Return to mounatin biking after chrodroplasty of the patella and femoral trochlear groove

by Sheila
(Colorado)

work done 5/6/08

work done 5/6/08

Thank You for this opportunity, and I hope you can help.

I had some surgery on my right knee and right ankle 3 weeks ago. Synovectomy including resection of the entire suprapatellar wall, medial synovial plica shelf and infrapatellar plica band. Also on the knee I had the chrodoplasty done of the patella and femoral trochlear groove.

On my ankle I had extensive debridement including chrondroplasty and synovectomy. I will need after a year, a cadaver bone and cartilage graft on the medial margin, talar dome about, the size of a nickel. (Sorry about all this technical quibble, I am not well studied in this area and am copying from the operative notes)

My question regards what it means to have 'chodromalacia grade 3' and also about returning to my pretty aggressive mountain trails biking. (just to let you know my ankle feels so mush better after the surgery even though it catches)

It seems my surgery is very common and not as serious as others in my town and I am really feeling stupid about asking about getting back to being who I was.I am not able to get the real info about my long term potential from the PT people or surgeon.

Leading up to this surgery I had cut back considerably on my sports especially in distance and uphill climbing on my bike believing that all would be extremely well(dumb?) after I could have surgery. I/we had no idea what the problem was with my knee was and the surgeons kind of went in blind since I was having surgery on my ankle already and had a MRI of my ankle 'pre-viewing' what was the cause of pain in my ankle.

So, after the surgery I didn't get the full picture of what was done on my knee till yesterday, 3 weeks later. I really thought I would be up and going after 7 to 10 days and it is so not true.

I guess the surgeons thought the same to. Of course now I am told 2 - 3months. I was also dismayed by reading online about problems with the grade 3 chondromalacia and adjusting my lifestyle to other sports not as punishing as to live without chronic pain. And that patellaectomy is a long term recourse. Is this true??? It can't be!!

Yea I am definitely swollen and stiff and have pain and this has been a slow process to heal these last 3 weeks(totally unexpected by me), but is 'grade 3 chondromalacia' that serious short and longterm speaking?

I know I have gone on and on for a simple question but can you give me any input, PLEASE. Thank you,
Sheila

Comments for Return to mounatin biking after chrodroplasty of the patella and femoral trochlear groove

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May 31, 2008
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Not a silly question...
by: Bart - SII

Thanks for your posts and photos - they make a great addition to the site!

The procedure you had is not a simple knee scope for two reasons. One, the chondroplasty - this type of procedure takes a little longer to recover from simply because of the type of work done. You have a lot of questions within your post, so let me see if I can answer all of them in an organized manner...first some background.

Chondromalacia is a degeneration of the articular cartilage...in your case, of the patella. It is usually graded on a 1-4 or 1-5 scale. Each stage is just a little worse than the previous one in reference to how much the cartilage is damaged. Grade III involves small pieces of the cartilage flecking off, creating a very unsmooth surface - there usually is still some cartilage still in place and the underlying bone is not exposed yet.

While grade III chondromalacia is not as serious as grade IV, it does cause problems. Surgical intervention to debride the area and smooth the surface is usually successful, but there remains a loss of the articular cartilage and that means you will probably have earlier onset arthritis in the future.

The synovectomy that you had to remove the plica band and the inflammed tissue is also another reason why your recovery is a little slower than a simple knee scope. Synovial tissue is very sensitive to changes in pressure and stress, and when it becomes irritated, it swells and produces synovial fluid. That is why you are still swollen 3 weeks after surgery. With a procedure that addresses anything with the synovial tissue, there is usually a lot of swelling it it can be persistent. With swelling comes stiffness and that slows your range of motion and strengthening down.

Overall, if you were my patient I would probably give you a good prognosis - 2-3 months before you are feeling back to normal, but if you monitor your activities and don't push too fast too soon, you should be able to get back to doing what you want to be doing.

