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Sports Medicine

Grade IV Chondromalacia in 32 yr Old Female

02/01/2011

Question:

I am a 32 yr old female runner who was recently diagnosed with bilateral stress fractures in both of my tibias. After reviewing the MRI paperwork, I noticed that it stated that I had probable focal grade IV chondromalacia on my central left patella.I researched this on the internet, and was horrified to hear the effects that it has had on other runners. I contacted my Ortho in regards to why he did not inform me about this knee injury, and he stated that it was nothing to worry about. He told me that it was normal wear and tear, and that everyone has it. When i asked him if it was going to effect my running when I was able to get back in to it, he told me no. My question is, does this sound accurate to you? Should I be worried about this? I was thinking of going to see a 2nd Dr just for peace of mind, would that just be wasting my time?

Answer:

MRI scans may reveal what appear to be "abnormalities", but those findings may or may not have any clinical significance. That is, these may or may not be symptomatic at present, and may or may not indicate a potential problem in the future.

If you have leg pain but not left knee pain - specifically, if you haven't had left sided patellofemoral pain, which is pain in the front part of your knee - this finding of "probable chondromalacia" would then be asymptomatic, and may not be any cause for concern. This is particularly true if your physical examination (or "structure")/style/shoes/surface/schedule reveal no factors which could predispose you to developing patellofemoral pain.

If your MRI scans which revealed tibial stress fractures were scans of your tibia and not of your knee, per se, sometimes anatomic areas at the fringe of a scan (in this case, part of your knee may have been visualized by the tibial MRI scans, but not in the detail as would be provided by a dedicated knee MRI scan) may indicate a possible abnormality which would then need to be correlated with the clinical picture, and possibly clarified with further dedicated imaging.

Finally, the reason you developed bilateral tibial stress fractures certainly needs to be determined and addressed to prevent this from recurring.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University