[rickk]

So I've been developing this problem primarily with my left patella that just bugs the heck out of me, however, it's starting to effect both now, but the left is the biggest concern. This has been progressively been getting worse over the last 6 months or so, I believe from riding.

Long story short, went to a knee specialist and the best he could tell me after an MRI and X-Ray's was that there's little he can do. Both came up showing very little in the way of any problems, but every time I ride, right above my knee (top of patella tendon) they get sore and I believe inflamed. At least that's the best way to describe it. Also, when I press on the top of my knee, I feel pain. It's a sharp pain, not dull, right under the knee cap, but up on the upper part.

It seems that constantly going from the seated to standing position has really started to bother my knees. This has now transfered to where it's even bothering doing normal tasks, like getting off the couch. The symptoms go from very noticeable and persistent, to hardly noticing anything, but this is becoming more rare these days.

The best diagnose the Dr had was called Chondromalacia Patellae

So what's the deal and what can I do?:excuseme:

[DrMark]

Its repairable. Post the X-rays, inclusive of the patella views.

[rickk]

Its repairable. Post the X-rays, inclusive of the patella views.

not sure how I would get the X-Ray's? they are pretty large and not sure they available in electronic format? The X-Ray's showed no misalignment or anything with the bones themselves.

As for the mri, these are a large series of images that are compiled to a special program that you need to run. I couldn't just pull the images that I'm aware of. These are detailed obviously related to the soft tissue.

[DrMark]

go to the clinic, as the lady there to put them up on the view box, take a picture of them with the cell phone-with the flash off. Publish them on one of those websites or directly on this one. Someone will on TT will soon offer your assistance.

B-Rabbitt, you know and your wife know alot about this problem. What do you thinK?

[rickk]

go to the clinic, as the lady there to put them up on the view box, take a picture of them with the cell phone-with the flash off. Publish them on one of those websites or directly on this one. Someone will on TT will soon offer your assistance.

B-Rabbitt, you know and your wife know alot about this problem. What do you thinK?

Wouldn't the MRI images be more important to see as the X-Ray's only show the bone alignment and they came up clean?

[surfer1100]

I have chondromalacia as well as a few other chronic running conditions in my right knee resulting from aggravating a bi partite patella skateboarding when I was 14.
My situation may be similar to yours or completely different IDK but for me to keep the pain levels down I really work the tear drop portion of the quadriceps(i.e. leg extensions etc.), it helps to keep the knee ligaments and muscles strong and together. As you may know the other three muscles in the quad are what really get worked when riding, so it maybe the fact the tear drop portion doesn't recieve enough attention.

Note: after aggravating that knee my freshman year in h.s. i went on to be MVP and captain of both the track and cross country multiple times as well as all-state honors and a few school records in mid-distance and distance events.
I also still run quite a bit, as I work as a Valet at restaurants and night clubs.

i attribute the drop in pain and increase health in that knee to keeping that quad strong.

hope this helps
Adam

[rickk]

I have chondromalacia as well as a few other chronic running conditions in my right knee resulting from aggravating a bi partite patella skateboarding when I was 14.
My situation may be similar to yours or completely different IDK but for me to keep the pain levels down I really work the tear drop portion of the quadriceps(i.e. leg extensions etc.), it helps to keep the knee ligaments and muscles strong and together. As you may know the other three muscles in the quad are what really get worked when riding, so it maybe the fact the tear drop portion doesn't recieve enough attention.

Note: after aggravating that knee my freshman year in h.s. i went on to be MVP and captain of both the track and cross country multiple times as well as all-state honors and a few school records in mid-distance and distance events.
I also still run quite a bit, as I work as a Valet at restaurants and night clubs.

i attribute the drop in pain and increase health in that knee to keeping that quad strong.

hope this helps
Adam

Thanks for the tips. I used to do squats for 20 years so my quads have always had meat on them, but I don't do that any more so I've been wondering if my legs just have started to become weaker with less strain and muscle mass, thus possibly contributing to the problem?

I've been curious if the front leg lifts for the tear drop muscle would help. Thanks for bringing that up as I may start to work on that. Thats the general area that gets tired quickly when riding, but I have more muscle there than most. It may just need to be worked more. I like this approach more than doing squats as that's one exercise that aggravates my knee going from a squat to standing position.

[biznet1]

So I've been developing this problem primarily with my left patella that just bugs the heck out of me, however, it's starting to effect both now, but the left is the biggest concern. This has been progressively been getting worse over the last 6 months or so, I believe from riding.

