Knee Extension Issues: Causes and Treatment Options

Inability to fully extend the knee joint?

Doctor, several years ago, I sustained a sports injury that resulted in my knee being unable to fully extend.
X-rays at that time showed no abnormalities in the bones.
However, since then, I have experienced frequent knee sprains during physical activity, especially with lateral movements.
The sensation feels like there is swelling inside my knee, making it impossible to extend fully; extending it causes pain, but bending it does not hurt.
After a few days, when the swelling subsides, I can gradually extend my knee, but just before it is fully extended, I hear a popping sound and feel pain for a moment, after which the bone seems to realign.
Once that happens, the pain disappears completely, as if nothing had happened.
Since it has been several years and I have recently injured it again, I would like to know what methods can be used to determine the underlying cause.
Is it necessary to undergo arthroscopy to check for any ligament tears? Thank you for your response, doctor.

Hanbao, 20~29 year old female. Ask Date: 2005/03/09

Dr. Shi Guozheng reply Orthopedics

Based on your description, it is possible that there is a patellar dislocation.
You may want to ask your physician to order an X-ray (Merchant view) to assess the relative position of the patella and the femur.
This will help determine if there is any dislocation or lateral shift of the patella.

Reply Date: 2005/03/09

More Info

Knee extension issues can be quite complex, especially when they stem from previous injuries. Based on your description, it sounds like you have been dealing with a persistent problem that may involve several factors, including potential ligament injuries, joint effusion, or even cartilage damage. Let’s break down the possible causes and treatment options for your knee extension issues.

Causes of Knee Extension Problems
1. Ligament Injuries: Given your history of sports injuries, it’s possible that you may have sustained damage to the ligaments around the knee, such as the anterior cruciate ligament (ACL) or the posterior cruciate ligament (PCL). These ligaments are crucial for stabilizing the knee during movement, especially during lateral or twisting motions.

2. Meniscus Tears: The meniscus acts as a cushion between your thigh bone and shin bone. If you have a tear, it can lead to swelling and pain, particularly when trying to extend the knee. This could explain the “clicking” or “popping” sounds you hear when attempting to straighten your leg.

3. Joint Effusion: The sensation of swelling and the inability to fully extend your knee could be due to excess fluid in the joint (joint effusion). This can occur after an injury and may be a sign of inflammation or irritation within the knee joint.

4. Patellar Tracking Issues: If the patella (kneecap) does not move smoothly in its groove during knee extension, it can cause pain and difficulty in fully extending the knee. This is often associated with muscle imbalances or structural issues.

5. Osteoarthritis: Although you mentioned that X-rays showed no abnormalities, it’s worth noting that early signs of osteoarthritis may not always be visible on X-rays. This condition can lead to pain and stiffness, particularly during movement.

Diagnostic Options
To determine the exact cause of your knee extension issues, several diagnostic options are available:
1. MRI Scan: An MRI is a non-invasive imaging technique that provides detailed images of soft tissues, including ligaments, cartilage, and menisci. It can help identify tears or other injuries that X-rays might miss.

2. Arthroscopy: If non-invasive imaging does not provide a clear diagnosis, an arthroscopy (a minimally invasive surgical procedure) may be warranted. This allows the surgeon to directly visualize the inside of the knee joint and assess the condition of the ligaments and cartilage.

3. Physical Examination: A thorough physical examination by an orthopedic specialist can help assess the stability of the knee, range of motion, and any signs of swelling or tenderness.

Treatment Options
1. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles around the knee, improve flexibility, and enhance overall stability. This is often the first line of treatment for knee issues.

2. Rest and Ice: If you experience swelling, resting the knee and applying ice can help reduce inflammation and pain.

3. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation, but since you mentioned allergies to NSAIDs, alternatives like acetaminophen or topical analgesics may be considered.

4. Bracing: A knee brace may provide additional support during activities, especially if you are prone to instability.

5. Surgical Options: If conservative treatments fail and significant damage is identified (such as a torn ligament or meniscus), surgical intervention may be necessary to repair the injury.

Conclusion
Given your history and the ongoing issues with knee extension, it is advisable to consult with an orthopedic specialist who can perform a comprehensive evaluation. They may recommend imaging studies like an MRI to get a clearer picture of the underlying issues. Depending on the findings, a tailored treatment plan can be developed to address your specific needs and help you regain full function of your knee. Remember, early intervention can often lead to better outcomes, so seeking professional advice sooner rather than later is beneficial.

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