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Author Topic: Chondromalacia Patella + Patellar Tendinosis  (Read 31725 times)

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Offline papasmurf1978

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Chondromalacia Patella + Patellar Tendinosis
« on: July 29, 2014, 07:04:30 PM »
Hi guys,

I was wondering if the area of my pain in the knee is normal due to chondromalacia patella.
Picture is not of my knee but an example. I have indicated where the chondromalacia patella was diagnosed. This is my right knee and cartilage wear is on the medial facet. I have this irrititating pain all the time on the lateral side of the patella, it's like if it's rubbing against the trochelea or something. It's like if there's irritated nerve or something or could be that my patella is maltracking due to softening of the cartilage. Any ideas?
« Last Edit: March 20, 2015, 05:22:12 PM by papasmurf1978 »
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline tinydinosaur

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Re: Chondromalacia Patella Pain
« Reply #1 on: July 31, 2014, 07:11:41 AM »
can you see a physio or something? they should be able to tell you if you are having tracking issues, you can - i suppose - just sit and flex your quads, if its way out of whack it will be easy for you to see. mine used to pull off way to the outside.

i get this same pain on my good leg due to having to compensate so much - (for me) it's caused by my outer quad muscles being too tight

Offline papasmurf1978

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Re: Chondromalacia Patella Pain
« Reply #2 on: July 31, 2014, 12:26:07 PM »
Hi Tinydinosaur,

following MRI, it was found that I have 6 mm x 4 mm involving less than 50% of cartilage in the medial facet of the patella. It doesn't say if it's softening or fissure. Could that be reason for my patella tilting up lateraly and rubbing against femur?
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline tinydinosaur

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Re: Chondromalacia Patella Pain
« Reply #3 on: July 31, 2014, 07:59:39 PM »
as i understand it, yes. i had the back of my kneecap replaced and my surgeon showed me my before and after x-rays, with restored cartilage there is a nice space between the patella and the leg bones. i know everyone is different but my pain in the joint is very specific, before i had it i would get it right in the middle of my kneecap where i had no cartilage and now i am having pain on the inside.

i'm not sure if it would help you, due to the location of your lesion but look into unloader braces, see if you can try one out (without buying). they are made for unicompartmental wear (one side of the knee) and they offload it to another side which buys you time. again, i don't know if that would work for you.

they also might recommend hyaluronic acid injections, have you had those? they can be expensive if your insurance doesn't cover it. my surgeon explained that for some people they work wonderfully and they just need to get them every 4-6 months, instead of reconstructive or other surgery.

cheers!

Offline papasmurf1978

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Re: Chondromalacia Patella Pain
« Reply #4 on: July 31, 2014, 08:27:29 PM »
Hi Tinydinosaur,

I'll look into the injections. In my case, the pain is really on the lateral outer edge of the patella, it's that tip of the bone that's on the outside of the patella, it's very sensitive, and it hurts when I touch it. I don't know if one of the nerves is causing it but the pain comes and goes but mostly it's painful. On scale of 10, the pain is constant 4 or 5. I ice it and rub it gently and it doesn't seem to go away. The pain is there already for about 2 months. You said you had knee cap cartilage replaced. Did they replace all of it or some and what procedure they used? So you had chondromalacia patella?
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline vickster

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Re: Chondromalacia Patella Pain
« Reply #5 on: July 31, 2014, 08:35:36 PM »
Given the MRI showed medial damage to the kneecap (the articular cartilage is only on the back of the kneecap) and you are experiencing lateral pain above and to the side of the kneecap, have you discussed the possibility of this being due to a tight ITB rather than the kneecap, or tendon/ligament inflammation (which would also tie in with the overuse you have described in other posts)?  Maybe discuss with the physio/specialist - a steroid injection or PRP may help if inflammation to another structure is the issue

You assume the pain is due to the chondromalacia as that's what the MRI showed, but it could be unconnected.  I have been having lateral knee twinges which I assumed was due to the meniscus tear and osteochondral defect, but the medics I have seen attribute it to ITB and LCL, not the other things on the MRI, and the treatment of these seems to be helping.  Knees can be really weird like that!!
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 tinydinosaur

