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Author Topic: Need help please with Chondromalacia patella diagnosis  (Read 182 times)

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Offline john_r

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Need help please with Chondromalacia patella diagnosis
« on: December 19, 2020, 09:45:04 AM »
Hi everyone,

So pleased to have found this forum!

I'm English and live in Spain. I've just had the results of my MRI on my left knee. My Spanish is not good. The doctor's English is ok but not great so I'm a bit concerned there's some confusion on my part.

I'm especially concerned that nothing she said yesterday, or that I've read, explains the rest of the pain I have, and I forgot to ask her yesterday because, frankly, I was quite shocked at what she was saying.

I've spent the morning trying to learn about this myself and then found this forum and hope someone may be able to help! Thanks in advance if you can!

I'm getting pains that I can only describe as a 'nerve' pain, but I've never been good at describing pain. The pain can go as low as my ankle (it can feel like it is in the bone itself) up to my backside, and any part of my leg in-between. It's a very sharp pain. I get it, for instance, when I get into my car (which is high) and swing my legs across. I get it often in the morning when I wake up, but it can happen any time, and perhaps later at night when lying no the sofa is worse? Sorry to be vague it's hard to remember/explain.

But it can so painful I literally scream out involuntarily. I can be sat or lying there, feeling fine. Often my legs are more comfortable in a position my wife thinks is crazy to put them in, but I've always sat like that and I just sit or lie in the most comfortable and less painful position.

Normally though that's it, the sudden utter agony causing that pain and scream and then it's just sore, or even gone. It's rare it continues at that level but sometimes it has been so bad I've been unable to move properly for a bit and just sat on the sofa basically crying.

The conclusion of the report (translated into English) is

"Patellar chondropathy Grade III-IV. Mild joint effusion.
Type I myxoid degeneration of the internal meniscus with transverse rupture in posterior Horn."

The findings section translates to this

"The femorotibial compartments maintain normal lineages. Osteochondral lesions and bone edema are not seen, Proximal tibioperoneal joint without alterations.
The femoropatellar compartment maintains a normal joint space.
Patellar cartilage shows signs of chondropathy Grade III-IV. Mild joint effusion.
Type I myxoid degeneration of the internal meniscus with transverse rupture in posterior Horn.
The external meniscus does not present alterations.
The menisci show a normal morphology.
Cruciate and colateral ligaments show a thickness and normal signal.
The iliotibial band and retinacles do not show abnormalities.
Patellar tendon, quadricipital, Hoffa fat and flexor musculotendinous elements do not show
abnormality."

She's prescribed physiotherapy which I need to book next week. And then I need to go back to her if it doesn't help. She's also told me to start taking Carticure which I am starting today. She has warned it could need surgery in the future if not 'fixed' although from what I can gather it can't be totally fixed?

I actually had the same issue this time last year and had 10 days therapy then, but I didn't have an MRI then so no one knew what it really was. The doctor who saw me then (a different one) diagnosed it within 30 seconds or so of feeling my leg and prescribed the therapy. It did help, and I felt better my the end, but it has returned. This time this doctor couldn't diagnose it by feeling which is why she had the MRI done (thankfully).

Both events were triggered after a fall (more a slip) from the bottom step of the stairs. So just a small drop, but one that sent a shock up my body as I landed suddenly. My home office is upstairs so I go up and down quite a lot.

In terms of my medical background, when I was about 9 (40 years ago) I was kicked in the knee at school. The hospital did an x-ray and found I had an extra bone in my knee which had been fractured or broken in the kick. I had to have surgery to remove it and was laid up for a month or so (I was 9 so I forget the details). What I do remember is when they did the x-ray I think almost every doctor in the hospital was called in to look at it. I was told it was quite rare to see which is why they were all having a look!

I used to have very flexible joints, I could put my leg behind my head (a sort of party trick at school), and I always won at the game of mercy against everyone, even the biggest strongest kids (for those who don't know it by that name, it's where you lock hands and bend each others fingers until one shouts MERCY!). I'm not fully 'double jointed', but I've always been able to bend my fingers back more than most people etc. Yeah, stupid I know, but when your 11 or 12 and it's about the only physical thing you are good at and it gets you respect from the bullies... ;)

I've spent most of my life sat down at a keyboard. Not much exercise although I have run a bit in the past, and I started exercising again a few months ago (a crosstrainer and exercise bike) but stopped about a month before this fall on the stairs because of tooth surgery followed by a virus. Before the surgery and virus though I was feeling great, no signs of pain in my legs or anywhere.

So my main question really is does this diagnosis explain the pain I'm getting up and down my leg? What I've found so far suggests a dull pain behind the knee should be expected? I'm a bit worried there may be two different issues going on and if I only get treated for one, the other could develop more or even that this treatment could make it worse.

Sorry, that's a huge first post but I hope someone can give some advice.

Many thanks
John











Offline vickster

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Re: Need help please with Chondromalacia patella diagnosis
« Reply #1 on: December 19, 2020, 01:04:44 PM »
You have a meniscus tear which could the cause of the pain if itís getting caught. Surgery to tidy it up might be your only option if it continues. At 49 itís not that unusual to have degeneration (starts from around age 30).
Thereís a good meniscus primer in the learning hub
The patella cartilage softening is also probably age related wear and is fairly common especially if youíve engaged in high impact sports etc.
Good luck with the physio :)

https://www.kneeguru.co.uk/KNEEnotes/primers/meniscus

Is the pain from buttock to ankle in the back of your leg? If so it could be sciatica, back related? See what the physio thinks

The extra little bone could be something called a fabella bone if youíre interested enough to look it up
« Last Edit: December 19, 2020, 01:08:47 PM by vickster »
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 john_r

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Re: Need help please with Chondromalacia patella diagnosis
« Reply #2 on: December 19, 2020, 04:31:49 PM »
You have a meniscus tear which could the cause of the pain if itís getting caught. Surgery to tidy it up might be your only option if it continues. At 49 itís not that unusual to have degeneration (starts from around age 30).
Thereís a good meniscus primer in the learning hub
The patella cartilage softening is also probably age related wear and is fairly common especially if youíve engaged in high impact sports etc.
Good luck with the physio :)

https://www.kneeguru.co.uk/KNEEnotes/primers/meniscus

Is the pain from buttock to ankle in the back of your leg? If so it could be sciatica, back related? See what the physio thinks

The extra little bone could be something called a fabella bone if youíre interested enough to look it up

Thanks so much for the reply.

Yes, fabella bone thatīs it. I read up on it a few years ago. Just having a quick look now and it says about 39% of people have it, but bi or tri fabella are more rare, so maybe that's what I had? The doctors were certainly very excited!

I haven't engaged in any sports really, never mind high impact. I've actually had problems on and off all my life (or at least since the fracture/break of the bone aged 9). But never to the level I'm seeing now. As you say, age... :(

Yes, the pain is in the back of the leg. When I first went in to see the traumatologist, I presumed it would be sciatica - because other people had suggested it - but she never mentioned that. Just checked my leg, asked for the MRI, and then gave me this report and physio with the warning of surgery ahead if it doesn't clear up.

I do often have lower back pack. It comes and goes but it's not unusual.

But yes, I will ask the physio. They will have a lot more time to discuss it with me than the doctor did.

Thanks again!















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