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 said:

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 said:

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?

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

surfer1100 said:

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.

rickk said:

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.

biznet1 said:

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

drmark said:

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?

rickk said:

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.photobuck...nt=Xrays007.jpg The screws are now removed and I couldn't be happier about my progress.

biznet1 said:

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.

drmark said:

Let me see what I can do.

rickk said:

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.photobuck...nt=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!

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.

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....