Knee Issues: From Injury to Rehabilitation and Treatment Options

Knee issues?

Hello Dr.
Shi, I would like to ask you about my condition.
Approximately nine years ago, I was in a car accident that injured both of my knees, resulting in a hematoma.
The doctor mentioned that I had ligament damage, and although X-rays showed normal bone structure, I was still in the military at that time and could not complete my rehabilitation.
Since then, my knees have been making a cracking sound, and I experience weakness in both knees when squatting (such as when using the restroom).
About two years ago, I visited an orthopedic doctor who immediately noted that my kneecap was misaligned and suggested that surgery might be necessary for a complete resolution.
If I chose not to have surgery, I was advised to perform some rehabilitation exercises, which I opted to try, but the results seem limited.
Currently, I have started playing badminton about two to three times a week over the past three to four years.
However, two weeks ago, after playing, I suddenly noticed discomfort in my left knee.
The cracking sound when bending my left knee has persisted, but now when I move from bending to straightening, I feel a pulling sensation in a tendon (or ligament?), which is quite painful.
After resting for a few days, there was no improvement.
Even when I tightly secure a patellar strap or knee brace, I still experience the pulling sensation and pain in that tendon (ligament).
Additionally, I have noticed a decrease in the range of motion in my left knee; I can only bend it to about 110 degrees with significant effort (it used to be normal).

I would like to ask you, Dr.
Shi, what might be the issue here? Should I refrain from exercising and wait for gradual recovery, or should I promptly see an orthopedic specialist, a rehabilitation doctor, or a sports medicine specialist? Thank you very much for your response!

kevin, 30~39 year old female. Ask Date: 2016/06/29

Dr. Shi Guozheng reply Orthopedics

Lateral patellar malalignment often leads to increased friction on the cartilage.
If there is excessive physical activity, it can result in inflammation and pain symptoms.
Typically, resting will alleviate the condition; however, if this occurs frequently, it is advisable to consult an orthopedic specialist.
The current inability to bend the joint may be due to inflammation.

Reply Date: 2016/06/29

More Info

Hello! Thank you for sharing your concerns regarding your knee issues stemming from your past injuries. It sounds like you've been through quite a lot, and I appreciate your patience as you navigate this complex situation. Let's break down your concerns and explore the potential issues, treatment options, and rehabilitation strategies.

Understanding Your Knee Issues
From your description, it seems that you have a history of knee injuries, particularly involving ligament damage and possibly some structural misalignment. The "clicking" or "popping" sounds you hear when moving your knees can often be attributed to several factors, including:
1. Ligament or Tendon Issues: If the ligaments around your knee are damaged or if there is inflammation, it can lead to abnormal movement patterns, causing sounds during motion.

2. Cartilage Damage: Damage to the cartilage, such as a meniscus tear, can also lead to joint noises and pain during movement.

3. Patellar Tracking Issues: If the kneecap (patella) is not tracking properly in its groove, it can cause pain and clicking sounds, especially during activities like squatting or bending.

Current Symptoms and Concerns
Your recent symptoms of increased pain, reduced range of motion, and the sensation of a "muscle or ligament" being pulled during movement are concerning. These could indicate:
- Exacerbation of Previous Injuries: The increased discomfort after playing badminton could suggest that your knee has been stressed beyond its current capacity, potentially aggravating previous injuries.

- Possible New Injury: It’s also possible that you may have sustained a new injury, such as a strain or sprain, particularly if you felt a sudden change in your knee's function after playing.

Treatment Options
Given your situation, here are some recommendations:
1. Immediate Rest: It’s crucial to give your knee some time to rest, especially if you are experiencing pain and reduced mobility. Avoid activities that exacerbate the pain, such as jumping or sudden changes in direction.

2. Ice and Compression: Applying ice to the affected area can help reduce swelling and pain. Compression with a knee brace or wrap can provide support and limit swelling.

3. Physical Therapy: Since you have previously engaged in rehabilitation, it may be beneficial to consult a physical therapist again. They can assess your current condition and develop a tailored rehabilitation program focusing on strengthening the muscles around your knee, improving flexibility, and restoring proper movement patterns.

4. Consult a Specialist: Given the complexity of your symptoms, it would be wise to see an orthopedic specialist. They may recommend imaging studies, such as an MRI, to assess the condition of your ligaments, cartilage, and overall knee structure. This can help determine if surgical intervention is necessary.

5. Gradual Return to Activity: Once you have a clearer understanding of your knee's condition, you can gradually return to activities like badminton. Start with low-impact exercises and gradually increase intensity as tolerated.

Long-Term Considerations
If surgery is recommended, it could address underlying issues such as ligament reconstruction or realignment of the patella. However, if surgery is not an option, ongoing physical therapy and lifestyle modifications will be essential in managing your symptoms and maintaining knee function.

Conclusion
In summary, your knee issues are likely multifactorial, stemming from previous injuries and possibly exacerbated by recent activity. It is essential to rest, seek professional evaluation, and engage in a structured rehabilitation program. By addressing these concerns proactively, you can work towards improving your knee function and reducing pain, allowing you to return to the activities you enjoy.

If you have any further questions or need clarification, please feel free to ask. Your health and well-being are paramount, and I wish you the best in your recovery journey!

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