Banner - Hide this banner





Author Topic: Severely debilitating Chondromalacia Patella problems  (Read 16535 times)

0 Members and 1 Guest are viewing this topic.

Offline Jasey122

  • MINIgeek (20-50 posts)
  • **
  • Posts: 47
  • Liked: 4
Severely debilitating Chondromalacia Patella problems
« on: May 16, 2015, 11:11:06 AM »
I have had chondromalacia patella for 13 years that has now developed into knee arthritis in both knees . ☹

This started when I was 21 (now 34) after using the cross trainer for 45 mins every other day. Over the years I have tried to get into jogging but each time I tried, I experienced sharp pains in my knees.. I havenít been able to comfortably walk up stairs for over 10 years.

My situation deteriorated in 2013, when I started walking for 45 mins to and from work everyday. I was walking home one day and felt my knee weaken. This situation left me crippled in my left knee for 3 months . Igot steroid viscosuplement injections as well as using Naproxen to ease the pain. I started seeing a physio and was doing knee exercises including squats and this helped at the time but my knee never fully recovered. (I would say I only regained 65% of it).

Later on in  Jan 2015 this year, I returned to the gym and was swimming for 30 mins every other day. This led to my second knee being totally debilitated and was on crutches for 3 months. I am off crutches now but cant walk for long distances, stand for long periods.  I heat the knees every day and I notice slight improvments every week. Its been 4 months to date that I havenít been able to walk.

My rheumatologist and surgeon maintain that the mainstay of my treatment is to develop my quads and glut muscles as I donít have much muscle at all.  My physio to date hasnít given me any exercises but focuses on the psychology of pain. Im not sure why he has taken this approach. Perhaps my knees are too soar at the moment

My surgeon  suggests a knee chondroplasty  in the future or tibial tubercle distalisation with medialisation but this is dependent on how well my physiotherapy goes as he thinks this would make me worse at the moment.

ĎSurgeons letter: Review of his MRI scans reveals bilateral retro patellar chondral defects. On the right, there is a large fissure with a significant associated chondral flap on the lateral facet. On the left, there is bone oedema in the lateral patellar facet with a thin line of high signal between the articular cartilage and the bone itself suggesting delamination. He has significant bilateral superolateral fat pad impingement and patellar alta although his TT-TG distances are only borderline high at 14mm.í My rheumatologist suggests my knees are grade 3.

1)Is it normal not be able to walk without pain for such a long time (its been 5 months). Has anyone been so severely  debilitated and not been able to walk. For how long did this happen and is it realistic to expect to be able to walk again properly?

2)  With physio meant to be the Ďmainstay of my treatmentí, my physio hasnít started me on exercises or any massages and just focuses on the psychology of pain. Do you think I should change him?

3) Can anyone interprete what the surgeons letter says and how bad it is?

4) Does anyone think I should give stemcell therapy or orthokine a go and what are the risks. Ive heard about orthokine, Dr Saw in Malaysia and Regenexx.  My rheumatologist has advised against it but im not sure why Ė is it that these treatments donít work, she isnít knowledgeable or doesnít want to lose a patient?

Obviously I am very depressed and not able to continue my job as I work as a surveyor and not sure what I can do next. Any help would be greatly appreciated. Many thanks.
« Last Edit: May 16, 2015, 05:26:03 PM by Jasey122 »

Offline gcoza

  • MICROgeek (<20 posts)
  • *
  • Posts: 16
  • Liked: 0
Re: Severely debilitating Chondromalacia Patella problems
« Reply #1 on: May 16, 2015, 05:51:00 PM »
My experience regarding orthokine procedure:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=58443.msg614246#msg614246

That was 15 months ago.

Recently I went for second treatment, but unfortunately, this time with no such improvement.
And I have just grade I in both knees.

Good luck!

Offline Jasey122

  • MINIgeek (20-50 posts)
  • **
  • Posts: 47
  • Liked: 4
Re: Severely debilitating Chondromalacia Patella problems
« Reply #2 on: May 17, 2015, 09:22:39 AM »
Thanks for getting back to me. Overall it does seem like you got some improvement.

What made you decide to use Orthokine rather than other treatments like Regenexx etc?

Offline gcoza

  • MICROgeek (<20 posts)
  • *
  • Posts: 16
  • Liked: 0
Re: Severely debilitating Chondromalacia Patella problems
« Reply #3 on: May 17, 2015, 10:43:51 AM »
Simply because the stem cell therapies as Regenexx aren't offered in my town, and there is also financial issue.

