Suggestions please Knee pain for 8 months

[GeorgieR]

I have had left knee pain for 8 months now. The pain is in the kneecap area and sometimes radiates down into the ankle and up into the thigh. It also clicks every time that I straighten or bend it which causes pain.
It is worse after sitting for a day with it bent or walking for long periods.
It is getting worse, particularly end of each day. I am taking up to 8 Panadol/Ibuprofen a day. Pain can be throbbing (pulsing), burning or cramping.

I have been doing physio for the last 6 months and during this time I have done strengthening exercises, taping, bracing, dry needling and iced it.
I have recently had a MRI done, which didn’t sure much apart from a decent amount of inflammation in the knee joint and what they called fusing of the joint….

Would like some suggestions as to what I should try from here.

[vickster]

Has the physio mentioned something called anterior knee pain or patellofemoral syndrome as a diagnosis?

https://www.kneeguru.co.uk/KNEEnotes/primers/patella/pain-syndromes-related-patella#pain-front-of-knee

Have you seen a knee specialist doctor/surgeon?

What is your job, do you spend a lot of time standing, walking, sitting, crouching that might be aggravating? Or any sport?

Also have you discussed medication with your doctor? Taking a lot of ibuprofen or anti inflammatory can be bad for your stomach, are you also taking a medication called a PPI to protect your stomach (something like omeprazole?)  if not, do talk to the doctor ASAP
A topical gel like voltaren is safer but not completely, could discuss that too. There are other stronger prescription medications you could also discuss.

If it is PFS due to overuse, often proper rest and severe restriction of walking and activity over many months is likely needed

Also get the physio to look at your feet to see if insoles might be helpful and your footwear, should be supportive, should not be flip flops or sandals or bare feet.

Get the full results of the MRI, discuss with physio and specialist and take it from there.

Good luck

[GeorgieR]

Thanks for that.
No don't think they did mention that, originally they were thinking it could be a menicus tear but that showed up all clear on the MRI.
No I haven't seen a specialist, didn't know if it was worth it?....
Most the day sitting, which seems to make the knee cramp up quite bad after an hour or so. Was running but haven't done that for the last few months cause of the pain.
Thanks, think it might be worth discussing pain meds with the gp again.
Yes I have had orthotics in my shoes for the last 18 months, this was suggested for back pain/hip pain as I have scoliosis.
Thanks for your help.

[vickster]

After 8 months, I’d see a specialist if just to get a fresh examination and review of the MRI. Pain around the kneecap doesn’t sound specifically like a meniscus tear but could be there. Meniscus tears are often missed on MRI but if the radiologist was specifically asked to look for it, that would be less usual.

Running is a common cause of anterior knee pain, stopping is sensible. Swimming or cycling are much more knee friendly

Perhaps the issue with your back/hip is aggravating the knee, knees can be heavily affected by everything else, presumably the physio has assessed your glutes,hip flexors, hamstrings etc and provided exercises to address any weakness or imbalance?
Do you also work on your core given the back issues?

[GeorgieR]

Thank you for your help.
Wasn't really sure where to take it from here but that has helped.
Yes, have been doing a number of strengthening/core exercises over the last 6 years or so.
Many thanks

[SuspectDevice]

Also, put a box under your desk so you can work with your leg out straight, not bent.  I still do this at work.

And Google the work done by Dr Scott Dye, Richard Bedard, Paul Ingraham, Doug Kelsey on the issue of loss of tissue homeostasis in the knee.  That was my main problem.  Took a long time to get under control (5+ yrs) but it was the answer to my anterior knee pain issues.

[GeorgieR]

Thanks for your help. Saw a specialist last week and had surgery today.
He said there was a medial plica from medial pad to fat capsule. Also large ligamentum synovium with teething to fat pad, grade 1 chondromalacia lat edge MFC.
So he debridement medial plica and ligamentum synovium with shave.Minor chondroplasty MFC . As well as LA + celestone

[react2resist]

Thanks for your help. Saw a specialist last week and had surgery today.
He said there was a medial plica from medial pad to fat capsule. Also large ligamentum synovium with teething to fat pad, grade 1 chondromalacia lat edge MFC.
So he debridement medial plica and ligamentum synovium with shave.Minor chondroplasty MFC . As well as LA + celestone

Let us know how it goes!

[Iris123]

Hello,
how are you after the surgery?
May I ask you why a minor chondroplasty was performed for just a first degree  of chondromalacia?
What does this chondroplasty consist of?
thank you

[GeorgieR]

Going okay thanks. Swelling is starting to go down, and getting more range.
Just have quite a bad ache, worse in the thigh for some reason. But guess that's all to be expected. 
Regarding the chondroplasty, I haven't spoken to the specialist properly since (only very briefly), but from I understand he trimmed/removed the damaged cartilage/tissue.
I see the specialist on Tuesday for a post op appointment so should get a better idea then.

[GeorgieR]

Just chasing some more advise.....
It is over 4 months since my arthroscope but my knee still isn't 100%.
Still painful if i try to do too much so I haven't got back to running yet. Also it is quite clunky first thing in the morning.
Pretty much every evening around 9pm the front of the knee (knee cap area) goes red, hot and burns. Any suggestions on what this might be?

