Chondral Defect of the weight bearing surface of the Medial Femoral Condyle.....Anyone?

Triathlon Forum
1

My MRI report says chondral defect and probable chondral flap of the weight bearing surface of the medial femoral condyle, along with Chondromalacia patella (Runners Knee)

I can deal with the runners knee no problem. That is a mechanical issue I can fix with strengthening muscle groups and working on my flexibility.

I am worried about the potential effect of removing that chondral defect (flap).

Anyone have a happy ending story to share to ease my mind or am I SOL and need to think about not running long anymore.

Thanks,

Dave

2

I have a defect like this. Unfortunately I have the same defect on the lateral side of my other femur. Do a search, there have been some really good posts about this type of injury lately. One guy that goes by the screen name of Former Fat Guy has a blog where he is documenting his process through this type of injury.

The bad news is that this can be a triathlon/running-ending type of injury. Depending on the size of the defect, the treatment, the PT, the type of surgery, etc., you will see myriad types of results.

The good news is that if you’re lucky, you can get back. I had microfracture surgery on my right knee for the lateral femoral condyle injury last September. After 6 months I was back doing some pretty good activity. Right now the knee is feeling really good, probably 95%. No problem running short distances(3-4 miles). I haven’t really tried running more than that yet.

During rehab however, I suffered a similar but smaller injury in my left knee. No real pain, just a lot of swelling and instability. Had an MRI and it showed a defect on the medial femoral condyle. There is very little pain, just swelling. Doc said I can keep doing what I’m doing, just plan on surgery. I’m having another scope done in the fall if I can make it that long.

In the mean time, I’m back racing. Just sprint tris an cycling TT’s for now, and maybe some 5k running races in a few weeks, but I’m racing without any pain. I’m not running as fast as I used to, but at least I’m running.

My feeling is that if the defect is not too big and you don’t feel the need to do marathons or IM’s you could be just fine.

I’m curious though. I’ve seen this type of injury a lot more in the last few years among triathletes, and I wonder if the bike then run order is creating a problem. After the bike portion your legs and muscles are fatigued, thus creating a slight instability in the knee. Running right after may be fine, but if there is any unnatural, lateral movement while the knee is unstable it seems like it could cause a problem.

I hope things work out for you. I’m back racing (for now) and couldn’t be happier. Just be patient.

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Thanks for your comments on your experience. I have done 4 IM’s so if I didn’t get to do another one it’s really no big deal. Long course racing is very time consuming and I was enjoying it less and less with every passing year.

I was planning a 50 mile run and hoping to qualify for the Western States 100 in October but that will have to be sidelined for now.

Same with my plans to try out Cyclocross this fall. The last thing I want to do is be just barely healed and then hammer on my bike during cross season.

I came to Triathlon to stay in shape in the off season from XC skiing. I have not skied at all in the past year and I really miss it. My plan for now is to get my knee operated on, go through the rehab and religiously do my exercises and strength building. I hope that I can return to the skis for a season of strengthening my knees and dropping some weight, including a lot of swimming and weights in the process. We just got the first ever West Coast Biathlon Training Center established at Northstar @ Tahoe last winter so I am looking at getting into the sport. XC skis and Guns, bring it baby!!!

Currently drooling over this:

http://i47.tinypic.com/2jb8upj.jpg

I will post on my progress from time to time.

Thanks,

Dave

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I had microfracture in 2004 to correct a defect on the lateral femoral condyle of my right knee. Rehab, blah, blah, blah. I did my first IM in 2007 (the knee probably could have handled one sooner, but I didn’t even get into triathlon until 2006, so…). I’ve been running 40-60 miles per week, and biking 250-350 miles per week for a long time, and have absolutely no knee pain. Modern medical science! Sometime, it really does work!

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Karma - I do this kind of surgery, when needed. Can you give us a little more info? Why you went to the doc, had the MRI in the first place? Age? Type of racing/training you typically do? Previous problems with this knee? Did you have regular x-rays first? Show any thing? How big/deep is the chondral defect?

                                                                    thanks, 

                                                                      John
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A little more encouraging news…I was XC skiing 3 months after my microfracture. No impact, no problem. I didn’t race last year but I did ski quite a bit, classical and skate (and some time on the biathlon range). The toughest part was getting up after shooting prone. By March I was doing it with relative ease.

My rifle of choice is an Izhmash 7-4, but it’s not as nice as that picture!!

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Get rid of the flap. It’s not doing anything but getting in the way. Prognosis (and treatment) depends on how big, how deep, and the state of everything else. It’s certainly not a death sentence, though. I have large, full-thickness kissing lesions on my lateral femoral condyle and tibial plateau and no meniscus, and I’m still doing relatively okay (although I am a short course athlete…longest running I do is training for half marathons).

Everyone is different. What you do is up to you–and how your body reacts, your surgeon, and your PT.

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Karma - I do this kind of surgery, when needed. Can you give us a little more info? Why you went to the doc, had the MRI in the first place? Age? Type of racing/training you typically do? Previous problems with this knee? Did you have regular x-rays first? Show any thing? How big/deep is the chondral defect?

