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Author Topic: Scoping my knees?  (Read 2395 times)

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Offline wturri78

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Scoping my knees?
« on: July 22, 2014, 01:40:45 PM »
I have chondromalacia patella in both knees per MRI scans last December. So far rest, PT and cortisone really have done little. My knees grind something fierce...my kids can always hear me crackling on the stairs from their rooms.

I've begun prolotherapy and am hopeful but not expecting miracles.

I know surgeries are done arthroscopically. My question is whether a surgeon can scope my knees to get a real assessment of how bad the damage is and where, and whether surgery would even be of benefit. I've heard of tiny scopes being inserted through needles. Also heard that tracking problems can be more accurately observed through scopes.

I wouldn't want to schedule surgery unless I'm certain there a need for it. That isn't at all clear from the MRI.

Offline papasmurf1978

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Re: Scoping my knees?
« Reply #1 on: July 22, 2014, 01:45:53 PM »
Hi wturri78,

did MRI show any damage to the cartilage? with chondromalacia diagnosis it should. Also the cracking you're experiencing is probably crepitus, I have it but only when I bend down completely and then lift myself up and my bad knee makes this noise only for about 1 second. What did your PT evaluate? Is your posture off, this could cause maltracking, muscle imbalance? I would get second opinion before getting arthroscopy, sometimes these things can be fixed by doing proper exercises, in my case, I'm doing squats and they really help. I have grade I chondromalacia patella and it came from muscle imbalance and so I'm working on realignment my knees.
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline wturri78

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Re: Scoping my knees?
« Reply #2 on: July 22, 2014, 02:52:50 PM »
Hello, Papasmurf! (If you were born in 1978, well, so was I, and we're too damn young to have busted knees!)

Couple answers to your questions:

1. MRI showed cartilage damage in both knees, grade 2 on left and 3 on right. However, I've since showed my actual MRI images to two other radiologists and each has had a slightly different impression. None thought I'm anywhere close to "bone on bone" or a likely candidate for surgery.

2. "Sunrise x-rays" showed "fairly normal" alignment of kneecaps and nobody seems to think there's any major tracking problem.

3. My knees have crackled since I was a young kid. But since the real pain started a year ago, they're WAY louder. I can hear them crunching up and down stairs, squatting, getting in and out of chairs, even pedaling a bicycle with some moderate resistance. The crunching doesn't hurt by itself but it's really creepy. *** Question to anyone reading...what IS crepitus? What's actually making the noise? Rough cartilage rubbing on something else? Bone? I sound like a bag of microwave popcorn and can feel the grinding if I put my hands on my knees.

4. I've tried all manner of squats, lunges, deep and shallow, hip strengthening with elastic bands, foam rolling, "active release therapy," stretches, heat, ice, Advil, no Advil, rest, exercise, glute workouts, ab workouts, core workouts. On a high note, I have stronger thighs, hips, butt and abs. But nothing has helped my knees.

5. The nature of the pain is, it almost never hurts during exercise. But like clockwork, 4 hours later they're stiff, painful, stairs hurt, etc. That's when I get stabbing pains behind the patellae.

I've heard wonder stories about prolotherapy, PRP, ozone treatments and other things. I've also heard from those who've gained nothing but debt from these alternative techniques. Of course I've also talked to plenty who've had arthroscopic surgeries and even partial replacements, and still had paint (and even MORE debt)  :-[

I've had one prolotherapy treatment to my right knee, 3 weeks ago. I can't say I've felt any difference. But except for the handful of miracle stories on the internet ("prolotherapy healed my knees in 2 weeks and cured my brain tumor too!") most success stories of prolotherapy involve people getting anywhere from 7-12 treatments per knee!!! Some say they've had faster results from "Prolozone." It sounds like it could be credible. But on the other hand, the inventor of Prolozone lost his medical license in California and has been sued several times in Nevada for malpractice...  :-\

At this point I'd put rattlesnake venom in my knees if I thought it might help. I'm going on 16 months of knee problems. I haven't run since last November, which sucks because running was like Nirvana for me.

