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Chronic Knee Pain. Took Cortisone Shots, Physical Therapy. Chances Of Patella Femoral Pain Syndrome?

Posted on Thu, 4 Apr 2013

Question: Hi. I have chronic knee pain around my knee cap, especially on my left knee, but on both knees. The main area of pain on my left knee is actually almost on my quad or the muscle just above my knee cap on the inside side of the muscle/bone as well as a little pain just below my knee cap in the middle of my knee. My right knee hurts mostly just below my knee cap in the middle of my knee. I've been to 2 orthopedic surgeons & doctors and 7 months of physical therapy doing every form of light exercise at therapy, stretches 2x a day, cortisone shots (into the knee and plica which did nothing) taping, a light brace/sleeve for me left knee, stimulation, icing, heating, the works. I've had xrays and MRIs and they only found that my knee caps are basically floating. One of my legs is a little longer than the other so I have a heel lift in my right shoe. My knee pain is MUCH worse than when I started seeking help and I can't do any form of exercise now. What can I do and what do I have if I don't have "patella femoral pain syndrome?" Please help! I'm an very healthy 31 year old female (5'5" 110 lbs)!! Thank you!

Answered by Dr. Saurabh Gupta (2 hours later)

Hi and welcome to XXXXXXX
Thanks for posting your query.

If you don't have patellofemoral pain syndrome, you might be suffering from chondromalacia patellae.
Initial management is with reduction of strenuous activities,non steroidal anti-inflammatory drugs( NSAIDs )and exercises to stretch & strengthen quadriceps muscle. As you had already done these conservative management and pain not get relieved,it shows the severity of chondromalacia patellae.
As you don't get releived by conservative management , discuss with your orthopaedic surgeon about arthroscopic debridement and lavage -It is diagnostic and offers short term symptomatic relief.

Hope this will help you. Please do write back if you have any additional concerns.

Wishing you good health...

Regards.
Dr Saurabh Gupta.
Orthopaedic Surgeon.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Saurabh Gupta (5 minutes later)

Thank you very much. Please note in my initial question/discussion that the majority of my pain is just above and on the inside of my knee, not under the knee cap where chondromalacia patellae is. I do have some pain under the knee cap but the majority of the issue is on the inside top of my knee just under the muscle below my quads (don't know the muscle, bone or tendon name). Can you please address that issue as asked in my initial question?

Thank you!

Answered by Dr. Saurabh Gupta (12 hours later)

Hi,
Thanks for posting your query again,

If the majority of my pain is just above and on the inside of your knee, you might having chronic quadriceps tendinitis.Chronic quadriceps tendonitis occurs over time and generally results from long term repetitive use of the quadriceps tendon.
Flat foot position, tracking abnormalities of the patella, rotation of the tibia, and a leg length difference(as in your case) can create increased and often uneven load on the quadriceps mechanism.

If the healing not occured with a wide range of protective measures, relative rest, ice, support, and rehab, you might need surgery which is designed to stimulate healing through revascularization (restoring blood supply). Weak, damaged tissue is removed and the injured tendon is repaired.Arthroscopic procedures can usually be done on an outpatient basis. Discuss these things with your orthopaedic surgeon.

I hope that clears your doubts.

Wishing you speedy recovery ...

Regards.
Dr Saurabh Gupta.
Orthopaedic Surgeon.

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar