I recently got diagnosed with a chondral defect at the medial femoral condyle (.6cm transverse/ 1.5 cm AP). The MRI also showed a Bakers cyst that is causing lots of swelling and limiting my ROM. Does anyone have any experience with this injury and can shed a light on the recovery process. Would a cortizone shot and PT be effective short term? Is microfracture surgery a good option? Are my running days over? I meet with the surgeon next week so I am attempting to be as informed as possible. Any shared experience with this injury and its recovery is very much appreciated.
bump…anyone?
Many on this forum have had baker’s cysts and chondral defects/osteoarthritis. The baker’s cyst is likely a by-product of the inflammation caused by your arthritis.
I had a baker’s cyst last year that limited my range of motion. PT and cortizone were mildly effective in the short term and I was able to complete my IM training and finish my event. The real issue is the arthritis.
There are many treatment options and you will need to talk with your surgeon to determine what’s best. Besides microfracture, there are various cartilage implants and transplants available. Whether or not you are a good candidate for these depends on the size and location, and condition of the defect, whether there is damage to the meniscus, tibial plateau, ligaments or other supporting tissue, and whether or not you have any alignment issues.
My defect is on the lateral size and is much larger than yours. I also have no lateral meniscus and (had) an 8 degree valgus misalignment. As a result, I was not a candidate for microfracture or any cartilage implants or transplants. About 9 weeks ago I had an osteotomy of the distal femur, which is where the surgeon cuts the femur an realigns the angle and fixes the bone with plate and screws. This surgery shifts the weight bearing axis to my medial side, where my knee is perfect. My other option was a partial or total knee replacement. I’m 46 and active so I chose this surgery as a way to stave off what will likely be a TKR or PKR down the road. Running for me is likely over. I’m now 2 months into what is a 9-12 month rehab.
Is your running career over? Too early to tell. Here’s some advice that I learned the hard way. Stop running for now so you don’t cause more damage. There may be some procedure for which you are a candidate, but if you run on it between now and the time you decide on your treatment option, you may eliminate that option because of further interim damage. I know no runner wants to hear this. Its just my 2 cents.
Once you have had your talk with your surgeon regarding options, I suggest you research them online. One of the best sites is Kneeguru. They have topic boards set up for almost every condition and surgery and you can read about peoples experiences and ask questions to those who have had the exact procedure, recovery etc. Also, I don’t know who your doctor is but be very selective. If your surgeon only does microfracture, he/she may not always recommend other procedures that may be more beneficial. I found the best guy in my area, someone who’s done everything from a-z and satisfied me that he had no other interest other than getting me the right care.
Good luck!
bump -
Great post/reply!
Thx.
And I really appreciate all the info and advice you’ve given here.
weenis and I are in similar boats, although I have not yet had an osteotomy (although it is the last option available to me). I have full-thickness chondral defects on both my lateral femoral and lateral tibial condyles. My femoral defect encompasses pretty much the entire lateral condyle; the tibial is about half to 2/3rds. I also lack a lateral meniscus, and have Baker’s cysts. The cysts do fill, and are annoying, but, honestly, the least of my issues. (Oh, and I now also have labral tears in my hip, which my doctor believes are primarily form compensating for years and years)
Each and every case is different–one person’s grade IV defect can be barely noticeable, while another can suffer with simple cartilage softening. And everyone’s progress differs as well. That being said…
I didn’t start at this point, obviously, but it has been a long time coming. In a nutshell, in 1989, I dislocated my patella, tore my lateral meniscus, and knocked off a chunk of articular cartilige. So, I’ve dealt with knee issues for the bulk of my life (I’m 33 now). I’ve had four arthroscopies, including 3 partial menisectomies, 3 debridments, 2 chondroplasties, and a microfracture.
A microfracture can work, and you can run on it, although it’s not always adviseable. Its success depends on where the lesion is, how big it is, and what complicating effects you may have. My microfracture that I had in 2002 failed, largely b/c the chondral defect was already pushing the limits of size for a MF, as well as b/c I had no meniscus where the surgery was. (By then I was down to about 50%) By then, I had cut my running down to a few days a week.
I have been running since then, although nothing longer than half marathon distance. My plan had been to get regular MRIs and then go for a meniscal transplant and cartiliage transplant/stimulation. But, as I noted above, I obviously didn’t get it done–my knee had gone too far to use those options. Like weenis said, though, those cartilage transfers/transplants etc., are good options for those who are a candidate.
Also like weenis said, take a break from running right now, and go see one, two, four, orthopedists–sports specialists–and let them look at your films, watch you move, evaluate you. See what options they present you, and go form there.
Your future may be just fine and you will get it fixed and never be troubled again–but the key is to have it throroughly evaluated TODAY so you can do preventative medicine, as opposed to overdoing it and trying to do repairs later.
What Rock, said X2. Get a couple of opinions.