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Arthritis and Rheumatism

Grade IV chondromalacia

08/15/2007

Question:

I recently had surgery for a medial meniscus tear. During surgery a second tear was found - lateral. In addition to the tears, The postoperative diagnoses included Grade IV chondromalacia of the medial tibial plateau, left knee and Extensive synovitis, left knee.

What does Grade IV mean exactly? How many grades are there and what do the grades mean? What does extensive synovitis mean? The surgeon gave me a copy of an operative report and photos during my follow up visit. He very breifly went over them before he hurried out of the room. I didn`t understand much until the pain wasn`t going away completely - even weeks after surgery.

I asked on my second follow up visit (this time with a physicians assistant) when I can expect to return to normal activities such as long walks and step aerobics. He looked at me for a long moment before he told me that I shouldn`t do those things anymore. I am just starting to realize what this all means and I am a bit depressed and very disappointed that my surgeon didn`t make sure that he gave me more information.

With the condition as described above, should I be seeing a Dr on a regular basis? I really would like some direction from a Dr but I don`t want to go back to the surgeon because he doesn`t exactly have good communication skills. I have been doing a little reading and doing some research but my concern is that it is not specific to me and that maybe there is more I should know or more I should be doing. What type of Dr. would be best for me to go to? Is there a specialist for this type of thing that is not a surgeon?

Thank you for your help.

Answer:

Chondromalacia roughly translates to diseased cartilage. There are 4 grades of chondromalacia that refer to the severity of the findings. Grade I is the least severe; Grade IV is the most severe. Grade IV chondromalacia refers to cartilage that is cracked/fissured to the extent the the bone directly underneath the cartilage (subchondral bone) is exposed.

Synovitis refers to inflammation of the joint lining (synovium).

Grade IV chondromalacia with associated pain and dysfunction typically warrants an Orthopaedic consultation. Surgical versus nonsurgical recommendations are usually based not only on the grade of chondromalacia, but also on other clinical considerations including symptom manifestation, extent of disease, stability of the cartilage lesions, and other factors. It seems your concerns regarding communication are based on an individual, but should not necessarily be generalized to an entire group of surgeons. Perhaps a second opinion from another Orthopaedist would be useful. If you are not deemed a candidate for a surgical intervention then an Orthopaedist or Rheumatologist may be able to provide noninterventional advice.

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Response by:

Raymond  Hong, MD, MBA, FACR Raymond Hong, MD, MBA, FACR
Formerly, Assistant Professor of Medicine
School of Medicine
Case Western Reserve University