Knee Pain: When to Consider Arthroscopy for Relief

Knee pain

Dear Dr.
Chen,
I noticed that your expertise includes arthroscopic ligament reconstruction, and I have some questions regarding this area.
In 2004, I underwent arthroscopy due to issues with my medial meniscus, which was found to have a tear.
After repair, my symptoms completely resolved.
About three months later, with my doctor's approval, I attempted to run, but experienced pain.
This pain has not been constant since then; over the past eight to nine years, I have experienced pain during certain activities, excluding running.
The intensity varies, but the duration of relief has progressively lengthened, now extending to over a year.
According to my description, my doctor indicated that the pain is located outside the joint rather than within it.
Previously, another physician performed a manual examination and suggested that there might be an injury to the posterior lateral meniscus, as well as tightness in my iliotibial band (ITB) and looseness in the lateral collateral ligament (LCL).
Therefore, the previous physician considered that the likelihood of improvement through release surgery was low.
Currently, if I engage in light running, I experience pain that lasts for about a day before subsiding.
The pain is still localized around the arthroscopic incision on the lateral side and extends to the posterior area of the knee.
Another physician also performed a manual examination of the lateral ligament and suggested that it might be injured.
I would like to ask if I need to undergo another knee arthroscopy.
My doctor suspects a lateral ligament injury, but he is not confident in the technique for repairing the lateral side.
Since I live in Taichung, could you recommend a physician in Taichung for me to consult?
Thank you, Dr.
Chen, for taking the time to read my inquiry.

wendy, 20~29 year old female. Ask Date: 2013/07/22

Dr. Chen Yongxue reply Orthopedics

Hello,
In response to your inquiry, the medial meniscus and lateral collateral ligament of the knee joint often sustain injuries together due to anatomical reasons.
You mentioned having undergone a repair surgery for a medial meniscus tear, and now experiencing pain after exercise, which seems to be located on the lateral side.
This suggests that the treatment for the medial meniscus was likely successful.

As for the lateral pain, it could be related to the iliotibial band (ITB) or the lateral collateral ligament (LCL).
Further examination is necessary to determine the exact cause.
Therefore, I recommend consulting an orthopedic physician for a thorough physical examination, which should provide clarity on your condition.

There are many reputable hospitals and excellent physicians in Taichung, so please seek out a trustworthy doctor nearby.
Thank you, and I wish you a speedy recovery.
Chen Yong-Hsueh
Orthopedics
Keelung Hospital

Reply Date: 2013/07/22

More Info

When considering knee pain and the potential need for arthroscopy, it is essential to understand the underlying causes of your discomfort, the effectiveness of previous treatments, and the current state of your knee health. Based on your description, it appears that you have a complex history of knee issues, including a previous arthroscopic surgery for a medial meniscus tear and ongoing pain that has persisted for over a year.

Understanding Your Knee Pain
Knee pain can arise from various sources, including ligament injuries, meniscal tears, and issues with the surrounding soft tissues. In your case, the pain seems to be localized around the lateral aspect of the knee and may involve the iliotibial band (ITB) and lateral collateral ligament (LCL). The fact that your pain worsens with certain activities, such as running, suggests that there may be mechanical factors at play, potentially exacerbated by tightness in the ITB or instability in the LCL.

When to Consider Arthroscopy
Arthroscopy is a minimally invasive surgical procedure that allows for direct visualization of the knee joint. It can be beneficial in diagnosing and treating various knee conditions, particularly when conservative treatments have failed. Here are some indicators that may suggest the need for arthroscopy:
1. Persistent Pain: If you have been experiencing knee pain for over a year, especially if it interferes with daily activities or specific movements, it may be time to consider further evaluation.

2. Mechanical Symptoms: Symptoms such as locking, catching, or instability in the knee can indicate underlying structural issues that may require surgical intervention.

3. Failed Conservative Treatment: If physical therapy, medication, and other non-surgical treatments have not provided relief, arthroscopy may be warranted to address the underlying problem.

4. Diagnostic Clarity: If there is uncertainty regarding the diagnosis, arthroscopy can provide a definitive assessment of the knee's internal structures.

Next Steps
Given your history and current symptoms, it would be prudent to consult with an orthopedic surgeon specializing in knee injuries. If your current physician suspects an injury to the LCL or other structures, they may recommend imaging studies, such as an MRI, to assess the condition of the ligaments and cartilage more thoroughly.

If you decide to pursue arthroscopy, it is essential to discuss the potential benefits and risks with your surgeon. They can provide insights into what the procedure may reveal and how it could help alleviate your symptoms.

Recommendations for Local Care
Since you mentioned residing in Taichung, I recommend seeking out orthopedic specialists in your area who have experience with knee arthroscopy and ligament reconstruction. You can ask your current physician for referrals or look for reputable orthopedic clinics that focus on sports medicine and knee injuries.
In the meantime, consider continuing physical therapy to strengthen the muscles around your knee, improve flexibility, and address any biomechanical issues. This conservative approach may help alleviate some of your symptoms while you prepare for a potential surgical evaluation.

Conclusion
In summary, if your knee pain persists and significantly impacts your quality of life, it may be time to consider arthroscopy as a diagnostic and potentially therapeutic option. Consulting with a specialist will provide you with the best course of action tailored to your specific needs. Remember, addressing knee pain early can lead to better outcomes and a quicker return to your desired activities.

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