Patellar Pain: Seeking Solutions for Chronic Knee Issues

Patellar tendinopathy

Hello doctor, I am a long-term patient suffering from knee pain.
I have undergone various treatments with little effect.
Since the car accident on December 28, 2014, I have experienced issues.
After the accident, there was a small localized hematoma and swelling around my patella.
I went to a nearby orthopedic clinic for an X-ray, which showed no issues, so I continued to exercise.
However, over time, I noticed that the area where the hematoma occurred began to protrude, leading to severe pain.
I then underwent an MRI and took the disc to various consultations.
I feel that there is an additional bone growth on my patella that continues to press on my patellar ligament, causing tightness and discomfort with bending.
The MRI shows a prominence at the inferior margin of the patella, which has altered the appearance of the patellar ligament.
However, doctors have diagnosed me with patellar tendinitis and advised me to continue rehabilitation treatment.
It has now been six months to a year of ongoing treatment.
The costs of rehabilitation and medical care have become a significant burden for me as a student.
I sincerely hope to find a definitive solution to help me heal, as I wish to continue exercising.
I hope the doctor can assist me.
Thank you very much!

Awei, 20~29 year old female. Ask Date: 2015/12/30

Dr. Shi Guozheng reply Orthopedics

If the prominence of the patella affects knee joint function or causes pain, local injection may be considered to see if it improves the condition.
Additionally, rehabilitation should be pursued unless it can be proven that the elevated area is indeed the cause of the problem, in which case surgery may be considered.

Reply Date: 2015/12/30

More Info

Patellar pain, particularly chronic knee issues, can be a complex and frustrating condition to manage, especially when previous treatments have not yielded significant relief. Based on your description, it seems that your knee pain may be related to a condition known as patellar tendinopathy, which is often referred to as "jumper's knee." This condition typically arises from overuse or injury to the patellar tendon, which connects the kneecap (patella) to the shinbone (tibia).

Understanding Your Condition
The history of your injury following the car accident in December 2014, along with the subsequent swelling and pain, suggests that there may have been some initial trauma that led to changes in the structure of your knee. The MRI findings indicating a prominence at the inferior pole of the patella and the altered appearance of the patellar tendon could indeed point towards patellar tendinopathy. This condition can manifest as pain during activities that involve jumping, running, or even prolonged sitting with bent knees.

Treatment Options
1. Physical Therapy: While you mentioned that rehabilitation has been a financial burden, it is crucial to continue with a structured physical therapy program. A physical therapist can provide targeted exercises to strengthen the muscles around the knee, improve flexibility, and enhance overall knee stability. This can help alleviate the stress on the patellar tendon.

2. Activity Modification: It may be necessary to modify your activities to avoid exacerbating the pain. This could mean reducing high-impact activities such as running or jumping and substituting them with low-impact exercises like swimming or cycling, which can help maintain fitness without putting excessive strain on your knee.

3. Pain Management: Since you have been dealing with chronic pain, consider discussing alternative pain management strategies with your healthcare provider. Options may include physical modalities such as ultrasound therapy, electrical stimulation, or even acupuncture. If you are allergic to NSAIDs, other pain relief methods, including topical analgesics or corticosteroid injections, may be explored.

4. Bracing: A patellar brace or knee sleeve may provide additional support and help alleviate some discomfort during activities. However, it is essential to ensure that any brace used does not cause additional pressure or discomfort.

5. Surgical Options: If conservative treatments fail after a significant period (usually 6-12 months), surgical options may be considered. Procedures can range from arthroscopic surgery to remove any damaged tissue to more invasive surgeries that may involve realigning the patella or repairing the tendon. A thorough discussion with an orthopedic surgeon specializing in knee conditions is essential to determine the best course of action.

Preventive Measures
To prevent further injury and manage your symptoms effectively, consider the following:
- Strengthening Exercises: Focus on strengthening the quadriceps, hamstrings, and hip muscles, as these play a crucial role in stabilizing the knee joint.

- Flexibility Training: Incorporate stretching routines to maintain flexibility in the muscles surrounding the knee.

- Proper Footwear: Ensure that you are wearing appropriate shoes that provide adequate support, especially during physical activities.

- Gradual Return to Activity: When you feel ready to return to sports or physical activities, do so gradually. Start with low-impact exercises and slowly increase intensity as tolerated.

Conclusion
Chronic knee pain, particularly related to the patellar tendon, can be challenging to manage, but with a comprehensive approach that includes physical therapy, activity modification, and possibly surgical intervention, there is hope for improvement. It is crucial to maintain open communication with your healthcare providers, seek second opinions if necessary, and explore all available treatment options. Remember, recovery takes time, and patience is key in the healing process.

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