Lateral Meniscus Tears and Patellar Chondromalacia: A Patient's Guide

Lateral meniscus tear & patellar chondromalacia

Hello Doctor,
Background: About 2 to 3 years ago, I first tried rollerblading, and I may have had improper posture (I did not fall).
Since then, I have experienced intermittent pain that persists to this day.
Recently, the pain has become more pronounced, and I am unable to fully extend my leg.

Symptoms: I have pain on the outer side of my left knee (which becomes more noticeable with changes in posture and walking), I cannot fully extend my leg, and I am unable to walk for extended periods.

Medical history (in order):
- January 2016: I visited the rehabilitation department at Hospital A, where I underwent rehabilitation and had an MRI.
The report suggested a possible lateral discoid meniscus tear.

- May 2018: I went to the orthopedic department at Hospital B, where the doctor reviewed the MRI images and confirmed a lateral discoid meniscus tear, stating it was congenital and that surgery (arthroscopy) would be beneficial if performed sooner rather than later.

- May 2018: I consulted with the orthopedic department at Hospital C, where the doctor reviewed the MRI images and mentioned that I had a naturally thick meniscus, which he referred to as a gift from nature.
He said surgery was optional and left the decision up to me.

- June 2018: I visited the orthopedic department at Hospital D, where the doctor did not review the MRI images but examined my left knee for extension and flexion.
He stated that it was congenital and diagnosed me with patellar chondromalacia, recommending that I take Move Free supplements from Costco and apply a topical treatment called Soothe.

I would like to ask Dr.
Li if a lateral discoid meniscus tear and patellar chondromalacia are the same condition.
What would be the best course of action for me? Thank you!

Miss Chen, 20~29 year old female. Ask Date: 2018/07/18

Dr. Li Yongheng reply Orthopedics

Hello, based on your symptoms and statements, if the MRI was conducted in 2016, I recommend that you undergo a new MRI.
A lateral meniscus tear and patellar chondromalacia are completely different conditions, and their treatment methods also differ.
I suggest you schedule an appointment with the orthopedic sports medicine subspecialty (major hospitals typically have various subspecialty clinics in orthopedics, which you can check on the hospital's outpatient schedule) to receive more accurate treatment recommendations.
Thank you for your inquiry.

Reply Date: 2018/07/18

More Info

Understanding lateral meniscus tears and patellar chondromalacia is crucial for managing knee pain and dysfunction effectively. Based on your symptoms and medical history, it appears that you are experiencing significant knee issues that have persisted for several years, likely stemming from your initial rollerblading incident.

Lateral Meniscus Tears
The lateral meniscus is a C-shaped cartilage structure located on the outer side of the knee joint. It plays a vital role in cushioning the knee, stabilizing the joint, and distributing weight during movement. A tear in the lateral meniscus can occur due to acute injury or degenerative changes over time. In your case, the MRI findings suggest a possible "disk-like" tear, which is often associated with congenital variations in the meniscus structure. Symptoms of a lateral meniscus tear typically include:
- Pain on the outer side of the knee
- Swelling and stiffness
- Limited range of motion, such as difficulty fully extending the leg
- A sensation of locking or catching in the knee

Patellar Chondromalacia
Patellar chondromalacia, or patellar cartilage softening, refers to the degeneration of the cartilage on the underside of the kneecap (patella). This condition can lead to pain, particularly during activities that involve bending the knee, such as squatting, climbing stairs, or sitting for extended periods. Symptoms often include:
- Pain around or behind the kneecap
- A grinding or clicking sensation when moving the knee
- Swelling in the knee joint

Distinction Between the Two Conditions
While both conditions can contribute to knee pain and dysfunction, they are not the same. A lateral meniscus tear primarily affects the cartilage structure within the knee joint, while patellar chondromalacia involves the cartilage on the kneecap itself. It is possible to have both conditions simultaneously, especially if there is a history of knee trauma or overuse.

Management and Treatment Options
Given the complexity of your symptoms and the differing opinions from various specialists, here are some recommendations:
1. Consult a Specialist: Since you have seen multiple orthopedic specialists, it may be beneficial to seek a second opinion from a knee specialist who focuses on sports medicine or cartilage injuries. They can provide a comprehensive evaluation and tailored treatment plan.

2. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles around the knee, improve flexibility, and enhance overall joint stability. A physical therapist can also provide exercises specifically designed to address both meniscus and patellar issues.

3. Activity Modification: Avoid activities that exacerbate your knee pain, such as high-impact sports or prolonged periods of standing or walking. Consider low-impact exercises like swimming or cycling to maintain fitness without stressing the knee.

4. Pain Management: Over-the-counter anti-inflammatory medications (like ibuprofen) can help manage pain and swelling. However, consult your physician before starting any medication.

5. Surgical Options: If conservative treatments fail to provide relief and your quality of life is significantly affected, surgical options may be considered. Arthroscopic surgery can repair a meniscus tear or address patellar chondromalacia through procedures such as microfracture or cartilage restoration techniques.

6. Nutritional Support: Supplements like glucosamine and chondroitin may provide some benefit in joint health, although evidence is mixed. Always discuss with your healthcare provider before starting any new supplements.

Conclusion
In summary, while lateral meniscus tears and patellar chondromalacia are distinct conditions, they can both contribute to knee pain and dysfunction. A thorough evaluation by a knee specialist, combined with a targeted rehabilitation program, can help you manage your symptoms effectively. It’s essential to listen to your body and seek appropriate care to maintain your mobility and quality of life.

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