The Difficult to Diagnose Knee Pain – It Could Be Due To Menisco-Capsular Separation
Knee Pain
Some knee pains are notoriously difficult to diagnose.
It is even more baffling when the expensive MRI scan of the painful knee is reported as being normal!
I occasionally encounter such patients. They come into my clinic with a problem of pain in the inner side (medial joint line) of the knee. There may be a history of twisting injury to the knee but sometimes there is no antecedent trauma to that knee.
Physical examination may be normal except for point tenderness (pain) in the posteromedial joint line. A clinical diagnosis of a medial meniscus tear is usually made. An MRI scan would usually be done to confirm the diagnosis.
However, in medial menisco-capsular separations, the MRI scan can often look perfectly normal.
A high index of suspicion is needed to come to a diagnosis and the treatment is surgery via arthroscopic repair of the tear.
What is Medial Menisco-Capsular Separation?
The menisci are C -shaped fibro-cartilaginous structures attached to the shin bone and their main functions are to enhance the contact between the two articular surfaces of the knee: thigh bone and shin bone. The thick outline of menisci allows for a firm attachment to the joint capsule.
In a medial menisco-capsular separation, the attachment of the medial meniscus to the joint capsule is disrupted. These fibres are called menisco-tibial ligaments (attaching the meniscus to the shin bone) and menisco-femoral ligaments (attaching the meniscus to the thigh bone of the knee joint).
It may be associated with an anterior cruciate ligament tear in some patients.
The separation causes the medial meniscus to move excessively during physical activities such as running, walking, squatting and pivoting. This causes medial sided joint line pain.
During arthroscopy, the meniscus will appear to be lifted off the tibial bone.
Right Knee Medial Menisco-Capsular Separation – The medial meniscus is lifted off the tibia
This is a video of a patient of mine who has this problem.
What Can MRI Show?
True menisco-capsular separation can be seen on MRI scan if it is done soon after the injury. There will be fluid signal extending from the superior to the inferior aspect of the menisco-capsular junction medially.
However, in the chronic cases, MRI scans are usually reported as being normal.
How to Treat?
A trial of conservative treatment through use of pain medications and physiotherapy can initially be tried.
If the pain persists, key-hole surgery to the knee may be needed.
Key-hole surgery to the injured knee via knee arthroscopy can allow the surgeon to visualize the tear directly and to repair it.
This is a video of how I repaired this patient’s medial menisco-capsular separation.
His knee pain went away and he was able to return to sports.
For more information on treatment of knee pain or if you need your knee pain to be evaluated, please contact Dr HC Chang at +65-683 666 36 or +65-6694 1928.
Visit as at http://www.ortho.com.sg
HC Chang Orthopaedic Surgery | Singapore 
hi i was wondering if you had any suggestions or help for me. i was running a half marathon 1 and a half years ago (i over pronate and was wearing neutral shoes at the time which i shouldnt have been) then i suddenly had pain in my knee in the lateral joint line. i have continued to have this same pain all this time later. i have had 3 mri scans but they show nothing. i have been told it could be a lateral meniscus tear that was missed by mri, but i believe i have something similar to what you are talking about in your article. my surgeon doesnt think that anything is wrong with my knee and tells me it is in my head/neuropathic! however my physiotherapist adamant i have something going on we are trying to get my surgeon to do a scope but he keeps putting it off. i have pain while walking and squatting and my knee generally feels unsafe and unstable i havent had any improvements through physiotherapy. do you have any suggestions for me? by the way my first mri scan was 6 months after my injury happened and i have a nuclear bone scan which did show a hot spot on the lateral lip of the lateral and postolateral area of the lateral tibial plateau. do you know if this could show on a bone scan and not on an mri. thanks so much for your help i dont know wether i just keep waiting and see if it will improve or keep harrassing the surgeonn for the scope. thanks kristy
Dear Kristy,
I have seen similar conditions in the lateral meniscus of the knee joint. It is nearly impossible to diagnose it on the standard MRI scan as there is no visible tear and the problem is the lateral meniscus slide in and out of the normal position excessively. It can only be diagnosed during arthroscopy when the surgeon probes the lateral meniscus.
I have had good results by scoping these patients and repairing the lateral meniscus to the capsule using Fast-Fix suture(s).
The problem is convincing myself and the patient to undergo a surgical procedure when the MRI scans were reported as being normal.
All the best!
Regards,
hc
thanks you so much for your time and advise i really appreciate it and will peruse the scope. kristy
by the way, sorry to bother you again, can this injury occur from running and over pronation? i have been told not, but i beg to differ. thanks
hi there Dr Chang. i had my surgery yesterday and there was nothing found in my knee to be a problem. me and my physio was sure this was the problem but obviously not. back to the drawing board. thanks kristy
Doc,
My 11y/o has complained of a dull, ache knee pain for awhile but after lots of playing over a week ago (no obvious injury noted) he has been in severe pain, right at the lower knee cap, radiating to the inside with significant edema. x-ray showed SLJ. Went home, rest, ibuprofen etc. It is no better and worsening. Edema still present and MRI today showed meniscocapsular separation at the posterior horn? the ligaments are all okay. The ortho doc states he is not sure about the separation from his view and still believes SLJ but wants to do a “bone scan”. thoughts? Ideas? He will not flex it and when we do some flexing minimal it hurts coming up and when going back down.
