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Offline anniep

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any ideas?
« on: September 01, 2004, 11:47:27 PM »
hi, I'm a 29 year old female who has suffered with knee pain about 4 years now. I have had physio, been seen by consultants who thought I had a cartalidge tear and had a arthroscopy last April,the surgeon said something had bore a creator into the back of my patella, they couldnt say what but flushed my knee through. Recovery was slow but fine with help from physio. For the past year now I have been using the gym and slowly have been starting to run, not the best thing for knees I know but I really enjoy it. My knee has been fine up till recently (2 weeks ago) but now the same nagging ache , tenderness,heat and occasional sharp pain has returned. I have not run on it since or been to the gym hoping for recovery but am now beginning to worry again. I have also been told that I over pronate on the same leg and I get tenderness in the hip on the same side. Has anyone had similar or been told a similar thing by a surgeon?

Offline Heather M.

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Re: any ideas?
« Reply #1 on: September 02, 2004, 03:43:36 AM »
The 'crater' in the back of your kneecap is called a chondral leasion.  Basically, it is damage to the articular cartilage that coats the bones and allows things to move smoothly with a friction-less glide.

If you have a deep chondral lesion, you should not be running!  It doesn't sound like the doctor did anything for you--flushing out the area doesn't do much, I'm afraid.  The thing to figure out would be WHY you have damaged articular cartilage.  Usually, it is due to patellar mal-tracking or a serious blow to the kneecap from a fall or car accident (where knee received a direct blow and dug a divot out of the articular cartilage).

So technically you have a focal defect (deep hole but small in area) which is basically severe chondromalacia or osteoarthritis.  I have two deep lesions on the back of my kneecap--mine are grade II osteoarthritis.  A few years ago they were grade IV chondromalacia (this is less serious, meaning the damage doesn't go down into the bone).

Here is a good link on chondral lesions, listing how they come about, what can be done, and what your options are.  http://www.steadman-hawkins.com/knee_chondral/overview.asp

At the very least you should not be doing impact activities while you are figuring out what to do.  Think of the lesion as a giant scab on your knee or something.  Every time you bend and straighten, you will irritate the scab and keep it from healing completely.  Unfortunately for us, a chondral lesion will never go away--it will never get better without surgical intervention.  

HOWEVER, all hope is not lost!  Lots of people have focal lesions and do just fine.  It all depends on the location of the damage, how deep it is, and if the doctor can get the inflammatory/irritation process to calm down.  This, theoretically, would slow the advance of the damage.  

If your chondral lesion was caused by blunt force to the knee in an accident-type situation, that is actually good news!  It means that you don't have a genetic problem, and that makes you eligible for some of the more exotic cartilage repair techniques.  However, if your lesion is from mal-tracking and poor knee mechanics, then this problem has to be corrected (usually by patellar realignment) before you can then address the cartilage problems.

I know this is a lot to take in.  If your doctor hasn't mentioned any of this to you, likely he or she isn't well-versed in PFS issues.  It sounds like you are in the UK (in the US we don't call surgeons consultants, so this is just my guess ;-)) and that certainly complicates things.  I would go to the list of surgeons in the upper left corner of this page and find a top knee doc around you.  There is a fantastic knee clinic in London that we have heard good things about (the kneeguru herself could point you in the right direction).

The surgeon you see will likely determine you course of action.  Some will blow you off and tell you there is nothing to be done.  I've heard this, and it is NOT TRUE.  You need to find a PFS specialist (patello-femoral syndrome) who has confidence in their ability to improve your quality of life.  Likely physical therapy will help you A LOT.  And avoiding activities which irritate the knee, like running.

Go down to the patello-femoral section and read up on chondromalacia, cartilage damage, OA (osteoarthritis) patellar mal-tracking, and so forth.

Heather
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Offline anniep

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Re: any ideas?
« Reply #2 on: September 02, 2004, 11:40:24 PM »
thanks heather, Wow, a lot to take in. I feel a bit disheartened though as have lost weight since having children and am really enjoying physical activity again. Was even thinking of entering a half marathon! Oh well back to the drawing board. Thankyou very much for you in depth answer.Youve been through a lot yourself. I shall do some more research and armed with your insight shall go back to the doctor, do not have private healthcare so lets see what the nhs come up with this time.
keep you posted - Annie p