MRI shows nothing, knee pain continues - do I need surgery?

[kneeman]

Hello,

I am writing this forum because in doing research on my knee injury I've found some excellent and informative posts that have been very helpful to me. I injured my knee three months ago doing some mountain climbing/hiking. I jumped up on a boulder and during the plant of my jump may possibly of hyper-extended my knee. After climbing down from the boulder I felt a sharp pain in the lower external (front left) part of my left knee as well as some pain in the upper external (front left) part of the same knee. It was especially painful hiking downhill. I thought I had strained some ligaments and rested it for a week. I then resumed activity and was able to jog/run/ride a stationary bike without too much pain. However, going down stairs or changing directions while running was extremely painful. I got an MRI that showed inflammation in the area of the injury, but no damage to the ligaments or cartilage. I was diagnosed with a bone bruise on the femoral condyll, but my doctor said that it was possible that I may have torn some cartilage even though the MRI showed nothing.

I am a pro basketball player in Europe and therefore in the past three months I have been trying to rehab my knee with the help of my team's trainers. I have made progress with my strength, but certain movements still give me very sharp bursts of pain. If I do too much I have residual pain for days that keeps me from being able to workout. Therefore I am in a constant back and forth game of trying to make progress without doing too much to set myself back.

Two months after the injury I got a follow up MRI that showed that the inflammation was gone and that the "bone bruise" was healed. The doctor said it was normal to have pain even after the MRI showed nothing. Therefore I have begun to step up the intensity of my workouts. However, as I increase the intensity I am starting to notice the familiar discomfort. It hasn't reached the levels of before, but I fear I am heading down that road.

My question is at what point do I need to pull the plug on the rehab process and get my knee scoped? If the MRI says the bone bruise has healed why do I feel like the pain and problems are still there (though I am able to do more than I was before)? Is it possible that a bone bruise can still be present though not visible on an MRI? Is it more likely that I have some cartilage tear that was not seen on the MRI? Would an exploratory scope resolve these questions? My season begins in several weeks and therefore the amount of rehab time I have is diminishing. Shortly I will begin to go all out and I fear that if I have another setback then surgery will be the only alternative.

Any help/advice/previous experiences with these type of injuries is greatly appreciated. Thanks.

[Vinman]

Although a very good test, MRI is not 100% accurate. I have worked with athletes who on exam have a clear meniscus tear but the MRI shows nothing.

However, bone bruises can take a long time to heal.

Do you have pinching, catching, clicking, locking in your knee? Pain with deep knee bending?

[kneeman]

I have no pinching, catching, clicking or locking in my knee. If I do two-legged deep knee bending I don't think I have problems, but one leg-deep knee bends are problematic. I reach a point about 120 degree angle when I have a sharp pain in the knee. I'm able to do leg presses without a problem, but leg extensions are practically impossible unless I do them at a very small angle.

[Vinman]

your pain sounds like it is coming more from the bone brusie or possibly from some other sturcture that might be irritated from you favoring the leg or limping on it.

You should really be asking these questions to your doc or athletic trainers.

[runt317]

Hey...I am having a lot of the same issues. I am 19 and in October of last year, I slammed my left knee into the dock (I am on the rowing team and had to jump out of the boat as we were docking, the dock was wet so my front foot slipped and the medial side of my left knee - pretty close to where the tibia and knee join/where the bursa is - hit the dock). since then I have had a lot of joint line pain, pain on the lower lateral side of the knee, and also pain in the area of the plica. we have tried rehab now for almost a year, pills, and also a cortizone shot. nothing has worked. I have had an x ray and also an MRI but both came back negative with no meniscal tears. All my OS could find is extra tissue near the plica and inflammation. I still have a little swelling in the area of the initial hit and also a little in my fat pad. I also experience a lot of clicking and popping and sometimes it "catches" and i have to wiggle it around for about 10 minutes before the sharp pain goes away. I have a normal ache that never goes away and every now and then i get the sharp pain just from sitting/walking/squats/running/etc. On exam, my athletic trainers still think it is a meniscal tear and i am going to have an exploratory knee scope in early november, but I just wanted to see if anyone had any ideas about what this could be since all the tests are coming back negative? and also, if anyone knew how recovery from the scope would go/what will it feel like?

sorry this is so long! and thank you for any help you can give me right now!!

