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Clean MRI, but worsening knee pain? Please help!!
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Clean MRI, but worsening knee pain? Please help!!

Hi all,

So, I'm incredibly frustrated right now. This is a little complicated, but I'll shorten the story as much as possible:

Ten years ago (1/9/03), I had major leg surgery that required me to be in a body cast for three months and then a full leg cast (L leg) for a full month. When I went to get the full leg portion off, I told the x-ray tech to let me know when he was going to touch my foot (I admit, I'm crazy ticklish, and I didn't want to jump). Well, he didn't tell me when he was going to touch my foot and when he did, my leg immediately shot up to 90 degrees. I was in immense pain. My (pediatric) surgeon at the time came running and asked if I heard anything pop, but I don't think I did; I just felt like the breath was literally sucked out of my lungs. My surgeon advised me to take this up with PT and treat it conservatively (he thought I may have a loose piece of cartilage), which I've done pretty successfully. When my knee does bother me, it'll hurt for about a week at a time and then go away for some time (I'll get minor catching, a little locking, and general pain near my patella and on the lateral aspect of my knee).

Cut to ten years later, and I'm really starting to have some issues. I've had several ankle surgeries over the years (long story), but now my L ankle is finally starting to heal (yay!) -- the only problem being that it's making my knee worse. Now that I am able to finally challenge my balance and really work hard at rehab, my knee is catching and locking, etc. with increasing frequency. I've had this particular pain for about three weeks now, and it's progressively getting worse. I have constant catching/giving way, I am unable to fully extend my knee, and I am incredibly uncomfortable when flexing my knee. I cannot stand for extended periods of time, as I favor my knee. I am still on crutches due to ankle surgery in November, but they are more so for safety at this point than anything else (I have pretty significant atrophy in my calf muscles due to several ankle surgeries in the last year). I am able to walk without the crutches in terms of my ankle, but not with my knee being like it is.

I saw my orthopedic surgeon yesterday (I've been with this particular one for almost two years now) and my sports medicine doctor. Both checked out my ankle via ultrasound and said it's coming along nicely, but my sports med doctor noted that my lateral meniscus on my left knee looks "pretty tenuous." Nevertheless, he did not feel comfortable making a positive diagnosis based on ultrasound alone, which is understandable. This is completely preventing my rehab of my ankle -- I am unable to perform any activities now; previously, I was able to bike, swim, row, and do yoga with very minor discomfort in either my ankle or my knee. My surgeon sent me for an emergency MRI last night, which is apparently clean. No loose bodies, no menisci damage, nothing. The only thing that was noted was that there was very, very mild fluid effusion. BUT in that same surgery I was speaking about ten years ago, I did have a femoral osteotomy and I still have a rather large plate and six screws that ends right before my knee. I was placed in a special MRI machine that supposedly slows down the images to compensate for the scattering from the plate, but I'm incredibly frustrated that my MRI is completely clean. Could it be possible that the MRI is mistaken?

I see my surgeon again on Wednesday, so I'm anxiously awaiting what he has to say. I'll also show him the MRI then too (my mom is an administrator at an MRI company, so I was able to get in immediately; if I went through the hospital my doctor is affiliated with, I would have had to pay a significant amount of money and also wait quite a while). My doctor said that if I do have a lateral meniscus tear, I would need emergency surgery (mostly because it is completely interfering with my recovery from ankle surgery). So, again, is it possible that the MRI could show up clean but there's a chance that I may actually have some tear or cartilage damage? I just can't imagine, based on the amount of pain I'm in, that everything is normal. And honestly, I'm NOT one to complain about pain -- I've had nine surgeries thus far, and I am absolutely terrified of anesthesia, so surgery is the last thing I want. But at this point, I would definitely prefer going in with a scope to check things out in place of this awful pain.

I apologize for the long post, but I hope someone has some insight! Thanks!
1711789_tn?1361311607
Hi there!

Well, without knowing the relevant clinical details or a detailed clinical evaluation it would be difficult to comment specifically on the situation. It is unlikely for the MRI report to be mistaken. Since structural issues have been ruled out on the MRI and there is evidence of an inflammatory reaction, rest along with anti-inflammatory medications to be followed by physiotherapy to strengthen the muscles around the knee joint would be advisable. I would suggest discussing the situation and the suggested management plan in detail with your treating orthopedician.
Hope this is helpful.

Take care!
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