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Author Topic: patella alta + chondromalacia: many questions  (Read 5730 times)

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Offline mamm-loic

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patella alta + chondromalacia: many questions
« on: January 27, 2014, 10:23:55 AM »
Hi, I'm a 41 years old female from Belgium. I'm fond of playing badminton, but I always end up with a painful, instable and swollen knee, which takes me more than week to recover (so it's getting worse and worse since I try to play every week). A few weeks ago, I was diagnosed with patella alta and chondromalacia in my right knee. Fortunately, I've never experienced any kneecap luxation. However, when I fold my leg, the kneecap moves a little bit outside. But that might be normal to any knee (?), I don't know much about patella alta. Should a normal kneecab stay in the center of the knee?

The OS told me last week that my patella alta is quite considerable and that my knee needs to be operated on (TTT) to prevent further damage of the cartilage. But he only watched the MRI photos, he didn't even take a look at my knee nor did he ask me any question (about work, sports etc). Is that normal?

The whole consultation took only ten minutes. I had expected to be told to wear a brace or to try PT, so I wasn't prepared to this news and didn't find the right questions to ask. When the doc told me that the surgery wasn't that urgent, I decided to wait till August. I asked a knee brace to be more comfortable untill surgery.

I felt very confused after this brief consultation. So I went to my GP, who took enough time to talk this over. We decided to get a second opinion, my appointment is set at the end of February.

Now I'm wearing my knee brace (Bauerfeind GenuTrain P3) to play badminton, but it doesn't seem very comfortable. My knee keeps popping and I'm afraid to make a bad movement. And it's quite painful to take the brace off afterwards. Is that normal? Doesn't the brace push my kneecab further to the femur and make everything worse? Or should I just get used to this brace? The muscles in my leg are aching today after I wore the brace yesterday.

The final thing I worry about, is my left knee. As far as I know, I have two similar knees. So I think I'm bound to have patella alta in my left knee as well. However, I don't experience the same pain and discomfort, it only hurts now and then. But I'll have an MRI next week to be sure about that. I'm afraid I'll need two operations. But if it's really necessary, I'd prefer to undergo surgery before my left knee gets as bad as the right one.

How can I find a good surgeon? How often does this problem occur and how frequent is this kind of surgery?
Thank you for any answers. I'm sorry about the poor quality of my English (my mother tongue is Dutch).
« Last Edit: January 27, 2014, 10:22:06 PM by mamm-loic »

Offline Leentje

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Re: patella alta + chondromalacia: many questions
« Reply #1 on: January 27, 2014, 11:18:59 PM »
Hey!
I'm also from Belgium and a badmintonplayer, How about that? Would be easier to reply in Dutch but I'll do it in English ;)
Anyway, I am 37 and have patella alta, chondromalacia grade IV, shallow trochlear groove and had numerous dislocations of my left patella. Had therefore a Fulkerson TTT on my L knee back in 2002.  They didn't do a trocheoplasty. I must say I am very happy with the results!
Recovery wasn't as bad as I expected. I went back to work 12 weeks post-op, was running again 5 months post-op and back to badminton a little later. Now play like 8 hrs a week (including competition) without braces, I run like 4x a week and have a very active life as an ER-nurse and EMT on ambulance. My knee isn't cured, but I can be active again without too much pain.

If you have questions regarding the TTT, shoot!

Leen
Bilat patellar malalignment/PFdysplasia
00/06/83 L wrist #
11/12/00 L knee LR + chondroplasty
21/08/02 L knee TTT
02/03/04 L knee stretched PCL
11/09/07 L ankle dislocation/medial avulsion #
25/05/09 L ankle medial avulsion # AGAIN!
05/06/13 R ankle dislocation

Offline mamm-loic

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Re: patella alta + chondromalacia: many questions
« Reply #2 on: January 28, 2014, 06:52:27 AM »
Hi Leen,

What a nice coincidence! I'm from Antwerp, where do you live? I'm asking this because I'd like to know who your surgeon was. I went to dr. Peersman in Stuivenberg (Antwerp) and next month I'll see dr. D'Anvers (UZA) for a second opinion. He seems to be a very good knee specialist. But you've probably seen more doctors than me, so I'm very curious about your experience.

Thanks for your reaction anyway! It's really nice to hear that you're doing so well after surgery. So, let's continue in English, this is an English-speaking forum after all.

