Prominent chondral degeneration of the medial patellar facet near median ridge

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Hi everyone,

I've been experiencing some bad knee pain in my right knee for around a year and a few months.

I get very severe pain near the bottom of my knee cap (inside, but behind the knee cap, if that makes sense) when I put a lot of weight on it (walking up stairs is the main time I get that type of pain).

Also, I can't seem to run more than 1/2 mile before I'm in excruciating pain in my knee. I can't really explain where the pain is while running, since it seems to radiate around the knee in general. If I were to take an educated guess, I would say that the pain happens on the right side of the knee, behind the knee cap. After my most recent run, my knee swelled up and has been swollen for the past two months or so. Not a huge amount of swelling, but enough for the doctor to notice.

I had an x-ray done, and that was inconclusive. My doctor said that I should do physical therapy in hopes that strengthening some of the muscles around the knee would make my pain go away. I did physical therapy for one month and my PT recommended that I get an MRI, as all of the exercises and treatment over the month had not helped the swelling and I was still having pain walking around and going up stairs.

After around a three week waiting period for my insurance to approve an MRI, I had the MRI done and got some interesting results.

I have looked up some of the terms I suspect are the main culprits of my pain, but could not find anything conclusive about the injury.

I also called up my uncle, who is an orthopaedic surgeon, and he gave me some unfortunate news which I hope is the end-game for my knee.

Here are the results of the MRI:

1. No evidence of meniscal tear. Intact ligamentous and tendinous structures.
2. A 5 mm focal area of prominent chondral degeneration of the medial patellar facet near the median ridge. Remainder of the articular cartilage appears maintained.
3. Small Bakers cyst.
4. Question of minimal edema adjacent to the iliotibial band. Recommend clinical correlation for any symptoms related to iliotibial band friction.

#2 and #4 are the ones that I can't seem to find a lot of information on. Can anyone tell me what exactly these might mean and what can be done to fix the pain in my knee? It is very tough to get around work right now.

I should add that I am going to see an orthopaedic doctor next week. I would just like to hear if others might have experience similar MRI results to this and have had success in getting rid of the pain.

Thanks for your time!

[jtcarlto]

You stated you talked to your Uncle so I figure he told something...

But #2 is basically CP or chondromalacia patella or the degradation of the cartilage of the patella.  That is likely why you have pain on the inside part of your knee climbing steers and running.  Cartilage can heal itself sometimes but very slowly.  Check out the site savingmyknees.blogspot.com.  He had CP and got back to biking is a 50+ year old guy. 

Alternatives would be therapy and then if that didn't work  you could try a cartilage repair surgey.  Or you could opt for something like stem cells or PRP, usually not covered by insurance (PRP might be, that is if you put up a fight ) that is less invasive and may help you out.  Nathan Wei does this is Frederick, Maryland.  There are guys in Baton Rouge, LA who do it.  Depends on where you live.

Hopefully therapy helps and some of your knee cartilage grows back.  Otherwise honestly I would try to get in one of those clinical trials with the stem cell stuff (bone marrow derived; inject in your hip, draw out bone marrow--or they take if from your bloodstream.  Some are fat-derived)  Anyways, depends on your location. 

Chicago, IL has Ross Hauser who does some of this stuff.  Hopefully your cartilage will regenerate through time and therapy but otherwise some type of intervention might be neccesary.  Some people might do a patella re-alignment surgery (i.e. have it rub on your lateral versus medial side) but I have heard BAD results from that stuff.

Maybe it works with some people but anyways I would AVOID that pending you hear great things of it.

Best of luck with your knee and all
Jeff