chronic knee pain

[jman426]

I have had knee pain since I was a kid. I am 20, and I have been a swimmer up until last year. I believe it may come down to more than one cause, but I will leave that up to the professionals to decide.

Bascially, I have alot of pain around my pattella when squatting past 30 degrees.  I believe it is in part due to patellar mistracking. I have been working on flexibility in my hamstrings and quads, as well as strengthening my VMO, since it is weaker than the outer quad muscles. I have been doing wall sits to strengthen my VMO, since squats are too painful and leg extensions agrivate the condition. However, these excersizes seem to do little to help with the pain, even though I have been doing them for at least 6 months now.

My second problem is pain above the knee cap, on the very lower part of the quads. I assume this to be the quad tendon.  I feel alot of pain here when i squat down more than 45 degrees. It is a sharp pain, and makes crouching down almost impossible

For a couple days the symptoms will not be as severe. But the next day they may be terrible.  both problems are slightly better with stretching and the exercises, but only temporarily (like 10 - 20 mins).  In addition, during swim season my pain was much much lessened (on a daily basis).  After swim season, the pain was generally worse.  Also, various anti-inflammatories alleviate the pain almost completely.  However, it seems that none are suitable for long term use.

I have been to quite a few sports medicine doctors, and they have mostly told me the same thing, that I need to work on flexibility and strengthening of the VMO - However, even with aggressive PT and dedication these problems never seem to go away.  So any other suggestions will be much appreciated, and thanks in advance to everyone!

[jman426]

Thank you for the response.  As far as the pain above the kneecap (which i am assuming is the quadriceps tendon), would you recommend I approach it as tendinitis? I really have no idea what else the problem could be.  There is pain there after I have had my knees bent for an extended period of time (such as sitting in a car), and it is very painful when i attempt to crouch down.

Thanks again!

[Michael L Gross, MD]

Patella femoral dysfunction can be a serious problem.  Most of these problems resolve with non-surgical management including NSAIDs, physical therapy, patella bracing or taping, shoe inserts, and activity modification. If you truly have exhausted these options, then surgery is a possibility.  The two most common procedures are an arthroscopic lateral release, or an antero-medialization of the tibial tubercle known as a Fulkerson Procedure. As to which of these is right for you, that is a decision that should be made by you and your orthopedist