Anyway, my OP wasn't about arthroscopic surgery, but whether a doc could ONLY scope my knee but not operate. I'm talking about getting real, live videos of the insides of my joints so there's certainty about the extent of the wear and the likely benefits of surgery, if any.

Offline papasmurf1978

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Re: Scoping my knees?
« Reply #3 on: July 22, 2014, 03:04:12 PM »
Here's something interesting for us, chondromalacia patella sufferers:

http://www.israel21c.org/health/good-news-for-knees/

This seems to be the "ONE" to cure but until I read more success stories on it, I'll remain skeptical as always.

Crepitus can be sign of cartilage damage, also it could be accumulation of gas and pressure in joints. There's a lot of stuff on Google on it. Since you have cartilage damage than that explains reason for your knees cracking.

Read the article above and let me know what you think about it.
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline papasmurf1978

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Re: Scoping my knees?
« Reply #4 on: July 22, 2014, 03:11:33 PM »
can you elaborate also how your damaged your knees? I'm at 36 and I think my posture contributed to bad  knee alignment and then when I started squatting, damage was done.
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline Vickster

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Re: Scoping my knees?
« Reply #5 on: July 22, 2014, 03:32:08 PM »
wturri78 - have you spoken to your Dr about hyaluronic injections - don't work for everyone or in all cases (50:50 it seems) but are actually licensed and indicated for articular cartilage damage.  I have been having these every 12-18 months for the last 3 years or so and certainly seem to keep my knee in check.  Not painful, not excessively costly (at least in the UK), risk of allergic reactions to some brands if sensitive to eggs but others are completely synthetic

Certainly worth discussing and considering as a way to calm and lubricate the joint and relieve inflammation and pain

An exploratory scope is an operation so I don't know what you mean - it involves cutting holes in the knee, filling the joint with fluid and inserting a camera.  Whether the surgeon does or doesn't do anything to the actual joint surfaces and structures makes it no less of an invasive procedure.  Normally if a surgeon finds something to fix, s/he will do so unless you specifically ask for nothing to be done, but then why would a surgeon do the procedure if not to repair?

You could try to get a better level of MRI or a CT scan (with contrast potentially) but then what do you do with the information if you don;t want anything done to the joint. 
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 wturri78

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Re: Scoping my knees?
« Reply #6 on: July 22, 2014, 03:37:00 PM »
Here's something interesting for us, chondromalacia patella sufferers:

http://www.israel21c.org/health/good-news-for-knees/

This seems to be the "ONE" to cure but until I read more success stories on it, I'll remain skeptical as always.

Crepitus can be sign of cartilage damage, also it could be accumulation of gas and pressure in joints. There's a lot of stuff on Google on it. Since you have cartilage damage than that explains reason for your knees cracking.

Read the article above and let me know what you think about it.

At this point I've read about so many miraculous treatments that I don't know what to make of it. It sounds plausible, to someone like myself who isn't trained in medicine and can't understand the clinical claims it's making.

Seems to be undergoing clinical trials in the US...I think. I know people who've tried to get FDA approval on products that barely touch the human body, and have seen the expense and delays involved. I can't imagine we'll be seeing approval for this thing anytime soon. And I can't imagine my health insurance will cover a trip to Israel for an experimental treatment. Maybe it's helpful. I don't know.

I'll tell you my real thoughts, though. I've been "lurking" on this and other knee forums for most of the last year. Sometimes I seen testimony of treatments that have really helped. Mostly, though, I see people whose signatures include nearly a dozen surgeries, injections, and experimental miracle therapies--and another dozen supplements I"ve never heard of--whose stories usually culminate in "well...nothing has actually helped in the last decade...but I'm thinking of traveling to another country for human-growth-platelet-stemcell-subchondral-knee replacement (with gorilla knee cell transplant) next month."

