You might want to get a bone scan to look for abnormalities.
The more I watch Dr. Scott F. Dye speak (thanks to TriAgain for yet another link), the more I’m convinced that knowing what's going on with the bone behind the cartilage is often critical to understanding knee pain. That’s what Dye thinks, and he makes a good case.
He attacks a lot of the received wisdom on what causes knee pain. He’s refreshingly unorthodox. For instance: what surgeon hates surgery? But he pretty much does, except for limited instances, and he appears to favor the least amount of surgery possible.
He’s also almost vitriolic in his dislike of structuralists. You know, the dozens of doctors who tell you your problem is because your kneecap is mistracking. I remember my first orthopedic doctor cited this as a reason for my pain, then when I queried him further on the point, he kind of mumbled it away. That’s probably because my kneecaps sat quite normally in their groove on my X-ray. So he probably realized that that standard argument was absurd.
Dye also doesn’t think much of blaming cartilage defects for your pain. On this, I’m not quite convinced – the cartilage does attenuate forces traveling through the joint, and if it’s damaged or missing, well, that seems significant. And Dye himself (through self-experimentation – now that’s dedication!) identified the synovium as being highly innervated, and a possible source of knee pain. So perhaps fragments of damaged cartilage could migrate through the synovial fluid to the synovium, irritating it?
Still, in his defense, he claims to have grade three chondromalacia in one of his knees – and it’s totally asymptomatic. So maybe I’m guilty of overselling the line “heal your cartilage.” Even so, I think my program for getting better would have fit a lot of his criteria for what makes sense for fixing bad knees: go slow, and stay within your “envelope of function.”
Curious about Dr. Dye, and what the heck I’m talking about? Check out these links:
Why You Need to Know About the “Envelope of Function”
What Implications Does “Envelope of Function” Have for Designing a Plan to Beat Knee Pain?
Scott F. Dye on Why Your Knee Pain Diagnosis Stinks (And Why You’re Not Getting Better)