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Chondromalacia Medial Femoral Condyle

Recently I encountered an individual diagnosed with Chondromalacia medial Femoral Condyle. As this condition is not an uncommon consequence of trauma—especially in motor vehicle accidents where the knee impacts the dashboard or another object—I thought it would be helpful to explain what chondromalacia medial femoral condyle is, its etiology, symptoms, diagnosis and treatment.

Origin of Term Proves to be Poor Descriptor

First, let’s start with the origin of the word, chondromalacia. Besides being a mouthful, the term is a misnomer when it comes to describing this particular condition. Chondromalacia was first coined by German researchers in 1906 when they discovered that the cartilage in the kneecaps of the cadavers they were studying was soft. They assumed that knee pain could be attributed to chondromalacia, which translated into English means “soft cartilage”.

Today, we know that the articular or joint surface cartilage surrounding the knee joint is the thickest and softest in the entire body (note: it has to be as it serves as a shock absorber, helping to dissipate forces of stress and strain and allowing for unobstructed movement in walking, running, squatting, etc.). Hence, chondral malacia or ‘soft cartilage’ is actually a normal condition!

What is Chondromalacia Medial Femoral Condyle

Chondromalacia medial femoral condyle represents damage to the articular cartilage lying at the end of the femur (also known as the thigh bone) where it is connected to the tibia (shin bone) by the patella (knee joint). The medial femoral condyle refers to one of the two—and the largest—projections on the lower extremity of the femur situated near the inside of the knee.

Upon close examination via MRI, chondromalacia appears as fragmentation of the typically smooth articular surface. The fragmentation or wearing away of the protective cartilage causes inflammation which in turn results in a buildup of fluid or effusion in the knee, producing pain when moving.

Symptoms

Symptoms associated with Chondromalacia Medial Femoral Condyle vary widely and cannot be used to make an accurate diagnosis absent MRI or MRA confirmation. Moreover, severity of symptoms does not necessarily correlate with condition progression (assigned stage) and should not be relied on as the sole gauge for determining need for surgery. Generally, patients with chondromalacia medial Femoral condyle report symptoms of:

  • Inside and/or lateral knee pain
  • Patellar crepitus (crackling and popping sounds of the knee)
  • Effusion in knee joint

Chondromalacia Diagnosis

An MRI or MRA is used to diagnose chondromalacia and to assign a grade relative to its severity. Chondromalacia is classified as one of four grades using an MRI/MRA. These include:

Grade I:

  • Areas of hyperintensity on MRI/MRA imaging with maintenance of normal contour of articular surfaces
  • Softening or swelling of the cartilage

Grade II:

  • Blister-like swelling or fraying of articular cartilage extending to surface
  • Arthroscopically: fragmentation and fissuring with soft areas of articular cartilage

Grade III:

  • Partial thickness cartilage loss with well-defined ulceration
  • Arthroscopically: partial thickness cartilage loss with fibrillation (a crablike appearance)

Grade IV:

  • Full thickness cartilage loss with underlying bone (subchondral bone) changes
  • Arthroscopically: cartilage destruction with exposed subchondrondral bone (the bone underlying the rounded end of the femur. The subchondral bone provides further stability to the leg bones and joints. It is also covered with articular cartilage to prevent friction between bones during movement.)

(http://radiopaedia.org/articles/chondromalacia_grading)

Diagnostic Techniques

X-rays are only helpful for diagnosing chondromalacia in later stages. Standard MRIs also have been found to be of dubious reliability in diagnosing early stages of chondromalacia. In fact, most imaging techniques are insufficient in identifying early stages of the condition, although MRAs appear to be the most sensitive.

Treatment

Treatment for chondromalacia is fraught with controversy. At one time, surgery was often considered the best option, but more recently, surgical intervention has fallen out of favor among many doctors due to poor treatment outcomes and its relative ineffectiveness. Most doctors subscribe to conservative management of the condition, including a combination of RICE (rest, ice, compression and elevation), use of anti-inflammatory medications and physiotherapy.  Allowing inflammation to subside—sometimes over a period of weeks—while avoiding activities that aggravate the knee is important is followed by a gradual resumption of conditioning.

We are St. Louis personal injury attorneys who serve all of Missouri, Illinois, and Arkansas. As leaders in our field, we are required to know not only the law, but also the medicine. If you have been injured in a car accident, 18-wheeler accident, or other accident, and suffered Chondromalacia of the Medial Femoral Condyle, or any other injury, contact our car accident attorneys at 314-444-4444. Schultz & Myers: Putting YOU First.

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