Knee Injuries: Symptoms, Diagnosis, and Treatment Options

Knee cap injury?

In December of the year before last, I injured my left knee while dancing, causing a loud pop that made me fall to the ground.
A few years prior, I had a similar incident where I heard a pop while turning incorrectly, but it wasn't as severe.
After the injury two years ago, I experienced pain in my left knee for a whole week, during which I couldn't bend it, and it became swollen.
I eventually recovered, but since then, I've occasionally had pain, and in recent months, I've been experiencing daily pain.
Sometimes it feels like sharp pain, and at times I can barely walk.
I have seen two orthopedic doctors; one diagnosed me with chondromalacia, while the other said I have knee inflammation.
Neither of them took X-rays.
I also consulted a traditional Chinese medicine practitioner who mentioned that I have bow legs.
Recently, I noticed a small bone protrusion under my left knee that is painful when pressed, and kneeling also causes pain.
Walking can sometimes be painful.
Should I go to a major hospital for further examination? Thank you.

nei nei, 10~19 year old female. Ask Date: 2017/05/27

Dr. Shi Guozheng reply Orthopedics

You may need to see an orthopedic specialist, and it might be necessary to get an X-ray examination.

Reply Date: 2017/05/27

More Info

Knee injuries can be complex and multifaceted, often involving various structures such as ligaments, cartilage, and bones. Based on your description, it seems that you have been experiencing ongoing pain and discomfort in your left knee following an injury that occurred while dancing. This type of injury can lead to several potential issues, including ligament sprains, cartilage damage, or even bone-related problems.

Symptoms and Possible Diagnoses
1. Pain and Swelling: The immediate pain and swelling you experienced after the injury are common signs of a knee injury. This could indicate inflammation of the joint, which may be due to a sprain, strain, or damage to the cartilage or ligaments.

2. Limited Range of Motion: Your inability to bend the knee fully after the injury is a significant symptom. This limitation can be due to swelling, pain, or mechanical issues within the knee, such as a meniscus tear or loose bodies within the joint.

3. Chronic Pain: The ongoing pain you describe, particularly if it feels like "sharp" or "shooting" pain, could suggest issues like patellofemoral pain syndrome, osteoarthritis, or chondromalacia patellae (softening of the cartilage under the kneecap).
4. Bony Protrusion: The bony prominence you mentioned could be a sign of bone spurs or other structural changes in the knee joint, which can develop due to chronic inflammation or wear and tear over time.

Diagnostic Steps
Given your symptoms and the duration of your discomfort, it would be prudent to seek further evaluation at a specialized orthopedic clinic or hospital. Here are some diagnostic steps that may be recommended:
- Imaging Studies: While you mentioned that previous doctors did not perform X-rays, imaging is crucial for a comprehensive assessment. An X-ray can help rule out fractures or bone spurs, while an MRI is particularly useful for evaluating soft tissue structures like ligaments and cartilage. An MRI can provide detailed images of the knee joint, helping to identify any tears in the meniscus or ligaments, as well as assessing the condition of the cartilage.

- Physical Examination: A thorough physical examination by an orthopedic specialist can help assess the stability of the knee, the range of motion, and any areas of tenderness or swelling. Tests such as the Lachman test or the McMurray test can be used to evaluate ligament integrity and meniscal tears.

Treatment Options
Depending on the findings from your evaluation, treatment options may vary:
1. Conservative Management: If the injury is determined to be a mild sprain or inflammation, conservative treatment may include rest, ice, compression, and elevation (RICE). Physical therapy can also be beneficial to strengthen the muscles around the knee and improve flexibility.

2. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and reduce inflammation. Your doctor may also recommend corticosteroid injections if inflammation is significant.

3. Surgical Intervention: If imaging reveals significant damage, such as a torn meniscus or ligament, surgical options may be considered. Arthroscopic surgery is a minimally invasive procedure that can repair or remove damaged tissue.

4. Rehabilitation: Regardless of the treatment approach, rehabilitation is essential for recovery. A physical therapist can guide you through exercises to restore strength and function to your knee.

Conclusion
In summary, your ongoing knee pain and the symptoms you've described warrant further investigation. Seeking a comprehensive evaluation at a hospital or orthopedic clinic is advisable. Early diagnosis and appropriate treatment can significantly improve your outcomes and help prevent further complications. Remember, the knee is a complex joint, and addressing any issues promptly is crucial for maintaining mobility and quality of life.

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