I've found the prices associated with some of these treatments. A couple hundred $$$ for basic prolotherapy type things...get into the stem cell business and people are dropping several thousand $$$ per knee, per treatment, several per year, over several years, with travel costs and time lost at work...often culminating in no improvement.

I know people who suffer from chronic pain. I've seen the cycles of hope, joy, letdown and depression. I don't want to go through that, but it's probably out of my hands. As it is, it hurts to run around the playground with my boys. They always look let-down when daddy can't play tag with them, and I feel like a failed lump of crap. I can write software, manage engineering projects, and have lengthy discussions about history...somehow that isn't very exciting to a 5 year old.  :'(

Sorry for my rant. But I don't want to spend my kids' futures on endless treatments that produce nothing. If anyone here has had REAL success with any procedures, I would surely love to hear those and see if there are paths to follow that can actually lead to improvement.

Offline papasmurf1978

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Re: Scoping my knees?
« Reply #7 on: July 22, 2014, 03:47:13 PM »
I hear ya wide and clear. I'm into 4 months of my problem and am going crazy as I want to be active and now I need to be cautious. Any wrong move can aggravate the situation. Patience in our cases is something hard to deal with cause it can go for a long time and patience does run out eventually.

I wish I had miracle cure for our problem. I am currently earthing myself. I purchased earthing mat which I use at work and home. After reading about it and science behind it, I decided to give it a try. Inflammation =pain, and since being grounded, I do not have inflammation anymore and the pain behind patella is gone. I can walk up down stairs without discomfort. I only have a sensitivity on lateral side of patella but that's maltracking in progress so I'm working on that. I'm not saying that this might help you, but it certainly did for me.

Also I found this:

http://www.forerunnershealthcare.com/

They are a liaison between patients (like us) and hospitals in India who do lots of knee surgeries. They will get you the info you need after evaluating your case.
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline wturri78

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Re: Scoping my knees?
« Reply #8 on: July 22, 2014, 03:50:33 PM »
can you elaborate also how your damaged your knees? I'm at 36 and I think my posture contributed to bad  knee alignment and then when I started squatting, damage was done.

People in my mother's side of the family (more men than women, but virtually everyone) have had knee pain issues and crackling knees for as long as anyone can remember. Most of them are also sedentary. I have read all sorts of studies showing that active people, including runners and cyclists, have LOWER overall occurrences of knee osteoarthritis. I have been a recreational runner since I was 16...so 20 years. But never more than maybe 8 miles per week. I'm hardly a marathoner. I kicked it up gradually over the last couple years as I began to study running form. I changed my form to being "mid foot landing" and I could tell that my landing impact became much less. Running quick and light took lots of shock and impact out of my strides. Switching to "minimal" type shoes actually seemed to help, vs. the "stability and motion control" bricks I'd strapped to my feet previously.

After a few days of consecutive running last spring--stupid, yeah, I knew I should've rested, but the weather was so nice--one night after a 4 mile run, my right knee felt like someone put a bullet through it when walking down my stairs. I rested, saw some docs, got conflicting advice, etc. Did some strengthening exercises that did seem to help. Got back into running at a greatly reduced level. Worked in more cycling and trail running, with less impact than pavement. Did great. But felt really shot after an 8 mile trail run last November so I called it quits to recover. (For the record, it was the best run and fastest time of my life, so at least I went out with a bang)  :-\

Tried "active recovery" with light cycling but it still hurt. So on the advice of one doctor, I tried 2 months of total rest. And both knees got WORSE. Strangely all the problems that had plagued my right knee suddenly appeared in my left. Now they're like mirrors of each other. MRI's showed rather small "partial thickness defects" in each knee, but I'm at a loss how such small defects would make the entire joint feel stiff, sore and painful. Maybe I just don't know enough?

I've even gotten some soreness on the tendons on the outsides of my knees. Don't know what's up with that. I'm not doing anything specifically to injure them? I now understand the plight of so many who say "I'm just falling apart."

