cannot build muscle with Chondromalacia

[robmaxfli]

30 years living with Chondromalacia. I used to have very muscular thighs before this pain set in. The VMO muscle on the troubled knee is noticeably smaller on the affected knee. Even though I have workout my legs for many years, that muscle - especially where it meets the knee (aka teardrop muscle) will not build muscle no matter what. Its like the chondromalacia will not allow the very bottom of the VMO to fire - only the middle section.

Has anyone else had this experience too?

[vickster]

Have you consulted a knee expert physiotherapist for advice on the best exercises? It may simply be that the knee issue is inhibiting that muscle. Muscle size and strength/function are not directly correlated so if those aren’t affected, it may not actually matter (my surgeon has told me  that you can lose 25% muscle bill and have same strength)

Get an expert opinion

What’s caused the chondromalacia, (which is a symptom, not a specific diagnosis). Age related wear and tear? Trauma? And where is the soft cartilage? Kneecap? How does the patella track?

[Brandon123]

I have the same problem. Unfortunately no solution to offer Blood flow restriction (BFR) training seems to help some people, but I haven't tried it myself. Same with electrical stimulation (e-stim). Might be worth looking into, though. 

[BenAldridge0]

Yes just to echo Vickster, the issue isn't necessarily the VMO's strength.

I met with a physiotherapist who was the first to catch my atrophied VMO. She had me lay on my back and straighten my leg to the point that my heel was off the ground, which got a response from my VMO. Then I began to do leg raises making sure my heels were off the ground. Initially I was encouraged as my VMO grew in size and definition, however the underlying problem wasn't caught because my knees are still similarly dysfunctional to this day.

[neptronix]

Has there been an assessment for rotational deformities?

I had a tibia corrected 20 degrees inward, and poof, i gained inner quads for the first time in my life without even doing physical therapy.

Of note, i also have anteverted hips as well, so that probably has an effect.

[Svatopluk]

I have lots of experience of this problem. Very frustrating advice to strengthen the vmo from physios. Didnt work for me. I found it practically impossible if there are any serious pfj issues. All quad strengthening exercises engage the patellar in the pfj joint and to grow muscle you need to overload the muscle (even minimally) And in my case i get pain and inflamation which switches off the muscles. A vicious circle. The joint needs to dealt with 1st therefore - and not the other way round. How to deal with the joint itself thats another issue which i could write a book about.

15 years right knee problems
Isolated pfj arthritis patellar/ femeral groove
2014 LR + chrondoplasty + microfracture

[Brandon123]

I have lots of experience of this problem. Very frustrating advice to strengthen the vmo from physios. Didnt work for me. I found it practically impossible if there are any serious pfj issues. All quad strengthening exercises engage the patellar in the pfj joint and to grow muscle you need to overload the muscle (even minimally) And in my case i get pain and inflamation which switches off the muscles. A vicious circle. The joint needs to dealt with 1st therefore - and not the other way round. How to deal with the joint itself thats another issue which i could write a book about.

15 years right knee problems
Isolated pfj arthritis patellar/ femeral groove
2014 LR + chrondoplasty + microfracture

I second this, having exactly the same experience myself.

[Dave33]

I have lots of experience of this problem. Very frustrating advice to strengthen the vmo from physios. Didnt work for me. I found it practically impossible if there are any serious pfj issues. All quad strengthening exercises engage the patellar in the pfj joint and to grow muscle you need to overload the muscle (even minimally) And in my case i get pain and inflamation which switches off the muscles. A vicious circle. The joint needs to dealt with 1st therefore - and not the other way round. How to deal with the joint itself thats another issue which i could write a book about.

15 years right knee problems
Isolated pfj arthritis patellar/ femeral groove
2014 LR + chrondoplasty + microfracture

I second this, having exactly the same experience myself.

Thirded. No physio approach of any kind helped my patellar function until after my PJFR.

[Svatopluk]

Hi Dave33 - looking at some boards you seem to have good experience with pfjr. Where i live in the Czech Republic they refuse to this op. The claim is they are too unpredictable and the plastic breaks down etc. They do however do a huge number of totals. My problem is isolated to pf joint so reading about it i would appear to be a candidate. I am likely to have to go to Germany or UK where there are more specialists. My conundrum is that whilst the knee does not interfere much with daily life, i cannot now remain active  and the my lookout is a sedentary life with all that brings.  The general opinion seems (from professionals) i should just put up with it which I take to mean ‘watch it get progressively worse’ with continued muscle wastage weakening the whole joint until in 10 years time they give me a total (i am now 58).

My summary -
After 10 years of failed physio I had LR + Mfracture + clean up in 2014. post op 1st year worse than before, slow recovery to better than before with last summer at cca 60% of good knee. Gave up running before the op but cycling, walking, elliptical, some ski, gradually became possible post op. All seemed to be going ok until about 2 months ago when got much worse, with symptoms quite suddenly returning to worse than pre op levels. Might be breakdown of Mfracture (common after 5 years), loose bits catching etc.

