I'm sure Rob H, Steve, or the docs have told you this already, but I've heard of chondromalacia being a result of imbalances between quad muscles; one side too tight can cause knee cap tracking issues that causes the cartilage wear. I've also heard that the results of arthroscopic surgery are disputed by some, ie. results not that different from physiotherapy. I'm sure it depends on the issue. Maybe read this; the wikipedia entry quotes two studies questionning it's effectiveness. Note the line at the end that even a torn miniscus may not be especially well treated by it. (I'd also add that even statistical evidence shouldn't rule it out; you might have the injury that does need it, even if many others are not helped by it.)
http://en.wikipedia.org/wiki/Arthroscopy
Arthroscopic surgeries of the knee are done for many reasons, but the usefulness of surgery for treating osteoarthritis is doubtful. A double-blind placebo-controlled study on arthroscopic surgery for osteoarthritis of the knee was published in the New England Journal of Medicine in 2002.[9] In this three-group study, 180 military veterans with osteoarthritis of the knee were randomly assigned to receive arthroscopic débridement with lavage, or arthroscopic lavage alone without debridement (a procedure only imitating the surgical debridement, where superficial incisions to the skin were made to give the appearance that the debridement procedure had been performed). For two years after the surgeries, patients reported their pain levels and were evaluated for joint motion. Neither the patients nor the independent evaluators knew which patients had received which surgery (thus the "double blind" notation). The study reported, "At no point did either of the intervention groups report less pain or better function than the placebo group."[10] Because there is no confirmed benefit for these surgeries in cases of osteoarthritis of the knee, many payors are reluctant to reimburse surgeons and hospitals for what can be considered a procedure which seems to create the risks of surgery with questionable or no demonstrable benefit.[11] A 2008 study confirmed that there was no long-term benefit for chronic pain, above medication and physical therapy.[12] Since one of the main reasons for arthroscopy is to repair or trim a painful and torn or damaged meniscus, a recent study in the New England Journal of Medicine which shows that about 60% of these tears cause no pain and are found in asymptomatic subjects, may further call the rationale for this procedure into question.[13]
As an alternative, I'm a big fan of biomechanical assessments by physiotherapists to determine the underlying causes of injury. My son had an assessment last year when it was included in the fee for his metro soccer team. It consists of a careful viewing of how you move as you walk, run, do exercises like lunges, and strength and flexibility tests. With no help from us, they found all his previous injuries, and even predicted one.
The same issue, tight hip flexors, caused Osgood Schlatter’s (inflammation below the knee) that stopped his track and field one year, then was a contributing factor in a pelvis fracture two years later, and was the cause of a toe injury a year after that.
At the walk-in clinic they thought the toe injury was a bunion, and the family physician thought it was an impact injury. The physio pointed out that in his gait, he toed off differently on the side with the tight hip. He did two treatments to the hip, and sent him home with exercises. The pain was gone in a week. Meanwhile I had been scouring the internet for info on bunion surgery in young teens.
Each time, renewed attention to hip flexor flexibility cleared things up quickly. (The speed of our learning is another question…. )
Given that many of us are at an age where our posture and movement habits are well learned and not easily altered by ourselves, I’m going to have an assessment every year and pay attention to the advice. $60. Cheap, cheap, cheap.
rather than as previously booked: April of next year!
Following Rob Hasegawa's "time, love and tenderness" prescription, I'm not even doing the 10 minute bike commute to work - for the first time in decades, I'm taking the bus, since even low gear/high cadence cycling was causing knee flare-ups...