Hi,
He is unlikely to have a meidal meniscocapsular separation without a knee injury. The pain should also be a the joint line. It is also difficult to diagnose MMS on MRI scan.
Regards,
hc
Dear doctor
I had a knee injury and the MRI scan showed the following
Bone marrow edema of patella and femoral condyles
Chondromalacia patella
Grade 3 tear of anterior horn of lateral meniscus
Lateral meniscopapsular separation
Please advise on way forward.
Thank you
Hi Angie,
The MRI findings must correlate with the doctor’s physical examination findings on your painful knee. If the pain corresponds to the area of the lateral meniscus tear, then arthroscopy with debridement of the tear can resolve your pain.
The lateral meniscocapsular separation may sometimes require a repair.
Regards,
hc
Thank you Doctor for your response.
I had the injury on the 31st of December and the knee is still swollen. Was given a knee brace and using one crutch.
Will the knee heal without any surgery?
It hurts to walk especially without the brace. Just started lifting the leg recently and that is painful as well and feels lumpy.
Kind regards
Angie
Hi Angie,
It is not wrong to try a course of conservative treatment of physiotherapy and medications first.
If the knee pain persists, and examination confirms the pain as coming from the meniscus tear, then surgery should be considered.
Regards,
hc
Hi Dr Chang i emailed you back in August and said that i thought i may have a lateral meisus tear or seperation. had my surgery and he found nothing. i am still dealing with the same pain. any chance that he could have missed it in the surgery. do you think a contrast mri would be helpful?
thanks krisy
Do you have a copy of the arthroscopy video? This may help me decide whether there is any issue with the lateral meniscus. MRI with contrast is unlikely to help you come to a diagnosis.
no i dont but my surgeon might have one. am due to see him towards the end of the month. i thought there may be more of a chance the die in the mri would show something weather it the separation or not. i did have a nuclear bone scan a while back that was positive around the lateral lip of lateral tibial plateau. right where my pain is.
thanks kristy
Hi.. this is Tiya i am a professional badminton player i am having a knee pain my MRI shows that i have a menisco-capsular sepration with grade 1tear . so doctor told me to take rest for 6 wks nd then if u persist with a same problem then we need to do surgery? m confused this is a very long time m having my tournaments i cnt affort to sit back.. plz tel me what do i do ?
Hi Tiya,
The approach taken by your surgeon is not wrong. Your knee pain may improve over the next 6 weeks making surgery not necessary. However, if your pain has been there for a long time, then I think arthroscopic surgery should be done now.
Regards,
hc
Thank you sir ,.
sir i forgot to tell you that i had a same pain this January too but that time i went to physio he told me that i have a normal muscle stretch no need to worry take a rest and ultrasounic therpy and i did the same took rest nd again startd my practice sometimes pain and swelling occurred but I put ice packs nd go on.. but this time pain was severe nd recently i had calcium and vitamin D3 test my cal is 8.7 nd in the reports i got to know. that I have a deficiency of V-d3 as its 12.78 ! sir is it possible my injury occured coz of low v-d3 …? Actually i am astonished that i have a this injury because i never gone through any trauma or any twist so how could this happened ? and m on rest from last 2 wks bt my pain is increasing day by day . i did nt take proper bed rest i mean i am walking and doing routine activities . plz tel me what should i do ? is it a kind of active rest or proper bed rest no movement of the leg ? if its active rest then what can I do to keep myself in a shape .? sir i ll send you my full report of mri may b it Will help you
hello sir this is my MRI report shows
*Menisco-capsular sepration with Grade 1 tear of anterior horn of lateral meniscus.
*Mild synovial effusion seen in knee joìnt and supra petellar bursa.
sir i have my match on 19th of July can I go for the tournament ? plz suggest me
Regards
Tiya
and sir i am 21yrs old .
i shall be very thankful to you sir
Regards
Tiya
Sir 1more thing none of my physical examination came positive .
Hi Dr. Chong,
I was in a car accident almost 5 months ago and have had knee pain ever since I went on a treadmill and elliptical after my accident 3.5 months ago. I have had physical therapy 3 times a week for the past 4 months and nothing has improved. My MRI came back negative. I hit my knee against the steering column a few times. Would you suggest surgery as the next step to try to figure out what’s wrong? My knee only hurts when bending and when I apply pressure on it. Thanks!
Hi,
I am against diagnostic arthroscopy to look for problems inside the knee joint when MRI scans are negative.
The best way to come to a diagnosis is to listen to the patient’s history and chief complaints carefully and then perform a very detailed examination of the painful knee.
Explorative surgery may lead to more problems.
Regards,
hc
Hi, had menisectomy of anterior lateral meniscus tear and chrondal flap back at end of June 2013. Started pt and all going well if a little slow. Then all of a sudden acute sharp pain in lateral joint line 4 weeks after surgery. Can not weight bear for more than a few metres without this sharp pain & feeling of instability. Am now back on crutches. MRI shows nothing other then 3 mm loose piece on medial side of knee.
