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Author Topic: Chondromalacia Patella ...Hope?  (Read 15720 times)

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Offline MDAL

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Re: Squatting with Chondromalacia Patella
« Reply #15 on: June 15, 2014, 11:42:39 AM »
I like this post from Canadian-Ice...

Sometime ago there was almost nothing available... Micro Fracture and transplant which would only buy you some extra time (for those it didn't fail in the first place), before your knees being turned into metal...

At the moment, multiple pieces are being put together that may in a few years become valid solutions...

Cartilage samples can already be extracted cultivated and grown in lab and re-inserted (ACI style), stem cells therapies are in fast development, but they don't yet return the full results expected. Denovo brought also new light for another type of solution. Other procedures are now under FDA trial, such as allogenic genetically modified cartilage cells, that once injected into the joint express growth hormones (this one is expected to be in the market in 1 or 2 years), if FDA approved.

HGH therapies as developed by Dr. Allan Dunn, seem to be the most effective at the moment, at least that is the only minimally non invasive option, where people come out posting Xrays and you see joint space growing without any doubt.

What PapaSmurf brought in to discussion by posting the link to Chondrofiller, I see it as a good possibility to develop valid scaffolds for implanting cartilage cells or stem cells.

I do have some doubts that the application as described by the company does generate the results they mention... The idea of filling a big hole with just inorganic Type I collagen and assuming that cells will migrate there by their own executive decision and start secreting their own type II collagen seems odd... I'm a bit skeptical, that it will last long, but if such solution buys you a few years and can be repeated sounds good. But I would prefer to use such scaffold material as a base to seed living transplanted cells, rather than just expect them to travel there by their own decision.

At the moment we need to keep some skepticism of new these hypes that pop around every 6 months and later turn out into nothing... there have been hundreds like this in the last 10, 20 years... yet, there is a global insane investment in the development of cartilage repair techniques, since this affect hundreds of millions of people as a result of global aging and growing life expectancy, and the big bucks will flow for any company that can bring solutions into the table... I agree with perspective of 20 to 25 years for full repair of cartilage, but there will be far more helpful things (even if they are temporary solutions) before that time. Stem cells as they are already help, even though just injecting them to swim around without a scaffold is unlikely to turn into a definite solution...


Offline papasmurf1978

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Re: Squatting with Chondromalacia Patella
« Reply #16 on: June 15, 2014, 12:38:19 PM »
Canadian-Ice, MDAL,

I really appreciate your guys' thoughts on this subject. It's great to get real honest opinions here thus putting things in real perspective.

I'm truly optimistic about this procedure and am hoping that this will turned out to be something big but I don't want to jump to conclusions since the results are not out there yet only facts of what the company is publishing.

I was wondering how you guys are dealing with your chondromalacia issues. I'm doing sissy squats (yes sissy) hehe. The pain is less and I don't get the burning sensation in front of knee as much as I used it. Also going up and down stairs is better than it used to be. My knee cap rattles a tille when I move it but I guess that's due to the cartilage softening. Since my thing is like 6 mm x 4 mm I don't know if that will get worse with time. Ortheo says it might not and he doesn't forsee at all knee replacement in my lifetime. Every morning when I wake up, lateral side of my kneecap hurts, I guess that's due to maltracking but I'm working on that.
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline Canadian-Ice

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Re: Squatting with Chondromalacia Patella
« Reply #17 on: June 15, 2014, 07:15:20 PM »
Thanks for your response posts guys and I'm really glad to be a part of the discussion. Wandering around the net for a couple years with no informed community before and glad to have found this site.

It seems to me important to distinguish "osteoarthritis" from "chondramalacia". From doctors I've spoken to and articles I've read, chondramalacia can be stopped early, and if not, usually does not lead to OA or knee replacement. It can, but not typically, for various potential reasons.

However, yes, I accept that there are procedures that might help slow chondramalacia progression and pain out today, such as the ones you guys describe. Actually there is a procedure "trochlea paste graft" specific for chondramalacia by Dr. Kevin Stone you may or may not know about.

http://www.stoneclinic.com/stem-cell-cartilage-study/

This link is not specific to the "trochlea" version but if you wander around the site you'll find it. The clinic told me their procedures are $10,000-$30,000 and the TPG in their study lasts an average of 9.9 years. Because his clinic invented the procedure, we don't really seem to have any independent verification, unfortunately.

Personally, I can't afford to try this surgery, and am trying more conservative measures than surgery. Which brings me to Papa's questions....

As mentioned I was dx with chondro in 2012 by MRI and by May 2013 had found a way to stabilize through regimen of electro machine, straight leg raises, 1-3 pound leg extensions, leg curls, double leg squats, to Single Leg Squats. Could not do endurance sports so sports doc did a series of synvisc but because of lousy restriction information my knee got worse than ever before. 13 months later I cannot go up and down stairs or in and out of my car without pain and damage.

