Sorry to hear about the bone injury. What is your calcium and vitamin d intake like?

You should go back to your doc. Not sure why he would have said quick heal - most fractures take 6 to 8 weeks.

---

maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
disclaimer: PhD not MD

The doctor said it was a quick heal because it is apparently in a good area conducive to blood flow. He said to try running again in 4 weeks and it should be ok. I am not a doctor nor do i have any knowledge about the medical field. This is simply verbatim from his mouth.

Regarding my calcium and vitamin D, im assuming they are average. I had a bone scan about 4 years back and it was normal. I eat an average diet, not abnormally healthy nor fattening. I did start taking some small chocolate circular calcium supplements last week. Hopefully this would work.

What is your experience like with stress fractures?

you need 3 x 500 mg of calcium a day

My experience with sfx is 6-8 weeks. See your doctor again if it still hurts.

---

maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
disclaimer: PhD not MD

Hi SHock, I'm an orthopaedic sports medicine knee surgeon. I only do knees and have been in practice for 25 years and I don't really understand what you are trying to say. Where is the fracture? Is is actually a sub-chondral bone lesion picked up on MRI? Is it visible on X-ray. Is there disruption of the overlying cartilage? Have you had a scope? Did anyone recommend a scope? Did anyone talk about a pre-stressed unloader knee brace? Have you previously had any knee problems?

Deak thanks for responding. I was hoping someone with your experience would reply.

One day I started running and the inside of my knee almost right in the middle of my knee vertically starting hurting, but i did my 10 mile run anyways thinking it would go away. The next day I could barely walk and was limping. I went to the ortho about 3 days later. Nothing on the Xray. Upon examination, he thought it was plica and I was preparing to have surgery. However, he suggested an MRI to make sure his diagnosis was correct. Had an MRI and the doctor told me it was not plica and that I had a medial femoral condyle fracture. He said it was not a typical stress fracture. He also said it was a good area because there was a lot of blood flow so i should be back running in about 4 weeks. He said it was at the bottom of the femur. This is all i know and all i have had done. I only ramped up my mileage for one week and have been a runner for years. I have not had any trauma. Never any problems on the left knee. Had some right knee IT band issues about 8 months ago which were cleared up with dry needle therapy. I have made an appointment for a second opinion. I'm going to get my MRI report faxed to me tomorrow and I will tell you what that says.

Shea.

Deak,

I have a fractured lateral femoral condyle from last May, and I am still struggling to get healed. My bone density tested good and I have done any and all types of treatment and therapy over the last few months, but it seems it has only slightly improved. Do you know of any studies on the lateral condyle that talk about specific treatments. Mine is more of a stress fracture, but the MRI showed a horizontal pattern rather than a vertical one. I have suffered some ITB issues in the same area, but that seems to be in the past now.

Thanks for any feedback, my goals for 2010 were skewered because of this (I could only swim in Kona and passed up on the ITU and 70.3 WCs) and it looks like now that 2011 will be more of the same, which is really disheartening.

Regards,

---

---

"Only those who risk going too far can possibly find out how far one can go." T.S. Elliot | Cycle2Tri.com
Sponsors: SciCon | | Every Man Jack

OK SHock and CPT Chaos. Sounds like both of you have subchondral bone stress reactions picked up on MRI and not visible on X-ray. The key is to have a high enough resolution MRI to make sure the overlying cartilage is intact. If the cartilage is intact, these lesions can usually be treated with-out surgery. The medial side has a better prognosis than the lateral side for healing. The initial treatment involves avoidance of all impact activities for 8-12 weeks (for the medial side, at least twice as long for the lateral side). Substitute cycling, swimming and water running to maintain fitness. I fit everyone with a lesion larger than 1 cm in diameter with an unloader brace to stop the impact loading at heel strike of the affected compartment. You should wear this brace for all weight bearing activities for the treatment period. I have also had good results with a bone healing stimulator such as the Exogen machine. Follow the recommended treatment protocol. Make sure your diet has enough Vit D (1000 iu/ day), Calcium (2000 mg) and Vit C (3000+mg). Some people think glucosamine and chondroitin help. Certainly they don't hurt.
I'm assuming neither of you have had menisectomies in the affected compartment?

OK SHock and CPT Chaos. Sounds like both of you have subchondral bone stress reactions picked up on MRI and not visible on X-ray. The key is to have a high enough resolution MRI to make sure the overlying cartilage is intact. If the cartilage is intact, these lesions can usually be treated with-out surgery. The medial side has a better prognosis than the lateral side for healing. The initial treatment involves avoidance of all impact activities for 8-12 weeks (for the medial side, at least twice as long for the lateral side). Substitute cycling, swimming and water running to maintain fitness. I fit everyone with a lesion larger than 1 cm in diameter with an unloader brace to stop the impact loading at heel strike of the affected compartment. You should wear this brace for all weight bearing activities for the treatment period. I have also had good results with a bone healing stimulator such as the Exogen machine. Follow the recommended treatment protocol. Make sure your diet has enough Vit D (1000 iu/ day), Calcium (2000 mg) and Vit C (3000+mg). Some people think glucosamine and chondroitin help. Certainly they don't hurt.
I'm assuming neither of you have had menisectomies in the affected compartment?

