OpenHealth Q&A

Knee Concerns at 33: Seeking Guidance

**Previous Activities** I often associate my knee troubles with my background in volleyball and softball, which I played predominantly. Throughout those years, I frequently twisted my ankles and knees, resorting to icing and elevation after games, using wraps to continue playing the following matches. **Present Activities** Currently, I engage in weekly sand volleyball sessions and make an effort to take a long walk once every week. Over the past decade, I've taken on weightlifting and joined adult volleyball and kickball leagues. Although my squat technique is solid, I've struggled with dynamic lifting, finding it difficult to transition into movements like the snatch due to a lack of stability during deep squats while lifting weights. I have noticed that my joints crack more than average, particularly when I twist my foot inward to relieve my knee stiffness, which sometimes helps momentarily. However, in recent years, I’ve experienced a troubling development: my knees now emit grinding sounds with each bend. My knees and ankles have their off days, requiring me to intentionally restrict movement and rely on icing and elevation for relief. **Current Knee Condition** - **2/4:** After a volleyball match, I struggled to straighten my leg upon waking. Only after massaging my quadriceps could I manage to pop my knee, which alleviated some discomfort. Unfortunately, throughout the week, my knee repeatedly locked and felt unstable, causing sharp pain during weight-bearing movements and walking. I purchased a supportive brace that weekend, which provided some stability and reduced locking episodes. - **2/10:** Wearing the brace during my next volleyball session seemed beneficial. The following morning, while my knee did not lock, I experienced significant ache on both sides. I continued to wear the brace and employed icing and elevation techniques. - **2/13:** Since the discomfort persisted, I sought help at an orthopedic urgent care. The physician's assistant suspected a meniscus tear, fitted me with another brace, and referred me for an MRI. I kept the brace on most of the time, except during brief periods at home when my knee would occasionally slip again. - **2/26:** By the time of my MRI, the ache had not subsided. Shortly afterward, I received a call to schedule a follow-up discussion regarding the results. I learned that I’m dealing with multifocal cartilage damage and was advised to keep wearing my brace while managing my movements to avoid exacerbating the pain. - **3/17:** During my follow-up appointment, I was questioned about any past knee injuries. The nurse practitioner indicated that the damage was likely the result of repeated injuries that had gone untreated, mentioning that I had worn down my cartilage and may require a replacement sooner than expected. I was instructed to undergo cortisone injections and physical therapy to alleviate pain until surgery became absolutely necessary. **Concerns Regarding Prognosis** - Considering that I have completely worn through the cartilage in several areas and experience locking and painful sensations without my brace, is surgical intervention or a replacement advisable now rather than waiting and risking further deterioration of my knee and other joints? - I regularly stretch, and my quadriceps are strong, but I believe that physical therapy with an emphasis on balance would be beneficial. Nonetheless, I am doubtful that PT alone will prevent further joint damage. - My left knee feels similar to my right but without the locking and slipping issues. Will compensating for the right knee put my left knee at risk of experiencing sharp pains as well? - I worry that limiting my movement to protect my knee may lead to a need for surgery in the future, increasing my time spent in pain and restricting my activity unnecessarily. **Summary:** At 33 years old, I have lost cartilage in two areas of my knee due to unaddressed injuries. My knee becomes sore with excessive movement and experiences locking and sharp discomfort. Although I have been advised to manage the pain through physical therapy and cortisone injections, I am anxious that this conservative approach may not suffice considering the extent of the damage. **Are there alternative non-replacement surgical options available? Or is knee replacement potentially a preferable treatment compared to ongoing injections and therapy, given the severity of the issue?** **MRI Findings:** **Indication:** (Not specified) **Technique:** Multisequence, multiprojectional imaging of the right knee conducted without gadolinium. **Findings**: - **Ligaments:** Both cruciate and collateral ligaments appear intact. - **Menisci:** No identifiable meniscal tears are evident. - **Extensor mechanism:** Quadriceps and patellar tendons remain intact. - **Osseous structures/articular surfaces:** A full-thickness cartilage defect measuring 5mm was observed on the lateral femoral condyle's weightbearing surface, with no associated bone marrow edema. Additionally, a 7mm full-depth cartilage injury with slight edema in the subchondral bone plate was noted on the posterior medial femoral condyle. Low signal alterations indicating chronic delamination were observed on the articular surface cartilage of the lateral patella, as well as similar changes at the weightbearing region of the medial femoral condyle. - **Miscellaneous:** Small joint effusion identified. **Impression:** Multifocal cartilage injuries as described above.

Answers (1)

3/20/2025, 2:50:54 AM

OpenHealth AI

Thank you for sharing your story and concerns regarding your knee condition. Given your multifocal cartilage damage, locking, and pain, decisive next steps can help manage your symptoms and potentially improve your overall knee health.

Main Points:

1. Your knee’s cartilage damage is significant, affecting stability and causing pain.
2. While surgery can be a last resort, there are several non-surgical options to consider.
3. Addressing both knee stability and pain management is essential for your quality of life.

Explanation:

Your condition reflects a cumulative effect from past injuries and wear, which has led to cartilage degradation. The multifocal cartilage issues, alongside your current symptoms of locking and pain, suggest that maintaining functional stability while managing pain is critical. While knee replacement might be a consideration in the future due to the extent of your damage, many options could potentially delay or prevent surgery, allowing you to remain active.

Next Steps:

1. Follow Through with Physical Therapy:

   • Focus on a tailored program emphasizing strength, stability, and balance tailored to your condition. A physical therapist familiar with knee injuries can develop a plan tailored to your needs, which may also help improve the overall movement dynamics in your left knee to prevent overcompensation issues.

2. Consider Consultations for Injections:

   • Corticosteroid injections can help manage inflammation and pain, but platelet-rich plasma (PRP) therapy or hyaluronic acid injections are alternative treatments that may provide longer-lasting relief and can be discussed with your orthopedist.

3. Explore Orthopedic Interventions:

   • Discuss with your specialist about the possibility of other interventions like microfracture surgery or osteochondral grafting, as these procedures can stimulate cartilage regrowth and repair without a full knee replacement.

4. Modify Activity Levels:

   • Engage in low-impact exercises to strengthen the muscles around your knee without excessive strain. Activities like swimming or cycling can improve your fitness without worsening your knee condition. Gradually increase activity while monitoring your pain levels to avoid exacerbation.

5. Apply Conservative Management Techniques:

   • Continue using your brace during physically demanding activities. Ice your knees after activities, employ elevation and compression, and consider taking anti-inflammatory medications as needed, based on the recommendation of your healthcare provider.

Conclusion:

While the progression of cartilage damage does lead to concerns, there are multiple non-surgical approaches to explore that may provide relief and prevent the need for immediate surgical intervention. Staying proactive and engaged in your management plan will be crucial. If symptoms worsen or significantly impact daily living, further evaluation of surgical options would be warranted. Remain in close communication with your healthcare team as you navigate your recovery journey.