Dr. Atul Prakash
Orthopedician and Traumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am a 35-year-old female. I have had pain in the posterior part of my left knee for the past year. Currently, I am eight and a half months pregnant, and I have continuous posterior knee joint pain. I did my MRI when I was four to five months pregnant. I do not have any pain in the anterior part of the knee. One year back, I had COVID also. After that, I have this pain. My MRI report shows chondromalacia patella type 4 with patella Baja and anterior cruciate ligament grade 1 sprain. In addition, there is a mild left knee joint effusion and minor focal articular cartilage erosion in the medial femoral condyle of the knee. I am so worried. Kindly help.
Hi,
Welcome back to icliniq.com.
I understand your concern. The patellofemoral pain not only causes pain while climbing or going down the stairs but after a period of rest, and the first few steps can be painful. Sometimes the pain is worse and radiates to the shin and the back of the knee. Considering the MRI (magnetic resonance imaging) report (attachment removed to protect the patient’s identity), I feel the first possibility is chondromalacia patellae. I would like you to share the MRI (magnetic resonance imaging) reports. I suggest you wear a knee cap to help reduce the effusion. As you are in the late stage of pregnancy, I suggest you avoid any painkillers unless advised by your gynecologist. I would also suggest you apply an ice pack on your knees to get good relief and Diclofenac gel in case of severe pain.
Kindly revert in case of further queries.
Patient's Query
Hi doctor,
Thank you for the reply. But I wanted to know, is this knee joint effusion and chondromalacia patella type 4? Is knee joint effusion treatable non surgically after pregnancy? I do not feel strength in my left leg, and while bending or sitting, I can hear clicking and cracking sounds from my knees, but I do not feel pain from that sound. Is it curable non-surgically or surgically? Is knee effusion because of pregnancy or chondromalacia, and will it disappear after pregnancy? What about articular cartilage erosion in the medial femoral condyle of the knee? Is that also treatable? Kindly help.
Hi,
Welcome back to icliniq.com.
I understand your concern. Yes, it is conservatively managed until you are three months post-delivery. After that, all the ligaments would have returned to normal, and the weight would have reduced too. But I need to see if that is in grade 4 as that means bone is visible. Knee effusion is not due to pregnancy, and it is due to the patellofemoral issue. The size and location of the defect in the cartilage have to be determined for any surgical management.
I hope you get well soon.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply. Are type 4 and grade 4 chondromalacia the same? Kindly help.
Hi,
Welcome back to icliniq.com.
I understand your concern. It is treated conservatively until you are six to 12 weeks postpartum, at which all the ligaments would have returned to normal, and you would have shed all the pregnancy weight. Once that is done, and you may be breastfeeding, there will be restricted tablets, and you could be more aggressive with your physiotherapy. If that did not help, I suggest you need an arthroscopic assessment. As the surgery is required for grade 4 lesions, the exact decision is made on the lesions' size, location, depth, and other requirements.
I hope you understand.
Thank you.
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Orthopedician and Traumatology
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