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Author Topic: Chrondomalacia vs PFPS  (Read 544 times)

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Offline Christine10S

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Chrondomalacia vs PFPS
« on: January 28, 2021, 04:18:22 AM »
Can anyone explain the difference (if there actually is one) between Chrondomalacia and PFPS?  And does cartilage degeneration happen with both?
Thank you!
-Chris

Offline vickster

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Re: Chrondomalacia vs PFPS
« Reply #1 on: January 28, 2021, 07:58:32 AM »
Chondromalacia (patella) is softening of the cartilage (on the back of the kneecap), it’s not a specific condition in itself. It is a name for cartilage degeneration / change

https://www.kneeguru.co.uk/KNEEnotes/primers/patella/cartilage-damage-patella#what-is-chondromalacia

PFPS is a syndrome affecting the knee around the kneecap
https://www.kneeguru.co.uk/KNEEnotes/knee-dictionary/patellofemoral-syndrome

There are other pain syndromes affecting the kneecap which may be part of PFPS
https://www.kneeguru.co.uk/KNEEnotes/primers/patella/pain-syndromes-related-patella#pain-front-of-knee

The most common cause of cartilage degeneration is age, inflammation and injury other causes. Maltracking, be it anatomical or due to muscle weakness or imbalance can also lead to wear on the kneecap and trochlear groove. Obesity also accelerates cartilage wear. Steroid injections can also cause harm to cartilage and heavy use in impact sport/heavy weight lifting

https://www.kneeguru.co.uk/KNEEnotes/primers/joint-cartilage-osteoarthritis/common-arthritis-pathway

There’s plenty of other related info in the learning portfolio

https://www.kneeguru.co.uk/KNEEnotes/learning-portfolio

Eg https://www.kneeguru.co.uk/KNEEnotes/primers/common-knee-disorders/what-are-common-kneecap-problems

https://www.kneeguru.co.uk/KNEEnotes/primers/joint-cartilage-osteoarthritis

https://www.kneeguru.co.uk/KNEEnotes/primers/patella
« Last Edit: January 28, 2021, 09:02:40 AM 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 SuspectDevice

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Re: Chrondomalacia vs PFPS
« Reply #2 on: January 29, 2021, 07:00:28 AM »
I've had both.

In my experience - Chondromalacia is much more specific both in definition and symptoms.  It is damage to the cartilage on the back of the kneecap, and a key symptom is a focused sharp pain with certain movements (e.g. going up or down stairs, deep knee bends).

PFPS is the term the 'experts' use when you have anterior (frontal) knee pain, and they can't really explain why.  In many cases I suspect the cause is the Dr Scott Dye defined loss of tissue homeostatis, which most 'experts' seem incredibly ignorant of. You will get constant burning pain, deep aching, stifness, loss of function.  The pain is far less focused in location, can move around a fair bit, kneecaps may get red/hot/discoloured.  It is much more constant, not really associated with particular movements, though overloading the knees with specific movements will pro-long it - in my case for over 7 years!
L Medial menisectomy 2012
PFPS both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2020 - ride 3x/week, swim 2x/week, gym 2x/week, aiming to get back to short triathlons

Offline silver_maple

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Re: Chrondomalacia vs PFPS
« Reply #3 on: February 15, 2021, 11:15:51 PM »
Suspect, there may be some practitioner ignorance, for sure, although can't say how widespread. My doc is definitely aware of the altered anabolic-catabolic balance in the CMP-affected knee in the direction of catabolism (i.e. degeneration). This is what bad knee homeostasis actually is.

That is why, in theory, nudging the knee in the anabolic direction - through PRP with all its growth factors and anti-inflammatory cytokines or through inflammatory cytokine inhibitors such as 1L-1Ra, should help. The sad reality is spritzing in PRP, even repeatedly, is not a sure shot to cure CMP. It hasn't worked for me so far (4 injections total). CMP is a tough beast.

You appear to be the only poster claiming to have cured his chondromalacia. Please tell us more, how did you do it? Do you have objective before and after evidence like MRI (realizing it's not perfect) or is it just your subjective opinion you don't have CMP anymore? Did you have crepitus that is now gone?

Awaiting your answer with anticipation!
2019 - Chondromalacia patella gr 1-2, both knees; early bilateral tibio-femoral arthritis; another 5mm focal lesion; partial meniscus tear (right knee)
2020 - PRP x3 in right knee
2021 - PRP x2 in right knee

Offline Brandon123

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Re: Chrondomalacia vs PFPS
« Reply #4 on: February 16, 2021, 03:28:53 PM »
CMP is a tough beast.