What could be causing this problem. I am also having difficulty even lifting the leg when in a sitting position. Am at wits end. Am I likely to require another arthroscopy.
One other thing doctor. They removed over 40% of the lateral meniscus in the arthroscopy operation.
Hi Mandy,
It appears that there is a loose body inside your knee. It could be a cartilage flap which has broken off or a meniscus fragment that was not removed during the first surgery. You will need another arthroscopy to remove this loose body if you experience repeated locking episodes of your knee joint. If there is no locking of your knee, then it can be left alone.
Regards,
hc
dr chang-
my 15 year old daughter, a level 9 gymnast has just been diagnosed with meniscus separation. in your opinion, with a highly elite athlete, what is the recovery time associated after this surgery??
About 3 months.
Dr. Chang,
I am a 22 year old female. I was bending my knee when I heard a pop and hand instant knee pain. I have been on and off crutches for over a month. Dr thought it was a meniscus tear but MRI came up normal. Therapy and cortisone has not helped. Dr told me there was nothing he could do. Could it still be a meniscus tear?
Dear Deziree,
Yes, it can still be a meniscus tear. You can either send your MRI films to an expert Musculoskeletal trained Radiologist for an opinion or you can repeat the MRI scan but with intra-articular contrast. Sometimes this may show up something that was not visible previously.
The usual cause of a “pop” with severe pain in the knee joint without significant trauma is a tear of the posterior root horn of the medial meniscus. Please ask your doctor to look out for it. The examination should show focal tenderness at the posteromedial joint line.
I wish you a speedy recovery.
Regards,
HC
Good afternoon Dr. I am a 40 yr old woman who was very active in sports and all types of physical activity. 13 yrs ago I had surgery to my left knee and was told I was missing cartilage and may require a second surgery to harvest cartilage if the pain came back. Recently I have been experiencing terrible pain and tightness in my left knee just under the knee cap on the inside of my knee. Pain and instability are worse when going downstairs as opposed to just weakness going up. Any prolonged standing causes pain and severe tightness as well. My MRI report states
MCL is mildly scar remodeled. Fibular collateral ligament is mildly degenerated proximal attachment but not disrupted. Popliteus tendon is mildly tendinotic at its proximal insertion
Mildly scarred posteromedial meniscocapsular junction. Mild chondral wear over the medial femoral condyle
Chondral flap formation over the medial patellar facet extending to the median eminence. Chondral signal heterogeneity over the medial trochlear near the junction with the central trochlea
Moderate effusion with mild reactive synovitis
Small bakers cyst
I am hesitant to have surgery again as it was extremely painful. Is that my only option
Any info will be greatly appreciated
Thank you for your time and expertise
Dear Dr Chong,
my own situation mirrors your description of a minisco-capsular separation exactly…..it came about by a period of stressing the knees with the wrong bike seat height, and then doing some rock hopping…..left medial area swelled slightly, and rotational sporting activity (running, bike riding) causes it to flare……the MRI came back normal, but the tenderness along the joint line is there, and it has been nearly 6 months now. I can alleviate it with anti-inflammatories, but any significant walking (as in 1-2 hrs) brings back the pain in that area; I feel that it is not getting better, despite ceasing most rotational activities. So my question is, how do I convince my GP who oversaw the MRI process, that I do have this condition? His response so far is that there is no serious damage and that I should do 5-6 weeks with the anti-inflammatories and revisit after that.
Many thanks
Garry Davidson
Dear Garry,
You should listen to your GP and wait 6 weeks. If it is menisco-capsular separation, the pain will definitely come back after you stop taking the medications. Then you should ask your GP to consider this diagnosis and refer you to an Orthopaedic specialist who can assess your knee and perhaps proceed with arthroscopic examination with possible repair.
Regards,
hc
Thanks very much Dr Chang, I will do that. Only another couple of weeks to go now. Anti-inflammatories have helped, certainly, but in the background the symptom is still apparent. Interestingly, surfing is the thing that can most rapidly bring the symptom back…perhaps something about jumping up and twisting as one catches the wave. Thanks very much for your thoughts.
Garry
Hello there Dr Chang,
I am an NSF currently serving in 21SA, and I have certain knee-related concerns that I would like to raise to you. The pain that I am currently experiencing is centralised around my right knee area, that which can best be characterised as a sharp, jabbing pain, and which only activates when I bear weight down upon said area, either through standing and jumping. As of the time at which this reply is composed, I have already been afflicted with this pain for five weeks and five days, dating all the way back to the penultimate week of my BMT period. I am unable to name the exact cause of the pain; All I know is that when it first started on this one fateful Sunday, I did not partake in activities that were particularly strenuous, not unless one regards languidly lazing about at home moments before booking in for the week’s worth of activities as an act that is agonising. 😦 I did, however, engage in physically strenuous activities on three consecutive days the previous week, specifically that of IPPT on Monday, UO on Tuesday and BIC on Wednesday.
