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Author Topic: Chrondomalacia and medial pain?  (Read 1303 times)

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Offline sparrowhawk

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Chrondomalacia and medial pain?
« on: October 31, 2014, 03:21:14 AM »
Hi all,

Today I got the results of my MRI. The surgeon originally thought I'd torn my medial meniscus, but there was no sign of a tear on the scan. However, the report says I have a small effusion in the suprapatellar bursa, and a very small plica in the same area.
It also reads: "Chrondal softening with transverse fissure noted in the lateral patellar facet, likely chrondomalacia patellae."
I have been getting crepitus and pain in my knee with particular movements, so the chrondomalacia stuff doesn't seem too foreign, but I am wondering if the medial pain I'm getting (in the meniscus/ligament area) would be a completely separate diagnosis, like a sprain. The surgeon didn't give much info unfortunately.

I do have a couple of questions, if anyone could answer:
1. Should I try and get a second opinion, or at least go back to my GP?
2. What kind of treatments help chrondomalacia and a sprain? I've been having these particular issues for over a month, so they're not too new.

Thanks all! :)

Injury to right knee '11.
Diagnosed patella effusion & prob. sprain '12.
Re-injured knee '12. Suspected meniscus tear/MCL injury. Pain cleared.
Re-injured knee '14. OS suspected meniscus tear. MRI shows effusion, small plica & chrondomalacia patellae. No evident meniscus injury, likely MCL sprain.

Offline LAS

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Re: Chrondomalacia and medial pain?
« Reply #1 on: November 01, 2014, 03:03:20 AM »
Hi sparrowhawk  Sounds likes you have bursitis in the knee and some tissue damage cause by a plica syndrome. Both can cause medial knee pain.  Lots of the time you can get a cortisone injection for this condition and it will probably settle down. Also you could try resting, icing, anti-inflammatories and physical therapy.  All of these treatments  would work as well for chondromalacia.   Usually bursitis and plica damage are caused by overuse or a trauma.    Are you an athlete?  I would advise you to see an orthopedic specialist as a second opinion to be sure of your options.  Most likely the GP would not be qualified to give you a joint injection and would refer you to a  OS for treatment.  Hope this has helped you.   Best of Luck, LAS
   

Offline sparrowhawk

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Re: Chrondomalacia and medial pain?
« Reply #2 on: November 01, 2014, 09:54:17 PM »
Thanks, LAS. The report says both the effusion and the plica are small, and didn't say anything about the plica being thickened, which in my understanding is what would cause irritation. Last time I had a knee problem I was told I had a sprain, and that there was a chance I could re-sprain my knee in future.

I am getting pain on either side of my patella, though more so on the medial side. The medial area of my knee is tender to touch, and I get pain mainly with sitting (both with knees bent and with legs extended), driving, and walking up an incline. When my OS was examining me, he said it is presenting as a meniscus injury in terms of where the pain is, but there's nothing to say I've damaged my meniscus on the MRI. The crepitus started after the injury, so I think they are connected.

I'm not an athlete. I injured my knee about six weeks ago, just doing housework, but the day before I did play basketball (not competitively, just with some friends). I do a bit of walking but since the injury have had to limit that a fair bit, and have noticed my muscle strength isn't that good.

The OS is fairly sure it is a sprain. Do you know how long a sprain can take to heal? Should I really be keeping off my knee as much as possible?

I'm kind of frustrated because the OS I saw really gave me no advice, other than to wear a compression bandage and take anti-inflammatories/pain medication. I think I will go back to the GP. With my last injury I did have physiotherapy, so I may be given that option again.

Thanks again.
« Last Edit: November 01, 2014, 10:01:38 PM by sparrowhawk »
Injury to right knee '11.
Diagnosed patella effusion & prob. sprain '12.
Re-injured knee '12. Suspected meniscus tear/MCL injury. Pain cleared.
Re-injured knee '14. OS suspected meniscus tear. MRI shows effusion, small plica & chrondomalacia patellae. No evident meniscus injury, likely MCL sprain.