+1

Check the posts (read the entire story) on this forum by Terry42. Use the Search function. Similarly to Suspect, he also overcame CMP/PFPS.
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline SuspectDevice

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Re: Chrondomalacia vs PFPS
« Reply #5 on: March 03, 2021, 11:15:10 PM »
Suspect, there may be some practitioner ignorance, for sure, although can't say how widespread. My doc is definitely aware of the altered anabolic-catabolic balance in the CMP-affected knee in the direction of catabolism (i.e. degeneration). This is what bad knee homeostasis actually is.

That is why, in theory, nudging the knee in the anabolic direction - through PRP with all its growth factors and anti-inflammatory cytokines or through inflammatory cytokine inhibitors such as 1L-1Ra, should help. The sad reality is spritzing in PRP, even repeatedly, is not a sure shot to cure CMP. It hasn't worked for me so far (4 injections total). CMP is a tough beast.

You appear to be the only poster claiming to have cured his chondromalacia. Please tell us more, how did you do it? Do you have objective before and after evidence like MRI (realizing it's not perfect) or is it just your subjective opinion you don't have CMP anymore? Did you have crepitus that is now gone?

Awaiting your answer with anticipation!

Sorry mate, only just saw your post.

The practitioner ignorance here in Oz seems widespread.  Not one of about 6 I went to mentioned loss of homeostatis.  I had to work it out myself thanks to Dr Dye.  And yes, I agree CMP can lead to loss of homeostatis - it was either CMP or my meniscus tear which lead me to a dramatic loss of homeostasis and 6yrs of misery.

Have I cured my CMP?  I'd say it's about 80-90% better.  And I first got it in my teens (I turned 57 a few days ago), the symptoms have been up and down ever since.  Yes, I had crepitus and it is gone now.  If I push too hard with certain exercises the CMP symptoms come back (but not the crepitus), but compared to the 'loss of homeostasis' symptoms, they are a walk in the park.

How did I cure it?  Buggered if I really know.  It got massively improved as a side-effect of dealing with the loss of homeostasis over 6yrs.  The keys to curing that were Celebrex for 6mths, activity modification, TENS machine, icing & trial and error with various leg/hip/glute strengthening exercises to figure out which ones I could cope with.  Then as things got better, getting back into cycling (MTB & road), and then a little running.  My legs and core etc. are now significantly stronger than they were when I was doing Ironman triathlon, even though I now cycle far less than before.

Running is a  bit suspect though - it can flare my CMP and has caused injuries in other parts of my body (abs, pelvis, achilles) which keep stopping my from doing it regularly.

I now swim 2x/week for up to an hour, cycle 4 times/week up to 2hrs, do strength work in the gym 2x/week, bur running is hit and miss & I never got back to more than 5kms.  I mostly save my run ammunition for a triathlon these days - which gets ugly on minimal run training.
« Last Edit: March 03, 2021, 11:16:49 PM by SuspectDevice »
L Medial menisectomy 2012
PFPS both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2020 - ride 3x/week, swim 2x/week, gym 2x/week, aiming to get back to short triathlons

Offline SuspectDevice

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Re: Chrondomalacia vs PFPS
« Reply #6 on: March 03, 2021, 11:17:16 PM »
Suspect, there may be some practitioner ignorance, for sure, although can't say how widespread. My doc is definitely aware of the altered anabolic-catabolic balance in the CMP-affected knee in the direction of catabolism (i.e. degeneration). This is what bad knee homeostasis actually is.

That is why, in theory, nudging the knee in the anabolic direction - through PRP with all its growth factors and anti-inflammatory cytokines or through inflammatory cytokine inhibitors such as 1L-1Ra, should help. The sad reality is spritzing in PRP, even repeatedly, is not a sure shot to cure CMP. It hasn't worked for me so far (4 injections total). CMP is a tough beast.

You appear to be the only poster claiming to have cured his chondromalacia. Please tell us more, how did you do it? Do you have objective before and after evidence like MRI (realizing it's not perfect) or is it just your subjective opinion you don't have CMP anymore? Did you have crepitus that is now gone?

Awaiting your answer with anticipation!

Sorry mate, only just saw your post.

The practitioner ignorance here in Oz seems widespread.  Not one of about 6 I went to mentioned loss of homeostatis.  I had to work it out myself thanks to Dr Dye.  And yes, I agree CMP can lead to loss of homeostatis - it was either CMP or my meniscus tear which lead me to a dramatic loss of homeostasis and 6yrs of misery.

