Joe A Shaw PA-C - 4/1/2013

Question
My 14yr old daughter is currently having knee problems/pain.  Approx. a year ago she suffered from knee bone contusions and just has not been the same since.  An MRI a couple of months ago indicated no meniscus tear but fluid on the knee.  After returning again with continued pain the dr made a diagnosis of chrondromalacia patella (the MRI indicated roughening of the cartilage and physical exam confirmed).  She is currently taking 4 cosamin asu and two aleve daily and has daily excersizes she must do.  A couple of things I have noticed recently, however, is a bubble looking swelling in the fatty part of her knee (to the lateral side of her knee cap) with maybe a slight discoloring and that her bone on the lateral side of her knee (I think that is her fibula?) protrudes signifacantly more than the other knee.  They both feel "funny" and are a little painful to her when touched or pushed.  Would these be common symptoms of chrondromalacia patella?  She plays soccer at a high level and is currently not being restricted but has had a somewhat light practice/game schedule for past 2-3 months.  Any information you could provide would be greatly appreciated.

Answer
C.Patellar typically presents w some crepitus(crackling)when bending knee, some will have pain or and ache. It may have some swelling from time to time depending on usage. The MRI is the test to get. There is something called Hoffman's fat pad sign -can google, but this would have showed up on MRI. THe lateral fibula area is not related to C patellar. Keep in mind a person's dominant leg or arm will be more developed than non-dominant one, so we are not symmetrical, but unless you have closely examined her leg(actually) both before she started having pain, then it's hard to know for sure if it is a new finding. It may be where her lateral collateral ligament of her knee is sprained or stretched, so I would cont w PT or exercises and go back to ortho if not better 2-3 mos.