Hey all. First post after lurking for a while.
I’m 43 with bilateral patellofemoral degeneration. Background: high-volume running and CrossFit in my late 20s/early 30s, left knee arthroscopy and chondroplasty in 2020, and confirmed full-thickness chondral loss at the patellar apex extending into the lateral facet. Underlying anatomy includes shallow trochlear grooves, dominant lateral patellar facets, patella alta, and trochlear dysplasia, so maltracking is structural, not just a muscle imbalance issue.
Just seen an orthopaedic surgeon. He’s ruled out further arthroscopy as unlikely to help, discussed but advised against tibial tubercle osteotomy at my age, and was honest that knee replacement is probably on the horizon long-term.
For now: non-operative. Cycling, VMO strengthening, leg press, gluteal bridges, weight management.
I’ve lost 10kg recently which I’m told will help. But I’m still really struggling day to day.
My first question is about differentiating symptoms, because I genuinely can’t tell what’s causing what.
The deep, hot aching behind and around the kneecap, is that cartilage wear, fat pad irritation, or just chronic inflammation?
Interestingly my surgeon’s physical exam didn’t find a positive fat pad impingement test, but the MRI shows fat pad oedema. Confusing.
And the sharp sensations at the front that force me to walk downstairs sideways or one step at a time, is that a different mechanism entirely?
My second question is for anyone who’s been in a similar place: did you find a way back to some level of normality?
Not asking for miracles, just whether consistent conservative management actually moved the needle for anyone, or whether it just slows the decline.
I’m pretty down about how limiting this has become. Playing with my kids, descending stairs, sitting too long, all calculated decisions now. Appreciate any experience people are willing to share.