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Author Topic: PFPS in 29 y/o cyclist -- pain cycling! I just want to ride my bike!  (Read 1364 times)

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Offline fivesevennine

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any cyclists out there?

I'm a 29 y/o female, former competitive distance runner that started cycling competitively 5 years ago when an x-ray revealed I had moderate arthritis in my patellofemoral joint.

I have grade 4ish patellofemoral arthritis/chondromalacia in my right knee. I'll post my MRI report at the bottom. I'm bone-on-bone on the lateral facet of my patella.

It all started last fall. I went for a long ride and sort of bonked. I think my form must've gotten wonky because my knee was sore afterward. It the rest of the following week to ride. A week later I went for a run and felt something pop (maybe the last of the cartilage that was in there?), and my knee swelled up. It stayed swollen and painful for the next few months. I couldn't ride without pain. It hurt to walk. It started locking up when I'd use the elliptical. Rowing was (and continues to be) the only thing that doesn't cause pain.

Beginning in January I started physical therapy. Mostly quad massage to get more space in the PFJ. Also a lot of glute strengthening (my glutes were super weak). And some IT band massage.

Four months of PT later and although the swelling went down and the pain during daily activities subsided, it still hurt to ride my bike.

Fast forward to now and I can walk, hike, and row, but it hurts to swim and bike.

I have talked to two orthopedic surgeons.

Surgeon 1 says: I could do surgery but it might not help and could make it worse.
Surgeon 2 says: I've seen tons of patients like you before and we should do a lateral release NOW NOW NOW!

I had a lateral release scheduled for last month but ended up cancelling it. I'm strongly considering getting a third opinion. I just want to be able to ride my bike again without pain or swelling. Right now if I ride even short distances it feels off and starts to swell.

My hips and glutes are strong. My quads are strong and balanced. My IT band is tight, and there are some osteophytes on the lateral side of my knee that my IT band "pops" over when I bend my knee. I'm not sure if this is a contributing factor to the pain and tightness.

I've had a professional bike fitting where they raised my saddle considerably and changed my cleats around. The fitting was, as far as I can tell, very thorough. I don't have much lateral movement in my stroke. My cranks are about as short as they make them (165mm), which is good because I'm tiny (5'3") with short femurs.

Other options/ideas:
--New PT/physical therapy regimen
--Orthotics--custom or maybe Superfeet green? I over pronate and used to use orthotics when I ran, which I still have and could use in my cycling shoes, but maybe I need new ones made?
--Third opinion from another orthopedic surgeon
--Invest in a short crank and see if this helps

I think that's all. Here's the MRI Report from last winter:
The medial collateral ligament remains intact but is bowed medially around small marginal osteophytes. The lateral collateral ligamentous complex remains intact as well but there are also lateral compartment osteophytes.

The anterior and posterior cruciate ligaments remain intact but small intercondylar osteophytes are present.

There is minimal speckling in the anterior horn of the lateral meniscus which does not meet criteria for meniscal tear. Both the medial and lateral meniscus remain intact.

Evaluation of articular hyaline cartilage shows essentially no remaining hyaline cartilage over the lateral facet of the trochlea and lateral facet of the patella. The median patellar ridge is also denuded. All of these involved areas, the median patellar ridge, lateral facet of the patella, and lateral trochlear facet, are undermined by substantial T2 hyperintense edema like marrow change. The patella is subluxed laterally and marginal patellofemoral osteophytes are evident.

Medial and lateral compartment articular cartilage is maintained.

The extensor mechanism remains intact. The tibial tubercle trochlear groove distance is normal. Trochlear depth is normal.


1. High-grade patellofemoral compartment articular hyaline cartilage loss.

2. 3 compartment marginal osteophytic spurring, most substantial at the patellofemoral compartment. The pattern of arthritic disease, despite the absence of chondrocalcinosis, suggests underlying CPPD arthritis.

Offline jtrue

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Re: PFPS in 29 y/o cyclist -- pain cycling! I just want to ride my bike!
« Reply #1 on: July 24, 2014, 05:03:18 AM »
Read this thread:

I'm a 32 yo skier and cyclist, been dealing with some overuse type knee injuries for a couple years now.  ITBS and some medial knee pain as well.  Is your pelvis aligned, do you have a leg length discrepancy, functional or structural?  If you want to chat hit me up via PM.