Hello, everyone…I was recently diagnosed with a stage 1 chondral defect in my trochlear groove. It is 1.5 cm. I started having pain right after Christmas while I was running. Was training for an ultra marathon. I took a week off, it felt better, I ran a 31 mile race, and it hasn’t been the same since. It was suspected that I had torn my meniscus, but MRI confirmed it was a chondral defect. I’m devestated. I have no idea how I even got it. Does anyone have experience with these, and does anyone have a success story? I caught mine early, so I am on 12 weeks no activity in hopes it will fill with fibrocartilage. I’m praying it does, because I am terrified to have the surgery. I have searched and searched on the internet, and can’t find a lot of information. It doesn’t seem like there are a lot of runners with a chondral defect in my location, and all of the ones I read about are more severe. The doctor seemed to think it was a positive that it was located in the trochlear groove, because it would have a better chance to heal. It doesn’t hurt to walk…only to run. I have so many questions though. Did I cause this by overtraining? I was only doing 60 miles a week (tops). Is there not a lot of information out there because people with stage one defects don’t typically need sugery? What are the chances mine will heal on its own? Will I ever be able to run long distances again? If I dug a hole into my knee from running before, and fibrocartilage is not as strong, it seems as though running again is out of the question. I’m devestated because ultramarathoning is my passion. Any suggestions/advice would be welcomed. Thanks!
Two suggestions for further reading.
Marc posts here on ST.
http://www.10-hours.com/about-marc_rubin_blog.php
My Story. Ironman Triathlete Recovering from Microfracture
I have osteochondral defects and am still running. Mine are grade IV over most of the lateral femoral condyle and also 1/3rd to 1/2 of the tibial plateau. It is in a full weight bearing area, and the lesions are kissing. I also have grade I and II changes at the patellar and medial sides, but nothing that I’d notice, comparitively speaking. I don’t run ultras, but am still running.
You are lucky in that it’s not advanced, and is in a good area. If the rest doesn’t help, you might also consider a microfracture to build fibrocartilage.
You won’t find much information that claims cartilage will heal. But cartilage has the potential to heal if you provide it with the right dosage of mechanotransduction, or loading and unloading. But it is not just cartilage that causes your pain, the whole joint is involved. The good news is the whole joint can get healthy even if the chondral defect never gets better.
Don’t just rest your knee, it’ll get worse, a synovial joint needs to move. But don’t overdo it with running, you probably did too much based on only 60 mpw then a 31 mile run. You may have some biomechanical issues that cause excess loading also.
Your not finished, you just need some professional help.
What are you doing to address some of the muscle imbalance (weaknesses) that may have played a BIG part in the formation of the defect? Clearly there was increased stress being placed on this part of the joint. Something some muscles are not doing their job at eccentrically controlling the deceleration necessary when landing. I as assuming this was not caused by any traumatic injury like a car accident?
apologize for the poor editing of last post (3rd sentence:)
.
The MRI showed it had started to fill with a little fibrocartilage, so I’m praying it will continue to do so. This injury could be caused by muscular imbalance, however, I have been a runner since 6th grade (almost 15 years ago) and have always ran the same. Same shoes, same mileage, etc. That’s why I’m SO puzzled by this. I can’t find much documentation of chondral defects of the knee caused by overuse. It seems like most are from traumatic injuries. That being said, my boyfriend is a phsyical therapist and under my doctor’s direction, I have started some hip/quad exercises to fix/prevent any imbalances. Him and I have both been so puzzled by this injury, however. It seems fairy uncommon. I just wish I could find more information on similiar injuries. I’ve found a lot on chondral injuries in different locations, but not many in the trochlear groove. My boyfriend actually thinks we may have caused this injury in the weight room. I take pride in having strong legs, and was showing him that I could do all the weight on the leg extension. I did it, and remember a slight pinch in my knee when I got off the machine. I shook it off and it was fine. I was in the middle of ultra-marathon training though, and ran lots of trails on it afterwards. I didn’t have pain until a month later, which was when all this started. My boyfriend’s theory is that I did the initial damage in the weight room, and then the long running is what actually caused the pain, because the bones showed signs of edema in the MRI and were hitting more because of the defect. The most times I feel my knee are when I use my good leg to pull on the heel of my bad leg’s shoe, and pull my leg out (to take off the shoe), and putting my leg up on a counter and extending it out. That goes along with leg extension, so I guess that would make sense. When you do a leg extension, the knee cap does shove into the groove, so if I used bad form because the weight was so heavy, I guess that could have caused it. Regardless, this injury seems so depressing with a bleak outlook. I’m feeling better today, but have definitely gone through the grieving process. I appreciate all the feedback.
This injury could be caused by muscular imbalance, however, I have been a runner since 6th grade (almost 15 years ago) and have always ran the same.
Cumulative effect. I’ve been running since I could walk, but it didn’t mean I didn’t have serious imbalance issues that made a whole host of things worse. Just something to keep in mind.
First, make sure you are working with a good sports med doc. Second, find a really good physical therapist. I’m a PT (in Portland) and have a trochlear defect that they found when I had an ACL reconstruction. I had micro fracture…took a couple years but it has gotten better. I can feel it if I really load my knees with heavy lifts in the gym but I can typically run/ride with no pain. Despite how strong you feel, I suspect we could find some imbalances. Not that this caused your problem. But, generally speaking, the stronger you are (hips, core, legs), the better. Beyond that, there are options that exist in the way of supplements, injections, etc. However, once again, you should be in touch with a good sports med doc if you want to head in this direction.
I wish you the best luck. I had a condral defect on my talus bone a few years back. Like you I had been a runner for a long time and ran up to 100 mpw at times. My injury was acute as far as i can tell and happend by stepping wrong out on a trail run. I had microfracture surgery to try and stimulate fibrocartilage but it did not work. I later had an OATS proceedure where they took bone and cartilage from my kneww and put it into my ankle. So far so good. I am a year out and just ran a half marathon with reasonable success. However, I would be unlikely to put my milage back to where it use to be (or run marathons) as I would be worried about re-injuring myself. You are unlikely to be out of luck but it may mean altering some of your race goals.
Well said JRAJR.
The human body is an amazing compensator.
I compensated huge in my 20s and early
30’s. I suffered from chronic back and neck pain
That whole time. I worked as an Athletic
Trainer and in PT. Also worked as an orthopedic
assistant. Was evaluated and had no real
Diagnosis other than some DJD in spine.
Did all the core strength and rehab including stretches.
Never had any long term relief. Now I run
(minimalist) and have far more mobility with
No pain. And I have not needed to stretch in years.
You have to address the weaknesses but evaluation
and being SPECIFIC are key. Need to get to the real
Underlying cause. If you tell ms your location I may
Be able to recommend someone for you to see
for evaluation. Traditional PT is great and can
help many people. It just needs to be
more specific and individualized. Need to
evaluate and treat one joint and one motion
at a time. Put the pieces of the puzzle together.
I had/have a chondral defect in my left knee. I ended up doing the microfracture surgery. It is now two years later and unfortunately I’m still having issues. Are you considering surgery? Would it be microfracture? IS there something else your doctor recommended? Just curious how it’s going and what the plans are…
Bill