Offline Jasey122

  • MINIgeek (20-50 posts)
  • **
  • Posts: 47
  • Liked: 4
Re: Severely debilitating Chondromalacia Patella problems
« Reply #4 on: May 17, 2015, 07:09:20 PM »
Thanks

Offline tinydinosaur

  • Forum Faithful
  • ****
  • Posts: 209
  • Liked: 19
Re: Severely debilitating Chondromalacia Patella problems
« Reply #5 on: June 08, 2015, 11:38:46 PM »
~not a doctor~

in my experience doctors can be reluctant to operate on you because of lack of muscle strength, which may be part of the reason physio is #1 priority. the other reason is usually they would rather you exhaust all non-surgical options. surgery is traumatic, you are also usually almost completely immobile for long periods of time leading to even more muscle wasting. as i've come to learn a lack of muscle strength can contribute to a procedure not being as successful as it can be.

2) i would ask your physio if there is any reason they are not proceeding with finding you some sort of exercise or regiment for you to undertake in terms of knee care. generally a good physio will work with you and explore options to find the most pain-free exercise program possible. i went through a ton with my 'good physios' and finally found out that gentle functional exercises are the best (where standard procedure still mandates weight-bearing exercises - that are terrible - like squats and step ups)

3) it ~sounds~ like you have a lesion (lack of cartilage) on your right knee with a bit of cartilage dangling about on the outer side of the knee. the left knee has bone swelling (oedema) with a suggestive separation of the cartilage at the high signal mark (high signal is a white line on MRI/xray, low signal is dark area). not sure about fat pad impingement, patella alta is - i believe - a high riding kneecap. grade 3 is pretty bad, in terms of cartilage wear, grade 4 is the worst i was told its bone on bone then.

hopefully this is helpful to you, maybe look into or try out some unicompartmental OA braces (ossur makes some), they are expensive but if your knee problems are on one side of the knee as opposed to directly under the kneecap you can offload it with those braces and perhaps recover some function while gaining muscle strength back. it's not a great solution but another one that prolongs the 'life' of your knee in its current state.

Offline Silkncardcrafts

  • SuperKNEEgeek
  • *****
  • Posts: 3916
  • Liked: 6
Re: Severely debilitating Chondromalacia Patella problems
« Reply #6 on: June 09, 2015, 12:53:04 PM »
Firstly, chondomalicia patella isn't a diagnosis. It's just a softening of the cartilage behind the knee cap.

There is a reason why this has developed, must likely malalignment.

I would suggest getting another opinion from a physio and knee surgeon, someone who specialises in patella problems. It's not satisfactory they haven't given you an exercise program.

Good luck !
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline Jasey122

  • MINIgeek (20-50 posts)
  • **
  • Posts: 47
  • Liked: 4
Re: Severely debilitating Chondromalacia Patella problems
« Reply #7 on: June 13, 2015, 03:29:47 PM »
I had got to the point where I was able to walk for a quarter of a mile with pain (4/10)  but still able to. I then started physio and it all seemed to go down hill over the last few weeks. We started exercises to strengthen the my glutes to start off with .  However the pain has increased in severity to the point where I now struggle to walk again. I spoke to my physio and he said  he doesn't think its the exercises but but if that were the case I should do less reps and take a days break in between.

Now Im not sure whether to give up physio totally in the hope that perhaps I can get to where I was pre physio.

Offline tinydinosaur

  • Forum Faithful
  • ****
  • Posts: 209
  • Liked: 19
Re: Severely debilitating Chondromalacia Patella problems
« Reply #8 on: June 13, 2015, 10:00:37 PM »
i would find another physio if that is possible, perhaps a sports physio or an athletic therapist, or just another physio in general. if you were doing 'okay' and now you have more pain/problems after the introduction of new exercises then it is ~probably~ those exercises. if your physio is not willing to consider that the exercises are doing it / change your exercise program to find better exercises for your particular case then either they don't have experience with your type of injury or are not going to be very helpful to you.



it could be that the new exercises are causing either a muscle imbalance or tightness causing extra strain through the knee (especially apparent with tracking problems). do they get you to do stretches regularly? foam rolling or self-massage on tight muscles can do a lot to help alleviate any muscle tightness related aggravation. eg. i have pain regardless but when my muscles get tight due to pain, it causes even more pain so i have to make sure i stretch and massage them.

