Deep Knee Pain: Causes and Treatment Options - Orthopedics

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Understanding deep knee pain can be quite complex, especially when it has persisted for several years, as in your case. Based on your symptoms and the information you've provided, it seems like you are experiencing pain primarily in the front of the knee, particularly during activities that put stress on the knee joint, such as kneeling, squatting, running, or cycling.

Possible Causes of Deep Knee Pain
1. Patellar Malalignment: You mentioned that some doctors have suggested patellar malalignment (patellar tracking issues). This occurs when the kneecap does not move smoothly in its groove at the end of the thigh bone (femur). This misalignment can lead to increased pressure on the cartilage and surrounding tissues, resulting in pain.

2. Chondromalacia Patella: This condition involves the softening and breakdown of the cartilage on the underside of the kneecap. It is often associated with patellar malalignment and can cause pain during activities that put stress on the knee.

3. Synovial Plicae: You also mentioned the presence of a synovial plicae in your MRI report. This is a remnant of embryonic tissue that can become inflamed and cause pain, especially during movement.

4. Meniscal Issues: Although you have had surgery for a meniscal tear, it is possible that there are residual issues or new tears that could be contributing to your pain.

5. Osteoarthritis: Given the duration of your symptoms, osteoarthritis could be a contributing factor, especially if there is any degeneration of the cartilage in the knee joint.

6. Tendinopathy: Pain in the knee can also arise from issues with the tendons, such as patellar tendinopathy, which is common in athletes and can cause pain during activities that involve jumping or running.


Treatment Options
1. Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can provide exercises to strengthen the muscles around the knee, improve flexibility, and correct any biomechanical issues. This can help alleviate pain and improve function.

2. Activity Modification: Since you have already stopped running, it might be beneficial to avoid activities that exacerbate your pain. Low-impact exercises, such as swimming or cycling on flat terrain, can help maintain fitness without putting excessive strain on your knees.

3. Pain Management: Over-the-counter pain relievers like NSAIDs (ibuprofen or naproxen) can help manage pain and inflammation. However, it is essential to consult with your physician before starting any medication.

4. Injections: Corticosteroid injections can provide temporary relief from inflammation and pain. Hyaluronic acid injections are another option that some patients find beneficial for knee osteoarthritis.

5. Bracing: A knee brace can help stabilize the knee and alleviate pain during activities. It can also assist in correcting patellar alignment.

6. Surgical Options: If conservative treatments fail, surgical options may be considered. This could include arthroscopy to clean out the joint, realignment of the patella, or even partial or total knee replacement in severe cases.

7. Alternative Therapies: Some patients find relief through acupuncture or other alternative therapies. While the evidence is mixed, these methods may provide additional pain relief.


Conclusion
It is crucial to work closely with your healthcare provider to determine the most appropriate treatment plan tailored to your specific condition. Given the complexity of knee pain, a multidisciplinary approach involving orthopedic specialists, physical therapists, and possibly pain management specialists may yield the best results. Regular follow-ups and adjustments to your treatment plan will be essential in managing your symptoms effectively.