Patient: Dear Doctor, I’m a twenty two year old female and when I was about sixteen my knees started hurting badly and locking into place, making awful cracking sounds when I straightened them. Eventually I went to the doctor who said he thought it was a condition, of which I’ve forgotten the name of, but he described it as me not having any backs to my knees and the fluid is what was causing the pain and swelling. He wanted to put me in a wheelchair but my mother thought that was a bit extreme as I could walk. About four years later I had a bad patch of it so I saw another doctor who disagreed with what I was told earlier and she thought it may be related to the back pain I’ve been experiencing. She sent me for a short term physio and that was that. To this day I still suffer with my knees and have had no official diagnosis apart from the original. My mother also has said my dad has suffered with a similar condition for years and he’s never known what it is. No x rays or MRIs have been suggested for my knees. If you have any ideas or suggestions I’d be grateful.
Doctor: Given the description you gave about the problem of your knee, and if you had previous history of a knee injury that yo ou can remember, it might be important to rule out a Meniscus lesion. The menisci are C-shaped wedges of fibro cartilage located between the tibia and femur, and very close related to knee ligaments and attached also to the joint capsule. They are susceptible to get injured with leg rotation movements or rotational forces applied to them, and the lesion produced can be partial or complete tear. Meniscus injuries are common in young and active people as you, moreover if you are involved in sporting or physical activities. Locking or buckling is a common symptom after a meniscus lesion develops. Locking usually occurs at 20-45° of joint extension. If a torn fragment has been trapped within the joint, extension may feel limited against a rubbery resistance. Joint inflammation or capsular involvement also may resemble locking. A more reliable indicator of meniscus lesion is a click or snaps after the joint unlocks, it can be or not associated with pain. A sensation of giving way may occur when the loose fragment becomes lodged for a moment in the knee joint, causing a sense of buckling. The other important process to rule out is the Patello Femoral Syndrome. Knee pain is the most common presentation of patellofemoral syndrome 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 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.