Collective Wisdom

[lonewolf]

My doctors and therapist stymied so I am turning to the collective wisdom of this forum for suggestion/solution treating my nagging knee injury.

July 2021, build up to my August 90th birthday 440, loping down a gentle grassy slope, suddenly sharp pain in my "good" right knee, rather like a hyperextension, almost collapsed but did not fall, walked home with mild discomfort, increasingly painful ever since and getting intolerable.
X-rays show "no fracture or dislocation, small knee joint effusion, calcification of insertion site of quadricep tendon, origin of patella tendon consistent with previous tendinitis, arterial calcification in soft tissues."
Doc has me on Celecoxib anti-inflammatory, no discernable relief.
I am not ready to concede to old age/arthritis. This happened in an instant but is not a meniscus tear like my other knee 40 years ago. I do not want another knee replacement. Doc says will talk to ortho about arthroscopic surgery. I dunno.
The sore spot is normally isolated on the inside of my right knee cap. Not really tender to touch but I must move slowly after sitting a while and a wrong twist is excruciating. Walking/jogging fast/slow/big steps/little steps/heel first/ball first makes no difference in pain level every time that foot hits the ground.
This is frustrating. My heart/lungs/muscles are still good but my moving parts are malfunctioning.
Does this sound familiar to anyone?

[jazzcyclist]

Bambam?

[Atticus]

Most doctors are VERY hesitant to comment on cases they are not personally familiar with, but good luck!

[bad hammy]

My heart/lungs/muscles are still good but my moving parts are malfunctioning. Does this sound familiar to anyone?

Heck yeah! The rest of your post - not so much.

Based on my past knee issues I'm surprised that they haven't MRI'd you to maybe find things that get by XRays. Insurance folks getting in the way because of your age, maybe? Best of luck getting your knee fixed up for your 91st.

[bambam1729]

Bambam?

Can't tell from that description.

[lonewolf]

Can't tell from that description.

That is the verbatim printout report I received. My shoulder X-Ray was obvious with humorous drooping an inch below the socket.
As soon as I use up these pain pills I am going back to the doc... if I can still walk.

[Fortius19]

Sounds a LOT like meniscus.

Just to be thorough:

Do your symptoms ever go down to zero at any time during the day? Even for as little as 30 minutes?
Can you see visible swelling?
If you perform some type of activity that irritates it, how long does it take for the increase in symptoms to return to baseline? More than 20 minutes?

Can you tell if you have lost any motion in your knee, bending or straightening?
Does your knee feel "unstable" ever?
Did the MD grab your thigh with one hand and shin with another and work it back and forth testing your knee? (Anterior drawer and/or Posterior drawer test if you want to Google)
If so, was there any mention of ligament injury?

The most common injuries, by far, are to either the ligaments or the meniscus. If it was ligament, I would think you would have mentioned the instability. Plus, you would probably see improvement month to month. If it's meniscus, it doesn't necessarily mean you created a fresh tear that is causing your pain. Menisci can move 'out of place' causing pain (and loss of motion).

All good rehab should address the swelling component first, then motion, then strength if needed. Your answers to the above questions can point to if swelling needs to be addressed (doubtful after 3 months). Restoring any lost motion (even if you can't tell that you may have lost motion) can 're-align' the meniscus and abolish your symptoms.

Arthroscopic surgery outcomes are very poor. I would not advise.

I would be happy to make further recommendations based on your responses. Thank you.

[schigh]

was hesitant to say anything as not the best way to get medical advice, but agree with previous statements, my first reaction was sounds like meniscus AND surprised no one has done an MRI, would think that an ortho would do that pretty much straight away.

[jc203]

I was struck by one word in Lonewolf's medical evaluation: "calcification".
That one term seems an apt description of my entire physical state !!!!

[lonewolf]

Sounds a LOT like meniscus.

Just to be thorough:

