthening in addition to vmo and glute strengthening.

Have you actually seen a knee surgeon yet ?

I am recovering from a trochleoplastyband have grade 2 cartilage damage. Am wondering if it has got worse or the bone or cartilage are still healing.

Not sure if you are currently doing it but I found clinical pilates very beneficial in terms of strengthening.

Good luck. :)
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline Hersh

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Re: Chondromalacia - In a dark place
« Reply #5 on: September 20, 2010, 12:23:55 AM »
Silkandcrafts,

I'm in Sydney.  I've seen one surgeon who was against doing any surgery - but that was around 6 months ago. 

I see from your history that you had a couple of lateral releases.  Did they help?  How was your level of activity on the knee (prior to the trochleoplasty - which sounds nasty by the way)?  Good luck with your recovery.

Thanks.

Hersh

Offline Silkncardcrafts

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Re: Chondromalacia - In a dark place
« Reply #6 on: September 20, 2010, 09:37:01 AM »
Hi Hersh,

The lateral release worked well on my right knee for about 9 years until I developed medial instability, a rare complication from a lateral release. Hence, the need for a trochleoplasty, which has worked well. The lateral release didn't work very well on my left knee so required a MPFL reconstruction. I also developed medial instability and required a trochleoplasty. All of this has been complicated by a couple of car accidents.

I was pretty limited prior to the trochleoplasties on my knees. Could barely walk. So, were definitely needed. For the left knee I couldn't walk without a hinged brace prior to my surgery due to a car accident. It was similiar for my right knee. The fact that I can walk and my knees are stable is a really good start. Fortunately I have a great surgeon in Melbourne that specialises in patella problems and works with a lot of elite athletes too, especially AFL players.

It is really important to go to a surgeon that specialises in knees, especially patella problems. Did the surgeon you see specialise in knees ?
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline Hersh

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Re: Chondromalacia - In a dark place
« Reply #7 on: September 20, 2010, 11:48:44 PM »
Hi Silkncardcrafts,

Yes - my surgeon is a knee specialist (Leo Pincewski).  What's the name of your guy in Melbourne?

Cheers

Hersh

Offline Silkncardcrafts

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Re: Chondromalacia - In a dark place
« Reply #8 on: September 21, 2010, 10:59:37 AM »
Hi Hersh,

My surgeon is Julian Feller, who specialises in patella instability.

No disrespect to your surgeon, but he doesn't specialise in patella problems. My suggestion would be to go and see a surgeon that specialises in patella problems.

Dr Merv Cross is an older surgeon, but is very good apparently. If I think of anyone else I will let you know.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline chupacabra

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Re: Chondromalacia - In a dark place
« Reply #9 on: September 29, 2010, 06:46:51 PM »
Has anyone here experienced chondromalacia due to direct trauma? About 6 months ago I bumped my kneecap on the ground when I came down to rest after doing a big set of pushups. Shortly following that event I would experience alot of pain under my kneecap while playing basketball and running track. I couldnt run more than 1/2 mile non stop. Now im able to play an unlimited amount of basketball at full speed without experiencing any pain or discomfort. However, I still cant run more than 3 miles non stop without my kneecap acting up. I have another 2-4 months until I'll NEED to have this injury totally healed, ability to do distance running will be extremely crucial. Any advice would be very appreciated.