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Sports Medicine

Knee problems

08/01/2008

Question:

I am 23/M. I have injured my knee on a couple of different occasions: 1. Dislocated patella as well as a partial tear of the patellar tendon. 2. Severely sprained knee as well as a partially torn MCL.

My knee feels unstable at times and gives out sometimes, I`ve also had instances where it felt like it popped out of socket and then went back in quickly. If I put my hand on my kneecap and take it from a straight position to a bent position I can feel my knee grinding.

In the last 3 weeks I`ve been trying to be a little more pysically active and get in better shape. I run a couple times a week and play tennis (very slow, amature tennis) 2-3 times a week. Lately my knee has been either swollen of full of fluid, and has felt kind of warm, it is also either a stiff feeling or like its full of pressure. It also has kind of a radiating pain from the top and bottom and inside of the knee and if I bend it in a certain position un expectedly I get a very sharp shooting pain.

What is your opinon? I regularly ice it, take arthritis medicine for it and wear a brace when Im running and being active like that. The pain has been pretty bad the last couple of days.

Both times I have injured it the doctor told me I didn`t hurt it bad enough to require surgery and to just take it easy and be on crutches.

Answer:

Your pain could be coming from several locations. 

1)Given your history of patellar dislocations, the instability you feel may be originating from a kneecap that is not tracking well within the patellar groove.  Also, it is common to have arthritic changes on the back of the kneecap after your type of injury, which is what is causing that grinding sensation you describe. 

2)Given your history of injury, you may have a torn meniscal cartilage in the knee causing the sensation of giving way and "popping out of socket"  although this could also be caused by your kneecap as described above.  Both a cartilage tear or unstable patella with arthritis could cause the swelling and fluid you mentioned.

The knee brace and regular exercise you are doing is good as well as using anti-inflammatory medications.  Glucosamine may be helpful and is worth giving a try.  However, given you attempts to be active and recurrent symptoms, it would be reasonable to consider an MRI to determine the exact cause of your symptoms.  A large meniscal tear would have a surgical repair as a possibility whereas degenerative arthritis could have you consider steroid or synvisc injections to help with your symptoms.  These things can all be discussed with your physician to determine the best course of action.

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Response by:

Charles Webster, MD
Assistant Professor
College of Medicine
University of Cincinnati