Need to know more info. Any healing noted on repeat MRI? Is the cartilage intact? How big is the lesion? Any previous menisectomy in that compartment. What is your age, height and weight. Have you had a scope?
What treatments have you tried?

Thanks for your response, that is the best info I have received from any of my docs (sports doc, PT, Ortho surgeon). I have had 1 MRI, 1 CAT Scan, 1 SPEC Scan, and the treatment has included weekly physiotherapy to ensure muscular imbalance did not effect the patella (and to attend to my tight ITB). I also have basically, tried to lay off running for a few weeks, then try to run (resulting in about 2-3 weeks off, and no progress at all between painful runs). I have primarily trained since Oct with only swimming a bit of cycling, but I lived in London until the end of November so I was walking extensively until that point.

I don't know how big the lesion is, but I am going to try and get the CAT and SPEC scan results and files emailed to me tomorrow. I was told from my MRI that the meniscus was fully intact and there was no issue there. Since I quit my job in London and returned to support my aging family, I no longer have health insurance so getting another MRI might be a bit too much for my limited budget. Do you know a good doc (someone who you would use) in Denver? I would really like to get another look and get the right brace you spoke of earlier.

I am 36, 5'8 and weigh 138lbs.

Thanks again, I am hoping this new info can lead me to a proper treatment plan and a healed bone before 2012 comes around. The good news is that my 100m times have come down significantly :)

Cheers,

---

---

"Only those who risk going too far can possibly find out how far one can go." T.S. Elliot | Cycle2Tri.com
Sponsors: SciCon | | Every Man Jack

Sounds like you need another MRI to assess current status of the lesion. As I said before, the MRI needs to be done with the lateral femoral condyle lesion in mind. You need to know if the cartilage is intact overlying the lesion and if there are any signs of healing. It is impacting force of any form that causes the damage and therefore cutting out running all together in unfortunately necessary. Even walking on a hard surface will delay healing, that is why I fit an unloader brace as it blunts the effect of peak loading during the heel strike of walking. Keep up the cycling and swimming. Obviously during cycling your goal is to keep the cadence high and not push big gears. You are young and light and these are factors in your favour but you may need something more done surgically if the lesion is not healing or the cartilage is cracked over the lesion. If the cartilage is intact I would try a brace and Exogen.
I don't know anyone with expertise in Denver but there is Richard Steadman in Vail. He is getting older and near retirement but he does have a lot of knowledge in this area. He has other great people at the Steadman clinic like Marc Phillipon and Robert LaPrade.
Good luck.

Thanks for this, I will reach out to that clinic. I just received the radiologist report from the spec scan in London, and it is all very hard to read, so I am not sure if your concerns were answered in it (cartilage damage, etc).

Kind regards,

---

---

"Only those who risk going too far can possibly find out how far one can go." T.S. Elliot | Cycle2Tri.com
Sponsors: SciCon | | Every Man Jack

Just came across this thread and had to chime in. I have to tell my running history because I have no idea if all these things somehow tie together.
I am 51, and have run 28 marathons over the past 13 years. I never have been able to run more than about 35-40 miles a week, even in my prime, due to various inuries that were iminent with increased miles. I've basically learned to do at least half my training on an Elliptical type machine.

Over the past 15 years, I have had:
Shin splints/stress fractures.....resolved with the use of orthotics.
IT Band issues.....resolved by making the orthotics more aggressive.
Patellar Femoral Pain Syndrome......wore a Patt strap to "float" the knee cap and learned to strengthen the medial group of quadricep muscles.
Posterior Tibial Pain Syndrome....Tried more aggressive orthotics, to disallow my extremely flat arches from completely collapsing, causing my feet to roll inward. Only true relief was time off, and fewer miles. Had to stop jumping rope.
Piriformis Pain.......Almost a year off before it went away, with mild stretching, ibuprofen, and patience.

Just about a year ago, I was feeling great. Running 10 X 6:45's at 50 years old! I felt like a jack rabbit. Then the knee pain started. Just inside from the lower edge of the left knee cap, the pain intesified each time I ventured out, to the point where I just couldn't run through it any more. I went to my Dr. and he did x-rays.....inconclusive. He then ordered an MRI. It showed a lot of edema in the femoral condyle area, and also indication of a medial meniscus tear.
In July of 2011 had it scoped and had a small radial tear and therefore had a small amount of cartilage removed in that very area of the stress of the femur.
Four weeks later, I started to run a bit. I was on a treadmill and felt a very subtle pop in my RIGHT knee! When I got off the treadmill, my knee would "pop" each step with the pronation of my right foot. The more it "popped", the more it hurt.