I have deigned to consult an appropriate specialist at Tan Tock Seng Hospital, where I had both an MRI and a bone scan performed on the aforementioned problematic area, only to be told just yesterday (a week after both tests were conducted) that the results were negative, with practically nothing malicious showing up on the appropriate images produced from the tests. Visibly flustered upon seeing the results, the same specialist speculatively asserted that the pain I am experiencing is “all in [my] head” (quoting him), and he thereafter slapped me with a RMJ status that lasts for three months and referred me to the pain management department of TTSH.
I am now beginning to develop a certain terror; Why am I experiencing pain of such an excruciating intensity if the sophisticated (and reputably very reliable) tests turned up with no indication of any portentous issues? This is, after all, my body, and I most certainly do not want for this condition to haunt me for as long as my life lasts. What should I do?
Dear Kelvin,
I believe you should seek a second opinion.
Regards,
hc
Hi,
Back in February I fractured my tibial plateau and was on crutches on for eight weeks. It healed back, but soon my knee started hurting and popping when I went back to playing sports. it hurts in the front of my knee and on the inside towards the lower point of my kneecap. It is hard sometimes to pinpoint the pain, it seems to radiate sometimes, but those two spots are the most difficult. I have been in physical therapy twice, and it has yet to get better. Doctor is hesitant to scope because he feels it’s too aggressive with clean MRI. I have not been active for a while and the pain has not gotten better with few weeks rest. Any suggestions?
Thanks,
Kylie
Hi Kylie,
Pain over the front of your knee tends to be caused by the patella (kneecap). I suggest you try a course of physiotherapy to improve the inner quads strength. Ask your surgeon if you have “patellofemoral” pain.
Cheers!
hc
Dr Chang,
I am a 23 year old male who has had 8 arthroscopic knee surgeries, 4 on each knee, due to Plica Syndrome. I am here because after my 7th and 8th surgeries my knees never progressed to be better as they had before. It’s been almost a year since that surgery and I’ve seen 2 different orthopedic specialists and just finished up visits with a doctor recommended rheumatologist. After the orthopedic specialists couldn’t diagnosis it from doing various blood tests and x-rays to check for arthritis and other problems I was sent to the rheumatologist because nothing came up. At the rheumatologist I received more x-rays and MRIs some with and without contrast and more blood work nothing came up. My doctor said she knows I’m in pain because I can’t sleep anymore, it’s actually 2 am as I’m writing this, because of the severe discomfort I feel. I have been taking 50 mg of indomethacin but even those don’t help anymore and I don’t like the fact of being on such strong medication. Anyways, the rheumatologist sent me home without scheduling me another appointment last week because she has nothing. She said she is sorry and confused that nothing came up from the surgery pictures as well as all of these other tests, but that I need to tell her what it is that I have when I figure it out as she is academically interested. If you have any insight you would be an answer to my prayers. Thanks,
Jay
Dear Jay,
I am sorry to hear about your plight.
It is difficult to make a diagnosis when many other doctors who have examined and seen your scans have not been able to solve your problem.
Just a few things that go through my mind with regards to your case:
Have your doctors considered you to be suffering from CRPS? CRPS is chronic regional pain syndrome. Previously also known as reflex sympathetic dystrophy. This is a condition that can affect any part of the body (usually hands) after surgery or injury. The affected area becomes sensitive to minor stimulus and even a small touch feels painful.
The other thing is whether the multiple surgeries have resulted in extensive scar tissue formation in the operated knee leading to tightness of the knee with movements such as flexion. This can lead to pain as well.
I hope you get well soon.
Regards,
hc
Hi, I had a sports injury(jiujitsu) where someone sprawled all his weight on the inside of my knee while on a flexed position, that was over year and a half ago. Couldn’t walk for a long time and have instability and medial pain on the knee. Didn’t really do anything other than strengthening and corrective exercise. After a year I started squatting and deadlifting heavy again and it started to feel unstable. Had an MRI and they found nothing, just some edema in the superficial supra patellar fat pad, suggestive of an impingement injury. Gave me a brace and sent me home. However it doesn’t feel good, I haven’t done any intense lifting since then because I’m afraid of tearing something, and it’s frustrating. I want to get back to sports. Any suggestions?
Hi Marcos,
It is difficult to come to a diagnosis of the cause of your knee pain based on what you just mentioned. It can be medial menisco-capsular separation, MCL tear with scarring, medial infrapatellar fat pad pain etc,
The key to the right diagnosis is to examine your knee carefully. The location of the pain on examination is very important. Hence the only suggestion that I can offer is for you to see an Orthopaedic doctor who can examine your knee carefully.
Regards,
hc
Hi my name is Cheris, I am – 30 yr old female. I injured my knee about 8 weeks ago. I’ve been in cronic pain ever since. I had an MRI two weeks ago and the Orthopedist said it came back clear, to be honest…I was shocked. Because how can it be normal when I’m in this much pain? When I read about this it seemed to be similar to what I’m experiencing. I have pain, on the inner part (on the back side of my leg) of my right knee and it feels like it’s crunching when I walk. I can’t keep my leg completely straight without pain, I can’t walk without pain, and bending or trying to sit Indian-style is completely out of the question. Any help or advice would be great! Thank you!