Offline Jasey122

  • MINIgeek (20-50 posts)
  • **
  • Posts: 47
  • Liked: 4
Re: Severely debilitating Chondromalacia Patella problems
« Reply #9 on: June 14, 2015, 03:40:05 PM »

Tiny dinosaur only just saw your previous post. Thanks for the info and getting back to me. Really appreciate it. I did want to give up physio but from what I have read, I should stick to it but perhaps adapt it.

Ive just read through your posts and am really sorry you and everyone else have had to go through all this knee pain. What are your plans now going forward.


Offline Jasey122

  • MINIgeek (20-50 posts)
  • **
  • Posts: 47
  • Liked: 4
Re: Severely debilitating Chondromalacia Patella problems
« Reply #10 on: June 14, 2015, 03:45:01 PM »
Silk, Im just reading through your posts now but you've got so many. THanks for your post. I noticed in one of your posts you pure mentioned sports medicine in London as being really good so Im going to look them up? Does anyone else know of any other practice  or Sports physician thats really good in London. So far Ive been using Fortius Clinic.
« Last Edit: June 14, 2015, 03:58:06 PM by Jasey122 »

Offline vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 5141
  • Liked: 454
  • Neelie knee!
Re: Severely debilitating Chondromalacia Patella problems
« Reply #11 on: June 14, 2015, 05:01:32 PM »
Wimbledon clinics at Parkside Hospital have a very good reputation. Jonathan Bell is highly regarded if you need a sports focused orthopaedic surgeon, but there is a full sports medicine, msk rheumatology and physiotherapy team at the hospital

http://www.wimbledonclinics.co.uk

Other than further opinions, I'm not sure what they'd be able to offer beyond the multi disciplinary team you're seeing. If you have severe arthritis, you could look at replacement. For unicompartmental, the Oxford group are pioneers in the UK

Are you also working with pain management specialists on non drug approaches,  such as mindfulness. Might be worth a go if medication isn't relieving the pain adequately
« Last Edit: June 14, 2015, 05:08:57 PM by Vickster »
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffaís fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline Jasey122

  • MINIgeek (20-50 posts)
  • **
  • Posts: 47
  • Liked: 4
Re: Severely debilitating Chondromalacia Patella problems
« Reply #12 on: June 14, 2015, 06:30:21 PM »
THanks , Ill look up the clinic in Wimbledon.

Docs have ruled out a partial knee replacement and would rather try other surgeries first.

Guess Ill give stem cell or prp a go as well.

Offline vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 5141
  • Liked: 454
  • Neelie knee!
Re: Severely debilitating Chondromalacia Patella problems
« Reply #13 on: June 14, 2015, 06:33:30 PM »
I dont think PRP is widely used in the UK for arthritis, and I'm not sure there is any stemcell treatment available outside of trials. Best speak to your specialists
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffaís fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline Jasey122

  • MINIgeek (20-50 posts)
  • **
  • Posts: 47
  • Liked: 4
Re: Severely debilitating Chondromalacia Patella problems
« Reply #14 on: June 15, 2015, 04:16:47 PM »
Thanks Vick. Like most surgeons , everyone is avoiding a replacement because of my age.

Having read through so many posts on this site, it seems there are more options outside the UK such as stem cell injections, PRP, Orthokine or even De Novo cartilage transplants. The problem is knowing which one to go for, because when I ask my docs they don't seem to be aware of these procedures.

I just got my mri report from the radiographer for my right knee which is the more painful of the knees. Can anyone please help or advise/ interpret the following please:

'There is an unstable chondral flap within the central third of the lateral retropatellar facet measuring 1.2cm in craniocaudal length and 1cm in width . Axial images 7-10 demonstrate full-thickness cartilage fissures the medial and lateral margins of the flap tear and high signal extending along the chondral bone interface between the two fissures. There is faint subcortical marrow oedema deep to the cartilage damage. There is heterogenous signal intensity within the medial retropatellar facet cartilage consistent with grade 1 chondromalacia.

Tibial tuberosity trochlear groove offset measures 10mm. No patella alta. Quadriceps insertion and patellar tendon are normal. There is moderate superolateral fat pad impingement'

Many thanks

« Last Edit: June 15, 2015, 04:58:46 PM by Jasey122 »















support