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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35031
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I'm a Soldier in the Army. I have had a right knee problem

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I'm a Soldier in the Army. I have had a right knee problem for about two years and I finally got an MRI on it. I thought maybe I had torn a ligament as my knee gives out when I make lateral movements or backward movements. I can lift well over 150 lbs doing leg extensions with my left leg, but barely 25 lbs with my right as the pain is excruciating. The doctor at the Army medical clinic didn't seem concerned as the MRI report reads, "The examination is notable for premature Grade III chondromalacia patella which is most notable overlying the lateral facet with premature osteoarthrities of the lateral and to a lesser extent medial femoral trochlear surface along with a joint effusion. The extensor mechanism appears intact. The menisci appear normal as do the cruciate and collateral ligaments. There are no findings of occult fracture." She told me there is not much I can do, just suck it up. I did asked to be referred to knee specialist and I'm going tomorrow. Would love to hear thoughts on why my knee is hurting so bad when I run/excercise, why my physician thinks it's not that big of a deal, and what I might possibly expect from the knee specialist tomorrow. Thanks for your time.

Greetings Shane Sims.

Your MRI has three main findings;

1) Grade III chondromalacia patella
2) premature osteoarthritis; it is secondary to above and in your case would be considered as an overuse complication which occurs in athletes.
3) joint effusion; it is inflammatory fluid collection sequelae to both of the above conditions.

The medical imaging findings need to be corroborated with the medical history (working in army can predispose to it as prolonged standing, walking and overwork is expected), symptoms, signs and physical examination. This will need an extensive rehabilitation program. A specialist in physical medicine and rehabilitation, apart from orthopedics is the best to handle it. Following is the mainstay of the management;

1) Knee care in the activities of daily living. Few simple self-care measures can be remarkably effective in ending pain cycle.

a) Avoid prolonged standing or walking or sitting with joint in a single position.

b) Whenever you sit, keep the knee stretched and fold them intermittently.

c) Squatting, sitting cross legged should not be done.

d) Avoid climbing stairs for about 3 weeks.

e) Avoid sitting legs unsupported or hanging.

f) Reduce weight if over weight/obese.

2) Rest: Taking a break from your normal activities reduces repetitive strain on your knee, gives the time to heal and helps prevent further damage.

3) Anti-inflammatory medications

4) Physical therapy; the goal of physical therapy is to strengthen the muscles around your knee and help you regain knee stability. Ideal is supervised physical therapy. Stretching exercises are also part of the physical therapy regime.Exercises in a pool (hydrotherapy) is most important component in your case.

5) Orthotics and bracing.

6) Glucosamine and chondroitin orally for about 1-2 years and a trial of diacerin for three months.

7) Hyaluronic acid injections in knee / steroid shot in knee.

8) Local analgesic sprays and ointments to your skin may help relieve the symptoms of osteoarthritis.

9) Deep Electrotherapy by physical therapist.

10) Acupuncture

These are the exercise resources for the knee. You can pick the exercises which suits you;

An arthroscopic surgery (minor procedure done by minimal access surgery or key hole surgery) can also help.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

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