I'm thirty-freaking-six years old. I know dudes in their 70's who are ripping off a couple marathons every year. Others doing century rides and triathlons. Guys at work still play basketball and soccer on their lunch breaks, and they're in their 50's. What's going on with me? You're the same age...you can probably understand my frustration. My wife patiently bears with my endless chatter about knees....I have nobody else to talk to. I'm sure she's sick of it. I would be. I never really did "appreciate" the pains she had in pregnancy...I listened, I tried, but I didn't live through it so I could only imagine it. Maybe it's similar for her.

Offline wturri78

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Re: Scoping my knees?
« Reply #9 on: July 22, 2014, 05:16:07 PM »
wturri78 - have you spoken to your Dr about hyaluronic injections - don't work for everyone or in all cases (50:50 it seems) but are actually licensed and indicated for articular cartilage damage.  I have been having these every 12-18 months for the last 3 years or so and certainly seem to keep my knee in check.  Not painful, not excessively costly (at least in the UK), risk of allergic reactions to some brands if sensitive to eggs but others are completely synthetic

Can i save money and just inject egg yolks into my knees?  ;D

Quote
Certainly worth discussing and considering as a way to calm and lubricate the joint and relieve inflammation and pain

Yes I've heard mixed results from these. It's always worth considering, I suppose. I wonder, too, whether such shots would be complimentary with things like prolotherapy/PRP?

Quote
An exploratory scope is an operation so I don't know what you mean - it involves cutting holes in the knee, filling the joint with fluid and inserting a camera.  Whether the surgeon does or doesn't do anything to the actual joint surfaces and structures makes it no less of an invasive procedure.  Normally if a surgeon finds something to fix, s/he will do so unless you specifically ask for nothing to be done, but then why would a surgeon do the procedure if not to repair?

You could try to get a better level of MRI or a CT scan (with contrast potentially) but then what do you do with the information if you don;t want anything done to the joint.

I thought I had read somewhere, that tiny scopes could be inserted through a needle. Maybe I'm making that up but I swear I've heard of it.

My goal (in fantasy land, where it's sunny all the time) would be to get much more precise answers about "where" and "how bad" regarding my cartilage damage, to then determine whether surgery would even be worthwhile.

Thanks for your answers!

Do you have any direct experience with the Synvisc or similar treatments?

Offline wturri78

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Re: Scoping my knees?
« Reply #10 on: July 22, 2014, 05:19:08 PM »
I hear ya wide and clear. I'm into 4 months of my problem and am going crazy as I want to be active and now I need to be cautious. Any wrong move can aggravate the situation. Patience in our cases is something hard to deal with cause it can go for a long time and patience does run out eventually.

I wish I had miracle cure for our problem. I am currently earthing myself. I purchased earthing mat which I use at work and home. After reading about it and science behind it, I decided to give it a try. Inflammation =pain, and since being grounded, I do not have inflammation anymore and the pain behind patella is gone. I can walk up down stairs without discomfort. I only have a sensitivity on lateral side of patella but that's maltracking in progress so I'm working on that. I'm not saying that this might help you, but it certainly did for me.

Also I found this:

http://www.forerunnershealthcare.com/

They are a liaison between patients (like us) and hospitals in India who do lots of knee surgeries. They will get you the info you need after evaluating your case.

I just read about earthing mats. To be honest it sounds pretty hokey...but then, you say you've had direct experience with relieved pain?

Do I have to grow my hair out and drink almond milk while using it?  :P

Offline Vickster

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Re: Scoping my knees?
« Reply #11 on: July 22, 2014, 05:25:37 PM »
Yes, I had Durolane given during my second scope in Dec 2010, then I had 3 x Ostenil shots in May 2012 (I think) and then a single Ostenil Plus jab in Dec 2013

It's not egg yolks, the HA is developed to mimic the synovial fluid in the knee I believe - should be an explanation if you Google, just manufactured from Coxscomb I believe, hence the poultry connection!

