Persistent Knee Pain After Injury: Seeking Answers and Solutions

Severe pain persists in the knee two and a half months after the injury?

Hello Doctor: Thank you for your tireless efforts in answering the questions of netizens.
I truly appreciate it.
In mid-February, while running, I tripped over an unknown object and fell, landing on both knees.
The pain was so intense that I lay on the ground for several minutes, unable to get up.
My right knee immediately swelled to the size of a bun.
I later went to the hospital for an X-ray, and the doctor said there were no fractures and that I would recover in two weeks.
I took this at face value and calmly waited for three weeks, but my knees were still very painful.
I then sought treatment at a well-known teaching hospital.
The doctor performed a physical examination and also said there was no issue, assuring me I would be fine in another two weeks.
After taking medication for another two weeks, a total of six weeks had passed, and my knee condition showed no improvement; in fact, the pain worsened.
After sitting for more than ten minutes, my knee joints would swell and hurt, making it impossible for me to stand for long, sit for long, or walk continuously for more than 15 minutes.
The pain in my knees was constant, and the swelling felt more frequent than my breathing.
Later, I had an MRI, and the doctor said I had a partial tear of the left anterior cruciate ligament (ACL) and joint effusion, while the right knee had a bone fracture and cartilage damage.
I was advised to rest for another month, and if the pain persisted, I would need arthroscopic surgery to repair the ligament.
However, I consulted three or four other doctors with the same MRI images.
One doctor mentioned meniscus wear, while three others said there was no issue with the ligaments or meniscus.
Yet, I was in so much pain that I couldn't sleep at night, and the pain had severely affected my mental well-being.
Three days ago, a doctor suggested that PRP (platelet-rich plasma) injections might provide relief.
I self-funded PRP injections in both knees along with anti-inflammatory medication, but the pain remains significant.
I have diligently followed rehabilitation, ultrasound therapy, heat therapy, electrical stimulation, and quadriceps exercises for over three weeks, all according to the doctor's instructions, but I haven't felt any improvement in my knees.
The most painful area is the lower edge of the most prominent part of the inner knee.
When pressed, it is extremely painful.
During the PRP injection, two nurses mentioned that this area corresponds to the meniscus, but the doctor stated that my meniscus was fine, although the injection was administered from that location.
My left knee has also been experiencing locking and instability, but during the physical examination, the doctor pulled on it and said, "This indicates the ligament is still intact, just a bit looser than the right knee." I would like to ask: 1.
After two and a half months, if there are no issues with the ligaments or meniscus, is it normal for someone to experience such pain? 2.
Is the location of my severe pain indicative of a meniscus injury? 3.
Why do different doctors interpret the same MRI images differently? According to the MRI report I obtained, the impression for the left knee is "Intrasubstance injury of PCL," while for the right knee, it is "Nondisplaced fracture of patella." The doctor had previously told me it was a partial tear of the left ACL; why does the specialist's report mention the PCL instead? I have been in excruciating pain for the past two and a half months.
Before I requested the PRP injections, the doctor saw my suffering and was even willing to administer steroids for relief.
I have always trusted the doctors' diagnoses, believing that the tense doctor-patient relationship in Taiwan requires patient trust and cooperation to progress.
However, now that two and a half months have passed, the pain I experience every moment has made me extremely anxious and depressed.
I would like to ask the doctor how I should resolve this.
If experiencing pain for two and a half months is considered normal, how much longer should I expect to be in pain? Four months? Six months? Or is it normal for it to last even longer? Thank you, doctor, for reading and responding.
I truly appreciate it.

Ni Ni, 30~39 year old female. Ask Date: 2018/04/24

Dr. Chen Yongxue reply Orthopedics

Hello, both meniscus and cruciate ligament injuries cannot be diagnosed with X-rays; an MRI is necessary.
Regarding the interpretation of MRI results, there can be some margin of error.
PRP injections cannot alleviate pain from a right knee fracture; if there is no displacement, it will heal gradually—being impatient is not a solution.
As for the left knee, a partial tear of the cruciate ligament will not heal on its own, but stability of the knee joint can be improved through muscle training.
Thank you.

Reply Date: 2018/04/24

More Info

I'm sorry to hear about your ongoing knee pain and the challenges you've faced since your injury. It sounds like you've been through a lot, and it's understandable to feel frustrated and anxious given your situation. Let's address your concerns one by one.

1. Persistent Pain Despite No Apparent Damage: It's not uncommon for individuals to experience significant pain even when imaging studies like X-rays and MRIs do not show clear injuries. Pain can arise from soft tissue injuries, such as ligament sprains, meniscus tears, or inflammation in the joint, which may not always be visible on imaging. Additionally, the body can react to trauma with inflammation, which can lead to pain and swelling long after the initial injury.

2. Location of Pain and Meniscus Injury: The area you describe as being the most painful could indeed be related to a meniscus injury. The meniscus is a C-shaped cartilage in the knee that acts as a cushion and stabilizer. If there is an intrasubstance injury or a tear, it can cause localized pain, especially when pressure is applied. Your description of pain in the inner part of the knee aligns with common symptoms of meniscus injuries.

3. Variability in MRI Interpretations: The differences in interpretations of your MRI results can be attributed to several factors, including the experience of the interpreting physician and the specific focus of their assessment. Different specialists may prioritize different aspects of the MRI based on their expertise. For example, an orthopedic surgeon may focus on ligament integrity, while a radiologist may emphasize cartilage and bone conditions. It's crucial to have a clear discussion with your physician about the findings and ensure that you understand the implications of the results.

4. Understanding Your Current Condition: The impression of "intrasubstance injury of PCL" on your MRI indicates that there may be some damage to the posterior cruciate ligament, which could explain some of your knee instability and pain. The nondisplaced fracture of the patella in your right knee also needs to be monitored, as it can contribute to pain and functional limitations.

5. Next Steps for Management: Given the persistent nature of your pain, it may be beneficial to seek a second opinion from a sports medicine specialist or an orthopedic surgeon who specializes in knee injuries. They can provide a comprehensive evaluation and may suggest further imaging, such as a repeat MRI or an arthroscopy, to directly visualize the joint and assess for any issues that may have been missed.

6. Pain Management and Rehabilitation: Continue with your rehabilitation exercises, but ensure that they are tailored to your current pain levels. If certain movements exacerbate your pain, it may be necessary to modify your rehabilitation program. Physical therapy can be incredibly beneficial in strengthening the muscles around the knee, improving stability, and reducing pain. Additionally, modalities such as ultrasound therapy, electrical stimulation, and manual therapy may provide relief.

7. Emotional and Psychological Support: Chronic pain can lead to feelings of anxiety and depression. It’s essential to address these feelings, possibly by speaking with a mental health professional who can help you cope with the emotional toll of your injury. Support groups or counseling can also provide a space to share experiences and strategies for managing pain and recovery.

8. Timeline for Recovery: Recovery from knee injuries can vary widely. While some individuals may start to feel better within a few weeks, others may take months to recover fully. It's essential to listen to your body and not rush the healing process. If your pain persists beyond the expected timeline, further evaluation and possibly surgical intervention may be necessary.

In conclusion, your situation is complex, and it’s crucial to have a thorough evaluation and a tailored treatment plan. Don’t hesitate to advocate for yourself and seek further opinions if you feel your concerns are not being adequately addressed. Your well-being is paramount, and finding the right path to recovery is essential.

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