Knee Pain: Causes, Diagnosis, and Treatment Options

Q: Knee Pain: Causes, Diagnosis, and Treatment Options

Hello： Based on your symptom description, it seems to be primarily an intra-articular issue. <br>If it has been a long-term concern, it may be advisable to undergo arthroscopy (a minor procedure that won't significantly impact future activities) to determine the cause and severit

Knee pain after sitting cross-legged, with an inability to fully extend the knee?

Knee pain is uncertain whether it is on the medial or lateral side, and certain angles of knee flexion cause pain.
Prolonged sitting, standing for long periods, climbing stairs, and sitting cross-legged exacerbate the pain significantly.
After sitting cross-legged, the leg cannot be straightened normally for a short time and there is intermittent pain.
Sometimes, while walking or climbing stairs, there is weakness and a feeling of instability in the legs.
In severe cases, walking causes pain.

The diagnosis from a doctor at National Taiwan University Hospital in Hsinchu, after an X-ray, indicated that the pain is caused by patellar malalignment (medial patellar instability), and medication has been ineffective, requiring self-rehabilitation.
At Tri-Service General Hospital, an X-ray indicated that the patient has bow legs (genu varum) and surgery is needed for correction (medication has been ineffective).

At National Taiwan University Hospital in Hsinchu, an ultrasound indicated a cartilage cyst that requires surgical removal, along with further examination to determine if there is cartilage damage that may require excision or suturing (medication has been ineffective).
At Cathay General Hospital in Hsinchu, after an ultrasound diagnosis without an X-ray, it was determined that this condition (medication has been ineffective) requires surgical removal of the cyst.

At National Taiwan University Hospital in Taipei, after an ultrasound, an MRI was arranged, which indicated cartilage damage (surgery was ineffective).
Pain relief medication is being taken while monitoring the situation.
The patient has seen five doctors and consulted many others.
They enjoy sports and dancing (for 10 years), cycling, playing basketball, and running.
Before the onset of the condition, they attempted to exercise, but the left leg easily becomes weak.
After a short period of exercise, the left leg becomes unable to exert force.
This issue has persisted for some time; sometimes, just walking for a while leads to weakness and even pain.
The patient has stopped exercising for fear of further injury and is seeking a doctor who can identify the problem and provide targeted treatment.

Xiao Jie, 20~29 year old female. Ask Date: 2015/08/26

Dr. Wang Shouji reply Orthopedics

Hello: Based on your symptom description, it seems to be primarily an intra-articular issue.
If it has been a long-term concern, it may be advisable to undergo arthroscopy (a minor procedure that won't significantly impact future activities) to determine the cause and severity.
You should reduce high-impact activities.
Basic strength training exercises are necessary, but activities involving jumping may not be suitable.
Thank you!

Reply Date: 2015/08/26

More Info

Knee pain can be a complex issue, often stemming from various underlying causes, and it can significantly impact one’s quality of life, especially for active individuals. Based on your description, it seems that you have been experiencing persistent knee pain that is exacerbated by certain movements, such as bending, standing for long periods, and climbing stairs. You have consulted multiple healthcare professionals, undergone various imaging studies, and received different diagnoses, including patellar malalignment, O-shaped legs, and a cartilage cyst.

Understanding Knee Pain
Knee pain can arise from several anatomical structures, including bones, cartilage, ligaments, tendons, and bursae. Common causes of knee pain include:
1. Patellar Malalignment: This condition occurs when the kneecap (patella) does not track properly in the groove of the thigh bone (femur). This misalignment can lead to pain, especially during activities that involve bending the knee, such as squatting or climbing stairs.

2. Osteochondritis Dissecans (OCD): This is a joint condition whereby a small segment of bone underneath the cartilage loses its blood supply and dies, potentially leading to pain and swelling. Your MRI report indicated a bony defect in the medial femoral condyle, which aligns with this diagnosis.

3. Cartilage Damage: Damage to the cartilage, whether from injury or degenerative changes, can lead to pain, swelling, and a feeling of instability in the knee. This may also explain the sensation of weakness or giving way that you experience.

4. Meniscal Tears: The menisci are C-shaped cartilage structures that act as shock absorbers in the knee. Tears can occur due to acute injury or degenerative changes, leading to pain, swelling, and mechanical symptoms like locking or catching.

5. Iliotibial Band Syndrome: This condition is characterized by pain on the outer side of the knee, often exacerbated by activities like running or cycling. It typically occurs when the iliotibial band becomes tight and rubs against the knee joint.

Diagnosis and Treatment Options
Given the complexity of your symptoms and the various diagnoses you have received, it is crucial to have a comprehensive evaluation by an orthopedic specialist. Here are some steps you can take:
1. Further Imaging: If you haven’t already, consider getting an MRI if your symptoms persist. This imaging can provide detailed information about soft tissue structures, including cartilage and ligaments.

2. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles around the knee, improve flexibility, and enhance overall function. A physical therapist can tailor a rehabilitation program specific to your needs, focusing on strengthening the quadriceps and hamstrings, which support the knee joint.

3. Activity Modification: While it’s important to stay active, modifying your activities to avoid those that exacerbate your pain is essential. Low-impact exercises, such as swimming or cycling, may be beneficial while you recover.

4. Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. However, since you mentioned that medication has been ineffective, discussing alternative pain management strategies with your doctor may be worthwhile.

5. Surgical Options: If conservative treatments fail and your quality of life is significantly affected, surgical options may be considered. This could include arthroscopic surgery to repair cartilage damage, remove loose bodies, or address alignment issues.

6. Consultation with Specialists: Since you have seen multiple doctors, consider seeking a second opinion from a specialized orthopedic surgeon who focuses on knee disorders. They may provide additional insights or treatment options that have not yet been considered.

Conclusion
Knee pain can be multifactorial, and it’s essential to approach it holistically. Understanding the underlying causes, engaging in appropriate rehabilitation, and considering all treatment options will be key to managing your symptoms effectively. Remember to communicate openly with your healthcare providers about your symptoms and concerns, as this will help them tailor a treatment plan that best suits your needs.

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