Chronic Knee Pain: Five Years of Unexplained Discomfort and Failed Treatments

Deep pain in the popliteal fossa, at the junction of the tibial plateau and the lateral femur, has persisted for over five years with no identifiable cause?

Dear Doctor, I have been suffering from knee pain for five years, which is a persistent issue that lasts 24 hours a day.
During this time, I have consulted many orthopedic surgeons and sports medicine specialists, traveling from north to south for multiple visits and examinations.
Four MRI scans have shown slight damage to the lateral meniscus, and I have undergone two meniscus surgeries, but I am still enduring pain.
Additionally, I had a decompression surgery at the L5-S1 level due to mild compression on the left side, even though my primary pain point is on the right side.
The doctors mentioned that this could be atypical symptoms of a herniated disc, so I opted for surgical treatment.
However, it is frustrating that my pain has not diminished to this day.
In multiple MRI scans, a popliteal cyst has been ruled out as the cause of my pain.
However, the MRI results indicated that I have grade 2 patellar chondromalacia and possibly plica syndrome, but most doctors agree that this is not the cause of my pain behind the knee.
Recently, two doctors carefully identified more suspicious areas in my MRI images.
Here are links to three of the images, where there are small white spots within the red boxes.
The doctors informed me that they cannot confirm whether these are related to my pain.
They also suggested that I seek further opinions from other doctors for confirmation, as the areas in the red boxes are indeed close to my pain point.
Therefore, I would like to ask the doctor about this.
https://hackmd.io/WoeRJ-pxTB6qz8XWQj2Kgg?view

JUNG, 40~49 year old female. Ask Date: 2023/08/29

Dr. You Dianqi reply Orthopedics

Hello, online consultations cannot replace in-person diagnoses.
We recommend that you bring your medical history, imaging, and other relevant information to an orthopedic or neurosurgery outpatient clinic for evaluation.
Thank you.

Reply Date: 2023/08/29

More Info

Chronic knee pain can be a complex and frustrating condition, particularly when it persists for several years despite various treatments and interventions. Based on your detailed history, it appears that you have undergone multiple evaluations and treatments, including several MRI scans, two meniscus surgeries, and a lumbar decompression surgery. Unfortunately, the persistence of your pain suggests that there may be underlying factors that have not yet been adequately addressed.

Firstly, it is important to understand that knee pain can arise from a variety of sources, including but not limited to structural issues within the knee joint itself, referred pain from the lumbar spine, or even conditions such as patellofemoral pain syndrome or myofascial pain syndromes. The fact that you have been diagnosed with mild damage to the lateral meniscus and patellar chondromalacia (grade 2) indicates that there are indeed some structural changes in your knee, but these may not fully explain the severity or persistence of your pain.

The absence of a Baker's cyst and the identification of synovitis in your MRI findings suggest that there may be inflammation within the joint, which can contribute to pain. Synovitis can occur for various reasons, including overuse, injury, or underlying inflammatory conditions. It may be beneficial to explore anti-inflammatory treatments, including corticosteroid injections or hyaluronic acid injections, which can sometimes provide relief from joint pain and inflammation.

Additionally, the mention of possible "wrinkle syndrome" (plica syndrome) could also be relevant. Plica syndrome occurs when a fold of synovial tissue becomes irritated, leading to pain and discomfort. If this is indeed a contributing factor, a targeted treatment approach, such as arthroscopic surgery to remove the plica, may be warranted.

Given the complexity of your case, it may be worthwhile to seek a second opinion from a specialist in sports medicine or a knee surgeon who has experience with chronic knee pain cases. They may be able to provide a fresh perspective on your situation and suggest alternative diagnostic tests or treatment options that have not yet been considered.

In addition to surgical options, physical therapy can play a crucial role in managing chronic knee pain. A physical therapist can assess your movement patterns, strength, and flexibility, and develop a tailored rehabilitation program to address any biomechanical issues that may be contributing to your pain. Strengthening the muscles around the knee, particularly the quadriceps and hamstrings, can help stabilize the joint and reduce pain.

Lastly, consider exploring non-invasive pain management techniques such as acupuncture, dry needling, or even cognitive behavioral therapy (CBT) to help manage the psychological aspects of chronic pain. Chronic pain can often lead to anxiety and depression, which can further exacerbate the perception of pain.

In conclusion, chronic knee pain that persists despite multiple interventions can be challenging to manage. A comprehensive approach that includes a thorough evaluation of all potential contributing factors, targeted treatments for inflammation, physical therapy, and possibly alternative pain management strategies may provide the best chance for improvement. It is essential to remain proactive in seeking care and advocating for your health, as chronic pain can significantly impact your quality of life.

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