(continued)

May 31, 2008
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continued response
by: Bart - SII

One thing you need to consider is why your knee ended up the way it is. Are there biomechanical issues in your lower extremity that have caused the increased stress on the knee? Do you have mobility or flexibility restrictions that have led to the increased stress that caused the chondromalacia? Do you have adverse foot mechanics that may have contributed?

All of these things can be evaluated by an athletic trainer or physical therpist and they should be looked at during your rehabilitation. Make sure you talk to your clinician about the whole lower body function and don't let them get so centered on just your knee.

Grade III chondromalacia does mean you have some damage to your knee which cannot be completely fixed. However, after the surgery and rehab you should have fewer problems in the near future. (3-5 years) And if you modify your activities and address any possible biomechanical causes you can slow the degeneration process in your knee.

I didn't ask how old you are, but that can also be a factor in your recovery. As the body ages, it heals a bit slower. So that is something to consider.

Long term prognosis for chondromalacia patella is usually an earlier onset of arthritis in the knee...so instead of it starting in the late 60s or 70s, it may become more apparent in 50s or 60s. Most of this is dependent upon what your activity levels are and if your lower body is functioning at its best capacity.

I hope this helps - comment back if you have other questions


Jun 01, 2008
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You are such a BLESSING!!!
by: Anonymous

Bart your response is the most direct and most helpful I have received! Thank You!
And Thank you for also saying there are no stupid questions!
I am glad the post knee@ankle surgery photos where of help @ a good addition. Decided presurgery photo's of 'flaps' in the ankle, 'crabmeat' hanging from the patella, plica walls and so on, may not be as important.
You asked about my age and what might of led to this surgery. Of course the ankle had the defect going on 5 years before I had the flaps taken out. Yet, I've have had some crashes and couple of surgeries in the past. And I think not getting professional help in some of the crashes was a detrimental effect. Especially since I had already been diagnosed with a highly mobile SI joint. I had avoided physical therapy which would of revealed many problems leading up to this surgery. Namely atrophy in my quads. Developing the vastus medials to fire first and not the lateral muscles might of lead to better 'tracking' of my patella in the trochlear groove. Less wear and tear and maybe less inflammation of my IB band,too(Learned all this 2 days ago).
First I'm glad I didn't tell you my age. This may of prejudice your response.You may not of been as straight forward.(you know like talking to your Aunt or Mom by not breaking the news to hard to them).
I'll be 54 this October. I began trail mountain biking(3-7 days wk)back when I was 35.(2hrs to 9hrs depending)I am just one of thousands here that ride.
I will pay attention to ‘Modifying' my riding, yet the thought is difficult. I will take your input to heart and make the requests needed at my next PT session; about getting mechanics, flexibility and mobility checked out.
Can't say thank enough(as you can see)
Sheila



Jun 01, 2008
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54 is not old by any stretch
by: Bart - SII

Telling me your age wouldn't have biased me at all. I deal with patients your age all the time...and I am always straight forward with them no matter what. In fact, I had a 52 year old ACL patient a few months ago who showed up almost all of my 18 year old ACL patients as far as work ethic, pain tolerance, and recovery. So...don't ever feel like you are too old to get back to what you want to do...

I figured there were probably a lot of different factors that led up to your knee and ankle problems. The patella femoral tracking is probably what led to the knee issues - You talked about your VMO and it needing to fire first - if you haven't seen it already, take a look at this article - just my opinion, but something that I believe in very strongly and wholeheartedly. Just another thing to consider as you work through your recovery. (just a warning - your PTs might think I am crazy if you show it to them ;-) )

Bart

Aug 16, 2009
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chrondomalacia grade 4
by: frank

gday 6months ago i was diagnosed with grade 4 chondromalacia. i have been heavily involved in athletics and rugby league up to the age of 31. i am now 32 and have a physical job as fireman what does the future hold for me and how long will my knee last before i need a knee replacement.

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