Pain in the left knee
25-year-old male suffers from pain in his left knee that shows up after carrying out a limited physical activity. The length and the importance of the pain are proportional to the intensity of the physical activity, the pain is gradual, and is linked to the movement of the knee joint. Knee MRN showed misalignment of the femur and kneecap with the patella, diffuse superficial edema of the kneecap cartilage, and signs of diffuse tendinopathy. In the expert's opinion, the patient suffers from patello-femoral knee pain due to patellar malalignment or patellar maltracking. The treatment options are conservative or operative.
1) What therapy do you suggest (surgical operation or pharmacological treatment)?
2) What diagnosis do you infer?
3) Can you explain why the pain shows up?
25 years old, male, Italy
Diagnosis: Pain in the left knee
The patient is 25 years old, generally healthy, without any medical history or prior illnesses. He does some slow running without intense efforts and without any prior orthopedic injury.
Appearance of painful symptomatology in the left knee from about 1 year that always shows up after carrying out a limited physical activity as, for example, a 40 minutes slow run. The pain persists for about 1 day and then disappears until the patient strains again the joint during any physical activity that needs a run, even a slow one, longer than 30 minutes. The length and the importance of the symptomatology are proportional to the intensity of the physical activity he performs. In particular, the disorder doesn’t show up as soon as the strains begins but it is gradual and it appears after a period of time beginning with a small trouble until forcing the patient to limp. The pain is not steady but it is linked to the movement of the knee joint, actually the most acute symptomatology shows up during the loading phase while the knee is slightly bent (for example when going up and down the stairs) while, on the contrary, it totally disappears and doesn’t get worse by the digital pressure if the patient's leg is completely still. The localization of the pain in the keen joint is difficult to determine even if the patient feels that the origin of the disorder is mainly “inside, under the kneecap and on the left external knee side”.
Therefore, the following diagnostic medical tests were performed:
- Left knee MRN dated March, 2008: No intra-articular effusions. Normal menisci and cruciate ligaments. Normal the cartilaginous articular surfaces of the femoral condyli and the tibial plates. Misalignment of the femur and kneecap with the patella moving laterally towards the outside. Diffuse superficial edema of the kneecap cartilage. Thickened synovial plica in the medial part of the Body of Hoffa. Signs of diffuse tendinopathy of the iliotibial tract of the fascia lata.
- Lumbosacral spine X-ray dated July, 2009: Slight sign of left lumbar convex scoliotic attitude with retrolisthesis of analogous importance of L5 as to S1. No focal bone lesions. Intersomatic spaces preserved. Reduced in size the L5-S1 intervertebral foramen.
- Left knee X-ray dated July, 2009: No focal bone lesions. Joint ratios retained. Moreover, the results of the latest blood tests performed are attached.
On the basis of the information available it seems very likely that the patient suffers from patello-femoral knee pain due to patellar malalignment or patellar maltracking.
This is a developmental anatomic problem of the patello-femoral complex that typically causing pain during or after strains as describe in the medical report. The result of the MRI confirms this assumption.
The treatment options are conservative (physiotherapy and using of special knee brace) or operative for re-alignment of the patella.
Surgery is considered if conservative treatments fail and only after a specific physical examination by orthopedic that specifically treat sport injury.