My OS doesn't believe there is evidence enough for PRP for cartilage damage (more so for tendon inflammation), can't get prolotherapy in the UK but it does sound like witch doctory from what little I understand

Best to discuss with a specialist ultimately

Yes, I also remember one poster on here saying he'd had a needle arthroscopy (in the US I think), use the search function :)
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 wturri78

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Re: Scoping my knees?
« Reply #12 on: July 22, 2014, 05:28:53 PM »
Yes, I had Durolane given during my second scope in Dec 2010, then I had 3 x Ostenil shots in May 2012 (I think) and then a single Ostenil Plus jab in Dec 2013

It's not egg yolks, the HA is developed to mimic the synovial fluid in the knee I believe - should be an explanation if you Google, just manufactured from Coxscomb I believe, hence the poultry connection!

My OS doesn't believe there is evidence enough for PRP for cartilage damage (more so for tendon inflammation), can't get prolotherapy in the UK but it does sound like witch doctory from what little I understand

Best to discuss with a specialist ultimately

Yes, I also remember one poster on here saying he'd had a needle arthroscopy (in the US I think), use the search function :)

And have your various knee lube injections reduced pain? Do your knees grind less? Are you able to do more activities with less pain and post-activity inflammation? It sounds like a good thing to try...

Offline papasmurf1978

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Re: Scoping my knees?
« Reply #13 on: July 22, 2014, 05:30:10 PM »
Something to consider: Chondromalacia patella occurs in mid 30's, early 30's in some people. Those old geezers who don't have it is because they were probably sedentary their entire lives and now they decided to run so chondromalacia didn't catch up to them. They could also be damn lucky for not having it. From what you're telling me, your family members had or have knee pain too so it could be genetic. Also, don't feel left out or abandoned, there's plenty of people here with same issue as us, some with more severe pain than others. Knee joint is the most susceptible part of the body to injury so it happens a lot to even unexpected people. You can sit all your life without doing sports and it can happen to you. Why? Because sedentary people will develop weak muscles and joints can no longer be properly supported and injuries are far greater to occur. So anyone can get it. We are just unlucky that it happened at all. As I have learned, keeping the joints active is the best end result. I know it hurts and it's not easy to deal with pain. I'm working through it right now and I can tell you it was worse 4 months ago. I was in such bad shape I just didn't have will to live as I though this would never end. What the body needs is continual exercise, it's like breathing, you do it on daily basis, well body is kind of same, you need to maintain it. Now having said that, your injury is not to take lightly. Last thing you want to do is to aggravate the injury.  I would go see another PT who will examine you. I went through two, first one just said to do leg raises and that's bullshit. Second told me to squat as the pressure put on the knee squeezes out the bad enzimes and gets them out and the pain subsides. That's what was recommended for me. I do have good and bad days too. I do feel good that there's no pain after doing squats, looks like my knee responds well to it. I know it's a long process and I don't want to give up. I've been also following the exercises described by some british guy who had chondromalatia patella:
https://www.youtube.com/watch?v=SZqN9PEmDyo
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline Vickster

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Re: Scoping my knees?
« Reply #14 on: July 22, 2014, 05:35:46 PM »
No grinding, some popping but I had chondroplasty in Feb 2010 for Grade 3 patella wear (among other things) and I am told that the removal of the cartilage can create a vacuum, it's painless.  I have a bunch of other stuff up - meniscus tears, a cartilage defect, softening all over.  My current knee niggles are due to issues caused by a shin injury and possibly a tight ITB, rather than the joint damage

Although I am not fully fit, I've cycled over a thousand miles this year, the other injury/surgery is the complicating factor, not the knee

Seems to help me, my surgeon says I'd be much worse off without the injections

I'd say definitely worth a try, there are risks as with any procedure, and some people do end up with reactions etc, but IMO much more benign than any surgery that involves cutting holes!
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















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