Never-quite-right knee pain - anyone else?

[LulaNo]

Hi all… I am stuck in a bit of a rut and looking for anyone with similar experience, advice or inspiration.

After a knee injury last summer, my achy-breaky right knee required arthroscopic surgery. I had a plica removed, lateral release, and torn cartilage trimmed/scraped. PT went well for a while but started causing severe pain around Christmas. My orthopedic surgeon recommended we stop PT, try a monovisc/synvisc injection, and consider a surgery to transplant donor cartilage into the tear (Grade IV, full depth tear.) Obviously I stopped riding and sent my leased horse home - so at this point, I have been out of the saddle for a year.

Monovisc did not significantly reduce the pain and I now have intermittent ‘locking’ of the knee. I can always get it unlocked again, but it is very uncomfortable. Even if I decide to ‘suck it up’ and ride, I am pretty concerned about the knee locking while riding. As things seem to be worsening, I revisited the orthopedic surgeon who sent me for an MRI and then recommended PT for ‘patella tendonitis’. He no longer thinks the donor cartilage surgery is an option (but can’t explain what changed his mind.)

I went back to PT, where both DPTs in the practice said they didn’t think I had tendonitis and encouraged me to seek a second opinion. Second opinion doc said nothing in the MRI points to an obvious ‘fix’ and suggested either A, return to normal activity and just deal with the pain/locking as it happens or B, exploratory arthroscopic surgery. (He suggested that since an MRI is a photo and not a video, it might not be possible to diagnose whatever is going on with an MRI.)

I am 38, in good shape and very active (as much as possible, now.) I have been told my knee will require a replacement but that we should aim to hold off on that for at least 10 years. Obviously I don’t want to jump into exploratory surgery, but I’d really like to get back to riding and I’m just not sure what the best way forward is. When I am riding, I do the hunters at a fairly competitive level.

Anyone had a similar experience? Also, has anyone ever tried to find an orthopedist who is familiar with equestrian sports? The two I have seen have no idea why a randomly locking knee would be a problem when cantering or jumping. As we are located in Virginia (horse heaven) I thought it might be worthwhile to get another opinion from a doctor familiar with riding - although I have no idea if there’s anyone out there that fits the description or how to find someone like that. Almost forgot - anyone have recommendation for knee bracing/taping so I can try to get back to riding? PT suggested KT tape and I like it very much; just wondering if that will be enough support for riding.

[Barn_Mom]

IDK as I’ve not had the severe injuries that you’ve had…the locking knee sounds similar to mine when I tore my meniscus. My knee would randomly lock up while bent, would swell and was incredibly painful and then would randomly release. I could not help it to release…although I was afraid to push it in order to find a way to make it release. Prior to the locking episodes, I had a nasty fall (stepped in a deep hole in the dark) and afterward it felt loose and unstable, then the locking up started.

I had arthroscopic surgery to shave off the small tear in my meniscus, I was mobile right away and had instant relief. The worst was the delightful after effects from the anesthesia. My knee surgeon was Dr. William Nordt in Richmond, Va. He was fantastic and specializes in sports medicine.

[painthunter]

I’m in NC (Raleigh-area) and came off last year. Tore a piece of cartilage off my right knee that was floating around and left a cartilage defect. My ortho surgeon went in just after Labor Day arthroscopically and pulled out the floating body, plus removed some good cartilage to grow out… My knee currently locks (where the defect is) and hurts, but I am still riding this season. I am having surgery in January with my own cartilage graft (MACI procedure) to try and fix things…

I opted to ride this year (my surgeon works on hockey players and thinks I am more stubborn) as I just rehabbed my horse… I will be out of the tack minimum 6-9 months post-surgery.

[LulaNo]

Thank you both for sharing your experience! Barn Mom, I am also in RVA and will keep Dr. Nordt in mind for the future.

Painthunter, good luck with your surgery! I hope it goes well for you.

[Henlie]

Amazingly, I had the exact same first surgery! All from a riding injury when my horse spun at a jump, I flew off, and my knee smacked against the arena fence. It was done 4 years ago and I never quite got back into my same level of riding/competing until recently, and I’m definitely starting to feel it again. However, during those few years I took it easy my knee was doing great.
As a healthcare professional as well as an equestrian, I would also 110% recommend finding an orthopedic surgeon who specializes in sports medicine. They’re pretty common, my surgeon was a sports ortho and was used to seeing all kinds of skiing and track injuries, so it only took one appointment for him to realize the extent of my need for a fix. I also can’t rep physical therapy enough, I would do it twice a week for the rest of my life if my insurance would let me! I guarantee the reason I did so well after my surgery was because I hit the gym every other day to use the bikes and get my strength up. I don’t have the same locking issues with my knee, but experience it with my SI and hip, and HOT YOGA FOR DAYS is my suggestion. A true life saver.
Best of luck!