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Re: Chondromalacia Patella Pain
« Reply #6 on: August 01, 2014, 01:09:00 AM »
yes, as Vickster says, it could be unrelated. i have the same pain on my good knee because of severe muscle tightness (having to compensate for my bad knee). your physio would be able to tell you if you have excessive muscle or IT band tightness, though there is a debate on whether foam rolling your IT band is good or not now.

i had a portion of the back of my kneecap replaced, they called it an osteochondral allograft. they use 'live cartilage' from a donor knee with very similar shape and size, and it's done within 30 days of receiving the donor part, so you're on a wait list. they use a jig to cut into the the bone on both kneecaps so the plug can fit it without any fixation. with my knee i had tracking problems that caused wearing of the cartilage on the back of my kneecap, the first surgery i had (lateral release) exacerbated the issue by causing muscle weakness. eventually i got that fixed with an MPFL allograft surgery but by then it had progressed to a grade 4 lesion (bone on bone) and that's when i was referred for the osteochondral procedure.

definitely, definitely look into everything else before looking towards surgery as a solution, as sometimes a combination of rigorous PT programs, bracing, etc can be a lot more effective and prevent or postpone any type of surgery. i wish i had known that before my first surgery, but my surgeon was certain it was a 100% fix and i had been at a (bad) physio for 3 months by that time  :-\

Offline papasmurf1978

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Re: Chondromalacia Patella Pain
« Reply #7 on: August 01, 2014, 10:25:19 AM »
Thanks guys for your comments / suggestions. My PT did say that I have muscle imbalance and that is causing maltracking of the patella. He said that my pelvic is not aligned properly so that's causing muscle spasms in my good knee and chondromalacia in the other. He put me on regime of front squats and stretching. He said that this is fixable as long muscles fire in harmony and without any tightness. I did a second MRI yesterday so I will tell you what the second opinion said about it. I did MRI on both knees.
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline papasmurf1978

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Re: Chondromalacia Patella Pain
« Reply #8 on: August 01, 2014, 10:46:48 AM »
He also said not to roll IT band as it doesn't do anything. Best solution is to roll the glutes, hamstrings, quads as once the muscles start firing properly by removing the knots, IT band will relax and not pull as much.
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline vickster

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Re: Chondromalacia Patella Pain
« Reply #9 on: August 01, 2014, 10:58:18 AM »
My hips are also weak and being knock kneed, the knees tend to roll in.  I now have orthotics to help, as well as exercises.  No squats, but lunges ensuring control of hips and knees, ITB stretches (no foam rolling) and stretches and strengthening of rest of leg muscles.  My bad leg is clearly weaker and skinnier than the right following injury and surgery, trying to use leg press and do single legged calf raises to bulk back.  It's an extremely slow process though

You need to work on core too, I am now rowing at the gym to help that
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: Chondromalacia Patella Pain
« Reply #10 on: August 01, 2014, 12:16:48 PM »
By the way, I was like a crepitus sound when I bend my knee when in vertical position or when I knee up from ass to grass to standing position. Is that bad?
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline vickster

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Re: Chondromalacia Patella Pain
« Reply #11 on: August 01, 2014, 12:24:18 PM »
Knees crackle all the time.  Is there pain or poor movement with it..  I have no clear idea of what movement you are describing though!
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: Chondromalacia Patella Pain
« Reply #12 on: August 01, 2014, 12:46:15 PM »
No pain, and knee tracks well but there's the cracking sound. Example: lie on your back, lift your leg up but keep it bend at 180 degree so heel to ass, then when I raise the foot to 90 degrees it cracks, no pain at all.
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps

Offline vickster

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Re: Chondromalacia Patella Pain
« Reply #13 on: August 01, 2014, 12:55:52 PM »
Sounds like nothing to worry about.  Chill :)
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: Chondromalacia Patella Pain
« Reply #14 on: August 01, 2014, 01:06:38 PM »
Thanks but I do associate it with the knee injury since I didn't have it before.
August 2014 MRI:
Mild Chondromalacia Patella in both knees
Normal cartilage thickness in both knee caps