unusual knee pain

[zanderman1985]

hi there, I have had my knee pain for 6 years. It started with an ACL tear and then I didn't leave it alone and now according to my last physio everything is fine but I'm still experiencing alot of pain and restriction of movement. After exercise it swells up on the inside posterior of my right knee, and according to my physio I now have a bit of bone which has formed on the inside of my knee which wasn't there before and is quite big and looks like swelling but he also says this is nothing to worry about.

any advice on this would be greatly appreciated, especially the bone growth, I didn't think that was possible

my background: I played alot of sports when I was younger - hockey for 12 years, cycling since I was 8, football for six years everyday, if any of this helps.

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[physiofixme]

Have you had an xray to confirm bony growth?? Could be a baker's cyst! A bit hard to diagnose obviously in a forum like this but I'd look in to Baker's cyst and/or xray to confirm bony growth. Your symptoms could all be a result of an unstable knee post ACL injury.......do you consistantly work on a strength programme???

[zanderman1985]

thanks for replying, I suggested an xray but he was so sure that it was bone that he said that there would be no point and that my leg was very stable.

my muscles are strong enough, there was a little clicking but said that my knee moved smoothly and I could go back to cycling and swimming, but then it swells up and gets sensitive around the bone growth and underneath the bone growth towards the rear of my leg on the inside.

I have been doing ankle excercises, balance exercises to make sure my leg is being supported properly and also been doing swimming which is fine unless I over do the breast stroke.

it seems more like my knee can't keep up anything weight bearing for any length of time, even cycling! which I used to do religiously about 24 miles a day... for fun, and now I can't manage 2 miles without my knee swelling up after it. its extremely frustrating.

kind regards
alex

EDIT:the main exercises that I do are leg lifts with 5kg weights and very gentle roller blading which I feel helps with my balance muscles and also helps with the weight bearing issue. I also stand on one leg with my eyes closed and stretch all my leg muscles before doing any of these exercises.

would it be just a case of determining how much time to carry on this routine and resting the joint? because I did this routine for 6 weeks and my knee felt pretty good, but I started cycling and five days after I started it returned again.

[pudding_bowl]

I think you need further investigations. It's been 6 years and still swells after only 5 minutes of cycling.
I suggest changing your doctor if they won't give you an xray at least... you need an MRI really. Or at the very least a good physio who can help you.

Pudding

[zanderman1985]

thanks I think I'll try and find a good private physio. The NHS physio's suck, but I still thought they all learned the same subject.

I'll try and find a specialist and see if they have a different diagnosis

thanks for the info

kind regards alex

[pudding_bowl]

Yes everyone studies the same... And although there is a reputation amongst the NHS for poor physio's it is unique to each physio. You get good ones and bad ones. they don't have to be public or private. And that variance is in every profession.
If you are getting better than stick with the physio. But if you aren't and they aren't interested in finding out why and cannot explain to you why then thats when it's a good idea to see a different physio. - You need to have confidence in your physio or your rehab won't go well.

Pudding

[zanderman1985]

sorry I didn't mean to paint all the NHS physio's with the same brush, its just that I've had two physio's from the NHS and they both seemed to do the same thing, where you would ask them to explain a reason for my pain or some swelling and they seemed to make it seem insignificant as if it wasn't a problem, I don't know is this what all physio's do?

its just the last physio I had, I would ask him about the swelling on my knee and he just said 'yeah its a bit of bone' as if it had nothing to do with the actual problem. I mean the first post I got back here suggested a possible baker's cist, which he didn't mention at all - he didn't mention any other possibilities actually - and then he would just say that my knee was stable and everything looked fine when I said I was still feeling pain, which I just find plain weird.

He didn't suggest any strength programs or anything, even after I suggested to him that endurance might be my problem he gave me an exercise for people who had a loose knee cap, which was putting my full weight on the one leg and dipping downwards which made it hurt eventually.

maybe its just my experience, but I think I'll try and maybe find a sports physio to have a look.

kind regards
alex

[pudding_bowl]

Good on you buddy. Don't worry I wasn't offended in anyway (I don't work for the NHS). Keep us posted as to how you go.

[zanderman1985]

Thanks i'll try another physio and see how I go, thanks for the help

kind regards
alex

[vam44]

It sounds like to me that you may have some osteoarthritis forming within the medial compartment of your knee and and at least and X ray or (preferably and MRI) would be able to correctly diagnose your knee Alternative provisional diagnoses that come to mind are hamstring tendonitis, cystic degenerative changes of the medial meniscus.

A correct diagnosis would guide the exercise advice but I would advise knocking off the 5kg leg lifts and replace with prone eccentric hamstring exercises for starters (your physio should be able to show you how to do these). Keep up with the balance exercises roller blading and swimming and cycle <1.5mile.

let us know how you go with your knee!

[zanderman1985]

osteoarthritis? I'm only 24, is that possible? seems a bit serious but, thanks for the info I'll stop the leg lifts for now and keep up with the other exercises.

regards
alex

EDIT: I forgot to ask, would anyone know a decent physio in glasgow? also if it would help I could post a photo of the knee? its just that there's alot of suggested diagnosis

[vam44]

Fair enough, it would be very early to have that as a diagnosis however if you were my patient I would insist on a proper orthopaedic evaluation and investigations via Xrays +/- MRI if that is available where you are.