[Vinman]

most likely a menisus tear. MRI is not 100% accurate especially the lateral meniscus. Your history and mechanical symptoms definitely point to the meniscus.

[runt317]

hey, just wanted to let you know i just had surgery last thursday on the 8th. They found a large bucket handle plica and bone damage from grinding. He took out the plica and cleaned up scar tissue and cartilage so hopefully this will work! He said the bone damage was not too bad yet so not to worry and that hopefully this would stop the grinding.

[Vinman]

glad you got your knee fixed and I hope your rehab goes well, Good luck.

[cowboy_33]

Hey guys, I am new to the forum. I just discovered it while playing around on the internet. I have had severe knee and lower back pain for a while now, but i have not done anything about it because I wasn't insured through my job. I now have a job with great insurance, so I decided to get myself checked out. My knee constantly throbs. Walking and going up or down stairs is very painful. I also have had horrible back pain for years. I think I injured it when i pushed my truck out of a ditch one night, but I'm not sure. It feels like a slipped disc or a pinched nerve. There have been many times that I have just been standing somewhere or walking, and I get this horrible twisting or pinching pain and it sends me all the way to the floor or the ground. I have to grab ahold of something to pull myself back up. I have had x-rays and MRI's, and both of them came back negative. My current doctor said there were minimal findings on the MRIs on my knee, thigh, and lower back. I am very concerned. People tell me it could be all in my head, but i just don't buy it. I live with the pain everyday of my life. My doctor has referred me to pain management. Should I go to another ortho doctor and get a second opinion? Should I just go to a pain management clinic? What do I do?

[grandprixone]

Having worked in an Orthopedic Hospital, and have had a knee surgery, I would suggest a second opinion. If you go this route, make sure you get your MRI's, X-Rays, and files sent to the second doctor. It would be pointless to start pain management if you do have damaged tissue which requires repair.

[Andy02]

One of the best ways to help build up cartilage in the knee joint is by taking a good supplement. A supplement can assist the body and can prevent any additional loss in the future. Supplements that contain glucosamine, chondroitin or similar substances actually help to rebuild cartilage. Specialists recommend moderate exercise to help relieve joint pain.

[babybear]

i had a bad bone bruise that went along with my acl tear (barely any meniscus damage though) and it still is JUST starting to get better (my injury was 12 weeks ago) so i think they take quite a while to heal. I went to go stomp the snow off my shoes the other day on my way into the office and almost fell over bc of the pain from bone injury. so I guess my point is that you should just give it some time- which is probably not easy given that you are a pro athlete- but the surgeon tells me that that area of your knee gets very little blood flow so it takes longer to heal than your normal bruising.
I would avoid surgery if you can- you're better off just taking a couple wks off to help the bruise heal than having to potentially take off several weeks/months to recover from surgery.
good luck!

[tmangel43]

Hi, I know this was posted a long time ago, but I was wondering I am a 43yr female. I got into a high impact car accident and my knees got hit in the dashboard. My left knee bruises but fine, my left knee bruises but I still have pain on the top half of my knee and the right side of my knee and underneath my knee. The accident was over two months ago. The mri showed negative. My knee still feels like it gives away and also walking for longer than a half an hour just feels like it's going to colapse. I did ask my OS if the mri is 100 perc. accurate and he informed me they have the best Dr's and to just keep going to physical therapy. I don't know about that explanttion due to the fact that I have a constant ache and the pain its still there.. The pain is tolerable, but I really feel something isn't right. Any help or suggestions would be great..

