Expert: Scott F. Gillman, DC, DACBSP - 1/19/2010

Question
Hi,

Some background information first: I'm 29 years old and have had an injury occur on my right knee about 2 months ago after 3 consecutive days of aggressive tennis. There was no pain at that time, however the knee started clicking and swelling a couple of days later. The clicking occurs mostly when the knee is fully extended, even while walking. After about a month break and some anti-inflammatory medicine prescribed by a doctor, I resumed physical activities, including leg strengthening exercises, some tennis, and skiing. Even though I was able to perform physically and the knee feels fine after warming up, it is still clicking and swelling after the fact.

Orthopedist' diagnosis: I consulted an orthopedist who was not able to pinpoint the exact source of the discomfort. He prescribed an MRI and after examining it concluded that there seems to be an injury to the connective tissue of the medial meniscus. His assumption is that because of this injury the meniscus has an extended range of motion which may be the source of the clicking. He also mentioned that there is a risk the knee may lock because of this. He recommended arthroscopic surgery to take a better look and fix whatever problem is found. A side note: I had ACL reconstruction surgery on my other / left knee and would like to avoid at all costs going through it on my "good" / right knee as well.

My questions: Is surgery absolutely necessary in this case (would I be able to live with this injury)? Is there a possibility the knee may heal on its own with some alternative treatments (i.e. physical therapy, supplements such as glucosamine sulfate, etc.)? Should I rest the knee for a longer period of time and suspend physical activities for a while? If yes, are there some leg exercises I can continue doing in order to maintain muscle strength?

Answers to any of the questions above will be highly appreciated.

Thank you.

Answer
Dan,

There is no law that states you must have surgery...  If you are able to do rehab' exercises, then it's worth while.   The basics include 1-leg deadlifts, 1-leg balance with eyes open and eyes closed, the "dippin bird," and lastly a 1-leg balance with "dip and reach" to place a dumbbell in front of you to the floor.   Some of these can be seen on www.coreessentials.biz.   I would then progress you to a balance pad or AirEx pad (google this) and train balance. Lastly, core strength and lumbopelvic stability exercises are key.    See if you can find a sports chiropractor (www.acbsp.com) that can evaluate your lower extremities and pelvis.  Some people get improvement with foot orthotics if they have asymmetric overpronation affecting the knee.  Often, prefab' orthotics work well and you can avoid $300+ customs.  ALINE (www.aline.com) makes a nice prefab' if your foot is amenable to it.  This covers the basics, Dan.  Let me know if you need more info.

'Best,

Dr. G
www.drgillman.com