Hi Cheris,
The diagnosis is usually made by a careful history and clinical examination of the affected knee. If the diagnosis is a menisco-capsular separation, then the treatment is surgical repair of the tear. Please consult your Orthopaedic surgeon.
Regards,
hc
Hello, I have been dealing with right knee pain for the past 6.5 years. It has actually been mostly bilateral. In the beginning of 2015 it began to hurt solely on the right side much worse. All my MRI’s have came back normal. However, I have chronic pain around the knee cap and a sharp stabbing pain on the outside portion of my knee around the end of the knee cap. How likely would the monicso-capular seperation be for the scenario I have detailed? I am running out of options and this has not come up with the doctors at all. Actually, they said that doing a athroscopy would probably do “ACTUAL” damage. I have seen four doctors in the 6.5 year span and all of them have relied heavily the results of an MRI and yet I am still in chronic pain.
Hi,
I was curious if maybe you had an idea of what could be wrong. Ive had cronic knee pain, instability, localized swelling and weakness for going on 3 years now. My knee has become so bad that I cannot walk without a cane to support me and it often gives out about half way through the day. I initially injured it during a command pt run when I caught the edge of a curb at full sprint and took the entire fall on the top edge of my kneecap. They couldn’t xray it until three days later because the swelling was so bad. However, the xray showed nothing. So they started me with physical therepy and two weeks later they abruptly stopped it because it began to bend inwards towards my other knee with every step. It has done this ever since. This motion is involuntary and very painful, and even when I try to fight the motion my knee does it anyways. It has never gone away. Ive had many more xrays since and three MRIs that all come back normal. Last year I had a sureon that was dead set on it being an ACL tear and did a scope. However, other than slight “mooning” he found on the underside of my patella, he said he saw nothing wrong. At this point my current doctor, who specializes in musculoskeletal conditions, says that if my fifth session of pt, including water therepy, doesnt show enough improvement in stability or muscle strength then he believes the only option is to label it nerve pain/damage.
I dont think thats the case, and this will disqualify me from finishing my naval career. To me this is not an option. The only other things I can think of that are present with my injury are muscle weakness in the entire joint, I get cramps in the area that extend up to my hip and down to the arch of my foot, and pain in the bursa on the lower medial side of my patella. However, I’ve had cortisol injections in all the bursa in that area and even in the center of the knee joint itself. These do nothing but agrivate the area for a few days.
Im at my whits end at this point and would be willing to live with the daily pain if the joint would simply work correctly.
Have you ever had a patient with a similar problem, or do you have any suggestions as to what could be the cause?
P.S. I do hereditary ligamentous laxity. But its minor.
Dear Dr. Chong,
I’m a 51 year young women, and was in a severe horse riding accident 34 yrs ago. I was kicked by a horse while riding a horse, the horse kicked under my left knee cap and I received no medical attention for four days. When I finally did no x-Ray was taken, but I was told to elevate my leg and let the fluid drain! No problem after the initial injury until 1998 when I started to have issues with my knee swelling, locking up and hyperextending to the outer left. Since then I have seen three doctors, X-rays, more physical therapy than I can count and still no resolve in issues. In July this year I went to my podiatrist because of a cyst on the arch of my left foot. After taking an X-ray they found I had a stress fracture in my foot between my second and third toe (counting from outer side of foot). My podiatrist believes it’s because of my knee as I supinate on that foot to align my knee over my foot/ankle otherwise my knee pulls inwards.
I’ve just gotten the results from my knee doctor and the MRI has come back negative! I had the MRI where they inject the dye. I feel like my knee cap is twisting inwards and have a lot of pain by the outer side of my knee. My podiatrist also said that they can’t repair my foot till my knee is fixed! I’m very frustrated and pretty depressed about the whole issue, given the years I’ve suffered with this and I can’t work at the moment…I teach kids and beginner adults Hatha yoga. The knee doctor is now referring me to a rheumatologist, and said if nothing still comes from that then I can opt to have a scope. But stated that because MRI came back negative a scope was most likely to show nothing. He suggested acupuncture and physical therapy…both just have put a band aid on the problem in the past!
Any suggestions would be helpful, I have good insurance! However, I’ve been unable to work for nearly six weeks and doctors bills are slowly amounting up.
Many thanks in advance
Alexis
Dear Dr. Chang,
Thank you for your wonderful insight. I hope you can offer some in my case.
– 1998 Right ACL Allograft Reconstruction
– 2012 Left Meniscus Repair
– 2015 Severe Arthritis Right Knee Diagnosed
– 2015 Moderate Arthritis Left Knee Diagnosed
20+ Years Jogging, Tennis, Skiing, Swimming, Team Sports, etc.
Now, this past year, constant sharp, breath-taking pain in both knees with severe disability.
MRI on left knee shows nothing according to ortho who only wants to try injections again on right knee (which didn’t work for me).
I am seeking a second opinion for both knees. Have you seen anything like this before?
Also, I’m apparently knock-knee’d, if that means anything (Although, I never noticed except in xrays).
