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Chondromalacia gr 4 (MFX help?)
Had injured right knee 3 years back playing with my daugter. Always felt minor pain while squatting for 3 years. Suddenly one fine day, got severe pain while sitting leg over leg. Afterwards, there is sharp pain in squat position (at 45deg knee flexion). MRI says chondromalacia patella gr 4 and acl sprain without discontinuity. Personally feel the patella projection thinned compared to left knee which is normal. I can walk without pain, climbing down with slight pain (need to jump and climbing so that knee doesn't reach at 45deg). Doctor suggested VMO exercise,PRP followed with Microfracture if no improvement in PRP.
I have done exercise+prp but not much improved in 4 months. Doctors, please advise how successful is microfracture for chondromalacia gr 4? It has a long rehab and unsure if it can completely cure.
Any other ways is available to cure this condition? I came to know mosaic plasty can give the hylaine but will it work on patella surface? Your valuable advice please.
Cartilage defects are very painful. If you have tried physiotherapy already then better to do arthroscopic microfracture procedure. You will need to take rest for atleast 8 weeks with dedicated physiotherapy during this period. It's already 3 years since the injury, hence I would advise to undergo procedure as soon as possible. If the size of lesion is less than 1 cm, it has food results after surgery as per literature. Bigger lesions are bothersome. The surgery is usually done via key hole or a miniopen ( small incision) technique
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There are multiple factors that need to be considered. First the cause for your developing chondromalacia, if it has been due to over activity and stress on your knees , you may get relief by rest and medications and surgery.
If it has been due to anatomical problems, like increased valgus/ Q angle/ hip rotation and tibial rotation,it is difficult to get relief if we dont adress the underlying issue.
Grade 3/4 don't have so good results. Newer modalities like aci or patellar arthroplasty have shown good results.
You can go for cartilage debridement and microfracture with stem cell therapy through arthroscopic technique followed by intensive Physiotherapy and rest.
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