Patient #9 – 56 year old woman with knee pain who had received a recommendation for knee replacement

About the Patient

This patient complained about pain in the front outside portion of her knee. She had seen another doctor and had arthroscopic surgery . During the surgery, a torn meniscus was resected and microfracture was performed. There was no improvement in her symptoms after the surgery. The patient had physical therapy for 3 months and continued to do exercises. She said the therapy hurt and the pain remained unimproved so her doctor recommended knee replacement surgery.

The patient’s x-ray looked normal. There was no spurring and good clear space was seen.

On exam, the patient had pain in the front outer part of her knee and walked with a limp. There was no swelling and a little clicking when she moved the knee. She was diagnosed with patellofemoral syndrome.

Treatment

The patient was taught behavior modification techniques. She was asked to avoid kneeling, squatting, stair climbing and other quadricep intensive activities. Phyisical therapy was started to emphasize core and hip stengthening. The patient started glucosamine and was instructed to avoid any other medication for her knee.

Results

When the patient returned in one month, her pain was beginning to decrease. She was doing the phyisical therapy exercises and having some pain with one of the exercises. This exercise was modified so that she had not pain when exercising. By 2 months, the patient’s pain was almost completely resolved and she no longer limped.