You mean 3rd opinion. I got a 2nd from a surgeon who does many of the pro athlete knees.

I've been off the bike and run for 6+ months now, and the depression is really setting in. I'm hoping someone has some ideas here about what's going on with my knee. I've seen two reputable orthos, had a cortizone injection, 3 Supartz injections (2 to go), and an arthroscope that showed some stage II chondromalacia under the kneecap and a minor groove in the femur. The meniscus is very healthy, looks excellent, as do the ligaments. The doc said it's a pretty normal knee for a 35+ athlete.

As physical therapy, I've tried strength training and extremely intense massage to work out trigger points, fibrous adhesions, and stretching.

It took about 2 or 3 months until I was about where I was pre-op. Since then I've made zero progress.

I'm struggling to believe this is all from the small fissure under the kneecap, and that it's not something else. So now here are my symptoms.

- Standing is the worst. It only takes 30 seconds from getting up in the morning before it starts to feel swollen, stiff, and heavy in the joint. I start to then stand with a slight bend in my leg. It feels harder to fully straighten/extend my leg.
- Sitting is completely comfy, no issues.
- It's never painful in ordinary use like walking, going up stairs, etc, just an annoying dullness.
- Going downstairs it feels like it is going to hurt, but doesn't. Just uncomfortable. It might pop/crack once.
- It pops a lot, especially if I sit, lift my leg and extend my knee.
- If I gently try to hyperextend the knee (or really just fully extend) when standing, there's a little pain in the joint, even though my kneecap is relaxed and I can wiggle it around easily.
- If I stand and flex my quads, it actually does hurt under the knee.
- It feels good after swimming, but bad after riding my bike (so I've stopped riding again, and no running since last year).
- If I do a hamstring stretch lying on my back, and then bend at the knee, the knee might crack and give a little shot of pain.

I'm really hoping someone can lend some ideas here. It seems to me that the fact that the symptoms are worse when standing when the kneecap isn't under pressure, that it's something other than chondromalacia, etc.

Two caveats: Not sure if its logistically possible for you and I know it's cliched to recommend a doctor as "the best" but I highly recommend seeing Dr. Kristjan Ragnarsson at Mount Sinai Hospital in New York if possible. He's the head of Rehabilative Medicine in New York and best known for working with Dennis Byrd - the New Jets defensive lineman who was paralyzed during a game in 1992. Dr. Ragnarsson got Byrd walking again.

I saw Dr. Ragnarsson after suffering what I thought was a back injury and was worried my "career" was over. I had seen several doctors and several physical therapists and was at wits end. It was pushing me towards depression. I saw Dr. Ragnarsson on the recommendation of a very good friend and accomplished physician (pediatrician). Dr. Ragnarsson figured out that I didn't have a back problem but was suffering from piriformis syndrome. He showed me some stretches, exercises to do on my own and then had me work with one of his PTs. I went from lying around in constant discomfort to running pain-free in the span of three weeks. My mother saw Dr. Ragnarsson on my recommendation and he really helped solve a lingering shoulder problem. She's a swimmer and was having trouble doing her normal hour-long workout. He got her back to her regular routine within a couple months.

What's different about Dr. Ragnarsson compared to other doctors? First, he was willing to spend a lot of time with me. My exam was almost an hour long and he had me perform different movements to identify the problem. All my other doctor appointments were ten minutes long and the diagnosis seemed set from the start. Also, since he's not a surgeon, he's not looking to open you up which can often causes more problems than solves them. For all their good intentions, surgeons want to perform surgery, even if it isn't clear that surgery will help (I'm not trying to flame surgeons, I think 99.9% are well intentioned, but there's plenty of research indicating this is the case). Perhaps most importantly, Dr. Ragnarsson doesn't just see the diagnosis as his job - he also wants to develop a rehabilative plan to get you back to what you want to do.

He isn't a miracle worker, but if you feel like you're out of options, I really recommend trying to see him. I don't know where you live, perhaps you could make a small vacation out of it? See Dr. Ragnarsson and then spend a few days in the city.

My two cents. You need to get the swelling down for sure. Get on some anti-inflamatories and ice down 4-6 times per day. Your joints need movement to heal. Since biking seems to cause you problems, for now you should do a lot of walking.

In Reply To

  Blanket statements are dangerous. There are many injuries (both muscular and skeletal) where the joint needs to stay immobilized for a period of time. They made need movement sometime during the recovery process, but just to blanketly imply that movement cures all is irresponsible at best.

John

In Reply To

  See a doctor who understands and can treat a condition called reflex sympathetic dystrophy (you will probably need to search out and see an anesthesiologist pain specialist). This could be a mild case. Untreated this condition can go on for years. If this is the correct diagnosis, treatment is usually successful and you will be symptom free within a week or two.

Two caveats: Not sure if its logistically possible for you and I know it's cliched to recommend a doctor as "the best" but I highly recommend seeing Dr. Kristjan Ragnarsson at Mount Sinai Hospital in New York if possible. He's the head of Rehabilative Medicine in New York and best known for working with Dennis Byrd - the New Jets defensive lineman who was paralyzed during a game in 1992. Dr. Ragnarsson got Byrd walking again. He isn't a miracle worker, but if you feel like you're out of options, I really recommend trying to see him. I don't know where you live, perhaps you could make a small vacation out of it? See Dr. Ragnarsson and then spend a few days in the city.

Have you seen Dave Hannaford? I'd give him a try.

clm

In Reply To

 
Frank, thanks for the idea. Does that fit with my symptoms in your experience? I found the link below that makes it sound really painful. Mine's just a dull inflamed feeling, and slight pain under certain circumstances.

http://www.ninds.nih.gov/...thetic_dystrophy.htm

In Reply To

  Blanket statements are dangerous. There are many injuries (both muscular and skeletal) where the joint needs to stay immobilized for a period of time. They made need movement sometime during the recovery process, but just to blanketly imply that movement cures all is irresponsible at best.

John