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Offline BenAldridge0

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full circle with my knee
« on: November 13, 2019, 11:43:12 PM »
Hey all,

Sporadic poster on the board. I've come full circle on my knee condition: kind of back to square one -- a persistent suspicion that I tore my meniscus and it never healed properly.  This community has formed the best resource on knee information in all of my studies, so I wanted to detail where my knee is now after two and a half years of debilitation that has not been adequately explained. I look forward to any responses and leads you may provide me with:

April 2017: externally rotated my right knee while dancing and felt a "popping" sensation.
Symptoms: slight popping and crackling noises with periodic numbness. Unable to bear any weight on the right knee while squatting. 

April 2017 -- April 2018
Initially diagnosed with Patella-femoral knee syndrome and assigned to physiotherapists. X-rays and MRIs show nothing; I perform the physio therapy exercises but did not get better according to their expectations. My surgeon, who was skeptical I had any issue from the beginning, performs arthroscopy, but seemed... I guess not as committed; dismissive, and often spoke over my condition. "Remember pain does not correspond to damage" when I was not emphasizing pain but rather bio-mechanical dysfunction and a sense of "lacking" in my knee joint.

April 2018 -- April 2019
I hooked up with another physical therapist outside of my network. She was fantastic. She observes that when I try to squat my quadricep muscles shut off. She is able to get my VMO firing once again, and under her guidance my quadricep muscles improve and I get more flexible. However, the sense of "lacking" in my knee and sense that it's not functioning normally persists, which surprises her.

April 2019 to the present: 
Symptoms and characteristics of my knee
-- unable to swim with my right knee joint, as if something deep inside isn't there or functioning.
-- I am able to squat with some weight, but when I do, something in my knee joint feels "not there," and atmosphere of my knee joint feels "dry"   (meniscus I've learned lubricates the joint with synovial fluid)
-- an ultrasound revealed that upon performing a knee lunge, there is a white line -- probably fluid-- at the superior pole of my patella. The imaging doctor said he believed it was because of activity under the knee cap.
-- unable to perform leg extensions or leg presses, comfortably, of even just 50 pounds.
-- a persistent sense that my right knee joint is mysteriously pointing diagonally, to my right, even though both of my knee caps face the same direction.
-- on the elliptical machine, it feels like the right side of my knee joint is somehow not participating in the motion. almost like my shin down to my feet are pointing straight, but my knee is pointing diagonally to the right. It gives it a feel as if my shin downwards is connected to my right quad upwards by some sort of machine.

My latest theory: the lateral part of my meniscus did not heal properly, and could be comprised of scar tissue creating a lack of activity and feedback in that part of the knee, and my lack of performance and function. This condition has somehow evaded the two MRIs, arthroscopy, and feedback from orthopedic surgeons.  Orthopedic specialists have consistently spoken past my condition, telling me pain does not correspond to injury, when pain is not even the primary symptom causing me concern and causing me to go to them.

I've exhausted all the available resources: three physiotherapists and four orthopedic surgeons. Don't really know what else I could viably do other than having a follow up arthroscopy with a surgeon that I feel will take me at my word and not be dismissive.













Offline The KNEEguru

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Re: full circle with my knee
« Reply #1 on: November 19, 2019, 11:19:28 AM »
Did any of your investigations hint at a plica - eg mediopatellar plica or suprapatellar plica? Perhaps you can download Dr Blond's book and read up about it... https://www.kneeguru.co.uk/KNEEnotes/ebooks/overview-plica-problems-knee

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Offline BenAldridge0

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Re: full circle with my knee
« Reply #2 on: November 20, 2019, 07:28:43 PM »
Did any of your investigations hint at a plica - eg mediopatellar plica or suprapatellar plica? Perhaps you can download Dr Blond's book and read up about it... https://www.kneeguru.co.uk/KNEEnotes/ebooks/overview-plica-problems-knee

Hi there,

Thank you for responding. I emailed my surgeon who had performed arthroscopy on me, and he said I had no plica in my knee.

Offline Vickster

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Re: full circle with my knee
« Reply #3 on: November 20, 2019, 10:16:19 PM »
Did any of your investigations hint at a plica - eg mediopatellar plica or suprapatellar plica? Perhaps you can download Dr Blond's book and read up about it... https://www.kneeguru.co.uk/KNEEnotes/ebooks/overview-plica-problems-knee

Hi there,

Thank you for responding. I emailed my surgeon who had performed arthroscopy on me, and he said I had no plica in my knee.

