Joe A Shaw PA-C - 11/18/2011

Question
I have had 2 MRIs in the past year indicating meniscal tears anterior horn. I had a scope on the left leg for a meniscal And fat pad debriment. I have been going  to physical therapy for a year and have had a cortisone shot with no relief. During a follow up they told me that my VMO is weak and sent me back to physical therapy. I went for a second opinion and was told the my knew caps are being push outward and that supratz injections would help. The problem is I do not believe the problem is a lubrication problem. When I'm sitting my knees throb and are uncomfortable. When I stand for a while it feels as if something is being squished as I go to walk away they POP pretty loudly and when I am going up or down stairs or inclines the pressure on my knees is very painful as if being stabbed just below the knee caps with an ice pick. I am becoming more and more depressed as I am getting no relief from the pain and can not do all the things I enjoy doing like riding q bike, jogging or playing sports. I am active duty Navy and as you 'an guess going up and downladders all day is very painful not to mention the type of ships I work on bob like a cork in a bath tub. I am concerned that these shots may not work and that something worse may be wrong. The pain began a long time ago but had thought it was just from being on my feet all day. I was wondering if you have any ideas or suggestions?

Answer
David,
The Supartz injections are typically for osteoarthritis,but it may be worth trying. Pain inferior to the patellar(knee cap) can be patellar tendonitis or jumpers knee..which is a tendonoitis type injury..and there really is no cure but can be treated..b/c it is caused by over useage of jumping or going up and down stairs etc..I would have them try a compounded NSAID (non sterodial anti-inflamm)Rx cream and apply this right where it is hurting..Voltaren gel is a trade name..but there are ones with NSAID,and lidocaine etc..that can be compounded by a pharmacist.
Chonrdomalacia (inflamm/arthritis behind the knee cap)this can cause popping cracking sound going up and down stairs etc..wouldnt mess with it unless it really gets bad then they can go in there and clean up the area.There is a big surgery that can be done to correct the alignemnt of you knee cap but would not recommend this unless really bad and knee cap is sliding out of the groove becoming dislocated.
You didnt mention weight but this is the biggest thing that can cause knee pain ie being overwt even by 15-20 lbs. Also smoking can of course cause decreased blood supply to the surfaces of inside of the joints.