In a car, your legs are tucked under the dashboard, so an auto accident can easily injure them. Your knees can smash into the steering wheel, a door, or worse.
Chondromalacia Medial Femoral Condyle & Infrapatellar Saphenous Nerve Injury
There are several traumatic knee dashboard injuries that can occur after a car accident when a front seat passenger or driver’s bent knee slams against the car dashboard.
Typically in our personal injury practice, we see victims of car accidents eventually diagnosed with either Chondromalacia Medial Femoral Condyle or Infrapatellar Saphenous Nerve Injury. While different injuries, the two can often go hand in hand, so in this post, we’ll take a look at the common knee injuries from car accidents.
Chondromalacia Medial Femoral Condyle
First, let’s start with the origin of the word, chondromalacia. Besides being a mouthful, the term is a misnomer when it comes to describing this particular condition. Chondromalacia was first coined by German researchers in 1906 when they discovered that the cartilage in the kneecaps of the cadavers they were studying was soft. They assumed that knee pain could be attributed to chondromalacia, which translated into English means “soft cartilage”.
Today, we know that the articular or joint surface cartilage surrounding the knee joint is the thickest and softest in the entire body (note: it has to be as it serves as a shock absorber, helping to dissipate forces of stress and strain and allowing for unobstructed movement in walking, running, squatting, etc.). Hence, chondral malacia or ‘soft cartilage’ is actually a normal condition!
So… What Is Chondromalacia Medial Femoral Condyle?
Chondromalacia medial femoral condyle represents damage to the articular cartilage lying at the end of the femur (also known as the thigh bone) where it is connected to the tibia (shin bone) by the patella (knee joint). The medial femoral condyle refers to one of the two—and the largest—projections on the lower extremity of the femur situated near the inside of the knee.
Upon close examination via MRI, chondromalacia appears as fragmentation of the typically smooth articular surface. The fragmentation or wearing away of the protective cartilage causes inflammation which in turn results in a buildup of fluid or effusion in the knee, producing pain when moving.
Symptoms associated with Chondromalacia Medial Femoral Condyle vary widely and cannot be used to make an accurate diagnosis absent MRI or MRA confirmation. Moreover, the severity of symptoms does not necessarily correlate with condition progression (assigned stage) and should not be relied on as the sole gauge for determining the need for surgery. Generally, patients with chondromalacia medial Femoral condyle report symptoms of:
- Inside and/or lateral knee pain
- Patellar crepitus (crackling and popping sounds of the knee)
- Effusion in knee joint
An MRI or MRA is used to diagnose chondromalacia and to assign a grade relative to its severity. Chondromalacia is classified as one of four grades using an MRI/MRA. These include:
- Areas of hyperintensity on MRI/MRA imaging with maintenance of normal contour of articular surfaces
- Softening or swelling of the cartilage
- Blister-like swelling or fraying of articular cartilage extending to surface
- Arthroscopically: fragmentation and fissuring with soft areas of articular cartilage
- Partial thickness cartilage loss with well-defined ulceration
- Arthroscopically: partial thickness cartilage loss with fibrillation (a crablike appearance)
- Full thickness cartilage loss with underlying bone (subchondral bone) changes
- Arthroscopically: cartilage destruction with exposed subchondrondral bone (the bone underlying the rounded end of the femur. The subchondral bone provides further stability to the leg bones and joints.
Infrapatellar Saphenous Nerve Injury
The infrapatellar branch of saphenous nerve (IPS) is a nerve located in the lower leg. The saphenous nerve lies at the terminal end of the femoral (upper leg) nerve. Located in the middle of the thigh, it courses through the thigh, piercing the long thin muscle called the sartorius and the fascia lata, the dense connective tissue that surrounds the muscles bones and blood.
Even though injury to the IPS has been recognized as a relatively common outcome of knee surgeries (one report estimates that 2/3 of meniscal surgeries result in an IPS injury) as well as other forms of trauma, the diagnosis, and treatment of IPS neuralgia is typically not taught in pain training programs and remains an undiagnosed or under-diagnosed condition. This is particularly concerning insofar as recent research has demonstrated that damage to peripheral nerves, including IPS, has been identified as the cause and potential explanation for chronic and debilitating conditions such as complex regional pain syndromes (CRPS).
How To Know If You Have An Infrapatellar Saphenous Nerve injury
Symptoms of an IPS injury can be difficult to pinpoint insofar as the pain is usually not well localized. Patients tend to describe a generalized spontaneous anterior (front) knee pain or sometimes more to the front and side (anteromedial). They may have difficulty squatting and extending their legs or may walk “stiff legged” to avoid flexing their knee. Tinel’s sign—a way to detect irritated nerves by lightly tapping over the nerve—will often elicit a zinging pain or a sensation of “pins and needles” consistent with the distribution of the nerve.
Diagnosis due to the vague nature of symptoms can be challenging and usually involves a combination of tests including:
- Palpation to replicate pain and numbness, including maneuver of Tinel’s Sign
- Von Frey filament Testing: Comparing sensation thresholds of the patient’s involved side to the unaffected side by applying pressure by the filament (nerve), nerve conduction studies and diagnostic injections to confirm the affected nerve.
- Nerve Conduction Studies
- Diagnostic Nerve Blocks
Treatment Of Dashboard Injuries From Car Accidents
Treatment for both chondromalacia and IPS is fraught with controversy. At one time, surgery was often considered the best option for both dashboard injuries, but more recently, surgical intervention for Chondromalacia has fallen out of favor among many doctors due to poor treatment outcomes and its relative ineffectiveness.
Now, for Chondromalacia, most doctors subscribe to conservative management of the condition, including a combination of RICE (rest, ice, compression, and elevation), use of anti-inflammatory medications and physiotherapy. Allowing inflammation to subside—sometimes over a period of weeks—while avoiding activities that aggravate the knee is important is followed by a gradual resumption of conditioning.
We are St. Louis personal injury attorneys who serve all of Missouri, Illinois, and Arkansas. As leaders in our field, we are required to know not only the law but also the medicine. If you have been injured in a car accident, 18-wheeler accident, or other accident, and suffered Chondromalacia of the Medial Femoral Condyle, or any other injury, contact our car accident attorneys at 314-444-4444. Schultz & Myers Personal Injury Lawyers: Putting YOU First.