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Dr. Richard B. Hawkins' Orthopaedic Practice
KNEECAP PAIN IN RUNNERSOne of the most common complaints of athletes is pain along the inside and lower kneecap (patella). What are some of the causes of this problem? The first problem area is usually the running shoe. A careful fitting with a high-quality running shoe frequently solves kneecap problems immediately. It may be necessary to consult a podiatrist (foot doctor) who specializes in treating sports injuries. An orthotic (shoe insert) may be necessary to prevent abnormal rolling (pronation or supination) of the foot. Next, evaluation by a physical therapist may be necessary, and may reveal specific muscle weakness. A common problem is weakness of the inside quadriceps (thigh) muscle, known as the Vastus Medialis. By doing short arc knee extension exercises with ankle weights, this muscle can be isolated and strengthened. When some of the above-mentioned conservative methods of treatment aren't working, the orthopaedic surgeon will often dig deeper to determine a differential diagnosis. Standard x-rays may reveal tilting or overriding of the kneecap on special "skyline" views. Physical Therapy may be prescribed for strengthening exercises. Taping and bracing techniques may be used by the therapist. If necessary, arthroscopic surgery can be utilized to cut tight ligaments holding the outside of the kneecap, a so-called "lateral release". Another common problem in running athletes is the medial plica, which is a band of fibro-cartilage tissue adjacent to the inside of the kneecap which can impinge and cause irritation, even arthritis, of the inside kneecap joint. Shaving back the plica to the level of the capsule, using arthroscopic techniques, allows athletes to resume their sport free of pain. Still another common problem seen in athletes of all ages is chondromalacia, which means literally, "cartilage that is soft". Traumatic injuries of a minor nature are thought to start the process of cartilage softening and breakdown, with eventual shedding of loose cartilage particles that float around the knee and cause symptoms. Removing these particles and shaving the soft surface cartilage of the kneecap (chondroplasty) often gives good relief of symptoms. Runners sometimes take 6 to 12 months to resume full training programs after such surgery, however. One of the most common athletic injuries is torn meniscus. The medial meniscus is a shock-absorbing cartilage along the inside of the knee which can tear with an acute episode of twisting or falling. It can also wear out over decades of running (a degenerative tear of the meniscus). In either case, an MRI scan (magnetic resonance image) is generally used to obtain the correct diagnosis. Arthroscopic surgery to remove the torn fragment of meniscus is usually followed by a rapid return to sports within a few weeks.
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