Do your symptoms ever go down to zero at any time during the day? Even for as little as 30 minutes? NO.
Can you see visible swelling? NO. JUST A SMALL TENDER SOFT SPOT.
If you perform some type of activity that irritates it, how long does it take for the increase in symptoms to return to baseline? More than 20 minutes?
CONSTANT IRRITATION, ABATES QUICKLY WHEN ACTIVITY STOPS BUT NEVER GOES AWAY. IF I SIT FOR A FEW MINUTES IT GOES AWAY BUT RETURNS STRONGER/IMMEDIATELY WHEN I ARISE. I HAVE TO MOVE VERY SLOWLY AND EASE INTO WALKING.
Can you tell if you have lost any motion in your knee, bending or straightening?
NO LOSS OF MOTION, JUST VARYING DEGREES OF PAIN.
Does your knee feel "unstable" ever?
YES, THAT WAS THE FIRST SYMPTOM, NEAR COLLAPSE WHILE RUNNING DOWNHILL. STILL HAPPENS UNEXPECTEDLY. PAIN IS USUALLY CONFINED TO A SMALL SORE SPOT ON THE INSIDE OF LEFT KNEECAP (CONSTANT 2 HURT THAT ESCALATES TO 5 AT EACH STEP BUT RADIATES 8-9 UP AND DOWN LEG WHEN NEAR COLLAPSE.
Did the MD grab your thigh with one hand and shin with another and work it back and forth testing your knee? (Anterior drawer and/or Posterior drawer test if you want to Google)
YES, TWISTING MOTION IS PAINFUL
If so, was there any mention of ligament injury?
NOT REALLY, JUST PUZZLEMENT.

The most common injuries, by far, are to either the ligaments or the meniscus. If it was ligament, I would think you would have mentioned the instability. Plus, you would probably see improvement month to month. If it's meniscus, it doesn't necessarily mean you created a fresh tear that is causing your pain. Menisci can move 'out of place' causing pain (and loss of motion).
WOULDN'T THE X-RAY REVEAL A MISPLACED MENISCUS? THIS IS DIFFERENT THAN THE JULY 4,1981 WATER SKIING MENISCUS TEAR AT AGE 49 YEARS 11 MONTHS WHEN I WAS POISED TO RUN 50 SECOND 440 YARDS ON MY 50TH BIRTHDAY. THAT ONE LOCKED UP EITHER STRAIGHT LEG OR BENT, NO RANGE OF MOTION. HAD ARTHROSCOPIC SURGERY IN AUGUST, RAN 10:35 TWO-MILE IN NOVEMBER, CONTINUED MASTERS TRACK AT NATIONAL LEVEL UNTIL BONE ON BONE INDUCED KNEE REPLACEMENT AT AGE 77. I COULD STILL RUN UNTIL RECENTLY BUT COULD NOT SPRINT ALL OUT BECAUSE OF BALANCE UNCERTAINTY AT A CERTAIN EFFORT.
All good rehab should address the swelling component first, then motion, then strength if needed. Your answers to the above questions can point to if swelling needs to be addressed (doubtful after 3 months). Restoring any lost motion (even if you can't tell that you may have lost motion) can 're-align' the meniscus and abolish your symptoms.
I HAVE BEEN HAVING SHOULDER REHAB, NO KNEE REHAB YET BUT HAVE DISCUSSED WITH MY THERAPIST WHO, COINCIDENTALLY, WAS MY THERAPIST 13 YEARS AGO AFTER KNEE REPLACEMENT.

Arthroscopic surgery outcomes are very poor. I would not advise.
ALTHOUGH I COMPETED NATIONALLY AFTER MY 1981 ARTHROSCOPE, THIS IS A LAST RESORT. JUST DOESN'T SEEM LIKE MENISCUS.

I would be happy to make further recommendations based on your responses. Thank you.

Thanks, Fortius. Good questions. SEE INSERTED ANSWERS IN CAPS.

[Fortius19]

Thanks for the answers. Meniscus can present in a variety of ways. Again, it can be torn or displaced or both. Displacements than can cause pain can be as little as 4 to 7 mm and will not show up in X-ray. Possibly in MRI, but due to natural differences in knee anatomy from person to person, it can be difficult to tell unless compared to your own previous MRI.

Constant pain is almost always either from inflammation OR something in the joint out of place. A tear usually only hurts when physically stressed. At rest it doesn't hurt. If your constant pain was from inflammation, your pain would get irritated from activity and take a long time to calm down. As yours doesn't, that points to your meniscus out of place

When it comes to the ligament or meniscus question, you could also have both. Partial ligament tears usually hear in 6-12 months and you usually feel better month to month. Complete tears can sometimes be difficult to diagnose, but usually do not get better. The laxity caused by any ligament lesion can add mechanical stress to the meniscus.

But, it's not good to get too caught up in diagnoses or X-rays/MRIs. It's better to treat the person, not a word or picture.

I would suggest a stretch that is 'designed' to put the medial meniscus 'back in place'.

Because you may get rapid results, I also suggest getting a baseline of pain and motion as a test/re-test to tell if what you're doing is working correctly.

1) knee flexion, in sitting reach down and grab your lower shin. Keeping knee muscles relaxed, use arms to passively bend your knee as much as tolerated. Note how far you can bend and how painful it is.

