I’m a 26 year old male and I’m seeking some wisdom on aggravating right knee pain I’ve been dealing with for 3 years now. I’ll copy and paste the impression from the MRI report:
Patellar chondromalacia, probably grade 3.
ACL sprain or partial tear, likely.
Fat pad impingement syndrome, likely.
Interval complete healing of prior osteochondral lesion at the
medial femoral condyle.
What I’ve been experiencing is, any time I bend my knee there’s a loud crunching sound and a sharp pain at my patella. Squatting, power cleaning, un-racking the press, and deadlifting aggravate it quite a bit, and it’s lead to lots of resets, de-loads, and layoffs. Stairs and hills aggravate the hell out of it too, as does my job in construction. The specialist I see has recommended: 1 month of “blasting it with anti inflammatories” (Naproxen) which I’m starting today. If that fails to relieve the pain, then on to hyaluronic acid injections (after reading reviews I’m skeptical that would help). If that fails, referral to a surgeon.
Any thoughts or advice would be greatly appreciated,
Hey Sam,
In the grand scheme of things hyaluronic acid does not have a ton of evidence so I do not know that I would go that route. Some of this gets into what you have been doing with resets, de-loads, etc and if there has been a tolerable entry point along the way. What you are describing with issues related to stairs/hills is pretty common and would make me slant a little more towards a pretty conservative start. Sometimes when athletes are having that loud crunching sound and sharper symptoms we need to either take out squatting for a little bit and instead use some different exercises to both load the quad and build some tolerance to activity or modify with a squat variation that is better tolerated. Without a full evaluation it is difficult to give specific advice, but from a general perspective I would probably start with the following paradigm;
Introducing some movements for quad loading where you are able to keep your shin more vertical through tolerable range of motion. This can be with exercises like Hatfield squats or often I will have athletes start with a split squat through tolerable range with their shin up against a bench so it cannot go forward much. This can also give us two variable from which to track progress with increasing the range of motion that is tolerated, as well as the weight on the bar. As range of motion is better tolerated, you can reintroduce some more shin moving forward. In the initial stages, I would likely slant towards a tempo for these exercises and of all the things you listed, I would keep power cleans out of the program until symptoms have started to improve as faster movements are also a little more likely to cause issues.
As far as the MRI itself, what you are describing symptom wise does track with the patellar chondromalacia/OCD findings. Sometimes when either of those are present, athletes can catch the “hot spot” where this exists with certain movements and provoke symptoms. From a rehab perspective, the approach begins as stated above. Depending on how far you can flex your knee without issue, you may need to start with some even more basic things to work on gaining full flexion without issue. If there is anything we can do from a consultation perspective, we are happy to do so.