Kind regards
Esther
« Last Edit: January 28, 2014, 07:00:51 AM by mamm-loic »

Offline mamm-loic

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Re: patella alta + chondromalacia: many questions
« Reply #3 on: February 21, 2014, 10:11:34 PM »
This week, I've had a MRI to check my left knee for patella alta + chondromalacia. My both knees look quite similar, but the right knee is far more painful. So I thought the position of the patella would be the same, but that the cartilage would be better.

Today, I had the result: patella alta (as expected), chondromalacia degree II (just like my right knee, so worse than expected) and Hoffa's syndrome (unexpected).

I don't understand why my right knee is more painful if the condition isn't worse. When I look at the pics, I think my left knee looks better than my right one. It's not swollen and the cartilage looks better to me. For my right knee, I was told that the cartilage of the femur was unaffected, but on the third photo (in my first post) it looks like it is damaged and I think the cartilage of the kneecap looks quite bad as well.

In the meanwhile, I've seen lots of MRI photos on the web and I think the cartilage damage on my right knee looks more like degree III at some parts. I don't know if this is true, but it would explain why it hurts so much more.

Next week, I'll finally see a doctor for a second opinion, I hope that will make everything clear to me.

Offline mamm-loic

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Re: patella alta + chondromalacia: many questions
« Reply #4 on: February 27, 2014, 12:15:10 PM »
Today, I had my second opinion. This doctor told me off surgery, it wouldn't help and it could even make things worse. Instead of surgery, he adviced me to move to an other house (without stairs) and to avoid stairs where possible. I could continue to play badminton, but I should take it easy (duh, sounds like jogging the 100m).

What should I do now? It's exactly the opposite from what the first doctor told me. It's the kind of advice you'd expect him to give to elderly people, but I'm only 41 years old and I'd like tot maintain my active life.

I think I'll need a third opinion now.  :(

Do you guys have any advice? Please? I'm just fed up with it.

Offline SuspectDevice

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Re: patella alta + chondromalacia: many questions
« Reply #5 on: February 28, 2014, 04:19:15 AM »
Read this - http://dougkelsey.com/knee-cartilage/

and this blog/get his e-book - http://savingmyknees.blogspot.com.au/

and this e-book - http://saveyourself.ca/tutorials/patellofemoral-pain-syndrome.php

you will then learn your 2nd opinion was quite likely the right one.  follow the advice in the above publications, prepare yourself that it may take years to heal your knees, and get to it.

I have the same problem as you (chondromalacia), I've been working to heal it for 20 months.  i've made some good progress, but still have a long way to go.
L Medial menisectomy 2012
PFPS both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2020 - ride 3x/week, swim 2x/week, gym 2x/week, aiming to get back to short triathlons

Offline mamm-loic

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Re: patella alta + chondromalacia: many questions
« Reply #6 on: February 28, 2014, 11:32:13 AM »
Thank you for your advice! Do you also have patella alta? My cartilage is a mess because the knee cap is in the wrong position. Wouldn't that be different?

The doctor I saw yesterday didn't talk about PT, only about moving to an other house and avoiding stairs.

Offline SuspectDevice

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Re: patella alta + chondromalacia: many questions
« Reply #7 on: February 28, 2014, 08:46:49 PM »
No, I don't have patella alta (at least not that I know of - but your scans prompted me to look at mine again, & my kneecaps do sit quite high like yours, perhaps not quite as high). But I was initially told my kneecaps tracked laterally and I should consider lateral release surgery by one top Sports Dr.  After reading the above publications, I decided to avoid more surgery & the OS who removed my torn piece of meniscus agreed.  On a subsequent visit to the Sports Dr, he decided the tracking problem was only minor and surgery was not needed.  I know several people who have had lateral release surgery for no relief.

The moral - don't rush into surgery.  Take your time.  Try conservative treatment methods for a few years if you have to.  It might mean stopping badminton for a while, doing more passive exercise.

My other question is - you are 41.  How long have you been playing badminton & how long have your knees hurt?  If you've been OK for a long time, is the patella alta the cause, or is it simply recent over-use & wear and tear?  If it is the later, conservative treatment plus careful strengthening exercises (as outlined by Doug Kelsey) may well heal things.  But at our age, it sadly takes longer than when we were 20.