Thank you for your time!
Hi,
It is possible to develop osteoarthritis of the knee is you are very active and has had injuries to that knee in the past. I can’t offer you any useful opinion as I have not examined your knee nor seen your x-rays and MRI scans.
Regards,
hc
Hi Dr Chong,
I wish I would have learned about MCS injuries earlier! I had several MRI’s over the past few years, all negative, but every year I’d “reinjury my knee” just a little. It would get better after 2 months until recently when I injured it. Waited 3 months, had no improvement. MRI showed nothing, but MRA which showed the separation. I then had the surgery to repair it. It’s still early on, but quite painful with straightening my leg all the way, the same pain I had when I injury it. Is this something you find with patients? more pain with fully straightening leg with MCS? And how long do you expect a patient to have pain where the injury is after surgery to repair it? I’m hoping the pain means inflammatory responses are in effect to help it scar down!
Dear Emma,
The post-surgical pain which you described is quite common. It will resolve over the next 6 weeks or so.
Regards,
hc
Hi Dr Chong,
I just wrote you a question above, thank you for your answer! I am curious to what a typical protocol (WB status and ROM), after MSC repair. I wonder because I am now 6 weeks post op and continue to have a lot of pain and 3cm of joint effusion at the end of the day. I’m wondering if my protocol was too aggressive ( therapist was working in getting back symmetrical hyper extension (3degreees), as well as hamstring stretches which both caused significant discomfort at the joint line. My Dr wants me to start walking with my brace unlocked but it causes me so much discomfort at the medial joint line and increases my swelling. I don’t think this is normal, Or could I just be that unlucky small % that is having problems healing the repair. Not sure what to do or what my options could be:/. There isn’t a lot of information out there on MSC and your site has been incredibly helpful! I appreciate any insight you may share.
thanks again.
Dear Emma,
My patients are allowed to walk full weight bearing immediately after surgery. Crutches are optional and depending on individual patients. They are asked not to bend the knee beyond 90 degrees for the 1st 6 weeks and not to squat for the first 3 months. I usually aspirate the swollen knee on the 3rd day after the surgery. Icing (cryotherapy) of the operated knee joint is very important.
Physiotherapy is usually static quads exercises, achievement of full knee extension and gradual flexion to 90 degrees.
Try to ice your knee, consider taking oral anti-inflammatory medications if you are not allergic to them and see how it goes.
Regards,
hc
Hello,
I am writing because on Nov 1,2015 I hyper extended my right knee at work. Tomorrow will be four months that I have been out of work. A little back ground. I have never had any pain in my right knee other than the normal I’ve had a long day at work and I am tired stuff. I have pain in my left knee all the time due to an old sports injury. But never anything in the right knee. I have been in physical therapy since 4 days after my injury and I have plateaued at about a 6 or 7 on the pain scale all of the time. They gave me an mri and they told me it came back normal. The only thing they found was something called tri-compartmental osteophytosis is what the dr wrote on my papers. They said my synovial fluid etc is all fine. I have pain with bending my knee going up and down the stairs or simple weight bearing trying to do light house work etc. The Dr. I was seeing told me he does not know why I am having pain ( in the front center of my right knee and the outer part of my right knee and also the back of my knee and the lower part of my knee down twords my shin bone. ) I have swelling after light walking etc. He told me he does not know what to tell me because my mri came back normal except for that tri compartmental stuff.. My knee constantly gives out and continues to hyper extend. I have a brace that helps a little bit with the hyperextending. but still no full relief. One physical therapist told me that i may be having problems with my patella femoral …but when i told my orthopedic this he told me i dont know what to tell you nothing is showing on your mri…. Help me here because im starting to think that I am going crazy.
I am 28. I walk with a cane and a bulky knee brace..who wants to do that for no reason? I could never imagine. I have tried aquatic therapy and land therapy a bit more relief from aquatic therapy. But ice or heat i dont get much relief from and no matter what i do it still swells. What should be my next steps?
Thank you for you time.
Regards,
Kristy
Dear Kristy,
A hyperextension injury to the knee usually results in fat pad injury, or injury to the anterior horn of the menisci. It can also result in strain to the posterior cruciate ligament. These manifests with different symptoms and clinical signs. A medial menisco-capsular separation usually occurs with an injury to the medial collateral ligament. A careful examination of your knee is the key to a proper diagnosis. The MRI is just an adjunct to a proper diagnosis and cannot be relied on without a proper clinical examination.
Regards,
hc
Hi,
About 7 years ago, I landed a snowboard jump wrong and felt immediate pain in my right knee. MRI showed nothing. They thought it was bursitis and just gave me cortisone shots every year. The pain is now regularly a 6-9. It is mostly localized to the medial meniscus area. When I met with an orthopedic guy 2 weeks ago, he said the old MRI looks like a possible root medial meniscus tear, but the new MRI seems clear, though. The whole joint feels unstable and even resting can give me twinges of incredible pain. I have done 2 rounds of PT without results. I am meeting an orthopedic surgeon in two weeks but this is frustrating and ridiculous. We had previously discussed arthroscopic surgery to take a look inside if the MRI was clear. Is that my best bet?