[neufox47]

^^^ So what does your PT say?

[tmangel43]

I went to the OS today and he said I tore the muscle that connects the knee to the thigh and the calf. I'm on steroids and crutches. Didn't say anything about my Knee cap that hurts. I'm supposed to follow up in 2 weeks

[edwardsak]

Why is it the doctors cannot explain pain if the MRI scan shows as negative? My son (age 12) injured his knee during a scrum in rugby last October, he has had 2 mri scans and 3 xrays and the only thing that doc could see was bruising to the bone on the inside of his knee. Due to the symptoms my son had prior to the mri scan doc was pretty sure it was a ligament damage, however deceided not to operate half hour before his schedule op due to the mri being negative. My son has seen a consultant every 6 weeks since then and nobody can explain the pain my son is still experiencing. It has been almost 11 mths now and the sensitivity and pain has not improved, the last doc said he would transfer him to cronic pain consultant. Im still not happy, i cannot feed my son permanently on pain killers so I have recontacted his initial consultant who has agreed to see him again tomorrow. Can I insist on an exploratory operation?

[Princesslilly]

About 3 weeks ago I fell and my knee instantly got swollen and i was in extreme pain. Oh 2 1/2 years ago i had a parcial minsus removal. I went to the ortho and he said the mri was perfect. Im still having extreme knee pain and it keeps giving out and locking. I also cant bent it. What should I do because the dr. just wont listen to me. Does am mri always show everything and if not what can it be?

[hutash]

First, get a new MD.

Second, no MRIs do not show everything. While very good, nothing is 100%

Third, you can bruise your meniscus or the bone underneath.

sometimes you just have they just have to go in and look. Much easier these days with arthroscopy. My right knee has a normal MRI, but is still painful, so I am have an arthroscopy still.

[doughboyshredder]

Another possibility is a dislocation with a relocation before the doc sees you.

That's what happened to me when I was 13. Bike vs. Car. Car wins. Dislocated my knee on impact with the car, and then relocated it on impact with the sidewalk. X-rays and MRIs showed nothing.

5 dislocations since.

[Coco1988]

Hi i had an injury where someone fell into the back of me and my knee buckled and smashed onto a solid wood door frame,it hit directly onto the front of my kneecap and i was in agony after about 5 minutes and couldnt put any weight on it,this was now 2 years ago and im still in alot of pain,iv had and MRI and an x-ray and nothing showed up,iv had physio for around 5 months and the pain is slightly better but i still wake up a few daysa week unable to get out of bed because of the pain,it is most difficult going up stairs,and just in general walking for over an hour,jogging is a no-no,and i still cannot kneel on the floor because the pain and discomfort is too great.if anything hits or knocks my knee slightly i am in great pain and it almost feels numb at times.i cant sit for a prolonged time with my knee bent or crossed because of stiffness and pain and i am unable to lead a normal life as it all depends on how badly my knee is hurting that day,on average there is a severe aching and burning sensation in the muscle and tendons around the kneecap,and a very sore pain underneath my kneecap,i have been told that my kneecap slides out of the tracking and goes sideways but physio has not helped this and it still doesnt explain the other pain.symptoms are severe burning sensation on and around kneecap,unable to apply any pressure directly on kneecap,difficulty using stairs and a constant aching which can be excruciating or just a dull ache.my doctor is debating over an arthroscopy or mri and im concerned iif the mri is negative then i will be refered to physio again which did not help.if the mri is negative will they go ahead with the arthroscopy or not?any advice is appreciated after 2 years of this im at my wits end!thanks! it doesnt give way it just is unbearable to walk on or move when it is at its worse,it is not whether or not i have over exhurted myself but at complete random :s thanks

[Coco1988]

hi could you possibly look at my post i put in this thread please?thanks

[lookinback]

