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  • Q&A with Australian Health Practitioners

    How to stop pain from grade 4 chondromalacia of right knee?

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    Osteoarthritis Rheumatology
    I have suffered from chronic lower back pain for 2 years and now pain in my right knee. Knee MRI shows grade4 chondromalacia with subchondral bony stress reaction. There is significant partially full thickness latero-patellar cartilage loss associated with cortical erosion and significant sub-cortical bone marrow oedema. Moderate osteophite formation of the patello-femoral joint is demonstrated as well. What does all this mean?
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    Dr Ryan Hislop

    Chiropractor

    Ryan Hislop is the Clinical Director at the Orange Chiropractic Health and Wellness Centre. As an experienced and evidence-based diagnostician, Ryan works largely by medical … View Profile

    Grade 4 chondromalacia infers that there is no gristle between the bones anymore, the bone surfaces can be directly opposed against each other.  This is known as bone-on-bone arthritis.  In addition, there can be bone spurs (osteophytes), increased hardening of the bone around the area of the arthritis (sclerosis), and a squaring of the bone surfaces rather than the normal rounded surface. The terms of full thickness latero-patella cartilage loss, cortical erosion and sub-cortical bone marrow oedema further support this and are radiographic signs of osteoarthritis. The usual clinical signs of osteoarthritis are pain and swelling with activities.  This is because the cartilage surfaces are damaged and impact activities can cause further wear of the surfaces.  The most important thing in treating osteoarthritis is to recognize it is there and to try to determine its cause.  One should specifically avoid those activities which cause symptoms because the symptoms indicate that the arthritis is becoming worse.  In general, we recommend light-impact activities, avoidance of activities which cause irritation, stretching, bracing, supplementation and if conservative care fails we may refer you to a specialist who may trial injections, and potentially surgery. 

    While one thinks about total joint replacement as a common result of osteoarthritis, most patients with arthritis can put off the joint replacement or avoid it altogether by following a proper rehabilitation program.  In addition, osteoarthritis surgery can be performed arthroscopically in many patients to clean out the irritated joint lining, to trim out any areas of meniscal tearing, to smooth off the cartilage surfaces, and to remove any bone spurs which may be impeding  knee motion.  

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