Question by Hans-Jürgen S. from Kamp-Bornhofen: I have tendon irritation in the outer area of my right knee - the cause was probably increased training volume. After an MRI scan it was diagnosed: Chondropathia patellae (cartilage disease under the kneecap), grade 2, with irritation in the attachment area of the patellar tendon. There is also slight damage and irritation to the meniscus and other tendons and ligaments surrounding the knee. My orthopaedist advised me to keep absolutely still, but after a good two months without any cycling, it's not really getting any better. I was "threatened" with absolute immobilisation with a plaster cast or frame, or a cortisone injection as a last resort. What could be the solution?
Answer from Dr Christian Merkl: Assessing pain from a distance is always a little problematic. At the outer knee joint, it may be caused by a dysfunction of the fibular head and inflammation of the femoral extensor insertion at the lateral tibial plateau. If the tension in this lateral muscle chain is increased, this can also lead to a rubbing mechanism on the outer femoral condyle.
If the pain only occurs when cycling, an incorrect seat or foot position is probably responsible for the problems. Reasons for this could be: Pedal plates are mounted unfavourably so that you are riding with your feet turned inwards or outwards. If the pedal connection is flexible, this may compensate for a poor mounting position. You should also check whether your saddle is set too low or too far back. It is always important to pedal loosely in order to stimulate the cartilage and ligament metabolism.
Under no circumstances, however, do I think it makes sense to immobilise your leg with a plaster cast! Inflamed tendon insertions can be treated very well today with so-called shock wave therapy (high-energy). Injections of hyaluronic acid into the tendons or the joint can also be given on a trial basis. A good physiotherapist should also make the lateral muscle chain and the fibula more flexible. If you do all this, it will probably no longer be necessary to administer cortisone.