What, if anything, did the surgeon find that might explain the pain? Has the knee improved since the surgery (assuming you've finished rehabbing)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline BenAldridge0

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Re: full circle with my knee
« Reply #4 on: November 21, 2019, 03:15:20 AM »
Did any of your investigations hint at a plica - eg mediopatellar plica or suprapatellar plica? Perhaps you can download Dr Blond's book and read up about it... https://www.kneeguru.co.uk/KNEEnotes/ebooks/overview-plica-problems-knee

Hi there,

Thank you for responding. I emailed my surgeon who had performed arthroscopy on me, and he said I had no plica in my knee.

What, if anything, did the surgeon find that might explain the pain? Has the knee improved since the surgery (assuming you've finished rehabbing)

Hi Vickster,

Thank you for the question. I want to be careful and clarify that pain is not my primary concern, but rather the changed sensation of my knee and the inability to perform weight bearing activities on it. These symptoms no surgeon or physical therapist has been able to explain, or even took a careful, diligent stab at trying to explain. In that sense, the diagnosis of patellafemoral knee syndrome has almost been a hindrance because in my experience it causes the medical community to speak PAST my actual condition.

My surgery was just arthroscopy with no findings. My surgeon has just said "remember pain does not correspond with injury," but he has never attempted to or been able to explain the primary symptoms that persist. His statement just speaks past my situation.

It is the prevalence of my symptoms that cause me to think meniscus in spite of the MRIs and arthroscopy :(


Offline Vickster

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Re: full circle with my knee
« Reply #5 on: November 21, 2019, 06:57:32 AM »
It seems surprising that the surgeon found nothing in addition to negative MRI

Even in patellofemoral syndrome, there is some sort of change to the synovium or articular cartilage in the form of chondromalacia, which an experienced knee surgeon would find in arthroscopy. Similarly, arthroscopy should show any change to the meniscus if done thoroughly (especially as he would have been trying hard to find something having put you through surgery). How old are you? What was the state of your meniscus under probing? A traumatic tear would normally have pain, swelling, biomechanical locking or buckling

Has your patella tracking been checked, also often an issue in PFS?  Why can't you weightbear if not due to pain? Has a physio done a thorough muscle assessment? Does a knee support or bracing help provide stability?

Have you seen anyone other than a surgeon (who are primarily interested in damage to the joint which they can fix surgically), like a sports physician who'll look more holistically that a knee specialist (e.g. At hips, feet, back all of which can affect the knee). And a neurologist for nerve conduction tests maybe (unpleasant but would look at nerve dysfunction). Even a psychologist who could help with some strategies for managing the symptoms and mental side of long-term knee issues.

Hope you get some resolution, good luck :)



« Last Edit: November 21, 2019, 07:07:05 AM by Vickster »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline BenAldridge0

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Re: full circle with my knee
« Reply #6 on: November 21, 2019, 07:11:57 AM »
It seems surprising that the surgeon found nothing in addition to negative MRI

Even in patellofemoral syndrome, there is some sort of change to the synovium or articular cartilage in the form of chondromalacia, which an experienced knee surgeon would find in arthroscopy. Similarly, arthroscopy should show any change to the meniscus if done thoroughly (especially as he would have been trying hard to find something having put you through surgery). How old are you? What was the state of your meniscus under probing? A traumatic tear would normally have pain, swelling, biomechanical locking or buckling

Has your patella tracking been checked, also often an issue in PFS?  Why can't you weightbear if not due to pain? Has a physio done a thorough muscle assessment? Does a knee support or bracing help provide stability?

Have you seen anyone other than a surgeon (who are primarily interested in damage to the joint which they can fix surgically), like a sports physician who'll look more holistically that a knee specialist (e.g. At hips, feet, back all of which can affect the knee). And a neurologist for nerve conduction tests (unpleasant but would look at nerve dysfunction).

Hope you get some resolution, good luck :)

Hi Vickster,

Good points and questions. I am currently 31 but was 28 at the time of my injury. I was the one who persisted in requesting arthroscopy because of my symptoms and the lack of improvement after doing the hospital's physical therapy protocols. It was about a year after my initial issue that I had arthroscopy.

