Knee Discomfort: Causes and Treatment Options

Occasional mild swelling and soreness in the knee affecting physical activity?

Hello, Doctor! Over the years, my knee has been injured multiple times due to motorcycle riding and sports.
I thought it was just external injuries and paid little attention to it, and it seemed to recover without issues.
However, three years ago, while jogging, my right knee started making a sound, like a friction noise between muscle and bone, which got louder as I continued running, forcing me to stop exercising.
The next day, my knee gradually swelled up.
I consulted several doctors, and aside from prescribing muscle relaxants and advising me to rest, they couldn't determine the underlying issue.

For the next two years, the problem persisted intermittently, characterized by no pain but occasional weakness and a feeling of heaviness at specific angles (which is difficult to replicate).
The affected areas are on the lower right or lower left side of my right knee, and occasionally about 1 cm above the knee.
It does not affect walking or climbing stairs, but running and descending stairs can be uncomfortable, and at times, it may even cause slight pain.

I have seen several doctors in between, and they all suggested inflammation and prescribed muscle relaxants along with anti-inflammatory pain relief.
This year, I have almost stopped exercising, yet there has been no improvement.
I would like to ask the doctor what my potential issue could be and what tests I should undergo at the hospital.
A friend introduced me to PRP therapy; could you provide me with some advice on that? Thank you for taking the time to help, and I wish you good health and well-being.
Thank you!

AL, 40~49 year old female. Ask Date: 2016/04/27

Dr. Shi Guozheng reply Orthopedics

It is possible that there is an issue with the patellar cartilage.
An X-ray can be taken at the hospital to examine the relative position of the patella and the femoral joint, as well as to check for any lesions on the patella.
Platelet-rich plasma (PRP) is more effective for the treatment of osteoarthritis, while its efficacy for ligament repair is still inconclusive.
In any case, it is essential to confirm the diagnosis before deciding on the treatment plan.

Reply Date: 2016/04/27

More Info

Knee discomfort can arise from a variety of causes, especially in individuals with a history of injuries or repetitive strain, such as from sports or accidents. Given your description of the symptoms and the history of knee issues, it’s important to consider several potential underlying conditions and appropriate treatment options.

Possible Causes of Knee Discomfort
1. Patellofemoral Pain Syndrome (PFPS): This condition is common among runners and can result from improper tracking of the kneecap (patella) during movement. Symptoms often include pain around or behind the kneecap, especially during activities like running, squatting, or going up and down stairs.

2. Iliotibial Band Syndrome (ITBS): This occurs when the iliotibial band, a ligament that runs along the outside of the thigh from the hip to the shin, becomes tight or inflamed. It can cause pain on the outer side of the knee, particularly during running or descending stairs.

3. Meniscus Tear: Given your history of knee injuries, a tear in the meniscus (the cartilage that cushions the knee joint) could be a possibility. Symptoms may include swelling, stiffness, and a sensation of the knee locking or catching.

4. Patellar Tendonitis: Also known as "jumper's knee," this condition results from overuse of the knee joint, leading to inflammation of the patellar tendon. It can cause pain just below the kneecap, particularly during activities that involve jumping or running.

5. Osteoarthritis: Chronic knee pain and discomfort can also be a sign of osteoarthritis, especially if there is a history of joint injuries. This degenerative joint disease can lead to cartilage breakdown, resulting in pain, swelling, and reduced mobility.

Recommended Diagnostic Tests
To accurately diagnose the issue, you should consider the following evaluations:
- X-rays: These can help rule out fractures, dislocations, or significant joint degeneration.

- MRI: This imaging technique is particularly useful for assessing soft tissue injuries, including meniscus tears, ligament injuries, and cartilage damage.

- Ultrasound: This can be used to evaluate soft tissue structures around the knee, including tendons and ligaments.

Treatment Options
1. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles around the knee, improve flexibility, and correct any biomechanical issues. A physical therapist can tailor exercises to your specific needs.

2. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation. Muscle relaxants may also be prescribed if muscle tightness is contributing to your discomfort.

3. Activity Modification: Reducing high-impact activities like running and focusing on low-impact exercises (e.g., swimming, cycling) can help alleviate symptoms while maintaining fitness.

4. PRP Therapy: Platelet-rich plasma (PRP) therapy involves injecting a concentration of platelets derived from your blood into the knee joint. This treatment aims to promote healing of damaged tissues. While some patients report positive outcomes, the effectiveness can vary, and it’s essential to discuss this option with a healthcare provider familiar with your specific condition.

5. Injections: Corticosteroid injections can provide temporary relief from inflammation and pain. Hyaluronic acid injections may also be considered for osteoarthritis.

6. Surgery: If conservative treatments fail and significant structural damage is identified (e.g., meniscus tear), surgical options may be necessary. This could involve arthroscopy to repair or remove damaged tissue.

Conclusion
Given your ongoing symptoms and the impact on your quality of life, it is advisable to seek a comprehensive evaluation from an orthopedic specialist. They can provide a thorough assessment and recommend appropriate diagnostic tests. Based on the findings, a tailored treatment plan can be developed to address your knee discomfort effectively. Remember, early intervention can often lead to better outcomes, so don’t hesitate to pursue further medical advice.

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