Long story short, went to a knee specialist and the best he could tell me after an MRI and X-Ray's was that there's little he can do. Both came up showing very little in the way of any problems, but every time I ride, right above my knee (top of patella tendon) they get sore and I believe inflamed. At least that's the best way to describe it. Also, when I press on the top of my knee, I feel pain. It's a sharp pain, not dull, right under the knee cap, but up on the upper part.

It seems that constantly going from the seated to standing position has really started to bother my knees. This has now transfered to where it's even bothering doing normal tasks, like getting off the couch. The symptoms go from very noticeable and persistent, to hardly noticing anything, but this is becoming more rare these days.

The best diagnose the Dr had was called Chondromalacia Patellae

So what's the deal and what can I do?:excuseme:

I've been plagued by this since my teen years and I'm 45 now. I spent a few hundred on a plane ticket and flew to Houston to let Dr. Mark fix both knees. The surgery went fine and I walked out of the hospital. It took about a year to fully gain the benefit but I'm happy with the result. The left knee was my worst and is now the best but I am at least 80 percent better after the surgery. Before, after a full days ride I would barely be able to walk and extremely sore the next day. Now, I get a little soreness at the end of the day but nothing that concerns me. The next day my knees actually feel better than the day before. The surgery, which is basically a lift kit for the knees (TTT) was a great success for me. After the surgery, you can probably expect to walk normally after 9 weeks. I actually rode MX after 9 weeks but I wasn't ready.

[rickk]

I've been plagued by this since my teen years and I'm 45 now. I spent a few hundred on a plane ticket and flew to Houston to let Dr. Mark fix both knees. The surgery went fine and I walked out of the hospital. It took about a year to fully gain the benefit but I'm happy with the result. The left knee was my worst and is now the best but I am at least 80 percent better after the surgery. Before, after a full days ride I would barely be able to walk and extremely sore the next day. Now, I get a little soreness at the end of the day but nothing that concerns me. The next day my knees actually feel better than the day before. The surgery, which is basically a lift kit for the knees (TTT) was a great success for me. After the surgery, you can probably expect to walk normally after 9 weeks. I actually rode MX after 9 weeks but I wasn't ready.

I view surgery as a last resort. What type of surgery can you do for a condition like this.:excuseme:

[DrMark]

The average MRI is worthless for this problem. Various CT techniques are helpful, but I can even imagine them even being considered by the average doc out there.

Since I too, view sugical treatments as last resorts, you perhaps should learn to live with the issues.

The surgical procedures usually involves transfer of the knob of the knee forward and to the inside. The stabilization with three screws allows functional rehabilitation, rather than casts, crutches, and braces. Occasionally other operations are necessary, but absent X-rays and a certain type of CT scan, I would be unable to elaborate further.

[rickk]

The average MRI is worthless for this problem. Various CT techniques are helpful, but I can even imagine them even being considered by the average doc out there.

Since I too, view sugical treatments as last resorts, you perhaps should learn to live with the issues.

The surgical procedures usually involves transfer of the knob of the knee forward and to the inside. The stabilization with three screws allows functional rehabilitation, rather than casts, crutches, and braces. Occasionally other operations are necessary, but absent X-rays and a certain type of CT scan, I would be unable to elaborate further.

Thanks for responding, Dr Mark, however, I guess I'm a little surprised that my knee specialist didn't order CT's after little could be seen in the MRI scans?

[DrMark]

Most people out there don't have a clue what they are doing. More than 50% of the surgical procedures I do, are cleanups of other people's messes. What does that tell you?

I am actually pretty interested in seeing the ordinary X-rays, particularly the patella views.

[biznet1]

I view surgery as a last resort. What type of surgery can you do for a condition like this.:excuseme:

It was my last resort. I tried everything else and my kneecaps were grinding away, arthritis was getting worse and I was desperate. I can ride as much as I want now, run, ride bicycles, climb stairs, do leg presses, etc. I couldn't do any of that before without suffering the consequences. To put it in practical terms, he uses a small piece of cadaver bone to raise the kneecap out of the socket a little and relocates it to a better position to prevent the grinding. What has been so great for me is that I can strengthen my quads now without the pain. The stronger the quads the better the knees track. Before the surgery my quads had atrophied very badly which contributes to the knee problem, so the problem is compounded. Now the reverse is true. I hope that makes sense. Here's a little pic for you.

http://smg.photobucket.com/albums/v211/biznet1/?action=view&current=Xrays007.jpg The screws are now removed and I couldn't be happier about my progress.