Have I cured my CMP?  I'd say it's about 80-90% better.  And I first got it in my teens (I turned 57 a few days ago), the symptoms have been up and down ever since.  Yes, I had crepitus and it is gone now.  If I push too hard with certain exercises the CMP symptoms come back (but not the crepitus), but compared to the 'loss of homeostasis' symptoms, they are a walk in the park.

How did I cure it?  Buggered if I really know.  It got massively improved as a side-effect of dealing with the loss of homeostasis over 6yrs.  The keys to curing that were Celebrex for 6mths, activity modification, TENS machine, icing & trial and error with various leg/hip/glute strengthening exercises to figure out which ones I could cope with.  Then as things got better, getting back into cycling (MTB & road), and then a little running.  My legs and core etc. are now significantly stronger than they were when I was doing Ironman triathlon, even though I now cycle far less than before.

Running is a  bit suspect though - it can flare my CMP and has caused injuries in other parts of my body (abs, pelvis, achilles) which keep stopping me from doing it regularly.

I now swim 2x/week for up to an hour, cycle 4 times/week up to 2hrs, do strength work in the gym 2x/week, but running is hit and miss & I never got back to more than 5kms.  I mostly save my run ammunition for a triathlon these days - which gets ugly on minimal run training.

My Ironman days are over, but I still do sprint triathlon when the body allows.  Also now do a lot more races in a team with my wife and daughter - usually I just get to do the swim, but sometimes the bike also.
« Last Edit: March 03, 2021, 11:19:59 PM by SuspectDevice »
L Medial menisectomy 2012
PFPS both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2020 - ride 3x/week, swim 2x/week, gym 2x/week, aiming to get back to short triathlons

Offline silver_maple

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Re: Chrondomalacia vs PFPS
« Reply #7 on: March 05, 2021, 05:20:23 PM »
Suspect, thank you for the answer. What you've achieved is impressive. Let's also be clear - your fitness level appears to be at the very high end for someone in their upper 50s. That's gotta help and is something to emulate, safely. Maybe you were a pro athlete earlier?

If not crepitus, what is your primary CMP symptom? Pain? For me CMP is synonymous with retropatellar cartilage softening or breakdown. One either has these histological changes or doesn't. As cartilage is aneural, there is usually no pain until cartilage has been stripped to the bone (and then it's far too late). This could lull people into complacency. But one can sense the crunching. The major danger is that cartilage destruction can progress if the homeostasis is out of kilter.

The established view is that innate cartilage regeneration in humans is very limited. There are some progenitor cells in the fat pads and the synovium that could migrate under chemotaxis and differentiate and repair - maybe you've managed to achieve that.

As a forum faithful you have lots of nice posts and I've read quite a few. I have not discovered how to search only a particular user's post history - maybe the admin can offer a hint.  Suspect, how did you handle your meniscus tear - benign neglect or something more interventionist? Do you have a take on biologics, esp. stem cell concoctions? Fyi, I've tried PRP which has been largely successful in neutralizing inflammation but quite impotent at regeneration, despite the much ballyhooed cocktail of growth factors it contains. I thus consider PRP better than NSAIDs given the well known systemic side effects of the latter. I am thinking of trying curcumin+pepper later in the year after I complete a PRP refresher series I am in the middle of right now.
2019 - Chondromalacia patella gr 1-2, both knees; early bilateral tibio-femoral arthritis; another 5mm focal lesion; partial meniscus tear (right knee)
2020 - PRP x3 in right knee
2021 - PRP x2 in right knee

Offline vickster

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Re: Chrondomalacia vs PFPS
« Reply #8 on: March 05, 2021, 07:21:35 PM »
To search for a specific user’s posts...the easiest is to click on their user name next to a post and go to show posts.
Otherwise, go to members above, search for the member, click on their name and that should take you to the profile where again you’ll see ‘Show Posts’
« Last Edit: March 05, 2021, 07:25:01 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 silver_maple

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Re: Chrondomalacia vs PFPS
« Reply #9 on: March 05, 2021, 08:32:42 PM »
Thanks for the pointer, Vickster. I actually knew that. What I was trying to achieve is only search Suspect's 286 posts, for example for the word "meniscus". When I bring up Suspect's posts (20-pages worth) and type "meniscus" in the search box, the hits do not appear limited to Suspect's contributions but rather span the entire forum. The only workaround I can think of is copy-paste Suspect's 20 pages of posts into Word and search within Word.

