The patello-femoral joint :

Help Please - Pain and Clicking 3+ years - - Posted by epmoyer (epmoyer), 19 August 2004

I have been dealing with my knee trouble for over 3 years. I have pain when I squat down past a certain point. After my knee is bent less than 90 degrees(probably almost 45 degree angle between upper and lower leg, close to a full deep squat)  there is this snap or click that occurs. It occurs every time I squat down. I've already had surgery once and the doctor removed the medial plica and smoothed some rough spots on the articular cartilage. Honestly, the surgery didn't help one bit. The snapping stayed the same. I have yet to find any exercises that help. Neither ice nor heat helps. Anti-inflammatories do absolutely nothing. The snapping seems to come from what I'll call the lateral upper quadrant of my knee, like between the outer edge of my knee cap and lateral femoral condoyle. The pain and snapping seem to come from the same place. Interestingly enough, I could sit with my knee bent for 12 hours straight and it won't ache or anything. The only time it hurts is when I squat down. After exercising my knee may feel slightly warmer than the other, but I've never had any swelling. Sometimes when I'm riding a bike, or especially when I'm trying to walk backwards on a treadmill(part of physical therapy) it almost feels as if something is catching at the top of my knee cap, to the lateral side. It's not a painful sensation, but it doesn't feel like it should be there. I've since moved to another area so I have not paid another visit to the doctor who did surgery. I did however see a doctor in the sports medicine dept. at Johns Hopkins. As is the case with most doctors now days, he spent maybe 5 minutes with me, didn't seem to care what I said, and then said go to physical therapy for 6 weeks I think it will help. The MRI, according to him, showed nothing abnormal. I guess what I'm wondering is, has anyone out there experienced symptoms like this? I've read that the lateral plica does exist but it is rare. Does anyone know anything about the lateral plica? For those of you who have suffered from plica syndrome, do the symptoms sound at all familiar? At what point during knee flexion did you experience the click? Any suggestions or help would be appreciated. This condition is really aggravating and it is very depressing to never have any improvement. I'm also starting to experience back pain as a result of favoring my right leg. Again, any help or comments would be appreciated. Sorry for the long post. Thanks!


Posted by nmcbride (nmcbride), 21 August 2004

Hey Epmoyer

Has anyone ever mentioned malalignment of the kneecap or tracking to you.  My kneecaps were both tracking very badly and I used to get that click you mention at about half extension, it might just be worth mentioning this to the doc next time you see him, I would also suggest that you try to see an orthopedic surgeon who specialises in knees, I have found that generally docs and physios don't really know enough to diagnose you properly.  Good luck.

Natalie.
Posted by Linds (Linds), 22 August 2004

I agree that this sounds like an alignment issue, Patella Femoral Syndrome or the like.  I would find an Orthopedic Surgeon and get a good set of Skyline xrays taken to see how the kneecap sits in the Femoral Trochlea,  hopefully they can get to the bottom of this for you.
Take care and goodluck
Linds
Posted by Mandy (Mandy), 22 August 2004

Hey Epmoyer!
how are u feeling today.  i totally agree with the others on this board.  this definatly sounds like a tracking or malalignment issue.  you should seriously get it looked at by an OS as soon as you can in order for u to get a correct diagnosis and perhaps discuss treatment options.  
I know exactly where you are coming from.  In my spare time i love lifting weights at the gym, but  i can only do mostly upperbody stuff cuz my knees just cant take it anymore (not too great for a 17 year old )  anyways, please go to an os and get some good x rays!  let me know how youre doing.  just IM me if u need to!
keep it real
~Mandy "party hockey girl"

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