Diagnosis

Getting a diagnosis of my knee problem turned out to be a long frustrating process.  The biggest lesson I learned was you know when something is "definitely wrong" and keep pressing until you get an answer you are satisfied with.  You are your own best advocate.

My knee pain started in May 2014 after I ran a half marathon.  The pain started as a vague slight discomfort on the inside bottom portion of my knee  After the half marathon I took a little time off then I began doing higher intensity sprint work on a track.  Mostly I was doing this because it was a great workout and a great way to stay in shape and get a little faster.  Also I had a friend come with me to the track and we would come up with different exercises and workouts to do that were challenging.  Working out together kept us from getting bored and we were able to push ourselves by coming up with creative workouts involving different types of sprints and body weight training.

By July my knee pain got a little worse and I decided to rest until it went away.  I got to the point that running was uncomfortable and I knew I had an injury.  So I would take a week or 2 off at a time then test the knee by jogging.  The pain was still there so I would stop and try to wait it out.  During this time I focused on stretching and low impact exercises such as biking and swimming.  This went on for months and the knee pain never resolved. In fact it got worse to the point I couldn't even run a few steps without a shooting pain on the inside of my knee and a giving out sensation.

I finally went to the doctor.  He did several tests and didn't find anything blatantly wrong.  I told him the pain felt like a stress fracture (something I was familiar with since I had had a few over the years).  Since the pain was on the inside of the lower part of my knee, I thought it might be an upper tibial stress fracture.  My doctor ordered x-rays which showed a potential stress fracture where the pain was.  However, he ordered a bone scan to confirm the diagnosis.  The bone scan showed a "hot spot" on my medial femoral condyle but was inconclusive for a stress fracture or any other diagnosis.  The calcification of bone on the x-ray was mostly likely a healed stress fracture that I had high school.  But there was something going on in the femoral condyle so my doctor sent me to a sports medicine doctor for further care.

The sports medicine doctor diagnosed me with runner's knee which is a common running injury due to improper tracking of the kneecap.  He sent me to physical therapy and said I'd probably be fine in a month or two after doing some strengthening exercises.  This was frustrating because I knew my pain had not gotten any better during months of rest.  Stress injuries such as runners knee typically get better when you stop doing the activity which caused it.

I reported to physical therapy and my PT said he didn't think I had runner's knee since I've had the same level of pain for months without running.  My PT ordered an MRI right away.  In the meantime he gave me several exercises to do to strengthen my abductors.  I did these exercises religiously over the next month and they did not help with my knee pain.  The MRI showed a "full fissure cartilage defect on my medial femoral condyle."  I went back to my doctor to discuss the results and the way forward.

My doctor said I basically had arthritis in my knee and there was nothing that could be done about it.  I didn't like that diagnosis at all.  I felt a healthy 33 year old should not have debilitating arthritis at this point in life.  I pushed for an orthopedic referral and was granted one although I was told there wasn't anything that could be done surgically.

The first orthopedic surgeon I saw looked at my MRI and recommended ACI surgery to fix the cartilage defect.  That night I googled all about ACI surgery.  After reading about the requirement for the procedure to be open knee rather that a less invasive arthroscope and a year long recovery I opted for a 2nd opinion. Additionally, I wanted to find a surgeon that had experience with this surgery since it is not one of the more common knee surgeries.

I decided to see a surgeon at a top orthopedic center in San Antonio.  This surgeon also recommended ACI pending a diagnostic arthroscope of the knee to determine if I was a good candidate and to harvest the cells for the procedure.  I decided to have this surgeon do the surgery and scheduled the scope for 7 May 2015, a year after the onset of the pain.