[rickk]

Before the surgery my quads had atrophied very badly which contributes to the knee problem. The screws are now removed and I couldn't be happier about my progress.

This I believe has been a leading precursor to my problems starting. Never had this condition, but then it started developing with more frequent rides. Now I really notice it, except when not riding.

Really had be baffled, initially.

Wow, so the whole tendon had to be put back onto bone? So it just heals and the screws can be removed?

Honestly, your condition sounds far more severe than mine at this point. I read your posts on this topic going back to early last yr when the Dr had got you started down this path.

For now at least, I'm going to proceed down the least invasive approach and try the Ice, quad strengthening exercises for a while. Eventually, I may need to consider a technique such as this, but it's nice to know the DR has experience and understand the demands of Moto-X.

[rickk]

Most people out there don't have a clue what they are doing. More than 50% of the surgical procedures I do, are cleanups of other people's messes. What does that tell you?

I am actually pretty interested in seeing the ordinary X-rays, particularly the patella views.

Let me see what I can do.

[biznet1]

This I believe has been a leading precursor to my problems starting. Never had this condition, but then it started developing with more frequent rides. Now I really notice it, except when not riding.

Really had be baffled, initially.

Wow, so the whole tendon had to be put back onto bone? So it just heals and the screws can be removed?

Honestly, your condition sounds far more severe than mine at this point. I read your posts on this topic going back to early last yr when the Dr had got you started down this path.

For now at least, I'm going to proceed down the least invasive approach and try the Ice, quad strengthening exercises for a while. Eventually, I may need to consider a technique such as this, but it's nice to know the DR has experience and understand the demands of Moto-X.
He doesn't remove the tendon from the shin bone. He splits the shin bone behind the tendon and down two or three inches. This allows him to pull the piece of bone away like splitting wood, then inserts the bone graft (correct me if I'm wrong doc). I'm not trying to convince you to have the surgery, but just remember it is not so much a surgery on the knees, only the bone that holds the patella tendon on the bottom. My knees were not affected in any way. Here is one of my knees after the surgery (still swollen a lot)

http://smg.photobucket.com/albums/v211/biznet1/?action=view&current=Knees005.jpg


I'll tell you what helped me the most before the surgery. I did nothing but isometrics to work my quads. I strung two chains from my garage hooked to the rafters (strong enough to hold the weight). I hooked a barbell to the chains so the the bar was level to my chest. High enough to get under it with my shoulders as if I were going to do squats except I would spread my legs to get under then work my feet together to fully support the weight. This way I wasn't using my knees. I would then squat down about a 1/4 of the way and hold it for as long as I could. I repeated this for about 5 sets every other day. This really helped to keep my quads strong enough to help the knees but frankly it got old and I wasn't satisfied. The difference between now and then is really incredible. Also, I avoided stairs as much as possible. Now I look for them!

[DrMark]

Biz, you didnt have a bone graft. Bone grafts are very rarely necessary nowadays.

[biznet1]

Am I confusing a bone graft with something else? I remember that we talked about you inserting cadaver bone inside the split part. Of course with the demoral I remember flying monkeys too.

[jgbnm]

Is this a tracking problem? If so, wouldn't it be reasonable to try a program of appropriate stretching/strengthening first (ie. tight on one side and weak on the other)? Might be able to improve the tracking without surgery?

Is a lateral release a possible surgical option?

I have more curiosity than knowledge and am just seeking a little more info....

[DrMark]

Biz, we may have put cadaver bone into the defect, although we haven't been doing that in the last couple of years without any ill effects.

As far as tracking problems, you can strengthen the week medial muscles, but I don't know any way to loosen the tight side in rehab. Furthermore, I don't believe we have been talking about tracking problems here.

Last, lateral retinacular release, on its own, has not been shown to alter the natural history of patellofemoral syndrome. By itself ist useful as titties on a boar hog.

