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Sports Medicine

Knee Pain

02/15/2011

Question:

I started a new high impact workout regimen 5 weeks ago and began having pain on the medial side of my left knee. The workouts consisted of a lot of plyo, power jumps, lunges, and squats. It is a sharp pain on the inside of my knee that is worse when I`m standing still. I had an MRI done that showed no meniscal tear, patella is aligned and intact,small joint accumulation, and mild chondromalacia on lateral aspect. My doctor did not go over the results in fact the only reason I know the results of the MRI is because I requested a copy of the report. He prescribed therapy and a patellar realignment brace. If the MRI says my patella is aligned why would I need a brace? And why does the MRI show chondromalacia of the lateral aspect when my pain is located on the medial side only? (I have no pain in anterior part of my knee or patella)

Answer:

It is not unusual for patellofemoral pain to present with medial- sided knee pain, which can be initially misdiagnosed as a medial meniscus tear due to its medial rather than anterior location. This medial pain may be due to repetitive tugging forces upon the medial attachments of the connective tissue (retinaculum) which surrounds or invests the patella.

A knee MRI is a "static" assessment, whereas the basis for patellofemoral symptoms is "dynamic." That is, patellar malalignment or maltracking, if present, may only be evident when motion is occurring, and possibly only when the foot is in contact with a surface ("closed kinetic chain").

You may be aware that patellofemoral pain can result from weakness at the hip or hyperpronation of the foot, in which cases the knee MRI may well be normal.

Chondromalacia ("cartilage softening") is an anatomic term, but does not necessarily mean there are any symptoms associated with it. MRI scans may reveal findings which do not necessarily correlate with a person's symptoms. One of the many subtypes of patellofemoral pain is "excessive lateral pressure syndrome," that is excessive contact forces between the lateral patella and the underlying femoral condyle. This condition would be one potential cause for patellar chondromalacia being located predominantly laterally, but this may or may not pertain to your situation.

You may wish to follow up with your physician to clarify how much of the above applies to you, and discuss the basis for the treatment recommendations so that you're comfortable proceeding forward with them.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University