Delayed knee pain - possible Chondromalacia Patellae

[gcoe]

You definitely have the clinical signs of patello-femoral syndrome. Given the good quality of the cartilage you may not meet the diagnostic criteria for CM. Remember with these sorts of things often different sources of info give different impressions

I think this is a good thing, Excili. You may of course have some minor changes that aren't detectable on the MRI but basically it suggests the patellae are in a reasonably robust condition.

Does it affect the treatment? Not really. I would just keep persevering. As I said in an earlier response the only thing to be sure of is if the tracking of the patellae needs addressing. Otherwise carry on the strengthening exs and be patient.

[Excili]

I guess that skyline x-ray could help with the tracking question after all.
I will try get that angle if it helps.

Now, about my eagerness to find out if I got CP or not - well, I just want to rub it in the face of all the doctors that told me I had to stick to straight leg strengthening for the rest of my life.

Also, I've been taking a glucosamine/chondroitin/MSM supplement for a month, and I was told it might be causing part of the pain, so I'll stop it since there's no point taking it if I don't have actual knee tissue issues

[vam44]

I think that the popping sound on flexion suggessts that your ITB and Rectus femoris muscles are still very tight. Try doing your lateral releases all the way down the side of your upper leg to the patella and then push your patella in towards the middle. This will only work if you have your leg relaxed out straight whilst sitting.

For the rectus femoris stretching lie prone and bend right knee up as far as you can and use your left leg to gently push the right knee further back into flexion. This may well give you a popping, grinding or pain so if it does try twisting your right foot in or out until you find the most comfortable postion. If you can't do this comfortably then you should be very gentle and perhaps use ice or your cream immediately after.

I wouldnt worry too much about the actual technical diagnosis because physios create the treatment plan based on the signs and symptoms that we find. The only benefit of more investigations would be to to better advise how long the symptoms may take to improve.

It seems as though its already taking a long time so your exercises may not be quite right and need review again by your physio.

I would bias your strengthening for the quads in standing with the 30 deg limit and doing small slow/step ups and downs to improve control rather than just strength. in my experience straight leg raises in sitting or lying are a waste of time.

Good luck and let everyone know how you progress.

[Excili]

I got my MRI results a few days ago.
Diagnosis was pretty clear, nothing wrong found in it.

I had a look at the pics and found some angle that should work similar to skyline x-ray view, so I'll attach them in case they are of any use.

So, on to the clean diagnosis, does it mean CP isn't there, or could it mean it's just not a severe form of it (considering i'm only 21 years old) so it can't be seen in the MRI?

As a side note, I'm still getting minor annoyance on the outter part of the knee after I foam roll my IT band, even if I didn't do any quad movement previously
When I checked with my pt about it, he told me I should give it 2 weeks and see if the pain persists, and that the first few times I foam roll a tight muscle it might give pain signals to the knee or something like that. I will be visiting my PT this week hopefully, and ask him about the tissue stretching etc.

Anyways, here's 5 pics from the MRI, tell me if it helps addressing the patella position question.(also tell me if you have any use for the rest pics of the mri)

[gcoe]

So, on to the clean diagnosis, does it mean CP isn't there, or could it mean it's just not a severe form of it (considering i'm only 21 years old) so it can't be seen in the MRI

So I am not an expert image reader. I would go by the radiologist's report. However superficially it looks like the patello-femoral cartilage surfaces are well preserved and the alignment looks ok.

From the report you got this would suggest you don't have CP. Yes it is possible there could be some minor changes not detectable on the MRI. But even if this is so it is nothing to worry about.

In most musculoskeletal conditions, there is more often than not not a hazy association between the severity of radiological evidence and severity of symptoms. You may just have had a lot of symptoms without much underlying radiological evidence. I wouldn't worry about it - as long as you are getting at least some marked improvement by now, even if there is a way to go with the PT.