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I am having chondromalacia, patellofermoral joints, bone-marrow edema, underlying tear, tricompartmental chondromalacia. What is wrong with my knee?

My MRI shows I have high-grade areas chondromalacia patellofermoral joints, extensive bone marrow edema in the medial femoral condyle, underlying tear of the junction of the posterior horn and body of the medial meniscus , fairly advanced areas of tricompartmental chondromalacia with a tear of the posterior horn and body of the medial meniscus. What does all this mean for my knee?
Asked On : Sat, 30 Mar 2013
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  User's Response
Dear Shoneyw

First of all, I'm sorry that your recent MRI showed such extensive changes in your knee.

Chondromalacia and bone-marrow edema are specific terms that describe certain types of changes that occur in arthritis. Arthritis is an extremely common condition that has a long list of possible causes, though the most common is simply an over-use or age-related condition caused osteoarthritis. Tears of the meniscus can also occur in osteoarthritis, but typically these are the result of acute trauma (for example sports injuries, car accidents, falls) or past trauma that didn't heal correctly. Osteoarthritis and pathology of this type without a known trauma typically develops slowly without being overly painful. Without knowing anything else about you, you likely have had changes developing in your knee for decades.

Chondromalacia is irritation and thinning or softening of cartilage. This is part of a condition called "patellofemoral syndrome" (also known as "chondromalacia patellae" ), very common in runners, people in their late 20's and early 30's, and the elderly. This condition is incompletely understood, but we do know that the back of the patella (knee cap) can become irritated if the muscles and soft tissue that support it are out-of-balance. Typically, the outer portion of the thigh and the iliotibial band become strong, pulling the knee outside and away from the weaker inner thigh muscles, and dragging the patella against the bottom of the thigh bone ("femoral condyle") when your knee bends, causing irritation over time. Treatment is directed towards identifying and changing the specific muscle pattern in the lower extremities with physical therapy to stretch tight tissue and strengthen weak muscles, and osteopathic manipulation to restore normal biomechanical function throughout the entire lower extremity.

Tears of the meniscus are more serious and concerning than chrondromalacia. They are also more complicated, as the nature of your pain, your history, co-morbidities, and the results of a physical examination will determine whether surgery is an option for you or not. Since the meniscus has a scant blood supply, it heals slowly (if at all), so people with high grade tears typically undergo surgery to clean out the joint. If surgery isn't an option, a typical recommendation is some form of physical therapy to optimize functioning of the knee and strengthen it against incidental traumas and physical activity.

A burgeoning field of medicine, regenerative therapy, may help regenerate your meniscus and cartilage. Regenerative therapy encompasses a host of different types of injections to activate the healing potential of tissues in your body. The most common therapies in this group are prolotherapy, platelet rich plasma (PRP), and stem cell therapy. Multiple high-profile athletes these days have used PRP to regenerate new or old injuries to return to the game, even coming out of retirement.

Your MRI showed moderate-severe damage in your knee joint. Depending on your age, functional status, pain, and goals, you may need surgery. The surgery could be as simple as an arthroscope or as extensive as a total knee replacement. No matter what, you will need to be on some sort of rehabilitation program. Osteopathic manipulation with or without surgery will improve the biomechanical imbalances that produced irritation in your joints. Regenerative therapy is an option if surgery isn't necessary. Both of these modalities are compatible with rehabilitation. Find a primary care physician that you trust to refer to an orthopedic surgeon. Ask them about these other options during your office visit.

Hopefully this answers your question.
Answered: Sat, 30 Mar 2013
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