I know surgery seems like an easy quick fix, but be sure you really need it before rushing in.
« Last Edit: February 28, 2014, 09:00:45 PM by SuspectDevice »
L Medial menisectomy 2012
PFPS both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2020 - ride 3x/week, swim 2x/week, gym 2x/week, aiming to get back to short triathlons

Offline mamm-loic

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Re: patella alta + chondromalacia: many questions
« Reply #8 on: March 01, 2014, 07:18:44 AM »
Thank you for your wise words. I'll keep them in mind.

I'll try to see a third doctor anyway. Even if surgery is not a solution, I'll still need PT to learn how to use my knee and strengthen it. So I'll need a doctor to prescribe me PT then.

The two specialists I've seen now were disappointing. None of them asked me about work, sports or life style. I could be a cleaning lady or sit behind a desk - that would make a huge difference (in fact I'm a teacher). It's very weird they didn't ask, but both of them were in a hurry. It's hard to believe a doctor who just leaves without saying goodbye or shaking hands.

I've been playing badminton for many years (but only once a week). And yes, I've experienced pain before, which always started shortly before the summer stop. After the summer I could start again without any pain. But it feels worse now.

Badminton is quite important to me since I'm a lung patient and I need to do sports to keep my lungs strong and healthy.

Anyway, I'll see my GP next Monday and ask him to send me to an orthopedic clinic for a third advice. I don't want to rush into surgery. But if an operation is needed, I'd rather have it done before the cartilage gets worse.
« Last Edit: March 01, 2014, 07:51:34 AM by mamm-loic »

Offline SuspectDevice

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Re: patella alta + chondromalacia: many questions
« Reply #9 on: March 01, 2014, 09:29:43 PM »
Thank you for your wise words. I'll keep them in mind.

I'll try to see a third doctor anyway. Even if surgery is not a solution, I'll still need PT to learn how to use my knee and strengthen it. So I'll need a doctor to prescribe me PT then.

The two specialists I've seen now were disappointing. None of them asked me about work, sports or life style. I could be a cleaning lady or sit behind a desk - that would make a huge difference (in fact I'm a teacher). It's very weird they didn't ask, but both of them were in a hurry. It's hard to believe a doctor who just leaves without saying goodbye or shaking hands.

I've been playing badminton for many years (but only once a week). And yes, I've experienced pain before, which always started shortly before the summer stop. After the summer I could start again without any pain. But it feels worse now.

Badminton is quite important to me since I'm a lung patient and I need to do sports to keep my lungs strong and healthy.

Anyway, I'll see my GP next Monday and ask him to send me to an orthopedic clinic for a third advice. I don't want to rush into surgery. But if an operation is needed, I'd rather have it done before the cartilage gets worse.

A few thoughts on this.

I really urge you to read those 3 links/publications.  They will explain how you need to be careful with PT - it can overload the knee and make things worse.  That's certainly what happened for me.  I found 20-30mins of easy walking most days and swimming 2-3x/week (freestyle, but with a pull buoy between my legs to minimise kicking) for 6-12mths helped my knees slowly recover.  Aggressive quad/hip/glute exercises made things worse.  For some perspective, I used to train 8-12hrs/week HARD for triathlon (e.g. 4 hour rides, 2 hour runs etc), so I've had to wind things way back to get my knees to start to settle.

Swimming is excellent for lung capacity.

I agree, if your kneecaps really are that far out of alignment, surgery might be needed to stop the wear, but be sure that is the problem, and not just overuse.

It sounds like your knees do settle with rest (mine were so bad they hurt most of the time), but then flare up again with badminton.  So maybe you need to get them to settle, then slowly strengthen hips/glutes/quads/calves/ankles so your knees can take the strain of badminton again.  But that process may take years.
L Medial menisectomy 2012
PFPS both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2020 - ride 3x/week, swim 2x/week, gym 2x/week, aiming to get back to short triathlons

Offline mamm-loic

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Re: patella alta + chondromalacia: many questions
« Reply #10 on: April 22, 2014, 12:10:33 PM »
Today, I saw a third specialist and he prescribed me a glucosamine supplement to make the cartilage stronger. That's it: no surgery, no move. Great news!

