Knee pain with previous history of Ligament repair

Patient

Q: I had a knee ligament operation last August/September and was told my knee was graded as a 3 with 4 being the worst, the doctor also said i had artitis in my knee, i have run on it a few times which all felt fine but in the last few days the knee is giving real pain when walking and laying down in bed it is also a little swollen.

Doctor

A:   It is not uncommon the associated meniscus lesions when a ligament injury occurs, also you may be have some degree of degenerative bone changes (osteoarthritis) in your knee, according to your description. On the other hand, the knee pain is the most common presentation of patellofemoral syndrome, where  the pain typically is located behind the kneecap and often shows during activities that require knee flexion and forceful contraction of the quadriceps (e.g, running, 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." Also “grinding” and “clicking” may be present. 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: wear a knee brace patella stabilizer, Physical therapy program (exercises and pain control with TENS, ultrasound, ice packs after exercises), anti-inflammatory drugs (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. Your physical therapist should educate you about 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.

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