1. #1
    ruby2zdy
    Firehouse.com Guest

    Lightbulb If you have chondromalacia

    Chondromalacia is discrete spots of worn articular cartilage on the underside of the kneecap or on the femur. The pain from chondromalacia can be crippling. There is a new technology, developed in the US, in which chondromalacia spots are drilled out and tough polymer plugs are inserted into the holes. There is NO recovery time. You're ready to go the next day. The company that developed the plugs is SaluMedica: http://www.salumedica.com/salucartinfodoc.htm . The plugs are called SaluCartilage.

    SaluCartilage has been approved for use in Europe for FOUR years, and in Canada for one. It has not been approved in the US. SaluMedica has submitted the results of its clinical trials to the FDA. The FDA is notorious for letting Europe "experiment" on humans for 15-20 years before they approve a procedure or device.

    Recently the FDA announced that it would try to speed up its approval process. You can imagine that it will take at least a year for them to figure out how to do this.

    I was a mountain climber until I got chondromalacia 13 years ago. It's ruined my life. I can't get enough exercise to maintain my health. If I could just get these plugs, I could resume a normal life and be healthy. This may apply to some of you too. (N.B.: You could go to Italy & get it done for 15,000 euro (almost $30K), pay up front, then hope for a generous reimbursement from your insurance company. However, because the FDA considers it "experimental", your insurance company probably wouldn't pay.)

    I recently wrote the FDA to ask them to please expedite the approval process for the plugs. I got a "we'll get around to it when we get around to it" response. If any of you have chondromalacia, please write to the FDA (go to http://www.fda.gov/comments.html, choose "Medical Devices, Radiation-emitting products" (the plugs don't emit radiation -- that's just how the FDA lumped a couple of categories together)) and write your comments. Please tell them that your chondromalacia has interfered with or ended your ability to be a firefighter and you want to use the SaluCartilage plugs so you can get back to your job. The more people who write in, the more likely the FDA is to move SaluCartilage to the top of the pile.

    Thank you.

    ruby2zdy
    Washington State

  2. #2
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    Default I won't argue...

    with your point about the FDA being slow, and I also won't argue that these plugs might in fact work to relieve pain right away. So, the systerm being what it is, and our having to live with it the way it is for the time being... let's talk about what might be done NOW.

    I will point out this: the mechanical cause of chondromalacia patella is not removed by these plugs- as far as I have seen in my 13 years in practice. Sure, the plugs may in fact cause a proliferation of cells, and rebuild the cartilage that has been worn away- for the time being. But, why did this happen in the first place? Why does the cartilage rub away unevenly? And just because we fill the wholes with plugs, and have it regrow at a fast rate, does that mean that the ineven wear and tear goes away? Especially if the mechanical inequity is not removed?

    Chondromalacia patella occurs because the posterior apsect of the patella does not run up and down smoothly in the chanel created in by the femoral chodyles. This happens because the lateral quad in many people is over developed (too strong) and overused in relation to the medial quad and the hamstrings. This pulls the quadracep tendon superiorly and laterally in relation to the track dictated by the anatomy of the knee.

    A solution we can work towards ourselves? Well, I'd hit it 3 ways:

    1. relieve the inflammation: ice, NSAIDS, MSM, and therapeutic ultrasound are things I'd recommend. I know you can't do the US, but the others... you can.

    2. Remove the offending action- deep knee bends (mountain climbing?) squats, whatever it is that causes exacerbation. Often, it is hyperflexion of the joint... engaging the lateral quads over and over, and not finishing the range of motion which challenges the medial quad as often, with the same relative load. This will need to be stopped for a time, until the inflammation is down, and the rehab process is completed.

    3. Strengthen the medial quad and hamstrings. Medial quads can only be strengthened with leg extension in the last 15 degrees of extension.... and by riding a bicycle... This type of exercise for balance should be worked at on an ongoing basis... not just until the pain subsides! Read this month's Firehouse.com's newsletter for more details on "Knees! Knees! Knees!". If you haven't signed up, go do it!

    4. Take Glucoseamine Sulfate- 1200-1500 mg/day to regrow the cartilage. It really works! Read "The Arthritis Cure" if you don't believe me!

    These actions might even be taken to change the mechanics in your knee so you won't need plugs. For now, you can't even get the plugs. And even if you can eventually get the plugs- this will make you actaully get better, not just plug the holes in the sinking ship! So try this!

    So red tape is what it is... in the mean time...

    Hope you feel better!

    Dr. Jen
    www.fireagility.com
    Last edited by Drjmilus; 05-31-2006 at 10:08 PM.

  3. #3
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    Default Whoa There

    I whole heartedly agree with Drjmilus, you are essentially changing the worn tires on a car that is out of alignment. Your treating the symptom rather than the root cause. I would also argue that there may also be a hip misalignment and muscular imbalance that may be the cause. In my practice the hip alignment is usually the first thing to be addressed by retraining as we,ll as the muscular imbalances found elsewhere.

    It is too bad the FDA is so slow to get good treatments to those who need it.

    Orlando Gomez FF/ PT/ PFT
    www.adapttraining.com

  4. #4
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    Default Hey, Maybe...

    The hip gets "coincidentally" trained/treated when I put people on the bike... the repetative circular motion retraining the hip to flow better in it's socket? I never thought about it that way, but truth is, when I adjust people, I always adjust (where needed) their hip sockets, pelvis, spine, and any other extremity thing I find. I am going to pay closer attention to the coorelation between hip disfunction and patello-femoral disfunction! Thanks for getting me thinking about it in another way!

    Dr. Jen
    www.fireagility.com
    Last edited by Drjmilus; 05-31-2006 at 10:08 PM.

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