I made this comment because of the pain, restriction and hard thickening around the knee and the swelling even on a small amount of loaded activity.

[zanderman1985]

Well all I can do now is to find another physio. thanks for the info you've been a great help.

kind regards
alex

[Josephine]

zanderman, I agree about the Baker's cyst although Baker's cysts are often a consequence of early arthritis or other inflammatory processes. I would also suspect that bony lump could be an osteophyte which is also a manifestation of arthritis!

I suggest you ask your GP to refer you to a knee surgeon who will xray it and MRI it as well. It isn't unknown for 20 yr olds to get arthritis, especially with history of the trauma. sports and athletics. Arthritis is, after all, a form of micro-trauma which is why it's often referred to as "wear and tear" and it's no respecter of age!

Sorry to depress you but I do I suggest you go see a good knee surgeon and get it properly investigated. Depends where you are in Scotland but I can recommend a great chap in Sunderland!

[zanderman1985]

Hi Josephine, thanks for replying, I don't know, I think Sunderlands a bit far for me to travel, I stay in Glasgow but if you could PM me the details that would be great.

I've came up with a theory as well, After I graduated I kind of prety much messed around on the net all day for almost a year and a half and I think that might have something to do with the bone degredation (vitamin D absorbtion, or lack thereof)
but I still need to get an investigation and see what it really is!

i'll post back whenever this happens.

regards Alex

[zanderman1985]

Hey there, just got an xray order from my doc. he says its definately bone - don't know if this is good or bad - and that he usually sees this in 12-14 year olds so I'm going for an xray today and he'll send it off to a specialist and maybe I can finally solve my knee problems.

[vam44]

It would be great for you to communicate your whole xray report. For such a longstanding problem you may need an arthroscopy( depending on the results) to view the internal structures within the knee, there may be some fibrosis around your old ACL repair limiting your knee movement. If this is the case your normal knee exercises will just inflame and aggravate your knee.

Well done to Andy Murray in the Australian Open Tennis

[zanderman1985]

Got my xray and waited a month and got an appointment with a consultant who said that there was no chance it was bone and its probably a cyst - he said it was like a bakers cyst, but only I had one on the inside of my knee as opposed to the back of the knee.

He also said that it was cause one of two ways;
either I put too much strain on the ligaments and it caused the cyst or;
I've damaged the meniscus cartilage (I think thats right) and the fluid seeped through the tear and caused the cyst - this is worse as it entails a longer rehabilitation.

so I'm waiting on an appointment for another scan to confirm it, - an MRI I think - to show more detail.

and Andy Murray still isn't good enough to beat federer!

[physiofixme]

Fantastic that you're making progress with your diagnosis! Hope you get a good outcome in the end. I hope this forum has helped too!!

[zanderman1985]

what I was wondering is, can I go back to nearly full function from this point? its just the consultant made some worrying faces...

and how long roughly would rehabilitation be for a condition such as this?

[roycar]

how do. just read this post with interest. im glad you've managed to get the issue investigated in more detail.

i had my acl repaired last june. uneventful rehab really but got flare ups and swelling when i exercised or stressed the knee a lot. also had painful and imited flexion. i gave it seven months of good rehab but was still happening. went in for a scope to sort the problem and my consultant found a soft tissue growth just anterior to the tibial insertion of my new acl. prob due to laydown of scar tissue/revascularising etc. my surgeon had never seen this before in near a thousand surgeries. whipped it out and not a bother since!

anyway. this doesnt sound a million miles from what your investigations have shown. hopefully its something that can be fixed quite easily also.

also, i could have been going for physio for years and it would have made no difference to this. sometimes a scope is the only option.

[zanderman1985]

Hey there, Just the results from the mri and is not that great, I think, from what the surgoen said, I have a horizontal tear in my cartilege which is creating a valve that once synovial fluid goes down can't come back up and so creates a lump on the other side.

He also said that to fix it he'll have to remove cartilege and that 25 to 30 percent of people, 10 - 15 year later will have knee pain or crunching - he said it was for unknown reasons but I though it was sort of obvious.

has anyone else had this done? and can they post their experiences of having this op?


kind regards
alex

[roycar]

i've not heard of that before. interesting. its great to see that you are getting somewhere with regard getting a solution to your problem.

any surgery that involves your knee cartilage will more than likely speed up the development of osteoarthritis in the knee. to what extent? hard to say. everyones different. after both of my knee surgeries where i had my acl replaced, medial cartilage repaired and lateral cartilage shaved, i've come to accept that i'l have degenerative changes come on me earlier than they would have otherwise. its about weighing up the pro's and cons. for me, i had to have the surgery to be able to function properly without pain and swelling and return to some form of sport. surgical approaches to cartilage are evolving all the time so hopefully when i don have problems down the road it'l be a nice easy job to sort it all out.

[zanderman1985]

Well the surgeon said that he would have to see how bad the inner structures were before doing anything, but he says he'll definately have to remove some cartilage

[zanderman1985]

Update: the arthroscopy went successfully and the surgeon decompressed the cyst and shaved the torn cartilege away.

Currently everythings going pretty well with physio but, my surgeon said there may be a chance of the cyst coming back and I was just wondeing if there was anything I could do to reduce the chances of this happening?

regards alex.