What am I doing? Never give up. Using electro machine 15 minutes a day for VMO which does help. Trying to return to straight leg raises which do not hurt IF I warm up properly and do only about 15 right now. Use spin bike up to 20 minutes every other day -- this is a major breakthrough as I've found it doesn't really cause any more irritation than daily activities now anyway.

Edit: Forgot to mention that Roller once or twice a day above the knee, IT Band, and Quad does seem to help. I think that previously I couldn't use exercise bike so much because the next day tissues were tightening up causing knee pain, and merely rolling has limited this problem -- was mostly not damage caused by the bike all along...hope this helps someone....

Also to add, I had a wrestling injury in 2008 in which a bigger guy fell on me and as I went down my left leg chicken-winged out to the side, I think left side. This "harangued" the knee. 4-6 weeks later I was fine, no PT. But by 2010 I got pain for days after skipping rope.

Today, when lying on my back with bent knees, I notice the two knees are different. Left knee is slightly more pointy, as though the knee cap is slightly more to the left. Suspect it did not heal back perfectly and is not gliding right. But surgeon 2 years ago told me surgery is only good for more gross problems, and my GP says surgery often makes knees worse. Any thoughts?

Of course it's a worry that too much damage is already beyond the point of no return. Which is why I've lost some heart, to be honest.

Turn 40 in a couple months and it comes down to, what's more important my knee or my cardio vascular system and the years of my life that I'll never get back? I've had non-stop injuries since aged 33 and refuse to allow my 40s to be that sedentary again.

My cabbage.

What about you guys? Any suggestions certainly appreciated. What is your plan?
« Last Edit: June 15, 2014, 07:23:40 PM by Canadian-Ice »

Offline MDAL

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Re: Squatting with Chondromalacia Patella
« Reply #18 on: June 15, 2014, 07:20:09 PM »
Personally I tried HA (works for very short time)...

PRP, a very unusual long series of injections, worked wonders for me...

Recently stem cells, now will wait to see the results.




Offline papasmurf1978

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Re: Squatting with Chondromalacia Patella
« Reply #19 on: June 16, 2014, 10:14:10 AM »
Canadian-Ice,

when you were dx with chondormalacia patella, what did MRI show? Since I have early wear and tear, I will definitely have it fixed later. I will put my money on chondrofiller for now. Currently I'm doing sissy squats to build knee muscle and also am foam rolling since I have lots of knots, it hurts a lot but I need to get rid of them so have my muscles regain natural lenght and strenght as currently my knee is very tight and the lateral muscle is firing constantly like a spasm without me having anything to say about it. Really weird. You mentioned that you still have pain after all this time going up and down stairs and also when getting out of car. Is there more serious damage done to your cartilage?

I read also that chondromalacia does not really lead to oa and it can be prevented from progressing if treated early. I will definitely opt to go with the procedure to get the piece of cartilage that is worn out or softened out fixed asap once I will get the chance.
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline papasmurf1978

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Re: Squatting with Chondromalacia Patella
« Reply #20 on: June 16, 2014, 01:26:56 PM »
Here's the latest article I found on Chondrofiller:

http://www.bio-pro.de/magazin/thema/00135/index.html?lang=en&artikelid=/artikel/09715/index.html

from what I understood, there's no microfracture or ACI involvment in the procedure at all.
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline papasmurf1978

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Re: Squatting with Chondromalacia Patella
« Reply #21 on: June 16, 2014, 04:05:55 PM »
MDAL, what is your knee damage, just to get an idea.
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline MDAL

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Re: Squatting with Chondromalacia Patella
« Reply #22 on: June 16, 2014, 09:17:50 PM »
Lol... Im not a typical case, have damage all over the place... bone, tendons, cartilage everywhere, meniscus, muscles, ligaments, scar tissue...

Long list of surgeries, would be here until Xmas to tell the all story...

Offline Canadian-Ice

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Re: Squatting with Chondromalacia Patella
« Reply #23 on: June 17, 2014, 03:06:26 AM »

I don't know but there must be cartilage damage for my knee to get inflamed and painful.

SaveYourself.ca says pain and cartilage loss are only correlated mind you. Like some people have tons of damage and no pain and others have pain without the damage. Plus there are no nerves in cartilage so the pain we feels is actually from a thin membrane that covers the cartilage that is very sensitive.

On that other point above, yes don't think chondramalacia is likely to lead to joint replacement. But still it's important.

What do you folks think of the trochlea tx I mentioned earlier? There is also Dr. Minas who treated Dara Torres's knee OA at Women's College.