There were zero abnormalities found or reported. My surgeon was experienced but not necessarily stellar. He was also skeptical there were any issues at all. I ended up having appointments with three more knee doctors, all of whom said I should be ok and it would take time. The last one was Dr. Stone of the Stone clinic, who I heard of through this forum.

Unfortunately my joint condition (whatever it is) never changed or improved in two and a half years. Two and a half years of my old lifestyle robbed from me without any explanation of my symptoms. It's been very hard.

Offline Vickster

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Re: full circle with my knee
« Reply #7 on: November 21, 2019, 07:46:17 AM »
Indeed it is hard. Hence, perhaps seeing a psychologist/counsellor for support and strategies.
Iíd also find a doctor who isnít a knee surgeon and would thus perhaps be more open minded about other potential causes.
Did you consult with Dr Dye who seems to be a bit more imaginative when it comes to PFS?
What makes a surgeon Ďstellarí if not knowledge and experience, who is a good listener. Personally I would avoid surgeons who think they are the Ďbestí (unless they truly are the expert in a very specific issue, eg Stone and meniscus transplant)
« Last Edit: November 21, 2019, 07:51:25 AM by Vickster »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline BenAldridge0

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Re: full circle with my knee
« Reply #8 on: November 21, 2019, 08:35:14 PM »
Indeed it is hard. Hence, perhaps seeing a psychologist/counsellor for support and strategies.
Iíd also find a doctor who isnít a knee surgeon and would thus perhaps be more open minded about other potential causes.
Did you consult with Dr Dye who seems to be a bit more imaginative when it comes to PFS?
What makes a surgeon Ďstellarí if not knowledge and experience, who is a good listener. Personally I would avoid surgeons who think they are the Ďbestí (unless they truly are the expert in a very specific issue, eg Stone and meniscus transplant)

Thanks Vickster,

Yes you're right. Dr. Dye could well be my next stop.  I've yet to run into anyone with PFS who has the same symptoms as I do. Recently browsing the post on this forum of someone with PFS, I was just reminded about how they seemed to be talking about an entirely different world than the one I'm experiencing.  Perhaps Dr. Dye could be the one to conclusively rule out PFS as being the correct "umbrella" to describe my terms.



Offline BenAldridge0

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Re: full circle with my knee
« Reply #9 on: November 21, 2019, 10:11:14 PM »
Indeed it is hard. Hence, perhaps seeing a psychologist/counsellor for support and strategies.
Iíd also find a doctor who isnít a knee surgeon and would thus perhaps be more open minded about other potential causes.
Did you consult with Dr Dye who seems to be a bit more imaginative when it comes to PFS?
What makes a surgeon Ďstellarí if not knowledge and experience, who is a good listener. Personally I would avoid surgeons who think they are the Ďbestí (unless they truly are the expert in a very specific issue, eg Stone and meniscus transplant)

One more thing Vickster,

Do I sound inaccurate in feeling like it's an issue with my meniscus? Does it truly sound like any case of PFS that you've heard of? I recognize you're not a medical expert, so I'll take it with a grain of salt... but I always end up feeling like I'm talking past people on my knee issue.
Thanks Vickster,

Yes you're right. Dr. Dye could well be my next stop.  I've yet to run into anyone with PFS who has the same symptoms as I do. Recently browsing the post on this forum of someone with PFS, I was just reminded about how they seemed to be talking about an entirely different world than the one I'm experiencing.  Perhaps Dr. Dye could be the one to conclusively rule out PFS as being the correct "umbrella" to describe my terms.

Offline Vickster

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Re: full circle with my knee
« Reply #10 on: November 21, 2019, 10:30:48 PM »
PFS being a syndrome means there arenít standard symptoms but a number that might occur
But usually the pain is around the front of the kneecap

Iíve had several meniscus tears (mine are degenerate so fraying). Pain walking, pain in joint lines, swelling, locking so unable to straighten and buckling have characterised mine. Pain being the common denominator so no it doesnít sound like meniscus esp as ruled out in scope. Iíve not heard of scopes missing meniscus tear (and mine have always been visible on MRI, although they can be missed)

Iíve never had PFS although I do have PF arthritis (as well as lateral and medial)

Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline BenAldridge0

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Re: full circle with my knee
« Reply #11 on: November 21, 2019, 11:15:27 PM »
PFS being a syndrome means there arenít standard symptoms but a number that might occur
But usually the pain is around the front of the kneecap

Iíve had several meniscus tears (mine are degenerate so fraying). Pain walking, pain in joint lines, swelling, locking so unable to straighten and buckling have characterised mine. Pain being the common denominator so no it doesnít sound like meniscus esp as ruled out in scope. Iíve not heard of scopes missing meniscus tear (and mine have always been visible on MRI, although they can be missed)

Iíve never had PFS although I do have PF arthritis (as well as lateral and medial)

Right that's a good point; PFS is an umbrella term. 

