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Old 04-19-2014, 04:30 AM   #1
Kimberly Murphy
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Question Chondral Defect of trochlea

I recently had surgery to repair my IT Band, as well as arthroscoptic dx and treatment, and of course, clean out. With every squat I would feel my IT Band snap inside my knee causing progressive pain in that area.

During surgery they discovered a chondral defect and I am now being told not to squat past 60 degrees EVER. I want to be able to do back squats!! So, I'm not very happy at the moment.

I would appreciate some feed back... Would I completely destroy my knee if I were to ignore the limitation and do back squats? Thoughts? TIA

Here is what the surgical report states:

"There was severe grade 4 involvement of the patellofemoral joint on both the patellar and trochlear sides, with a chondral defect, which was grade 4. An abrasion arthroplasty was performed, with a good bleeding response."

Preoperative Diagnosis:

1. Lateral retinacular defect with intra-articular scarring, left knee.
2. Grade 4 degenerative arthritis, patellofemoral joint, with chondral defect, trochlea.
3. Chronic synovitis - extensive.
4. Intra-articular scar.
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Old 04-19-2014, 08:29 AM   #2
Chris Carroll
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Re: Chondral Defect of trochlea

3 months ago I had a right knee debridement which revealed bone on bone on both patellar and lateral femoral condyle....I have been fighting this for three+ years. In 2012 I qualified for the games as a masters, but 2 years later I am unable to do most crossfit wods. Some people can work through the pain w/o significant post workout swelling. It will never get better and crossfit will only exacerbate the loss of cartilage. Everyone's different but my experience pushing through the pain has been negative. I hope yours is better and wish you luck.
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Old 04-21-2014, 07:06 PM   #3
Kimberly Murphy
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Re: Chondral Defect of trochlea

Thanks for the reply, Chris. It is what I needed to hear.

I have no articular cartilage left, which is surprising because I experienced no pain. After a year in crossfit I had started to feel the occasional "tweak" in that area but didn't think much of it. Now I know what that was about.

I'm bummed but grateful this was treated before things advanced to constant pain. I will be choosing my activities carefully.

Thanks again.
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Old 04-21-2014, 08:59 PM   #4
Sean Rockett
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Re: Chondral Defect of trochlea

Kim If a person in your condition came into my office, and I have not seen you or treated you, but I would suggest the most important thing you can do to help yourself is keep moving and try doing so without pain. If a certain angle hurts then squat to a smaller angle. If jumping hurts try stepping. Keep flexibility and range of motion and do as much as you can get away with. Grade 4 is bone on bone but a lot of people can be very active with modifications with grade 4 arthritis. Yes you may not be able to do every workout as designed but at least you can get the benefit of exercise. If pain interferes and you have tried everything else then you can consider injection therapy. Godd luck
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Old 04-22-2014, 07:25 AM   #5
Tighe Crovetti
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Re: Chondral Defect of trochlea

Sean -

I'm curious, as someone with cartilage/bone issues since I was 17 (OCD, right lateral femoral condyle). I go through stages constantly: feels great when I move, hurts when I move, feels good to rest, start to hurt/weaken when I rest... Are there any advancements that you know coming down the pipeline, concerning maybe artificial cartilage (or harvested?) implants to help cases like these? It just seems like, we can replace entire joints, which seems inordinately complex, but we can't do something seemingly much more simpler, such as just recovering a worn surface. Feel free to point out my complete naivete, if necessary, but I keep hoping something like this is in the works!
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Old 04-22-2014, 06:33 PM   #6
Sean Rockett
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Re: Chondral Defect of trochlea

Happy to help. For starters the cartilage we are talking about is articular cartilage or the soft cushioned covering of the bone vs meniscal cartilage or the shock absorbers. We can grow cartilage and do cartilage transplantation for cartilage defects that are surrounded by healthy cartilage. We can sew the covering to healthy cartilage and implant the cultured cells into the defect. We do not have great results with transplanted cartilage cells into arthritic areas or areas that have no cushion on the joint-as there is nothing to sew it to. Regarding implanting healthy cartilage onto areas of arthritis, the issue is the incredible uniqueness of the articular cartilage. It has no blood supply, it adheres to bone, and it has very few cells, receives its nutrition from the fluid in the joint and is incredibly durable. So we can grow cells but as far as having them adhering to bone, keeping the same function, and not breaking down we are not close. Implanting stem cells are being looked into as well as synovial cells with the hope that they can convert into a cartilage cell. Hope this helps.
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Old 04-23-2014, 04:56 AM   #7
Tighe Crovetti
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Re: Chondral Defect of trochlea

Awesome info, Sean, thanks!
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Old 04-27-2016, 07:10 PM   #8
Kimberly Murphy
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Re: Chondral Defect of trochlea

I thought I would update this thread for others that may come across this topic looking for information.

The "abrasion arthoplasty" I had on my trochlear chondral defect was a failed surgery. Eventually, I was able to do just about anything but squat and lunges. I gave up squatting and lunges.

Three months ago I had surgery again and that defect was treated with microfracture. They found a second defect on the medial femoral chondyle, a weight bearing surface, and rather large around the size of a quarter. I received experimental stem cell therapy (from bone marrow taken from my hip bone) and injected into the area of the femoral defect. (Arthrex same day procedure)

Three months later that weight bearing area feels great, feels normal. But am once again wondering if the treatment to the trochlear defect is failing as I've had some recent pain develop in that area.

I think I'll pass on another treatment to that area and will perhaps pursue stem cell injection. I'll keep this thread updated.
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