Both of my knees are grinding and popping when I bend and straighten them. It's been ongoing for years now. Getting more painful as time goes on. I have seen an orthopedic doctor before (who I did NOT like) and according to my xrays I have bone spurs on both sides of both of my knee caps and the back of my knee cap is rough. The doctor never told me if I had a specific condition or if there was a name for it. I would like to get another opinion from an orthopedic surgeon but I've been told to see a sports medicine doctor because it's an "injury." Even though it's not an injury, is this who I would see? And would I most likely need surgery? Two of my sisters have had to have knee surgeries for similar issues.
Hi there. I'm sorry you are having problems with your kneecaps. I'm also sorry that you did not like your previous Orthopedic doctor. There is nothing wrong with getting a different doctor. It sounds like you have osteoarthritis of the kneecap/femur joint, also known as the patellofemoral joint - patella (kneecap), femur (thigh bone). Osteoarthritis is the condition where the cartilage at the ends of bones that make up your joint wear out. This is painful because cartilage is soft and can tolerate the stress in your joint whereas when it is worn out it is kind of like sandpaper grinding on sandpaper. The endstage of arthritis is bone rubbing on bone and you can imagine how painful that is. The knee is composed of three compartments - medial (inside of knee), lateral (outside of knee), and patellofemoral. Most people refer to arthritis as medial or lateral compartment and not necessarily of the kneecap joint. It is rare to have isolated arthritis of the patellofemoral joint and not of the other compartments. However, if you are relatively young then patellofemoral cartilage wear is common. In its early stage it is called chondromalacia patella. I think the person to see is an Orthopedic Sports Medicine doctor. How old are you? How active are you? Do you have arthritis of the other compartments? Surgery for patellofemoral pain or arthritis in general is not super successful if there is little cartilage left. Resurfacing/replacement procedures for that joint are not that successful. Realignment of the tibial tubercle (where the patellar tendon attaches) may shift the kneecap to a less spot where there is still cartilage but I would emphasize that a Sportsmedicine Surgeon is who you want to see. If you could provide any other information that might be helpful. Feel free to message me or ask follow up questions. If you have your xrays and would like me to take a look please post. Thanks.41052.9157020833
Thank you so much for your thorough answer. I really appreciate it! I am 32 years old. I am only lightly active at this time. I do work full-time, and I stand on my feet all day. I have a 10 month old baby so I don't get out and do as much exercise as I need to. And not that this is an excuse, but it's hard for me to find physical activities that don't hurt my knees or make me completely sore later on. Even if I'm on my knees for a while, such as when I give my son a bath, it is painful to get up. Just taking the pressure off of them to even stand up is painful...if that makes sense. I will give you a little background. When I was in high school I was a dancer. All together, I danced for 11 years. My dancing in high school was pretty intense. We practiced for about 3-4 hours 2-3 times a week. I noticed that during my pregnancy, as I gained weight, it got increasingly harder and more painful on my knees to go up and down stairs. And I only gained 20 pounds. However, I am overweight at this time and I know that if I were to lose more weight that it would take some of the pressure off my knees. Since having my baby I have lost 43 pounds. I would like to lose more but it's not coming off as quickly anymore. Currently I am 5'8" and am 213 pounds. As for your other question, I'm not sure if I have arthritis in the other compartments. I have never been told I had arthritis at all. But like I said before, I didn't like that last orthopedic surgeon I saw. He was not in the room for more than 3 mins and was walking out the door as he asked me if I had any questions. So, needless to say, I did not get a lot answered. And certainly did not even get as much information as you gave me in your one paragraph of response. So again, I appreciate you taking the time to help figure out my problem and how to go about possibly helping me. So, after telling you all of that...do you still think I need to see a sports medicine surgeon? And is there anything I should ask specifically or have them check or xray to make sure I get an answer? I feel so hopeless right now with my knees. I feel like I'm really young to have arthritis. So, I'm not sure what to do. It's all very frustrating to me. Thank you again, in advance, for your response.
Thanks for the additional information. If you are 32 that is very young and it is unlikely that you have osteoarthritis unless you had a previous bad injury or previous surgery. I probably went into more detail about osteoarthritis than I should have previously because you said your surgeon told you you had bone spurs. However, it really sounds like you have patellofemoral syndrome and some chondromalacia or wear under the knee cap. Patellofemoral syndrome is essentially when the kneecap and the groove that it runs in (trochlea of the femur) are not perfectly aligned. If the kneecap does not track down the center of the groove then it can be painful and over time causing clicking and crackling. There may be some bone spurs as your physician said but probably not severe arthritis. The most common reason that the kneecap does not track properly is that your thigh muscles are not as strong as they should be on the inside (medial). All of your thigh muscles attach on the outside (lateral) aspect of your pelvis and thus pull your kneecap in a vector that is laterally based. People with strong medial thighs balance that pull to help the kneecap track more centrally. If you have wide hips then that exacerbates the problem. Your dancing history does put you at risk for arthritis but once again you are really young. My suggestion is to see a sports medicine surgeon. You should do formal physical therapy to learn exercises to strengthen the mucles. In specific the "VMO" muscle complex. Stationary biking is very good for this type of problem. If the chondromalacia is very severe then also in physical therapy they could try kneecap taping, also known as McConnell taping, to see if moving your kneecap over slightly relieves the pain. Regarding your weight, the one thing going for you is that you are tall, have an athletic history, and are young. Imagine trying to lose weight without having an athletic background. All I can say is that you are only in your 3rd decade of life but being a doctor I can say that the best thing you can do for yourself is to get in as good of shape as possible now. It only gets tougher and tougher with each decade that goes by. Good luck and feel free to follow up. Thanks.
Thank you SO much for taking the time to really explain this stuff to me. Not to mention being personable. I feel a lot more confident now that I will have information to take to my new orthopedic doctor. I did make an appointment today with a new one. And he is a sports medicine surgeon. He came highly recommended. So, I'm hoping for a better experience. Especially going in there with more information or things to ask about. The only other question I have for you is if any kind of cortisone shot or some sort of injection to help "cushion" my knee cap would be helpful/effective?
No problem. You can always find me here by going to your question history and clicking on my username to ask me directly or you can post a new question with the title "For Orthosportsdoc Only" and it will get routed to me. With regards XX XX injection, cortisone would relieve the pain but it might not last that long. I generally do not recommend it for my patients in their 30s because it can be a slippery slope to start injections and I think it is more important to address the underlying issue. There are shots of synthetic joint fluid (hyaluronic acid aka synvisc). However the results are variable and for patellofemoral pain not really the main indication. I think again you need to get examined and get a true diagnosis that you understand and agree with before proceeding to any major treatment. If after you see the new doctor you have further questions, you can follow up with me. Thanks.
Hi there. Your question remains open on my outstanding questions until you either click accept or state somewhere in the chat that you accept the answers I have provided. Thanks so much. I hope your knees get better soon!