I went back to my Orthopedic Surgeon and had him look at it. He told me to stop running for a while and see if the problem went away......it did not. He ordered an MRI on my right knee. Results? A small meniscus tear in precisely the same location as I had previously experienced on the LEFT knee. Surgery... November 2011. Same results. Both knees had similar size tears in same location, no arthritis, everything else looked good.......Doctor told me I could resume running in 4 to 6, depending on how I felt.

This knee just didn't seem to be getting better however. I visited my Dr. two more times, and he suggested more time. After 12 weeks, I began to get frustrated. I tried to run through the pain several times and the pain was sometimes excruciating. There were also good days occasionally. One "fluke" day, I was able to run 10 miles on a treadmill with a tolerable amount of pain.
But the past few weeks have been brutal. I can take my finger tip and find a spot right at the edge of the femoral condyle that when I touch it, I practically jump through the ceiling! The pain radiates all the way through my knee joint.
Yesterday I went to see my Ortho again, and he said he felt a bit of "fluid" around my knee. I showed him where the "hotspot" was. He pulled up my MRI pics from last year for my other knee and noted the pain was in the exact same area as that previously diagnosed "pre-stress" fracture. He suspects I have the same now on my right knee. I don't know why? All I've been doing is Elliptical, Stairmaster, stationary bike, rowing machine, AMT, ARC Trainer......all low or "no" impact stuff. Not sure where the knee trauma is coming from. Also, my knee pops or "cracks" when I do even shallow squats. How could a stress fracture "pop"?
I have another MRI scheduled for a week from today. (Cha-ching).

Any ideas Deak?

Thanks in advance!

You do need another MRI. Report back what it shows. How much meniscus was removed at the time of surgery?

According to my doctor, about 25% was removed.

Got the results back from another MRI and the Dr. told me that my femoral condyle was "hotter than a firecracker". The MRI showed definite trauma to that area, but no confirming signs of another meniscus tear. My next thing, once the knee trauma subsides, is to have a kinetic chain assessment done to determine "why the stress" on the femoral condyle. I'm not sure what's going on……I haven't even been running. How can I have that much stress in that area from doing low impact machines at the Y?

Hi Deak,

I am a physiotherapist with a patient who has had an MRI diagnosed subchondral medial femoral condyle fracture, initially he had pain only with running but has now progressed to walking, standing etc and I was wondering which unloader knee brace you recommend? He is a bit hesitant due to the cost. Any help would be greatly appreciated.

Just wanted to say, "I understand where that is now!" Anatomy class~

Hope it's healing up quickly!

Any of the major ones will do. DJ Ortho, Ossur, V/Q or CTi2. I usually have them put 2-3 degrees of correction into the brace. Sounds like he needs a reassessment by the orthopaedic surgeon.

Hi Deak - I sustained a lateral femoral condyle fracture (1.1 x 0.8 cm) on my left knee from playing tennis. The injury happened back in June but it wasn't diagnosed
until August because X-ray didn't pick it up and I continued to play with pain until I decided to get an MRI on Aug. 21, which showed the fracture. I stopped playing tennis after the diagnosis and has been biking instead. I read your comment about Exogen bone healing stimulator so I decided to give it a try. I purchased a used Exogen 4000 and has been using it everyday since Sept. 22. I think it is working for me. How long should I continue to use it and how soon can I go back to playing tennis? The strange thing though is since I injured my knee I have also been feeling pain near the fibular head (just below it) which the doctor said is not part of the knee. Is it related to the condyle fracture? Thanks for your help.

Deak:
I have been following your posts and a little concerened with the progress of my 12 year old son. He suffered a 1.6x1.0cm subchondral fracture along the anterolateral femoral condyle within the epipysis. based on MRI is states that there is no disruption on ovelying chondral plate. The Orthopedic doctor had him stop any activity and thinks he will be better in 6 weeks, its been 3 weeks, and does not seem to be improving. I requested a load bearing knee brace at diagnosis, but he thought it was not necessary. Im concerned. Should I ask for this brace again?

RMA;
Looks like you have a similar fracture as my 12 year old son, how long did it take to heal since the day you stopped running on it? thanks would appreciate a response

SHock, when you have the high-resolution MRI as recommended by Deak, ask to have your articular cartilage defect (ACD) graded on the Outerbridge classification system. Grade II ACD (partial-thickness with fissures on the surface that do not reach subchondral bone or exceed 1.5 cm in diameter) usually respond well to unloading and modified rest. Current opinion is that grades III and IV heal in only about one third of patients, and typically worsen symptomatically over time. Prognosis after autologous chondroycyte implantation surgery in grades III and IV is very good to excellent.

Pedalhead:
Any thoughts on what I have posted earlier?