Any comments on your PFJR welcomed. what type, recovery etc. My dream would be to be able to just do the physio to rebuild my muscles, something I have not been able to do for more than 15 years, nevermind the activities that might enable.
 

[Dave33]

My conundrum is that whilst the knee does not interfere much with daily life, i cannot now remain active  and the my lookout is a sedentary life with all that brings.  The general opinion seems (from professionals) i should just put up with it which I take to mean ‘watch it get progressively worse’ with continued muscle wastage weakening the whole joint until in 10 years time they give me a total (i am now 58).

Hi Svatopluk - yes, can't agree more, essentially the same story. I was unwilling to live a sedentary life due to a 3 centimeters of lost cartilage, so I had to go with the pjfr, after ten years of trying more conservative treatments.

I certainly wouldn't want to talk you in to any joint replacement over a doctor's recommendation for your specific situation, but my surgeon was very optimistic about a long lifespan for the implant, and I'm a fair bit younger than yourself. Apparently the new onlay implants are far superior to the older generations, and 5 year studies have them more or less parallel with the full replacements for complications -  there's significant bone sparing with them vs a full replacement, if there's truly no damage other than the pf joint... my surgeon showed me the hardware for the pfjr vs the full implant, and it's tiny.. i'd say the whole process is more like capping a tooth than putting in a denture, if that's any sort of usable analogy. That said, it's still artificial, and it's not a normal knee. But it does have me active again.

At any rate, if you want more info, feel free to join RGB, Brandon123 and I in the PJFR post op activity thread in the general section, or feel free to PM.

cheers and best of luck.

[Svatopluk]

Thanks Dave33 - thats really useful info. I've had a few MRIs on the knee and there has not been any sign of deterioration of the lateral or medial compartments. I have cca 2cm hole in the patellar cartilage plus what the surgeon called a kissing lesion in the trocheal groove.

I suspect one of the main reasons for the reticence to consider PFJR is that as a small country (Czech Republic) there will be few surgeons experienced in this procedure (a factor of the small number of potential PFJR candidates in any population). I will likely go and see a specialist knee surgeon in Munich who has lots of experience dealing with PFJ issues.

I noticed on posts that you are still skiing - skiing is one of my biggest passions and I have managed to continue (of sorts) by using a ski mojo which is an amazing product which can take up to 30% of load of the knee joint. I gather there are lots of skiers out there with partials / totals who use this to help protect their replacements - www.skimojo.com. May be some posters who are still active skiers (or would like to get back) will already be aware of this product.

These boards are certainly a great resource.

Thanks and good luck

[db1984]

Sorry to bump an old thread but I think I have some relevant input on the muscle wastage issue.

I've recently been using electrical muscle stimulation on my VMO. I have some lateral trochlea cartilage damage and my goal is to improve the strength ratio between the VMO and VL to try and unload the lateral cartilage. The device I'm using is called a Compex Edge, only about $100. There are lots of devices on the market, I just picked this one because it's cheap and had pretty good reviews. I've only been using it for about a month but it allows you to aggressively activate the muscle without loading the patella. When doing closed chain exercise with the electrodes on my VMO it has a very noticeable effect on the patellar tracking, pulling the patella medial. I don't use it on my lateral quads since I have no issues with muscle activation there. There's a number of studies on it that seem to show it had the potential to work for that purpose. Hope that helps.

https://www.researchgate.net/publication/328734130_The_Effect_of_Exercise_and_Electrical_Muscle_Stimulation_on_the_Architecture_of_the_Vastus_Medialis_Oblique-The_'Empi'_Electrotherapy_System

https://pubmed.ncbi.nlm.nih.gov/21340241/

https://spinalflowyoga.com/exercise-wont-selectively-activate-the-vmo-but-electric-stimulation-will/

https://www.compex.com/compex-edge-2-0-muscle-stimulator-kit-with-tens

[SuspectDevice]

Lots of evidence that knee pain causes muscles to switch off.

I notice it in my VMOs particularly when my knees are sore (either due to synovitis which I've now got largely under control or chondromalacia which I've lived with for decades and comes and goes).  Recently, the chondro has been good and I can actually feel my VMOs working properly while doing hard intervals on the windtrainer.

But then the chondro will flare briefly under the most innocuous activity (e.g. a bit of steep downhill walking while out fishing).

[db1984]

Another issue is knee effusion (excess fluid). There were some studies from the 80's that showed fluid in the knee causes inhibition of the quadriceps, and the VMO has a lower threshold of inhibition than the VL. They actually put electrodes on the quads to measure the nerve signals and gradually injected saline into the knee. They found that the more fluid was in the knee the more the nerve signals shutdown, and this even occurred in the absence of pain:

https://pubmed.ncbi.nlm.nih.gov/6712434/
https://pubmed.ncbi.nlm.nih.gov/3403614/
https://pubmed.ncbi.nlm.nih.gov/7063526/