Hi Allison,
I generally do not like to do “exploratory arthroscopy” to “look inside the knee” and hope to find something wrong with it. It is better to have a likely diagnosis and plan a course of action be it arthroscopy or physiotherapy. The knee joint is a joint that is amenable to a careful examination. Most of the time we can get a diagnosis. Arthroscopy can sometimes result in scarring of the fat pad and lead to more problems later on.
Regards,
hc
Hi
I been having a right knee swelling and I feel like it so tender with the fluid in , I have done x Ray and mri shown normal, but I am still to lay my knee on any surface, I don’t know when I have any injuries but it’s swelling when I do any workout or playing games or stand up work, would any one suggest anything regards this matter please
You may have to see a Rheumatologist to rule out rheumatological causes of your knee swelling and pain.
Ive had knee pain and cracking sine i was 7 months pregnant.my child is going on 7 months and i stil have pain hurts when i bend my knee.what could it be xray was normal
Hi Dr. Chang,
I had a knee sprain playing basketball and my urgent care dr. would not let me get a MRI. I finally did have one after 4 months after the injury with these results
There is a small knee joint effusion. The menisci are normal. There is no lateral meniscal tear seen. There is a chronic tear of the anterior cruciate ligament that appears partial thickness. There is no surrounding marrow or soft tissue
edema. There is increased signal in the distal posterior cruciate ligament, however, the fibers are intact. The medial and lateral supporting structures are intact. The extensor mechanism is normal. There are no focal cartilage defects.
I have been doing physical therapy twice a week to rehab my injury for the past 6 months and my leg feels stable and has not given out on me for months. I feel relatively confident that my knee can do everything I want it to do.
There is still pain though when I walk up stairs where I can feel a noticeable click in my knee joint (i cant pinpoint where though) and varying degrees of pain. One time, my physical therapist decided to roll my kneecap for 30 minutes and now the clicking happened when I did the squat and side lunge (it would not click on those exercises before) and not going up stairs. It seems like the “clicking” keeps hurting me from different things and different times. If it’s not going up stairs, it may be from doing the lunges. If the lunges don’t have the click pain than maybe the side lunge will hurt me. There can also be a dull ache for awhile.
Would it be advisable to ask for an arthroscopy?
Dear Dan,
I suggest you consult an Orthopaedic specialist with an interest in knee injuries. The painful click could be a medial plica impinging on the distal femur causing pain.
Try to avoid arthroscopy without having a diagnosis.
Regards,
hc
Hi Dr. Chang,
Just wondering if you have any advice or suggestions for my situation with chronic medial knee pain in both knees, with negative MRI for both.
Pain comes from a trauma injury to both knees when knee caps impacted padded floor during martial arts exercise. Left knee took most of the impact and is worse with pain and symptoms. No knee problems prior to injury.
– Sharp aching and burning pain along inner side of knees
– Dull aching swollen feeling around knee area, mostly inner area
– Pain can radiate up into inner thighs and down into calves
– Left knee can give way at times
Pain aggravated and reproduced by
– Sitting with knees fully bent
– Sitting with knees partially bent for extended periods of time (driving etc.)
– Sitting or lying with legs straight out, particularly when knees and feet lean outwards
– Exercise involving repetitive bending or twisting
I can no longer partake in any previous exercise like running, kickboxing, cycling, squats or lunges as it becomes too painful. My orthopaedic surgeon basically said after seeing the MRI that from his perspective he cannot offer any further assistance since it shows nothing. My chiropractor suggested the possibility of Medial Plica Syndrome, or could this be menisco capsular separation. I am 33, fit and healthy, any advice or suggestions would be greatly appreciated.
Thanks,
Nick
Hi Nicki,
Yes, the diagnosis of a medial menisco-capsular separation is possible.
Regards.
hc
I tore my PCL in my knee almost a year and a half ago, I didn’t have surgery, I did Physical therapy for 7 months then went on to do cheerleading and softball… After tons of pain I decided to get another MRI which came back clear other then severe thickening of the Previously Torn PCL. I have now completed 2 more months of Physical Therapy and am looking for a second opinion on my knee.. Is this possibly whats going on???. I have pain in the back of my knee, the medial side and also slight joint line tenderness.. and it hurts to almost anything. My PT thinks I may have damage that didn’t show up on the MRI is this possible? Would I possibly benefit from having knee arthroscopy done?
Hi Kassidy,
It is very difficult for me to comment on your condition without having examined your knee or seen the MRI scan.
The pain can be due to instability – posterior sag causing altered knee movements (kinematics) or from meniscus injury or from cartilage injury.
Sometimes the posterior sag of the tibia with respect to the femur due to a grade 3 PCL tear can cause the medial meniscus to be impinged during knee movement. That can be a cause of the pain.
Please see a doctor.
It is very dangerous to perform a scope without having an idea what is the actual problem. Diagnostic scopes may cause more problems than they can solve.
Regards,
hc
Hii sir i am also dealing with the same problem ,, 1 year ago i was a runner as well as gym lover but because of my knee pain i left running and i went to a doctor he told me for MRI scan of my both knees as pain is there in both knees but my mri scan was normal and pain is still there in inside of knee near to the knee cap .