I went to see the doctor because following a rather difficult (OK - BRUTAL) Xterra Triathlon on May 8th I couln’t walk down stairs without pain. I rode my MTB I have been rinding pain free for years and ran in a pair of trail runners I have only got about 100 miles on at this point. I noticed the knee pain about 30 minutes into the bike on a steep uphill. I forgot my saddle was a bit low from a descent the week before so I got off and raised it back up about 1.5 inches to where I normanlly ride it. The run was either straight up hill or downhill, very steep. The knee was yelling at me on the downhills so I went very slowly and gingerly down the hills. Immediatley got Ice on it after the race. It never really swelled up. Rested it for about three days and continued ice treatments. On the fourth day I went to see my deep tissue / AR guy and spent the next two weeks going in twice weekly for work on the tissues surrounding my knee, including my quads, hamstring and calf muscles. After two weeks he said it should really have seen improvement and he was worried about a possible miniscus issue or a problem with my knee tracking.

I couln’t sleep after hearing the words “bad miniscus” so I decided to see an orthopedist. I went to the St. Mary’s Sports Medicine Clinic in Walnut Creek, CA. Orthopedist measured my muscle strength and didn’t think that was the culprit since I’m pretty fit from doing a lot of cycling the past few months. Since I have a PPO and I can self direct my care, we had an open playing field. Their x-ray tech took the day off so there was nobody around to take the images that day. The doctor put in a request for an MRI to the insurance company to see if they would do it without an x-ray. They responded within a day that I was ok to go to get the MRI if I wanted to. MRI clinic had an opening that afternoon so I took it. Got the images the next morning with the report that said I have a Stage II Condral defect and secondary to that was a bit of runners knee.

I am 41 years old.

I adventure race at the sub-24 hour distances and have done an IM every season for the past 4. Never really been a runner. Lifelong biker and did a fair share of backpacking as a younger man. That was until I jammed my back (l4/l5 ligament tear in 1993). I started to up my mileage running in February because I decided to give IM a break and try a little ultra-running. My mileage at the time of this latest incident was only about 80-100/wk of cycling and 30/wk of running. Nothing extreme by my past experience. Only new thing was an increase in trail running since the ultra I was planning is a trail run.

No previous problems with this knee, except that both of my knees are somewhat “stiff” in the morning after a nights sleep. They sometimes “pop” when I first straighten them from the bent position, more so after sleeping, but sometimes after sitting. The patella doesn’t track smoothly, it’s best described as “crunchy”.

Right now I can’t work out because of the pain and going down stairs is pretty much painful with every step. I have completely laid off all exertion of my knees/legs (no cycling or running because they both hurt too much to do even if I wanted to) for the past two weeks and it has not gotten even the slightest bit more bearable. The pain is on the very edge of my knee cap on the inside (medial).

Hope this information helps, I’m going NUTZ !!!

Dave

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I can’t help but send ((((hugs)))).

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Well, Dave, that’s really quite a lot of information. Thanks. As I understand this, the only lesion seen on MRI involved the MFC and the menisci, patello-femoral joint, etc. are clean. This much pain after this much time, “they hurt so much” is hard to attribute to the single MRI finding. Also, pain descending stairs, down ramps, etc. is frequently attributed to the PF joint. Funny, you’d expect something here on MRI as well but good for you that it wasn’t. I’m sure your doc told you that there’s little correlation between a “crunchy” PF joint and presence of real pathology.

So, where from here? If you were my patient you’d at least be in the pool. Both swimming and water running. The elliptical would be ok too. I would have had you on an NSAID and a lot of ice for the first week, and consider a Medrol dosepak the second week. I’d hold off on surgery for the time being. Secondly, I can’t speak for/against AR, I just don’t know that much about it, but I do know a local physical therapist (every town has one like this) who *enjoys 100 mile mountain bike rides *and does wonders with patients (including me.) Some of my patients will describe help from Glucosamine/chondroitin but the literature is not strong here.

Lastly, I’d ask the doc to review the actual MRI images with you so that you have both control as well as an understanding of what’s cooking. It is your body after all.

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Thanks John. And yes, I’m in to pool and a lot of open water swimming. Also yes, all tendons, ligaments and minisci are clean. I think the main reason he is suggesting surgery is to get rid of the flap and take a good look around while in there so we have an eyes on approach to exactly what is going on in there. There is really no visible swelling to speak of at all and I’m not puffy anywhere. I was on ice 3x day for two weeks and it did nothing but make my knee cold. Doc and I looked at the MRI together in his office already too. He’s quite the well respected surgeon around these parts, does a lot of the cal berkeley athletes knee and shoulder work. I don’t think he was suggest surgery just to make a cut and a few more dollars.

Dave

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If you were my patient, you’d be prepared for a host of surgical outcomes and post op courses. This may turn into a repair using chondral darts, resection, microfracture or even OATS (cart transplant from another part of the knee) and each has its own post op requirements and courses. Wishing you the best from the ST community.

             John
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Surgery was yesterday. a small chondral flap was shaved off and a thickened senovial area wall was also shaved down. Nothing more radical was needed. Doc says there is a lot of good cartileage still there so prognosis is looking better than we first expected. No need for microfracture or anything more invasive. Now it’s just time to rehab slowly and carefully to be sure I get as much recovery as possible before starting on a strength building regiment.

Dave

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They got you in pretty fast.
Day surgery?

Thanks for the update. My love and (((hugs))) for a speedy recovery.

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Well, lucky you. You dodged one this time. Good luck in your recovery…and pay your bill! (just kidding)

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Always good news. :slight_smile: Take it easy and recover well.

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Good to hear. Who did your surgery?

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trackie - This operation could have been done by just about any competent orthopedic surgeon…particularly one in your insurance plan!