Chondromalacia of the Left Patella in a 31-Year-Old Male
Hello everyone, I would be incredibly grateful for any guidance you can provide. Several years ago, I sustained an injury while playing soccer, and over the last year, it's begun to significantly influence my daily activities. I enjoy running and competing in soccer, but I’ve found myself hesitating to engage in any vigorous activities for the time being. Following an MRI, it was revealed that I have a tear in the medial area of the cartilage located behind my kneecap, which has resulted in a fragment of cartilage becoming loose. This loose fragment appears to be catching, as I hear a clicking noise when I extend my leg. This sound is coupled with a peculiar dull ache, which at times includes a tingling sensation. I primarily notice this discomfort after sitting for extended periods with my knee bent or during long walks. Occasionally, it starts hurting, but I can alleviate the pain by shaking my leg. My physician mentioned the possibility of surgically removing this loose flap, but the procedure only has a 50% success rate. There is also the risk that removing the flap and the damaged cartilage could worsen my condition. Has anyone experienced something similar or have insights into this issue? Thank you for your support!
Answers (1)
9/11/2025, 4:50:37 PM
OpenHealth AI
It sounds like you're dealing with a frustrating situation, and it's understandable that you're seeking guidance on how to manage your condition. Chondromalacia patella, particularly with a loose cartilage fragment, can lead to discomfort during activities you enjoy, but there are ways to potentially alleviate your symptoms and improve your knee function.
Key Points:
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Understanding Your Condition: Chondromalacia is the softening and damage of the cartilage on the underside of the kneecap. Symptoms can include pain, clicking, and instability, particularly during motion or after long periods of inactivity.
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Current Concerns: You are dealing with pain, clicking, and a potential loss of mobility, which affects your ability to engage in activities like running or soccer. Surgery is an option but has mixed success rates and varying risks.
Actionable Next Steps:
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Activity Modification: Limit high-impact activities that can worsen your knee condition, such as running and jumping. Instead, consider low-impact alternatives like swimming or cycling, which can help maintain fitness without stressing your knee.
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Physical Therapy: Consider engaging in a structured physical therapy program focused on strengthening the muscles around your knee. This can improve stability and reduce strain on the affected cartilage. Look for exercises that target quadriceps, hamstrings, and hip muscles.
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Pain Management: Use over-the-counter pain relief methods judiciously. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help relieve pain and inflammation. Always follow the dosage recommendations.
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Knee Support: Using a knee brace may provide additional stability and could help alleviate discomfort during activities.
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Stretching and Strengthening: Incorporate gentle stretching exercises to maintain flexibility and strength training for the muscles surrounding your knee joint. Focus on maintaining good knee alignment during these activities.
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Monitor Symptoms: Keep a symptom diary noting when you experience pain, its intensity, and activities that exacerbate it. This could help you identify triggers and tailor your activity planning accordingly.
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Consider All Options: While surgery is one avenue, gather more information about your options, including potential outcomes, and weigh them against your current quality of life. It may be worth discussing with your physician the possibility of cholesterol injections or other non-surgical treatments.
Remember to listen to your body and gradually return to activities as your symptoms allow. Managing chondromalacia can take time and patience, but with the right approach, you might find ways to enjoy your activities again. If you have any further questions or need more details on any specific points, feel free to ask!
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - **Portocaval shunt size: 9.9 mm** (blood bypassing the liver into the inferior vena cava) - **Arteriovenous shunt size: 4.4 mm** - **Portal vein size: 6.1 mm** (patent) - **Three nodular cystic lesions** located in the perivascular area, with largest measuring 11.6×20.7 mm, enhancing during the venous phase - Liver features a heterogeneous architecture, exhibiting irregular enhancement - Gallbladder appears elongated and slightly enlarged - Other abdominal organs exhibit normal findings **RADIOLOGIST’S ASSESSMENT:** "Congenital portosystemic shunt indicative of Abernethy malformation; less likely arteriovenous malformation (AVM); cannot dismiss the possibility of localized liver lesions." **ADVICE:** Seek consultations with an abdominal and vascular surgeon. ### Blood Tests (August 1, 2025): **Complete Blood Count:** - WBC: 10.44 × 10⁹/L (normal range) - **RBC: 2.1 × 10¹²/L** (LOW - indicating severe anemia) - **Hemoglobin: 69 g/L** (CRITICALLY LOW; normal is 117-166) - Platelets: 403 × 10⁹/L (elevated) **Biochemistry Analysis:** - 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Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.