Means along the joint line so please suggest me what should i do because DR. had told me that my knee joints are normal….
Hi Madhav,
Perhaps you can seek a 2nd opinion with another doctor.
hc
Hi Dr Chang
5 months ago I squatted for 20 mins to mob the floor and felt something wrong in my right knee when I got up. Thinking that it might be a minor sprain, I went jogging and felt pain in my right knee and leg. I again tried jogging a couple of times and every time it hurt. I did not exercise after that but even normal walking was gradually become painful at times. Finally one day (about two months from when I squatted), I felt that I could not put weight on my right knee at all. At that point I rested for a few days and met an orthopedic sports doctor who told me that my MRI looks perfect, except mild chondromalacia and bakers cyst. She told me not to worry and start doing PT. After a month of PT I could still barely walk. I could basically walk in baby steps and that too not more than 15 minutes. My doctor then gave me a cortisone shot due to which my condition started improving to some extent. I could walk for 40 minutes better but still on an extremely slow pace and my legs would feel weak. But soon after(5th week of getting cortisone), as I cycled on a stationary bike for slightly longer than usual my condition again went bad. In a couple of days I was again limbing, unable to put weight on my knee. My knee feels stiff and slight swollen and this does not better. My doctor says that she cannot do anything as MRI is normal. I have not been able to recover even half way and am unable to stand or walk, mainly because I am unable to put weight on my right knee. I also did some blood work, including uric acid, CCP, RA, ESR, and complete blood cell count, and all tests are normal. I can barely put weight on my right knee. Any suggestion from you would be really helpful.
Hi Mohit,
Try to look for a medial meniscus posterior horn root tear or impending root tear. It can present like this. Ask a Musculoskeletal Radiologist to relook at the MRI for this diagnosis.
Regards,
hc
Hello Doctor Chang,
Seven weeks ago I awoke with an odd (but not per say painful) feeling in my left knee. Two days thereafter I had severe swelling from my knee to my ankle and severe pain on my left inner knee. I hopped around on my right knee for a couple of days and then the same thing happened to my right knee. So I’ve had severe pain (and still fairly swollen) in both knees for weeks now. I cannot fully extend or fully bend either knee. MRI’s and XRays both came back fairly normal – although showed bilateral “chronic ACL sprain”, presumably unrelated to my current issue. My Orthopedist told me he cannot help and I should see a rheumatologist. In the meantime I cannot walk and am in quite a bit of pain. Any feedback would be greatly appreciated.
Thanks, Kimberly
Dear Kimberly,
A few things can cause sudden knee pain and swelling.
A posterior horn root tear of the medial meniscus may present as aching discomfort over the posterior aspect of the knee for a few weeks before a sudden episode of severe pain that makes walking difficult. There will be swelling (effusion) of the knee joint after that. However, the MRI scan should pick up this diagnosis.
Swelling from the knee to the ankle can be from a ruptured Baker’s cyst.
I am unable to tell you what you have as I have not examined your knee nor seen your MRI scan.
Please consult with your Orthopaedic Surgeon.
Regards,
hc
Sorry, I should have mentioned in my previous question that I have not had any known injuries to either knee. Symptoms started without any known cause…
I injured my knee in Jan 2016 after 4 MRI they doctors and workers comp are still claiming that there is nothing wrong. I am having sharp pain in my knee, my knee locks up, gives out and pops constantly. there are days when it stays locked up for so long I can barely walk
My 16 year old daughter landed a back tuck wrong about 3 weeks ago. She had a sensation that there was a bubble in her knee as she described it right away. There was swelling and fluid in the medial knee with pain to straighten the knee and some mild bruising, and it was very uncomfortable at night to sleep. Orthopedic testing was positive for medial meniscus and mild mcl strain. We treated it with PRICE protocols primarily and she stopped tumbling and jumping but continued to cheer with a soft brace on. We had it retested about a week ago and the laxity was still there and the click was reproducible. She is still having popping, clicking and pain with swelling after activity. We just had an MRI on Friday and got the results today. All negative. She had practice yesterday and it swelled and is painful today. What in the world could be going on?
Hi my 12 year old 88 pound son injured his lateral knee/leg. Now he can sprint full speed forward jump squat duck walk all with no symptoms. If he does something laterally some how not sure what he is doing he will have sharp pain that stops him dead in his tracks. But can sprint full speed forward with no pain? Could it be his meniscus still?
He has no poping, catching, joint line tenderness or swelling only occasional sharp pain with movements of that leg.
There are instances of menisco-capsular laxity in the lateral meniscus giving pain such as his. The other issue is to rule out popliteal tendon strain or sprain. Do take him to see a doctor if it is bothersome.
Hi Dr. Chang. I had an injury to one knee several years ago, and I fully recovered within a few months. 3 years later I suddenly started having pain and swelling in the knee. The doctor says the kneecap isn’t tracking properly. He says it must mean that my bad knee is weaker than the good knee, but I tested them and the strength is the same in both. My x-ray and MRI show no problems.