Hi i had an injury where someone fell into the back of me and my knee buckled and smashed onto a solid wood door frame,it hit directly onto the front of my kneecap and i was in agony after about 5 minutes and couldnt put any weight on it,this was now 2 years ago and im still in alot of pain,iv had and MRI and an x-ray and nothing showed up,iv had physio for around 5 months and the pain is slightly better but i still wake up a few daysa week unable to get out of bed because of the pain,it is most difficult going up stairs,and just in general walking for over an hour,jogging is a no-no,and i still cannot kneel on the floor because the pain and discomfort is too great.if anything hits or knocks my knee slightly i am in great pain and it almost feels numb at times.i cant sit for a prolonged time with my knee bent or crossed because of stiffness and pain and i am unable to lead a normal life as it all depends on how badly my knee is hurting that day,on average there is a severe aching and burning sensation in the muscle and tendons around the kneecap,and a very sore pain underneath my kneecap,i have been told that my kneecap slides out of the tracking and goes sideways but physio has not helped this and it still doesnt explain the other pain.symptoms are severe burning sensation on and around kneecap,unable to apply any pressure directly on kneecap,difficulty using stairs and a constant aching which can be excruciating or just a dull ache.my doctor is debating over an arthroscopy or mri and im concerned iif the mri is negative then i will be refered to physio again which did not help.if the mri is negative will they go ahead with the arthroscopy or not?any advice is appreciated after 2 years of this im at my wits end!thanks! it doesnt give way it just is unbearable to walk on or move when it is at its worse,it is not whether or not i have over exhurted myself but at complete random :s thanks

You do know this is a skiing forum right?

To start things off...get a new PT who you can communicate your issues with, a PT should be a dynamic figure and should work with you to establish the best possible options for you. Its VERY hard to just post pain symptoms on an online forum and expect a correct diagnosis, a history only helps so much. Did you receive treatment right after the injury? Was an xray taken? Are you on any meds?

Since you really want an answer.... Right off the bat several things come to mind...is your pain bilateral? Do any of your other joints ache? How old are you? Have you had a rheumatoid test? You mention your platella is subluxing, this is an issue on its own, your pt should be building up your medial musculature as well as giving you stabilizing exercises. Do you do your exercises? Waiting 2 years before addressing the issue has most likely resulting in scar tissue building up, you might need surgery just to clear things out in there. Do you have crepitus? Have you considered insoles? Do you pronate when you walk? gait patterns can manifest to knee issues verry quickly.

As you see there is much more to figuring out the underlying cause than posting "my knee hurts"

i suggest:
1) Finding a PT who you can communicate
2) get a second opinion from several docs before you are opened up
3) Get a surgeon who takes said PT's diagnosis into account
4) If you really feel the need to ask the online community post your issues on a medical forum JONG!!

[kenn_kenn2]

hey i play soccer and i've had patella tendonitis for over a year now. i got a mri and it came back negative. so i went to physical therapy for 3 months and it went away. so i returned to soccer in april and did my exercises every day. then in september it came back. i didn't tell anyone because i didn't want to sit out. but during one practice we scrimmaged the boys and one boy kicked the back of my knee, the same one that was injuried. i didn't think much of it until i got up and the outside of my knee hurt a lot. i still didn't tell anyone. so when the season ended i thought it would go away in a month, but it didn't. so i told my dad and we went to the doctor and he said i had a 50-50 chance of a meniscus tear. i got a mri and it came back negative, except i had bone marrow edema on the medial side of my bone. now im doing my exercises until january, and if i dont get better i have to go back. what should i do?

[kenn_kenn2]

also i forgot to mention that the lateral side of my knee pops, clicks, and sometimes lock

[CarlGleave]

Hi also am suffering with knee injury I fell in a small hole in work my ankle was wedged in the hole and my body weight then fell through my knee this caused me the worst pain I have ever experienced. 4 months on I am as sore as the day it happened I am still unable to work, walk with aid etc. my x rays are clear and waiting MRI results later this week any ideas if the MRI shows no tear