Knee Pain: The Impact of Leg Raises After Surgery

Leg raises can cause knee pain?

Five years ago, I underwent arthroscopic surgery for patellar chondromalacia combined with patellar malalignment.
After the surgery, I received high-dose hyaluronic acid injections and a course of PRP therapy.
Nine months post-surgery, I began experiencing a sharp pain in my knee.
Since it was tolerable and didn't involve any audible sounds, I didn't seek medical attention.
Recently, someone told me that performing leg raises with my foot pointed forward should not cause pain in the middle of my knee, which prompted me to see a doctor.
However, the X-ray results were normal, the cartilage had regenerated, and the patella had returned to its proper position.
Why is it that when I raise my leg, as long as my foot is not pointed towards my body, I do not experience pain? When I squat, my feet become numb, but resting alleviates the discomfort.
However, getting up directly from a squat is difficult; I usually have to sit down first, straighten my painful knee, and then rest before using something to help me stand up.
Why is this happening? Please let me know.
Thank you!

Bai Bai, 20~29 year old female. Ask Date: 2017/04/23

Dr. Shi Guozheng reply Orthopedics

The cartilage in the patella may have issues, causing discomfort when standing up from a squatting position.

Reply Date: 2017/04/23

More Info

Understanding knee pain, especially after surgeries like arthroscopy for patellar chondromalacia and patellar malalignment, can be complex. Your experience of pain during leg raises and other movements is not uncommon, and it can be attributed to several factors related to the surgical procedure, the healing process, and the mechanics of the knee joint.

Firstly, after knee surgery, it is essential to understand that the knee undergoes a significant amount of trauma, not just from the injury itself but also from the surgical intervention. The pain you experience during leg raises, particularly when the foot is pointed forward, may be due to several reasons:
1. Soft Tissue Healing: After surgery, the soft tissues around the knee, including ligaments, tendons, and muscles, need time to heal. If you are experiencing pain during specific movements, it could indicate that certain structures are still sensitive or not fully healed. Pain during leg raises may suggest that the quadriceps muscle or the patellar tendon is not yet strong enough to support the movement without discomfort.

2. Muscle Atrophy: Following surgery, it is common for muscle atrophy to occur, especially in the quadriceps. If the muscle is weak, it may not stabilize the knee joint effectively during movements like leg raises, leading to pain. Engaging in rehabilitation exercises that focus on strengthening the quadriceps and surrounding muscles can help alleviate this issue over time.

3. Patellar Tracking: The patella (kneecap) needs to track properly within the femoral groove during movement. If there is any misalignment or if the muscles around the knee are not functioning optimally, it can lead to pain during specific movements. The fact that you mentioned the pain is less when the foot is pointed forward may indicate that this position allows for better tracking of the patella compared to other positions.

4. Nerve Sensitivity: Post-surgical changes can lead to increased sensitivity in the knee area. This can manifest as pain or discomfort during certain movements, especially if there is any irritation of the nerves surrounding the knee joint.

5. Knee Mechanics: The mechanics of the knee can be affected by previous injuries, surgeries, and the overall alignment of the lower extremity. If you find that squatting causes your foot to feel numb, it may indicate that the position is placing undue stress on certain structures, leading to nerve compression or other issues.

To address these concerns, consider the following recommendations:
- Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can provide exercises tailored to your specific needs, focusing on strengthening the quadriceps, improving flexibility, and enhancing overall knee function.

- Gradual Progression: When performing exercises like leg raises, start with low resistance and gradually increase as your strength improves. Pay attention to your body and avoid pushing through pain.

- Pain Management: If pain persists, consider discussing pain management strategies with your healthcare provider. This may include modalities such as ice, heat, or anti-inflammatory medications.

- Follow-Up: Regular follow-up appointments with your orthopedic surgeon or healthcare provider are essential to monitor your progress and address any ongoing concerns. If pain continues or worsens, further imaging or evaluation may be necessary to rule out any complications.

In summary, while it is encouraging that your X-rays show normal findings and cartilage regeneration, the pain you experience during specific movements can be attributed to a combination of healing tissues, muscle strength, and knee mechanics. By focusing on rehabilitation and addressing these factors, you can work towards improving your knee function and reducing pain.

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