After 3 months, I should be able to see if it works or not. If not, he would give me injections. But he expects the supplement to work fine. It doesn't even have any side effects. Could it be that simple? How strange that it took me 3 months and 3 specialists to be offered a simple solution.
« Last Edit: April 22, 2014, 06:10:09 PM by mamm-loic »

Offline Vickster

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Re: patella alta + chondromalacia: many questions
« Reply #11 on: April 22, 2014, 01:55:44 PM »
I don't think glucosamine has been clinically proven one way or the other. Ideally it should be taken with chondroitin (as long as mot allergic to seafood) and msm but in specific doses. Also omega 3 fish oil can be useful for joints

Hope it helps :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline mamm-loic

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Re: patella alta + chondromalacia: many questions
« Reply #12 on: April 22, 2014, 05:37:33 PM »
oops, mistake  :o

Offline mamm-loic

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Re: patella alta + chondromalacia: many questions
« Reply #13 on: November 15, 2014, 08:25:04 AM »
It's been a while since my last post.

I've been trying glucosamine with no result.
I tried hyaluronic acid (injections) with little result; I received the treatment in August and it took 2 months to get any better. But now I have the impression that the pain is returning little by little.
I've been trying PT which made my muscles stronger but it's no miracle therapy since it won't correct the wrong position of my kneecaps.

Yesterday I saw the OS and he told me very little can be done for me right now. He thinks that I'll need a kneecap prosthesis in about ten years. In the meanwhile I could try PRP / growth factors (but I'd better wait till the treatment gets less expensive).

I've been reading about PRP on this forum and I have the impression that it doesn't work so well on cartilage. Growing hormones seem to have dangerous side effects on the liver and/or blood sugar. Plus, will this treatment fill up the gaps? You can't really steer the regrowth of cartilage, or am I wrong?

Please, what's your opinion?
« Last Edit: November 15, 2014, 08:57:40 AM by mamm-loic »

Offline randoknee

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Re: patella alta + chondromalacia: many questions
« Reply #14 on: November 16, 2014, 04:36:08 AM »
Hi Mamm-loic,
 
Your condition sounds very familiar to me.   I've had chondromalacia since I was a teen.  I used to be a very active alpine skier and mountaineer and runner in my teens and early twenties.   The years of heavy back packs, and up and down pounding took it's toll and beat up my knees.  In 2008 I slipped on some ice and ended up rupturing my patellar tendon.  My tendon repair healed up with my patella on my left leg sitting 25mm higher than my right leg.  Subsequently I suffered a fractured patella, and have been comprehensively dealing with these issues.   

I'm a 53 y/o male.  I've tried dietary supplements and minimal surgical intervention for the cartilage issues, but had no significant improvement.  When dealing with a delayed / non-union of my fractured patella, I finally located a real patella-femoral specialist.  Who I've been working with for the past 4 years.   I sought out his opinion as a third and fourth opinion for my fx patella.   His exam was by far more nuanced than all of the other doctors I consulted and was very clued into nuances of the pain profile I was experiencing.   When my chronfromalacia pain progressed to the level where I needed maximum daily doses of over the counter anti-inflamitories, and visualization of my PF compartment confirmed that I was bone on bone.    I chose to proceed with resurfacing my patella-femoral compartment. 

Over the last year I had PFA's' on both knees.  As I recovered from my last PFA,  the instability and pain associated with the patella alta became much more pronounced and I recently decided to pull the trigger and have a TTO to improve my patella stability and it's engagement in the femoral groove.   This procedure has been on my and my doctors comprehensive plan to deal with my situation for several years now.  The first step was to get my patella healed up enough to be able to accommodate at new surface in the future.  I also had a chondroplasty to smooth out the cartilage (as much as we could), and then get the surfaces of both knees as "good" as we could get them, and finally remove the "slack" from my patellar tendon to improve stability and function.

I'm now almost three weeks post surgery from my TTO procedure where my tubercle was moved down 11mm and medially 5-6.  This recovery will be lengthy, but I'm hoping it will be functional resolution to my issues.

My best advice is to find a true PF specialist.   A regular general OS just isn't that "into it". 

My passion is long distance cycling.  I rode Paris-Brest-Paris back in 2007 and hope to ride it again.  I may not be able to get there this next summer, but I'm going to try.

I wish you the best in working through your knee issues.
12/08 L patellar tendon rupture (mush) -ORIF  -  8/10  fx of L patella  - 8/10 ORIF L Patella 9/10  dx patella alta  - 2/11 dx "delayed union" - 6/11  L knee scope / HW remvd.- 6/13  R Knee Scope - 11/13 R knee PFA - 6/14 Left knee PFA - 10/14 L Knee TTO- 11/16 L patellar tendon repair & augment















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