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Author Topic: No cure for the Patellofemoral Syndrome / Chondromalacia  (Read 7502 times)

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Offline Lanterne Rouge

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No cure for the Patellofemoral Syndrome / Chondromalacia
« on: May 28, 2014, 09:39:03 AM »
As far as I understand, in the process of fighthing with this problem for two years, there is simply no cure for this issue. Once your patella is out of its groove, you are done for your life. I have seen 6 different orthopedists in two years and about to finish a physical therapy program of 2 weeks and nothing has changed. I feel a relief only when I am resting at home, no walking, no exercise, just resting. As soon as I walk a couple of miles or exercise which involves flexing the knees I am in pain. Actually it is more like inflammation if I don't push a little too much. I keep reading stories about people who suffer from this issue and how they can't find a solution. I am one of them. Some people even mention they had lateral release and their pain got worse. Usually doctors offer that as a last resort. Even the last resort is a no resort! Injections also don't work. Any kind of them. Some of the people complaining of this issue are just so young. I really don't understand. Is there anyone here with the same situation?

Offline schnops

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Re: No cure for the Patellofemoral Syndrome / Chondromalacia
« Reply #1 on: May 28, 2014, 08:18:55 PM »
Hey there!)
Like you, I suffered with chondromalacia for a little over 2 years. Notice how suffered is in past tense!! :) For most people, intensive PT does the trick. You've only been going for 2 weeks, right? Sucks, but it can take months of work. Does your kneecap sublux or pop out at all? From what I've heard from multiple surgeons and even PTs, lateral releases are being used less and less because they often don't work or even make the pain much much worse. Have you tried injections? There is no definite cure, but different things work for different people.

In my case, my chondromalacia was caused by horribly maligned knees. I ended up having a major surgery to fix it, but all my symptoms have gone away :) But if your legs are aligned and everything then a lot of PT and possibly injections could do it.  But it takes a TON of time, so hang in there!
TTO, LR, arthoscopy, medial tightening R leg -03/'13
Hardware Removal- 9/'13
TTO, LR, athroscopy, medial tightening L leg- 10/'13
VMO advancement, LR, trochleoplasty

Offline Lanterne Rouge

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Re: No cure for the Patellofemoral Syndrome / Chondromalacia
« Reply #2 on: May 28, 2014, 08:57:59 PM »
Thanks a lot for your comments. It is good to hear that you are healed. My problem is also malalignment. My kneecap is tilted laterally and it is very apparent as you can see in attached MRI scan. I don't know about subluxation. It doesn't pop out. I didn't try any kind of injections yet because I didn't understand the mechanism of injections yet. If it is my tilted patella causing all the pain why should I have injections? I have to fix the patella itself. If I don't fix the source of the problem it will repeat itself anyway.

Offline schnops

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Re: No cure for the Patellofemoral Syndrome / Chondromalacia
« Reply #3 on: May 29, 2014, 09:24:31 PM »
My biggest suggestion is to keep going to different orthopedic surgeons then. Not all malalignments need surgery, and sometimes that's where the injections come in. It depends on the severity of the mis-alignment. I tried 2 years of intense pt and strengthening because sometimes strengthening the right muscles can help pull things back into line.  But I totally agree with what you're saying, you have to go to the root of the problem. I guess your symptoms might be able to be managed with PT and injections but probably have to be cured surgically. It's different for everyone though!

I'm in no way shape or form a doctor so everything I've told you is just based off of my own personal experiences and reading that I've done. Def go see an OS. And if he/she suggests a lateral release then I would do some research on the success of that operation or even look around on this site to find people who have had it done. A lot of times lateral releases are done along with other procedures. So I had a TTO and an LR. But again, these are just my suggestions!
TTO, LR, arthoscopy, medial tightening R leg -03/'13
Hardware Removal- 9/'13
TTO, LR, athroscopy, medial tightening L leg- 10/'13
VMO advancement, LR, trochleoplasty

Offline 2cutekiddos

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Re: No cure for the Patellofemoral Syndrome / Chondromalacia
« Reply #4 on: May 30, 2014, 03:02:59 AM »
Hey,

First, I must say I am impressed that you say you haven't had a subluxation or dislocation yet! Looking at your X-ray shows your knee cap is tilted too far laterally. If you have grade 3 chondromalacia you probably got it from the malalignment as it is a softening of the cartilage due to abnormal wear and tear.

I suggest going to a patella-femoral specialist to have your knee assessed: CT Scan, measurements of your TG-TT, and such.

During my TTT and MPFL+r they did a "dibridgement" fancy word for clean up of my cartilage. They take away the damaged cartilage and smooth everything out. This helped get rid of the arthritis type pain, but my doc says it can come back due to the malalignment. During my first knee surgery in 1993 they cleaned up the cartilage but I didn't have the relalignment procedure (TTT) so the grade 3 chondromalaica came back 10 years later!