Offline LAS

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Re: Chrondomalacia and medial pain?
« Reply #3 on: November 02, 2014, 04:28:28 AM »
Hi sparrowhawk:  It is my understanding that MRI is of limited value in in determining an abnormal or normal plica.   The meniscus tear was excluded along with other conditions with similar  symptoms. When this happens the plica becomes the concern or focus but the mention of  a small plica does not necessarily mean it's a conclusive diagnosis as I understand it.  If the OS is certain it is a knee sprain,   then it involves a ligament and could take up to 6 weeks or more to heal.  Conservatively
RICE is best and physical therapy.  Some use a knee brace.   I had a ligament strain and I used crutches every  now and then.  I tried to avoid stairs as much as possible.  Seriously resting my knee and elevating was what helped the most and I did ice 2-3 times a day for the most part.  Even the small amount of fluid you have will cause pain.   If you are using an elastic wrap then take it off once a day and rewrap but not too tight so that it cuts off circulation.  It took about 6 weeks for my knee to feel normal for me.    I hope this helps.   Best of Luck;  LAS 

Offline sparrowhawk

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Re: Chrondomalacia and medial pain?
« Reply #4 on: November 02, 2014, 05:18:56 AM »
Hi LAS,
Well, I read up on plica syndrome and I have to admit that I do have a few symptoms described: pain in the medial area, near the joint line, which gets worse at night; pain with sitting down too long, with activity, etc. The first MRI I had also mentioned the plica, but didn't go into any detail.
Do you think I should bring up the plica with my GP/OS?

The OS didn't sound completely definite that it was a sprain; he said that if it is, it would take 2-3 months to heal. Stairs haven't been too hard to use, but I do try and take it slow up and down stairs. I am wearing a tubular bandage but am looking at something that will give me a little extra support for my patella.
I found some exercises that are useful for muscle strengthening, so I'll try do them, but I think getting some physio will help.

Thanks!
Injury to right knee '11.
Diagnosed patella effusion & prob. sprain '12.
Re-injured knee '12. Suspected meniscus tear/MCL injury. Pain cleared.
Re-injured knee '14. OS suspected meniscus tear. MRI shows effusion, small plica & chrondomalacia patellae. No evident meniscus injury, likely MCL sprain.

Offline LAS

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Re: Chrondomalacia and medial pain?
« Reply #5 on: November 02, 2014, 04:03:32 PM »
Hi sparrowhawk:  Yes you should ask all the questions you can.  I would be very surprised if that was not  already  being questioned. Also ask why they don't think it's a abnormal plica.  Also if it is a sprain which ligament is involved.  They may of seen a ligament problem and an issue going on there.  The fact that your knee has been compromised in the past may of brought the OS to that conclusion.  On top of all that not all meniscus tears show up on MRI.
If your pain does not subside with the conservative treatment then I would get a second opinion if that is an option for you.  I have had 3 MRI's and not once the plica was mentioned because there were confident of the diagnosis.  If you feel comfortable with your GP then get a referral for PT.  I don't think it will hurt.   I did not use formal PT only some exercises  the OS printed  out for me and that was good enough for me.  Certainly keep away from basketball for a bit, avoid twisting type activities.  I will say that usually the OS get's it right so it would be wise to take his advice for now.  Best of Luck and let us know the outcome.   LAS

Offline sparrowhawk

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Re: Chrondomalacia and medial pain?
« Reply #6 on: November 02, 2014, 08:27:58 PM »
LAS,
I was expecting the OS to go through the report with me, but all he really said was that I had an "irregularity" in my kneecap (I assume he was referring to the chrondomalacia, but not entirely sure). He didn't talk about the plica at all, and I only discovered it through reading the report myself. He also said that given my pain is medial, the "irregularity" shouldn't be a problem, but I have been getting a bit of pain around my kneecap and crepitus/grinding with movement, so it is something I'm concerned about.
The sprain's affecting the MCL. He did seem surprised that I didn't have more of a problem showing up on the MRI, given that the pain I'm getting presented like a meniscus tear, but he said that my images are good and the MRI is usually accurate.
I did RICE yesterday and I think I'll keep using it, and I'll try get back to my GP as well.
Thanks!

Injury to right knee '11.
Diagnosed patella effusion & prob. sprain '12.
Re-injured knee '12. Suspected meniscus tear/MCL injury. Pain cleared.
Re-injured knee '14. OS suspected meniscus tear. MRI shows effusion, small plica & chrondomalacia patellae. No evident meniscus injury, likely MCL sprain.