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Painful knee, diagnosed as patellar tendonitis, no swelling or stiffness. Should I get an MRI for ligament tear?

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Last February I was running down a hill, fell, and landed on both of my knees. There was minor bruising and swelling for a few days, but everything seemed to clear up. However, about two weeks later I went on a 10 mile run (longer distance than usual) and the next day I could barely walk. My knee wasn't swollen, stiff, or locking at all but it hurt quite a bit and it felt like fluid was running along the inside of my knee. I saw a doctor in urgent care of briefly examined it, took an x-ray, and upon finding nothing concluded that I most likely had patellar tendonitis and should just lay off on the exercise for a few days. Over the next several months I went back and forth between experiencing very little pain unless I went out running too much and being in enough pain that just walking around was almost too much. Then, starting in November I started to see a chiropractor and massage therapist and things gradually improved to the point where I could run a couple of times a week, jump rope, perform barbell squats, sprints, etc., with little if any discomfort. Unfortunately this just emboldened me all the more so two weeks ago I went out and ran a half marathon. My knee didn't really hurt while I was running but for the next week I definitely felt it, although it wasn't as bad as the 10 mile run last year that started it all. By the next weekend I felt fine so I ran a hard 10K, with no pain whatsoever. This was a few days ago and unfortunately my knee is now at the point where I can get by with everyday activities but the thought of running at the moment is unimaginable. The pain isn't severe but there is enough of it at the moment to keep at minimal activity. There is not just one spot where I feel the pain, however it seems to be primarily on the medial side, very close to the knee cap. Other than this pain the only other thing I am feeling is the occasional sensation of fluid inside the knee. However, there is no bruising, swelling, stiffness, loss or range of motion, or locking. This being said, should I seriously consider an MRI (my insurance is very high deductible so I would be paying for it entirely out of pocket) to check for ligament or cartilage tears or is my main problem my inability thus far to rest the knee adequately? My chiropractor believes my pain is mainly a result of muscle imbalances and until a few days ago I was confident that this was the case. On the other hand, it is really possible to be able to perform high impact exercises like jumping, sprinting, and heavy lifting with tears in a ligament or meniscus and not feel pain right away? Thanks so much for your help.
Posted Tue, 24 Apr 2012 in Back Pain
Answered by Dr. Praveen Tayal 4 hours later
Thanks for posting your query.
Persistent symptoms even after one year of injury might be due to a ligament ir meniscus injury. Doing an MRI of the affected knee will be helpful in detecting the exact cause and extent of the injury.
All the soft tissue injuries of the knee do need adequate rest and inactivity for proper healing. At the times of discomfort, i would advise you to use a knee cap or knee brace for proper support.
'High impact exercises can be performed with minor ligament tears and as it is an old injury immediate pain is not a necessary association. The discomfort you are feeling is suggestive of a persistent inflammation and local steroid injections might be of help.
You can discuss the treatment options with your orthopedician after proper investigations like MRI.
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.
Above answer was peer-reviewed by
Follow-up: Painful knee, diagnosed as patellar tendonitis, no swelling or stiffness. Should I get an MRI for ligament tear? 14 hours later
Thanks for your response, Dr. Tayal.

I don't doubt that an MRI would be useful at this point, as it could either rule out ligament and/or cartilage damage or confirm it. However, I'm still undecided at this point about scheduling one, as it will be a costly procedure.

Since I am not experiencing any swelling, locking, clicking, or instability in my left knee, do you think there's a good possibility that my recurring pain (caused primarily by running) is due to tendonitis and/or muscular imbalance which is aggravated by overuse? I ask this partly because I am fairly tall (about 196 cm) and most of my height is in my legs, which are long and narrow.

I realize there is a possibility that I have sustained a tear of some sort in a ligament or cartilage, however I have found that stretching and exercise (even high impact exercises, with the exception of running) have helped more than rest. Therefore, although you recommend an MRI, do you think it is relatively safe for me to postpone the procedure and see if my knee continues to improve with proper exercise, chiropractic treatment, and massage? My primary aim at this point is to avoid the costly tests and procedures (MRI, arthroscopy, etc.) unless absolutely necessary.

Thanks for your help!
Answered by Dr. Praveen Tayal 39 minutes later
Thanks for writing again.
I do understand your concern. If you feel, you can postpone the MRI for next 8 to 12 weeks. But during that time you need to give adequate rest to your knee along with anti inflammatory medicines to allow the knee to heal. Along with that, regular hot fomentation and physiotherapy sessions are recommended.
Calf and hamstring stretches can be helpful under the guidance of a physiotherapist after the acute pain subsides completely.
Generally we recommended, rest, graded exercises, rest and graded exercises to let you know the right amount of time you can spend on exercise without injuring yourself.
Hope my answer is helpful.
Please accept my answer in case you do not have further queries.
Above answer was peer-reviewed by
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