Some of your description does apply to me in the past: especially the pain in the joint line. That was just more indicative of the first two years. In the past year, joint line pain has not been as significant.

What about the other oddities, however? My right knee joint is "dry" when I attempt a squat on it (meniscus lubricates the joint); there is a sense of lacking in the right knee joint as well, like it has had a missing hinge for ever since my injury two and a half years ago. What if the meniscus just healed back abnormally because the condition was mismanaged? Could that potentially evade MRIs, and perhaps even arthroscopy?

Thanks for engaging with me I appreciate your input and experience.

Offline Vickster

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Re: full circle with my knee
« Reply #12 on: November 22, 2019, 10:47:36 AM »
I donít know. Meniscus is made of fibrocartilage which is like scar tissue any how and it does dry out and go brittle as we age (from 30 onwards)

Have you tried a viscosupplementation injection like Synvisc if the knee feels like it needs lubricating? Normally for arthritis but if your knee is dry maybe a consideration (avoid steroid tho)

Do you stretch the muscles from hips to feet regularly too? Tight calves can hinder squatting for example. Have you tried a series of sports massage focussed on legs, hips, lower back, all those muscles affect knee. Has your gait been professionally assessed?

Maybe youíre overthinking this all too much if you have no pain or inflammation?
It doesnít sound like any surgical intervention would be of benefit and no surgeon should be allowed near a pain, inflammation free knee in my view as youíll only end up with pain, inflammation and importantly some scar tissue
« Last Edit: November 22, 2019, 01:20:36 PM by Vickster »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline BenAldridge0

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Re: full circle with my knee
« Reply #13 on: November 22, 2019, 07:21:45 PM »
I donít know. Meniscus is made of fibrocartilage which is like scar tissue any how and it does dry out and go brittle as we age (from 30 onwards)

Have you tried a viscosupplementation injection like Synvisc if the knee feels like it needs lubricating? Normally for arthritis but if your knee is dry maybe a consideration (avoid steroid tho)

Do you stretch the muscles from hips to feet regularly too? Tight calves can hinder squatting for example. Have you tried a series of sports massage focussed on legs, hips, lower back, all those muscles affect knee. Has your gait been professionally assessed?

Maybe youíre overthinking this all too much if you have no pain or inflammation?
It doesnít sound like any surgical intervention would be of benefit and no surgeon should be allowed near a pain, inflammation free knee in my view as youíll only end up with pain, inflammation and importantly some scar tissue

No but that is something I will bring up if I see another sports doctor at Kaiser.  The past two and a half years was spent following physical therapy protocols. My right leg, generally speaking, is more flexible than my left, despite being more problematic -- that's one of the reasons that makes me think it's not a PT issue!!! 

I HAVE had pain, non stop, ever since I injured my knee. It's just that the pain itself is not the compelling reason that convinces me something deeper is going on, so I try not to emphasize it as much as it seems to distract people from being able to embrace my main symptoms which are the dysfunction of my bio-mechanics and sense of lack in my right knee.
I've also had sports massage and while that eased some of the general pain, it had no bearing on the deeper issues.

For the record, my arthroscopy was roughly a year after my injury, so maybe by then the meniscus was a little weird but not necessarily noticeable. I don't know... I just know that there is something seriously malfunctioned with my knee and that hospitals treat me like I'm crazy.  I was an athlete into sports from 5-28 and dealt with wear and tear injuries all the time. This knee issue is something totally different.

Offline Vickster

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Re: full circle with my knee
« Reply #14 on: November 22, 2019, 08:55:35 PM »
Ok. Good luck with whoever you see next :)

Have you had an MRI recently, perhaps one with a higher powered machine to get more detail? Or a CT scan (I had a SPECT [nuclear CT] of my foot which showed details that weren't visible on MRI)?
« Last Edit: November 23, 2019, 09:20:24 AM by Vickster »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up















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