I got this comment recently:
I have been struggling with knee swelling/pain sporadically over the past 7 years and got frustrated with the Ortho's recommendation of RICE... I finally got an MRI and found out it is a real problem - stage IV Chondromalacia, no cartilage in part of my knee joint. I found your book on google and then Doug Kelsey's book and now I'm starting online therapy with the PT he recommends - I'm so grateful. What I'm curious about is if you've known much success of people in their mid 30s in surgery. I seem to see pretty low success rates so I'm not seeing the point of paying a ton in surgery... any thoughts?
Ah, surgery. That's a big topic.
I considered it once myself. I'm so, so, so glad I didn't go through with it. However, I don't mean to imply it's the wrong course of action for you. I wouldn't try to judge what's best for you.
First, I guess it depends on what kind of surgery. There's a kind of "I'm going in to have a look around and clean up the joint" surgery that I, personally, would run like hell from. Studies have shown this surgery isn't any more effective than conservative treatment of the bad joint.
But if the surgeon wants to perform a microfracture, where he creates holes in the bone to spur bleeding and prompt cartilage regrowth in an area where there's no cartilage, that's different. Is that worth it? Well, I guess it depends. Cartilage, it appears, can grow naturally even where there's bare bone -- just consider this study.
Still, is the replacement cartilage that regrew in this study fibrocartilage? Would a microfracture get you better cartilage, and faster? That's something for you to discuss with your doctor certainly, but I'm just letting you know what I know.
Notice I haven't said anything about your age. I honestly don't think there's much difference in your chances for a successful outcome between mid-twenties, mid-thirties, or mid-fifties, if you're healthy and committed to doing the right things to aid in your recovery.
Also, this person wanted to know whether I had an MRI and what did it show?
I've written about this extensively, as the question comes up frequently. So I'll just send you here for that answer.
One final observation on surgery: if you do have surgery, my personal observation is that the biggest mistake people make post-surgery is doing too much, too quickly (shamefully, I think their physical therapists are partly culpable in this).
So, if I did have surgery, I would go very, very, very slowly in my recovery, even if my knees felt great.
Hi Richard. Thank you for writing your book. You've done a great service to me and other readers who go through this struggle.
ReplyDeleteI'd be curious to hear if you or any readers have successfully convinced their doctors/therapists that anterior knee pain is mostly mistreated. I've begun to introduce ideas like envelope of function and how a joint first approach trumps addressing biomechanic irregularities. All of my therapists entertain the discussion and do not dismiss me, which I greatly appreciate. However, none have embraced those ideas. Frankly, I understand why. It feels like the height of arrogance for a patient to tell a doctor they are mistreating people. I feel like the crazy patient sometimes. Still, I feel compelled to convince medical professionals they are treating the most common type of knee pain incorrectly. Has anyone successfully convinced their doctors? Richard, do your doctors in Asia know you wrote a popular book on the subject?
I emailed all the 'specialists' I saw to enlighten them about the Dr Scott Dye theories on treating anterior knee pain and loss of tissue homeostasis. Also discussed it with some therapists online. The silence was deafening mostly. Some acknowledged it, but it did not seem to suit their dominant paradigm, which to be fair to them, it probably driven in part by their patients wanting a quick fix.
DeleteI was lucky in that our local ortho said do not have surgery for your condition (which was a combination of chronic synovial inflammation - diagnosed by no experts but by myself, and patella chondromalacia, diagnosed by several MRIs over the years). My conditions have improved immensely without surgery.
Glad to hear your condition has improved. I stumbled upon your personal story after searching "TriAgain" in the search bar. Thank you for taking the time to type that up years ago. My knees are at rock bottom but my spirits are high thanks to the knowledge everyone on this site shares. I can't say I'd be in a good mental place right now if I didn't stumble across this website.
DeleteRichard, and others here: I am curious what you think about pro treatments. I am grade 4 chondromalacia patella in left knee and grade 3/4 in right knee since a car accident 15 months ago. According to x-rays the fracture in the left knee has finally healed but my pain has not decreased dramatically. I am constantly taking off from my teaching job and have had 4 doctors and 2 physical therapists and am still like this. The prp is not covered by insurance. I had one treatment 2 mos ago and it may have helped the fracture heal the rest of the way but I'm still suffering immensely.
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