Cartilage Injuries Cont

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EXERCISE PRESCRIPTION Rest is only recommended temporarily. Cycling and swimming are good alternatives to keep up general fitness. Rehabilitation back to full sport usually takes a long time, up to 12 months or more. EVALUATION OF TREATMENT OUTCOMES Monitor clinical symptoms and signs. Different functional knee scores for different sports are available to measure when the knee allows the return to full sport.

DIFFERENTIAL DIAGNOSES Meniscus injury, loose bodies, medial plica syndrome; all differentiated by arthroscopy.

PROGNOSIS Surgery will allow a return to professional sports in anything from two weeks to several months. The knee with serious cartilage damage is more vulnerable to stress and in the long term, 10 to 20 years, the risk of developing osteoarthritis is significant compared to a non-injured knee.

Fig. 100 Chondromalacia patella can be diagnosed by arthroscopic probing

SYMPTOMS There is gradual onset of diffuse exercise-induced pain around the anterior part of the knee. Prolonged sitting or squatting often trigger the symptoms (positive movie sign). Walking down stairs is more difficult than up. AETIOLOGY Chondromalacia means 'soft cartilage'. The exact aetiology is unknown. The correct diagnosis must be identified, by arthroscopic probing, before treatment can be successful, since this is only one of many diagnoses that result in anterior knee pain.

CLINICAL FINDINGS There is recurrent effusion and a positive grinding test. Tests of core stability, proprioception, muscle strength and balance and the flexibility of the entire kinetic chain must be thoroughly evaluated.

INVESTIGATIONS X-ray can exclude fractures, OCD, patella abnormalities, other osteochondral injuries and bone tumours. MRI can exclude soft tissue tumours and other localised soft tissue lesions but often underestimates chondromalacia and other superficial chondral injuries as well as many meniscal

Fig. 101 Grinding test is positive if there is underlying chondromalacia, but this is also present in mal-tracking and other injuries tears and medial plica syndrome. CT scans can rule out severe patella mal-tracking, which in some cases may be the cause of the chondromalacia. Ultrasound can be useful for evaluating functional tendon and ligament disorders such as jumper's knee or tendi-nosis around the knee. Arthroscopic probing is required for the diagnosis. TREATMENT Long-term symptomatic and functional treatment by a physiotherapist is required. REFERRALS These patients are very much helped by being evaluated clinically by their physician, surgeon and physiotherapist in close collaboration. EXERCISE PRESCRIPTION Cycling and water exercises are good alternatives to keep up general fitness.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs. DIFFERENTIAL DIAGNOSES Meniscus tear, chondral injuries, OCD, medial plica syndrome, chondromalacia patellar, patellar instability or mal-tracking, quadriceps insufficiency,

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