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Knee discomfort, low vitamin D, grinding knee caps, wear patella straps. Do I have cartilage damage and do I need microfracture surgery?

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Orthopaedic Surgeon
Practicing since : 1994
Answered : 10442 Questions
I’d like to describe the condition of my knees and ask you some questions.

The symptoms: Knee discomfort in general but mostly in the area under the knee cap (the area the doctor hits to test your reflexes). When extending my left knee after having it bent, I get some slight grinding in the knee. In the right knee, though, I get quite a bit of grinding and sometimes it hurts. Two years ago, my knees were great and I was playing basketball twice a week. Now I can’t do much other than walking and very light strengthening exercises (e.g., straight leg raises with ankle weights while lying down). I have seen orthopedists, podiatrists, rheumatologists, and physical therapists. The consensus is that my knee caps don’t glide right because I have weak quads and tight muscles in my legs. Also note that as of last December, I had low vitamin D levels (22 ng/ml). I’ve been taking a 5000 unit pill daily and am now at a normal level though. Also, I’m 32 and relatively lean (5’5”, 140).

The good news: After many years of bad orthotics, last week I got new orthotics from my podiatrist and they feel great. I can tell there’s MUCH less pressure on my knees and I feel better balanced than I ever have before. My knees caps (especially the right) still grind though and extending the right after having it bent causes discomfort. I’m not in constant pain, though. It’s just occasional movements that cause discomfort. My podiatrist showed me that the different orthotics I’ve worn over the past 5 years (I brought them all to show him) did not fit my feet well and may have actually done more harm than good. Note also that I wear patella straps for walking.

My questions:

A) Does it sound like I have significant cartilage damage, especially in the right knee? With these new orthotics and strengthening and stretching exercises, what’s the best case scenario? I know that wouldn’t make the cartilage come back but am wondering if I can get to a point where I can play sports again? Will my right knee always hurt upon extension after being bent? I’d love to be able to play basketball again but don’t know if that’s completely unrealistic.

B) Will I need microfracture surgery if I want to get to a good level of athleticism or could there be a lot of improvement just from the orthotics and exercises?

C) Can I do lying leg raises *daily* to strengthen my quads or do my muscles need a day off in between to grow? I use only a 1 lb weight on each ankle but work the quads *very* hard (holding the leg in the air for many sets with reps varied from 5 to 90 seconds).

D) In my lifetime, do you think there will ever be cartilage restoration options that don’t have as brutal a recovery period as microfracture surgery (either a gentler surgery or a nonsurgical approach)?

Thanks for all your feedback!

Posted Mon, 21 May 2012 in Back Pain
Answered by Dr. Praveen Tayal 6 hours later
Thanks for posting your query.
I have read the detailed description of your problem.
1. From your description, it seems that you have only a minor cartilage damage. Appropriate orthotics and physiotherapy is the best approach of treatment. Please do not worry you will return back to your normal routine. It is difficult to say whether you will be fit enough to play basketball again. Only the time will tell that.
2. If you recover well with orthotics and physiotherapy then i do not feel that surgery will be needed. Surgery again is not likely to make you fit enough to play sports.
3. You can do the lying leg raises 5 days a week. This will give you a two days rest for your muscles to grow.
4. Cartilage restoration surgery is the last option in case the problem is persistent. Most of the cases do improve on regular physiotherapy and appropriate posture.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Dr. Praveen Tayal.
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