Good Luck!!!
Andrea
1981 First Subluxation/Dislocation Rt knee - 7yrs old
1981 to the Present: Countless Subluxation/Dislocations of Rt & Lt knees
1993- Rt Knee LR & Medial Reefing (failed)
1996- Lt Knee LR & Medial Reefing (failed)
2012- Lt Knee Fulkerson TTT & MPFLr
2014 -RT Knee Fulkerson TTT & MPFLr: scheduled 6/18

Offline Lanterne Rouge

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Re: No cure for the Patellofemoral Syndrome / Chondromalacia
« Reply #5 on: May 30, 2014, 12:43:11 PM »
Thanks a lot for your comments. I am still counting on few possible solutions before considering a surgery. First and most important one is stretching quadriceps muscles. I was doing foam rolling time to time but yesterday I found a video on youtube and it was recommending that if you want to stretch a muscle on the foam roller, you should elongate it first. That means if you want to stretch your quadriceps you should roll the roller on your thighs while your knee is flexed. I tried it and it gave me a good painful stretch on certain points. It is more effective to release tight muscles than strengthening the counterpart muscles (eg. VMO's). I am also working on strengthening of my hip muscles. They seem to be weak since they exhaust easily when I try side-lying leg lifts. I also think that I have microtrauma on the tissues around the quadriceps tendons. I will try naproxen and ginger tea as anti-inflammatory. I will see how it goes for a few months. If nothing works I will see another doctor which will be the 7th time in two years.
« Last Edit: May 30, 2014, 12:45:08 PM by cycling_freak »

Offline Vickster

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Re: No cure for the Patellofemoral Syndrome / Chondromalacia
« Reply #6 on: May 30, 2014, 01:44:18 PM »
Steroid, hyaluronic acid and prp are all potential anti inflammatories which are injected.  Could be worth trying, to get the knee settled if the NSAID.  Be careful with naproxen, only ever take with food.  If taking for an extended period, talk to your doctor about an antacid/PPI

Are you working with a physio to make sure you are doing all the exercises correctly, it's really easy to do them wrong, watching YouTube videos is no substitute for hands on experience with a trained medical professional

Given you have a clear mechanical issue in the position of your kneecap, the physio should be able to advise whether exercise is sufficient for long term relief. 
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 papasmurf1978

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Re: No cure for the Patellofemoral Syndrome / Chondromalacia
« Reply #7 on: May 30, 2014, 02:13:18 PM »
***I've posted this blog in another topic here as well on can cartilage regenerate***

Hi everyone who posted here.

A little about myself. I have been diagnosed with beginner stage of chondromalacia patella via MRI test. My orthopedist said that the signal they saw is so small 6 mm large x 4 mm high affecting less than 50% of my cartilage that he guarantees me I will not need a knee replacement later in life. I`m 36, male. He said with good physio I will help me knees to stay healthy for long time.

A very good question posted here if knee cartilage can regenerate. Technically no unless it goes all the way to the bone and then a similar type collagen is excited to be produced by the bone but it`s not even close to the real hyaline like collagen.

Is there hope for cartilage defects today? YES!!!!!!!! I stumbled upon an article describing German pharmaceutical company that invented a gel substance that can regenerate cartilage in any defect. Product is called Chodrofiller. Here's the link to the article:
http://www.sciencedaily.com/releases/2014/04/140428074648.htm

It seems all it takes is a minisurgery to get the needle in and patch the defect and in relatively short time cartilage starts to regenerate with the surrounding cartilage and according to once preclinical trial, it took less than 6 months for the MRI to reveal the patched cartilage defect no different than surrounding tissue.  It might be the big thing in science as other procedures are available but me personally I don't want to get ACI treatment and have two surgeries and year of rehab.

Check it out guys, let us know what you think.

Cheers and good luck to everyone!
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August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline papasmurf1978

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August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline Lanterne Rouge

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Re: No cure for the Patellofemoral Syndrome / Chondromalacia
« Reply #9 on: May 30, 2014, 02:22:41 PM »
It should be very expensive. I heard something like that called Prolotherapy.

Offline papasmurf1978

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Re: No cure for the Patellofemoral Syndrome / Chondromalacia
« Reply #10 on: May 30, 2014, 02:29:31 PM »
Prolotherapy is expensive because it's stem cell based procedure.
Chondrofiller is a gel implanted in the defect to regenerate the cell growth. Should be considerably less expensive.
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline Lanterne Rouge

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Re: No cure for the Patellofemoral Syndrome / Chondromalacia
« Reply #11 on: May 30, 2014, 02:31:36 PM »
In Turkey, even PRP is known as a new thing. It would take years to have this operation here.

Offline papasmurf1978

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Re: No cure for the Patellofemoral Syndrome / Chondromalacia
« Reply #12 on: May 30, 2014, 02:33:23 PM »
I'm from Canada, and if it's not available here yet in the next couple of years, I will go to Germany to have the Chondrofiller procedure done there.
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline papasmurf1978

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Re: No cure for the Patellofemoral Syndrome / Chondromalacia
« Reply #13 on: May 30, 2014, 02:34:13 PM »
Company confirms that it will be available shortly. But where? It does not say. Surely Europe will be the best bet.
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline Vickster

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Re: No cure for the Patellofemoral Syndrome / Chondromalacia
« Reply #14 on: May 30, 2014, 02:37:36 PM »
Is it a bit like cartifill, which is available in the uk? But that's more for full defects, rather than chomdromalacia softening?

http://www.rmsbio.net/html/RegenGraft/Cartifill.asp

It's also like amic, with chondrotissue, again for defects
« Last Edit: May 30, 2014, 02:39:27 PM by Vickster »
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