Condylar chondral defect

September 5, 2018

I am keen to hear how you might be able to assist in rehab following a traumatic medial floral condylar chondral defect in one knee. The injury was sustained early June and was diagnosed a week ago.

The surgeon has recommended micro fracture surgery but I am keen to avoid this procedure. Over the past week I have vastly improved the mobility and started to regain muscle tone using a Yoga rehab DVD and have been astonished by the improvement I have made.

Are you able to provide any further rehab that would assist in rebuilding the lost muscle and mobility in my leg?

Thanks, Karen

September 5, 2018

Hi Karen

I hope you mean a femoral not floral defect!

Some OS will use micro fracture as their go to for primary choice of intervention, and unless you’ve got a really big chunk of chondral surface missing and have failed (or failing) at rehab, then stay well away from micro fracturing – I’ve seen plenty of poor, post op results and a few good ones. The good ones are probably due to the post op rehab rather than the operation itself…

Your femoral surface is covered in articular cartilage which is great at helping distribute load across your knee, and when you have a defect you get a issue with how that load is spread. Micro fracture causes a blood clot to form which then turn into fibrocartilage – like articular, but doesn’t have as good load distribution property.

But, if you improve your control of you entire lower limb – foot, knee, hip and pelvis then you automatically improve your load distribution across all joint surfaces. It’s a win-win situation.

Yogary (!) type stuff is good as it maximises how you use your joints but I’m not sure that it helps control what you do with your joints – and I think this is key.

It’s a little like Goldilocks – you don’t want too much or too little movement, you want the right amount and that needs control.

Lunges and squatting and all the variants are great for your knee as long as you do it with great form and control – it’s not what you do, but it’s how you do it.

So, yes – we can do lots. The range will come with movement (Yoga) and the strength will come with the more you do (without pain or discomfort). We’ll show you how to control the range and control the strength so you can control the pain, and do more.

The Guru

Karen gives the Guru some more information:

Thanks for your quick response and my typo was indeed amusing!   The cartilage missing is around 1.5 cm square.

The DVD I have been using combines deep tissue work (mashing with a couple of tennis balls) with stretch and basic strengthening movements, working everything from the glutes, hip flexors, right down to the feet.  I am also already doing controlled lunges and squats, along with other strengthening exercises set by my own physio and I am comfortable with the mechanics and form of lunges and squats (I have been a Crossfit athlete for years and the gym I go to puts create emphasis on form, although that didn’t help me prevent the original injury of course!).

I am based in Kent but work in London so if you think I will benefit from an assessment and sessions over and above what I have already been doing then I will book a session once I am back in London.



The Guru replies:

That’s a fairly decent size, but without knowing what you can or can’t control, I’d still push for a non operative, rehab route to recovery.

The fallback is (should you fail conservatively) the better you go into any op, the better you’ll come out.

You sound like you’re doing some pretty decent stuff and you get the control piece – well done.

I think you’ll always benefit from a least a single session and we should be able to give you a decent overview of needs to happen next.

Let me know if you’d like to book in and I’ll tee up with the most appropriate Physio, in the right location.

The Guru

Guru Responded

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