Knee pain after 6 months of arthroscopy surgery

Patient

Q: I tore cartilage in left knee last May 2010. Had MRI and then arthroscopic surgery at end Sept. 2010. During all that time my good right leg began to hurt very much but doctor and surgeon took no notice when I mentioned this. Took longer than doc said to come off sticks after etc. but cartilage op seemed to heal okay - however, pain in right leg and knee got worse and eventually both knees painful. Doc now says chrondomalacia patella and I am attending physio gym twice weekly and doing exercise 4 times daily at home. Problem: with gym and exercises knees feeling worse not better. Specific movements no improvement eg. stairs, squats (exceptionally painful) etc. I cannot jump, skip, jog, run at all. Cannot lift left leg at all when lying down and haven't been able to do this since tearing cartilage last May. I am desperate to get better - any idea what is going on?

Doctor

A:    Knee pain is the most common presentation of patellofemoral syndrome. The pain is typically located behind/under the kneecap and often shows during activities that require knee flexion and forceful contraction of the quadriceps (e.g, during squats, bicycle, ascending/descending stairs or pendants). Pain may be worsen by sitting with the knee flexed for a long period of time, such as while 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 and pain control with TENS, ultrasound, ice packs after exercises), anti-inflammatory medication (i.e.: “Aleve”, “Advil”), educate you about which activities avoid because those can aggravate patellofemoral syndrome. Also, and very important, remark the need for extended adherence to the exercise regimen. The physical therapist should show you how to practice a home exercise program. Please,allow time for these conservative measures (e.g.: exercise program) to have an effect, usually 4-6 weeks is adequate for some resolution of symptoms, maybe a little bit more in your particular case because you are in a post arthroscopy surgery status.

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