[b-rabbit]

My name is Melissa and I am 26 and passionate about moto-x. I have had all kinds of patella pain and issues since a crash in July. After my original doc here in DE kept farting around and telling to take more pain pills and see him in 2 weeks, my husband and I sought out Dr. Mark. It has been 6 weeks since my sugery and I am loving life. He did relocate the tibial turbical in order to put my knee into proper re-alignment and allowed my knee cap to fall into the right place. I walk totally normal and have such a great range of motion that people don't believe that I had anything done until I show them my kick ass scar and a photo of my x-ray with three big screws in my knee. Big props to Dr. Mark on the incision, I will still have sexy legs! Anyway, working with Dr. Mark was such a great experience. The knee I had operated on feels so much more solid than my "good" knee. I have more patella pain now in the knee that I did not have the surgery on. I have every intention of having Mark do the other one next year so I can have 2 reliable, pain free knees. I can't wait to get back to riding in just 2-3 more weeks! I could have never achieved those kinds of results with just therapy and I was not willing to settle for anything less but getting all my function back and being pain free.

[rickk]

My name is Melissa and I am 26 and passionate about moto-x. I have had all kinds of patella pain and issues since a crash in July. After my original doc here in DE kept farting around and telling to take more pain pills and see him in 2 weeks, my husband and I sought out Dr. Mark. It has been 6 weeks since my sugery and I am loving life. He did relocate the tibial turbical in order to put my knee into proper re-alignment and allowed my knee cap to fall into the right place. I walk totally normal and have such a great range of motion that people don't believe that I had anything done until I show them my kick ass scar and a photo of my x-ray with three big screws in my knee. Big props to Dr. Mark on the incision, I will still have sexy legs! Anyway, working with Dr. Mark was such a great experience. The knee I had operated on feels so much more solid than my "good" knee. I have more patella pain now in the knee that I did not have the surgery on. I have every intention of having Mark do the other one next year so I can have 2 reliable, pain free knees. I can't wait to get back to riding in just 2-3 more weeks! I could have never achieved those kinds of results with just therapy and I was not willing to settle for anything less but getting all my function back and being pain free.

Thanks for taking the time to write and share your story. So you could walk out of the OR right after surgery?

[b-rabbit]

I sure did. Dr. Mark said I could have crutches if I wanted them, but crutches are for p***ies. I was able to get up and walk to and from the bathroom. I even felt up to taking a bath. I can honestly say that I was skeptical about how fast Dr. Mark said I would heal, but he and his trainer Ed are no bullsh*t. I rode my stationary bike last night for an hour and 20 minutes and my knee didn't even get a little inflamed. I practice standing up on my footpegs and sitting back down again like I was doing turns while my bike is on the stand. I do it over and over and it doesn't even hurt a little bit. Taking the trip to Houston was a very small price to pay to get my life back. Just accepting that I was going to have to do the things I love in pain for the rest of my life was never an option for me. You should really consider taking the trip. I would be more than happy to share anything else about my experience that may help you make a decision. On a side note: I could have had my surgery done much closer to home, but I am very confident that I would not have had the same outcome. Sure, they could have fixed the issue as many surgeons could have but I would not be doing so well only six weeks after. The difference is that most surgeons learn how to do a procedure and then continue to do it the same way for a long time because they are comfortable with it and they know it works. Dr. Mark, on the other hand, takes time out of his personal and prefessional life to learn the newest techniques and continues to devise rehab methods that get people back fast and safely. He is a truly gifted surgeon.

[jtn 06 wr450]

do as many Vastus medialis strengthenging exercizes as possible and keep your IT band loose by deep tissue massage.

to maintain both of mine over 15 years while bike racing i did 3 sets, 50 reps, 25lb leg curls one knee at a time for a total of 150 reps on each vast. you start at the top and drop down 1/4 distance and back to the top. no need to curl entire length. start at a lower weight and rep and work up to the 150 range or so.

my chondro probs went away in 1 month after starting this routine.

i had the chondro artho op and it did nothing to keep the problem from coming back. the only miracle cure is your will power to strengthen the vastus....:blah: :blah:

[b-rabbit]

The surgical fix to the problem is not able to be done arthroscopically. Dr. Sanders did a tibial osteotomy and a lateral release. Due to the degree of my issue, it would have not been corrected through therapy or excercise. Trust me, I tried that. I also tried the injections, no luck there either. The other issue for me is that because of my sloppily misaligned knee, my knee had a tendency to go out of place fairly easily, causing pain and tissue damage. Having the sugery has given me a strong joint where that should not occur again, potentially keeping me from ever having to have a knee replacement. Anywhere you read about the condition will tell you that sometimes through moderate therapy it can be corrected, other, more severe cases, just do not respond well. And, personally, I just wanted the d*mn thing fixed so I didn't have to rely on exercises the rest of my life. It is a personal decision.

[DrMark]

The commonly done arthroscopic surgery for shaving the patella and lateral release is often known in medical circles as a wallet biopsy.