I might as well sit down this weekend and read through ALL of Suspect's posts as he seems to be quite a clever fellow.
2019 - Chondromalacia patella gr 1-2, both knees; early bilateral tibio-femoral arthritis; another 5mm focal lesion; partial meniscus tear (right knee)
2020 - PRP x3 in right knee
2021 - PRP x2 in right knee

Offline vickster

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Re: Chrondomalacia vs PFPS
« Reply #10 on: March 05, 2021, 08:34:16 PM »
Ah ok.
Think he had a menisectomy if that helps?
Yes...he did if you read his very first post on page 20 of his posts
https://www.kneeguru.co.uk/KNEEtalk/index.php?topic=35811.msg594198#msg594198
I’m sure he can fill you in more :)
« Last Edit: March 05, 2021, 08:37:00 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 SuspectDevice

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Re: Chrondomalacia vs PFPS
« Reply #11 on: March 05, 2021, 10:23:33 PM »
Suspect, thank you for the answer. What you've achieved is impressive. Let's also be clear - your fitness level appears to be at the very high end for someone in their upper 50s. That's gotta help and is something to emulate, safely. Maybe you were a pro athlete earlier?

If not crepitus, what is your primary CMP symptom? Pain? For me CMP is synonymous with retropatellar cartilage softening or breakdown. One either has these histological changes or doesn't. As cartilage is aneural, there is usually no pain until cartilage has been stripped to the bone (and then it's far too late). This could lull people into complacency. But one can sense the crunching. The major danger is that cartilage destruction can progress if the homeostasis is out of kilter.

The established view is that innate cartilage regeneration in humans is very limited. There are some progenitor cells in the fat pads and the synovium that could migrate under chemotaxis and differentiate and repair - maybe you've managed to achieve that.

As a forum faithful you have lots of nice posts and I've read quite a few. I have not discovered how to search only a particular user's post history - maybe the admin can offer a hint.  Suspect, how did you handle your meniscus tear - benign neglect or something more interventionist? Do you have a take on biologics, esp. stem cell concoctions? Fyi, I've tried PRP which has been largely successful in neutralizing inflammation but quite impotent at regeneration, despite the much ballyhooed cocktail of growth factors it contains. I thus consider PRP better than NSAIDs given the well known systemic side effects of the latter. I am thinking of trying curcumin+pepper later in the year after I complete a PRP refresher series I am in the middle of right now.

I was never a pro-athlete, just a weekend warrior.  But I was pretty obsessed with triathlon for a long while.  Started doing it in my mid-late 20's, the wheels fell off with my knees at age 49 and 8 months.  But comparatively speaking my fitness level is still high....though when I do the odd race, I'm reminded how much I've lost - 17% to be exact!

Yes, my patella cartilage had fissures/defects right down to the bone (one medico pointed this out to me on my MRI), but it seems to have healed significantly.

My meniscus tear occurred suddenly on a cruisy little run as I was ramping up for an Ironman in NZ.  Stupidly, I opted for surgery within a month or so.  I could not run, but kept cycling & the loose bit of cartilage chaffed my femur cartilage, and I still pay for that.  But it was a bad tear, my knee was locking, so surgery was probably the only option - though I now advise people to see if they can wait 6-12mths before going down the surgery route.  Within 2mths of surgery, I was into complete loss of homeostasis in BOTH knees and the 6yr nightmare commenced.

I had PRP and it seemed to do nothing.  Apparently PRP does have some stem-cell type effects but not for me.

I considered stem cells, but very expensive.  And I know a local woman who was a keen runner who had it, and every time I ask her did it work, her responses are not encouraging.

I had no side-effects from NSAIDs (if that's what Celebrex is?).  People really worry about this, but for me, it was the only circuit-breaker which stopped the constant burning/aching/hot kneecaps/discoloured kneecaps.  It allowed me to start strengthening, which ultimately accelerated my cure....and my CMP got significantly better along the way.

I tried lots of natural remedies, but can't say any worked.

However, lately, I've started having some arthritis in other joints (big toes, thumbs, wrists) and started taking collagen tablets and I'm convinced these have made a huge difference.

A clever fellow !  Mostly just stubborn, though my background in research really helped me find good stuff online, which eventually led me to Dr Scott Dyes papers/videos and the solution to loss of homeostasis.



L Medial menisectomy 2012
PFPS both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2020 - ride 3x/week, swim 2x/week, gym 2x/week, aiming to get back to short triathlons

Offline Christine10S

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Re: Chrondomalacia vs PFPS
« Reply #12 on: March 12, 2021, 03:58:30 AM »
I really appreciate all the information that you provided regarding your quest &  incredible determination for a cure for CMP/PFPS.  I will be researching the many options you suggested.  It gives me hope. :)