Knee pain after 2 months period of immobilization

Patient

Q: Hello. I am 23 years old and when i was 18 i fell on my knee and ended up with a harline fracture to my knee and a torn ligament. The hospital made a leg brace for me which was worn for i think about 2 months before it was removed. After a couple of weeks of the brace being removed i started getting pain in my knee when i sat with my knee bent in the same angle for 15 minutes or more, it would ache quite badly to the point that i had to move my knee to an angle. When touching my knee i also noticed when i bent my knee forwards and backwards i could feel something grinding , almost like 2 bones in my kneecap were grinding against each other if that makes sense. I ignored the trouble that i was having with it for so long due to work commitments but now i know that the time has come to do something about it. I haven't been able to kneel since i hurt my knee as the pain it just awful. i literally can't kneel on it for more than one second without falling to the side. it's almost like my knee won't hold me up??? It just aches if my legs kept in the same position for too long so i have to move it to a different angle. i don't go to the pictures anymore either as it aches so much that it's simply not worth it. I've been unsure wether to go to the doctors because when you look at my knee theres nothing physically up with it and i don't want them to think i'm wasting there time, but people have told me that it could possibly not have healed properly and this would cause me to have more problems with it when i'm older. What do you think it could be and what would be the solution? Thanks

Doctor

A:    After a period of immobilization any joint tends to be stiff and most require physical therapy to get the normal range of movement back. On the other hand, according to your description of the pain, “grinding”  and limited flexo-extension movements, may correspond with the most common presentation of patellofemoral syndrome or Chondromalacia Patella in young and active people. The pain typically is located behind the kneecap and often shows during activities that require knee flexion and forceful contraction of the quadriceps (ei, during squats, ascending/descending stairs or pendants). Pain may be worsen by sitting with the knee flexed for a long period of time, such as while you are playing as a catcher, watching a movie, hence leading to the terms "theatre sign" and "movie-goer's knee." The causes are diverse: Overuse (repetitive use or activity), overloading, and misuse of the patellofemoral joint. The suggested strategy for conservative treatment should be as follows: Physical therapy program (exercises to stretch and strengthen quads and pain control with TENS, ultrasound, ice packs after the exercises), anti-inflammatory medication (i.e.: “Aleve”, “Advil”), education about which activities avoid because those can aggravate the patellofemoral syndrome. Also, and very important, remark the need for extended adherence to the exercise regimen. Your physical therapist should educate you about a home exercise program. Allow time for these conservative measures make any effect and improve your condition.

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