2) knee extension, sitting on edge of chair, straighten knee so that leg is straight with foot on floor, use hands to push just above kneecap, pushing knee straight (perpendicular to line from hip to ankle, not straight down to floor).

You already have listed a great description of your pain numbers as a baseline.

The stretch I would recommend you try first is sitting on the front half of a firm dining room type chair with feet (pointing forward) on floor. Feet should be forward of knees a little, so knees are bent about 70 to 80 degrees, not 90. Put both your fists between your knees as a spacer, do not squeeze your fists. In the following movement, do not let your fists come apart or your knees come away from your fists. With your involved side, rotate your foot and shin outward (for right knee to the right) as far as you can tolerate. Visually note the amount of movement and the pain number associated with it. Hold just 1-2 seconds and rotate shin back straight. There probably will not be much movement, that is ok. Repeat 10 times.

Make a note of the pain with each repetition. Is it increasing? Is it decreasing? If it gets to be too much, stop. Then make a note of pain when you are done. It may be stirred up and take up to 3 to 5 minutes to calm down to tell if your pain is overall better, worse or same.

If your pain is better, this is the exercise choice for you. Repeat 10-20 times every 3 hours or so until 5 days of zero symptoms. Usually takes 6-8 weeks.

If your pain is the same, reassess your motion. Sometimes your motion improves before your pain decreases. even if you think you had full motion to start with, you may notice you now have a little more, OR you may have the same motion but less pain with the motion. Either one (more motion OR less pain with same motion) qualifies as you are better and this is the exercises for you.

If the same, repeat the rotation stretch up to SIX sets of ten, reassessing after every 10-20 reps.

If you think this is making you worse, STOP.

I would be very interested in your results. If you are same or worse, there are other options.

[lonewolf]

Thank you, Fortius. I have been experimenting with some of the exercises you suggest. I will follow up with a little more dedication. I am trying a few days' rest from my usual evening walk/jog. Doesn't seem to help but my blood sugar has gone up.
Re:1) Flexing knee is not painful. Except for the occasional near collapse, the pain is only at that soft spot inside the knee cap when the foot hits the ground, a little less painful on grass for a few steps, then makes no difference.
Re: 2) I have been doing that. No pain.
Re: Dining room chair rotation) there is no pain or limit on rotation.
The most severe pain is an 8 when I stand after sitting or get out of bed. Eases after a few cautious steps to a 3, escalates to a 5-6 if I keep walking.
I will go back to the doc in a few days. Hopefully, he/they will try something else. The pills ain't woring. In the meantime, I appreciate your interest and suggestions.

[Fortius19]

You're welcome. The rotation is the only exercise you should be doing. The other two were supposed to be tests (they can turn into exercises later on based on how you do). It's best to try just one stretch at a time, as if you're meniscus is out of place in one direction, it should only take one direction to put it back in place. But if you perform the rotation 5-6 times a day for three days or more and there is NO improvement, it's not likely to help. (then you could try the bending at the same frequency, if no change then the straightening, but one at a time).

Anyway, the 'unstable' feeling, the hyperextension injury and the location of pain next to kneecap are all signs of an ACL injury. The pain with sit-to-stand, walking, and twisting point to meniscus. Given the relative importance of these factors, plus the fact that meniscus injuries are more common than ligament injuries leads me to think meniscus. But, as I said, it can be both. There's another possibility that the 'slop' or 'play' in your knee joint due to a compromised ACL is causing you to pinch your healthy, in-place meniscus as the joint is not lined up properly. Or, you may have torn some tissue that doesn't show up on X-ray. There is something fairly rare called 'plica syndrome' (I actually was diagnosed with this). Arthroscopic surgery CAN help this very well (if failed conservative therapy) and did for me. Plica symptoms can be all over the map, but typically include pain with squatting and stairs.

If your knee isn't getting better from the rotation exercise, I would respectfully suggest you ask for or ask about an MRI, and also ask about plica syndrome (which can be difficult to diagnose).

MRIs are not 100%. Some torn menisci, torn ACLs and plica will not show up. So, if you're MRI is negative, it doesn't rule those conditions out 100%. But, it's non-invasive and more info for the next step.

If you're a gambling man, you could try ordering yourself an ACL brace off of Amazon.com to see if it helps your symptoms. I haven't kept up with the rapid increase in tech the last ten years, but Donjoy is a good company. Or you could wait and maybe get a referral from your MD to see an orthotist/prosthetist to fit you for a custom brace or even for them to just make a recommendation on what type of brace.

[lonewolf]

Thanks, Fortius. I am going to ask for an MRI. Friends have suggested a knee brace. I will ask doc for a recommendation, also about plica syndrome.