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Author Topic: My chondromalacia is not improving - been 6 months  (Read 1415 times)

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Offline Ukap

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My chondromalacia is not improving - been 6 months
« on: August 08, 2014, 04:46:43 PM »
Your advice please I started having problems in one knee in January.  Went to Dr. & diagnosed with chondromalacia patella.
My symptoms were swelling & inflammation of knee.  Knee weak & unable to bear weight.  Could not stand for 5 minutes without having to sit.  I am 52 years old and I would run every day on inclined treadmill and think I may have damaged it on this.
Fast forward to today.  I saw an Ortho in March.  He took xray & MRI & meniscus is intact. Was prescribed meloxicam 7.5mg which did not reduce the swelling. I also had cortisone shot in April that had no effect at all.  Below are my MRI results (I do not know how to interpret these)
IMPRESSION:
1. Small areas of full-thickness cartilage loss in the patellofemoral joint with Iibrocystic changes
2. Small joint effusion
3. Incidentally noted small cartilage lesion the distal femur suggestive of a benign enchondroma

I did PT from March through June which was very helpful continue PT at home by myself using the same exercises.  I do not seem to be making progress.   Six months later and yes I can stand for longer periods but it is still uncomfortable.  I can walk for nearly a mile with effort & then get fatigue in knee and thigh and must sit down.  I cannot run at all or put weight on knee.  Knee still feels swollen, inflamed. I am slightly limping and still not bending knee as freely as the other one.  Can only wear flat shoes & can only walk in sneakers/trainers.  I get home from work and take off flat shoes & wear sneakers ALL the time. I have worn these for 6 months.  I cannot walk up or down stairs.  In PT I could not do Anterior step down exercise and still cannot do it.
What are my options now?  I know knees take along time to heal.  I am willing to do the time and wait it out as long as it does heal in the end.   This is affecting my life and my job and I would like to hear some positive experiences or some other things I might try.
I live in South Florida & plan to change my OS as he seemed disinterested & had no time for me. He told me nothing about my MRI/Xray results and gave me no advice, education or suggestions other than go to PT.
I do not have pain but do have knee tenderness, sensitivity and discomfort all the time. Uncomfortable to sit and stand.  I am not sure if I should stop exercise or push harder.  I never know if I am helping or aggravating my knee.
Would surgery work?  - a knee replacement?  I am feeling very depressed about this and would do anything to get my knee working right.
Please reply if you have been through this.

Offline tinydinosaur

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Re: My chondromalacia is not improving - been 6 months
« Reply #1 on: August 08, 2014, 07:50:38 PM »
Definitely find another surgeon, and take your MRI with you - i don't understand why the MRI would mention things and your surgeon would not go over them with you. They didn't explain any of it or say there's nothing to worry about/continue PTing?

if it's cartilage damage there's lots of things that can be done, it depends on the severity but there are options out there for you, some people have lots of luck with hyaluronic acid injections, one of my surgeons told me some people get them every 4-6 months and it does wonders for them but it depends on the knee (they're expensive too if not covered).

my physio would say that the limits generally are to stop or lessen the exercise if you get pain or aggravate your pain. i know that with my knee when the problem wasn't fixed (tracking problem) no amount of straight leg raises and quad contractions would improve the strength or function. one surgeon told me i wasn't trying hard enough and to do at least 100 straight leg raises a day, i did and was miserable because of the pain it caused and surprise surprise it didn't help. being through some surgeries and rehab i've gotten to the point where i hit a plateau with strength recovery and function and at that point it's time to relook at the knee.

tl;dr: if there's a problem, treating the symptoms won't solve the problem, ie. strengthening the leg muscles trying to fix lack of cartilage that's causing weakness, whereas if you have tracking problems caused by a muscle imbalance, strengthening the right muscles would help.

so definitely go find another surgeon, someone who will help you, and keep hope that there is a solution out there for you!


Offline LAS

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Re: My chondromalacia is not improving - been 6 months
« Reply #2 on: August 08, 2014, 10:09:59 PM »
Hi Ukap:  I sympathize with you and know exactly what you are going through.   Unfortunately chondromalacia at any stage is degenerative and really does not go away for good.  It's a constant uphill battle.   Continuing PT is a good idea.  If Cortisone injections do not work than Hyaluronic injections are the next step.  Have they looked into your knee arthroscopically?  Sometimes they can do a procedure that will help called microfracture,  but only works temporarily.  How long is different with each patient.  Also before you  start thinking about knee replacements you could look into some resurfacing.   That's when they replace only one part of your knee.  The rest of your knee has to be pristine for it to work effectively.    I do believe they will do this procedure at age 52.  They give it a 10 year life span at least. It will stall a total knee replacement.    I have looked into it myself but have damage in the other compartments so therefore not a very good candidate.   For now I would try the Synvisc injections with some cortisone along  with it.    It seems to jump start the Synvisc.  It was a great therapy for me but  Drs won't do that every time.  It lasted about 8 months before it started to wear off.  I also do a lot of icing before an after exercise. I don't do any exercise that requires bending and extending my knee with weight or my knee will feel like  caving in.  You could try the elliptical, it's easy on the knees  and yet you get a good cardio workout. Get another Ortho Dr.   You have to be able to communicate with your Dr.   I had the same problem and I came on to this site and got advice and the kneegeeks  told me to dump him. Best thing I ever did.  There are a lot of good OS in Boston.   I don't know any in Florida but I know a lot of patients who had surgery there and did quite well.   If you don't like that one go to somebody else. You might be passed this stage but a personal trainer at the gym might help.  I did that because I didn't know anything about the gym and he was very good and did give me some good advice.  I continue to go to the gym 4-5 times a week.  I know what you mean about the shoes, can't wear anything that looks good.  Try a shoe with a low wedge or get fitted for orthotics that you can place into your shoe or sneaker. This helped me get through the day.
I hope some of these ideas help you out but first I would get another OS.     Best of Luck,   LAS