[jgardner]

Hi GeorgieR,

Sorry to hear you are experiencing so much pain. Some people feel a lot better 4 months out from arthroscopy, but others take longer to heal. Perhaps a check in with your medical team would be helpful.

I'm not a physician or a therapist, but for what it is worth, I'll share a few thoughts...

Sounds like you are experiencing some inflammation in the evening. See SuspectDevice's post above...could be synovitis brought on by doing more than your knee can handle right now. Perhaps you can identify the exercises or activities that you are reacting to and eliminate them?

Also, since you experience that inflammation around the same time every evening, maybe you can get ahead of it and do some icing a little earlier in the evening (8 PM?) to prevent some of that inflammation.

I'm a runner so I totally get why you would want to get back to it. You should probably wait until your knee is  more stable and less reactive before trying. You also need to have good quad strength to absorb the shock of running.

I'm about a year out from right knee mosaicplasty surgery and I've only just started to do a few short jogging intervals. I started with a little slow walking every other day. I gradually (over about 3 months) worked up to 20 minutes of brisk walking before even trying to do a few seconds of running. I don't know if my story will have a happy ending, but patience does appear to be paying off right now.

[GeorgieR]

Thanks jgardner!
I have been icing and taking anti inflammatories for the last few weeks and unfortunately there hasn't been any difference.
Over the last day of so there has been constant pain and the knee is staring to make a clicky/clunk noise again which I'd what I had before surgery. I have a physio appointment tomorrow so hopefully get more answers.

[SuspectDevice]

Yes, the 'red, hot, burning' means you need to take great care as that is a key sign of possible loss of tissue homeostasis/chronic inflammation of knee structures like the synovial lining.  All the Dr Scott Dye stuff which I finally discovered which got me on the path to recovery.

I had those symptoms and it took 6 years to sort out!

Returning to running too early will only send you down a path you don't want to go.

I had to get my aerobic fix through swimming & gym only for many years, run & cycle were out - not ideal, but better than nothing.  And I did all my freestyle swimming with no/minimal kicking using a pull buoy between the thighs and my ankles strapped together.

I'd also warn of being very careful with PT/physio.  All the ones I saw were fixated on building leg (esp. quad) strength & their exercises only made me worse.  5-6 months on Celebrex was the only thing that got my inflammation down to a level where I could safely start to build strength - and hip/glute/core/back strength to take the load off my knees was far more important than quad strength in my case.

Edit to say, using a TENS machine also gave me a lot of symptomatic relief.  Ice seemed to do nothing when the symptoms were really bad, but later as they subsided, icing was good & I still ice today if I've overdone things.

[GeorgieR]

Hey SuspectDevice,

Thanks for that info! Helps a lot.
I have wondered if the physio may have aggravated things a bit.
OS has decided to do another MRI of the knee and take it from there.
Pretty much back to where I was pre op, but the pain is in a different area. He is wondering if it is new issue.

[GeorgieR]

Hello,

After a few discussions with the specialist he decided to do another mri, had this done and it showed up abnormalities so had a ct scan done as well.

Basically the specialist is saying the knee bone is badly inflamed and there appears to be a issue with blood supply to the knee joint. He is suspecting AVN. I have a face to face appointment with him this week to try work out what's causing it (last few appointments have been on the phone). But in the last week or so my other knee (right knee) has been having similar issues, it goes bright red and burns, pain on the inside of the knee when I bend it.
Hoping to hear if anyone has experience this or have suggestions as to what might be causing it?

[SuspectDevice]

Hello,

After a few discussions with the specialist he decided to do another mri, had this done and it showed up abnormalities so had a ct scan done as well.

Basically the specialist is saying the knee bone is badly inflamed and there appears to be a issue with blood supply to the knee joint. He is suspecting AVN. I have a face to face appointment with him this week to try work out what's causing it (last few appointments have been on the phone). But in the last week or so my other knee (right knee) has been having similar issues, it goes bright red and burns, pain on the inside of the knee when I bend it.
Hoping to hear if anyone has experience this or have suggestions as to what might be causing it?

Now that it is also in the other knee, still makes me think about the Dr Scott Dye loss of tissue homeostasis issue.

My problems were in both knees.  Red, hot & burning, but not just pain on bending, pain most of the time, and made worse by too much movement/stress on the knees.

I know nothing about AVN, never even heard of it.

[vickster]

Have you seen a pain specialist? Has CRPS/RDS been ruled out if there’s discolouration and heat?
Or a rheumatologist to check for something systemic?

[GeorgieR]

Thanks for the replies.
Have been on anti inflammatories for a few weeks. Apprently there is less inflammation in last mri but still in just as much pain, still have red burning pain, etc.
Surgeon is referring me to a pain specialist. If I don't get anywhere with this he will consider another arthroscope as last mri showed further issues with the fat pad.
No haven't heard of CRPS.
Pain is really starting to get on top of me. Interfering with sleep etc, not far from breaking :'(