Offline papasmurf1978

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Re: Squatting with Chondromalacia Patella
« Reply #24 on: June 17, 2014, 01:13:21 PM »
I think you mentioned you never had MRI done but wanted to be sure I understood if you did or not. I read that MRI is not the best tool to determine cartilage issues, but I don't want to go under arthroscopy unless I really need to. Are you icing your knees regularly to keep the inflammation down? Also, it will sound corny but I'm grounding myself at work and home. I put my feet on earthing mat which has helped me a lot in getting most of pain out, could be related to inflammation and it was proven scientifically that earthing gets rid of inflammation and speeds up healing process whatever can be fixed. In my case since there's something with cartilage, fat chance this will be fixed on its own. I'm working hard on finding a clinic in Poland to get me to fix the little tiny thing I have with cartilage. Why? it's weird but I do feel pain sometimes in front of my knee if I would move it to the side, it's like the cartilage would have nerves and they are sensitive. Right now I'm working on getting the knots out of my muscles, they are really big and painful. My knee is contracting a lot on its own and very tight and this is putting more pressure on the knee cap as well. So been rolling and it helps a little, I still have lots to get rid of.

Also, is it possible that patella maltracking can cause inflammation of the cartilage and this is dx as chondromalacia on MRI but there might not be anything wrong with cartilage after all? To me, chondromalacia is a very vague diagnostic. ANy thoughts on this? I can't give you advise on trochlea issue you are experiencing. But how is your biomechanics? Is your knee tracking properly?
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline vickster

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Re: Squatting with Chondromalacia Patella
« Reply #25 on: June 17, 2014, 01:29:26 PM »
Not the same issue but have you read suspect device's advice here on managing pfps, often labelled chondromalacia? Could be useful

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=64300.msg616543#msg616543
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline papasmurf1978

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Re: Squatting with Chondromalacia Patella
« Reply #26 on: June 17, 2014, 02:03:53 PM »
Hi Vickster,

quite interesting posting. I know it's long run for me as well, that girl does have huge amount of damage to her knee.

Here's the posting from my MRI result, it's in french and I can't translate easily so I don't know if anyone out there speaks french and can interpret better. That's all there's mentioned on the MRI:

Il y a une toute petite zone d'hétérogénéité
de signal du cartilage de la rotule au niveau de la facette médiale au tiers moyen en hauteur sur
environ 6 mm de largeur x 4 mm de hauteur impliquant un peu moins de 50% de l'épaisseur du
cartilage compatible avec une chondropathie débutante. Le cartilage des deux autres compartiments
est normal. Les ménisques sont intacts tout comme les ligaments croisés et collatéraux ainsi que
l'articulation péronéo-tibiale supérieure.
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline vickster

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Re: Squatting with Chondromalacia Patella
« Reply #27 on: June 17, 2014, 02:24:39 PM »
I can speak French, the translation would be as you've posted before.  All normal, apart from the tiny (6x4mm) half thickness fissure on the medial (inside) facet of the patella.  This shows the early start of chondropathy (i.e. an issue with the articular cartilage)

Have you read about the grading of cartilage, 50% depth is grade 1-2 if I recall.  It'll be extremely hard to see on the MRI unless you are practised at reading them.  You should ask your ortho to go through the images with you when you discuss what treatment may be required if any (not much is really done usually unless the cartilage is quite torn up or worn through).  I'd try for an HA injection to settle the joint down
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline papasmurf1978

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Re: Squatting with Chondromalacia Patella
« Reply #28 on: June 17, 2014, 02:37:06 PM »
Thanks for the translation Vickster. My ortheo was a d**k. I brought him my cd with images on it that can be read on any computer and he didn't bother looking. Only glimpsed on the test result paper and said that this "thing" is so small it might not even ever progress. ??? I though Chondromalacia is a progressive condition. He said there's nothing to be done to it.

Now, since I read so much about CHondrofiller and that they can work on even very tiny fissures since they work with a needle than that's what I will consider. The sooner I close that gap the better.
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline vickster

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Re: Squatting with Chondromalacia Patella
« Reply #29 on: June 17, 2014, 02:43:29 PM »
One thing that concerned me was that chondrofiller is given through a mini arthrotomy (and not only arthroscopically) - for something so small, I'd be very wary due to all of the risks that go with open surgery, indeed any surgery.  Also, it is hard to get to the back of the patella, so often it needs to be turned over to get good access, so you'd definitely want clear answers on that

Go see another surgeon who specialises in cartilage.  He could be right though - chondromalacia is a symptom and not a diagnosis, yes as we age, the cartilage wears, that's actually pretty inevitable it seems

Have a read of this http://www.kneeguru.co.uk/KNEEnotes/primers/joint-cartilage-and-arthritis-primer, including  http://www.kneeguru.co.uk/KNEEnotes/primers/joint-cartilage-and-arthritis-primer/classifying-amount-cartilage-damage

and this  http://www.kneeguru.co.uk/KNEEnotes/primers/patella-primer (especially  http://www.kneeguru.co.uk/KNEEnotes/primers/patella-primer/what-chondromalacia)

and this  http://www.kneeguru.co.uk/KNEEnotes/courses/patellofemoral-pain-course-ronald-grelsamer-md
« Last Edit: June 17, 2014, 02:47:49 PM by Vickster »
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone