ALTorGT

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Feb 25, 2003
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Hi there
I've had this niggling knee pain for over 4 years now. The basic problem. My right knee appears to be internally rotated when viewed front on. In other words, my right foot needs to be externally (laterally) rotated by 30 degrees for both my knees to face straight agead when my ankles are brought together when standing up.

I have no problems when walking. However, when I stand for long periods in the OR, and I shift weight onto my right knee from time to time, I have this dull tight sensation which progresses to a crushing tight sensation on the outside of my right knee joint. And I can feel it in my ankle too after a while. Its almost as though my femur has been rotated on its long axis (like a propellor on a plane has been turned inwards along its longitude). However, I can stand for long periods of time on my left knee without any problems.

Any suggestions. Knee exam reveals much more crepitus on flexion and extension over the joint surface and patella on the right than on the left. If it helps, about 6 years ago I used to be able to anchor my right foot on the ground and rotate my femur on top externally causing my knee to click. Maybe that caused some damage?

Thanks for your response in advance.
 

DPTATC

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Nov 20, 2004
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ALTorGT said:
Hi there
I've had this niggling knee pain for over 4 years now. The basic problem. My right knee appears to be internally rotated when viewed front on. In other words, my right foot needs to be externally (laterally) rotated by 30 degrees for both my knees to face straight agead when my ankles are brought together when standing up.

I have no problems when walking. However, when I stand for long periods in the OR, and I shift weight onto my right knee from time to time, I have this dull tight sensation which progresses to a crushing tight sensation on the outside of my right knee joint. And I can feel it in my ankle too after a while. Its almost as though my femur has been rotated on its long axis (like a propellor on a plane has been turned inwards along its longitude). However, I can stand for long periods of time on my left knee without any problems.

Any suggestions. Knee exam reveals much more crepitus on flexion and extension over the joint surface and patella on the right than on the left. If it helps, about 6 years ago I used to be able to anchor my right foot on the ground and rotate my femur on top externally causing my knee to click. Maybe that caused some damage?

Thanks for your response in advance.
varus knee? could be ITB friction syndrome and lateral compartment laxity. look into a foot assessment for the potential need for orthotics that actually promote pronation at the foot. That might unload the latera structures and reduce your pain nearly immediately. Medial glide patellar mobilization and ITB stretching will also help but you have to stop irritating it by unloading the lateral structures.
 

volkl7

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Oct 23, 2004
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if your tibia is internally rotated, it will cause your patella to subluxate laterally (or at least have more contact pressure on the lateral femoral condyle and lateral facet of the patella). this may explain your crepitus and pain in the lateral compartment.
the situation could be exacerbated if you have increased femoral anteversion (miserable mal-alignment), and if you are a chick who has a valgus knee, increase Q angle, and weak quads/VMO.

or i could be completely wrong. but certainly don't go out and buy some freaking orthotics to pronate your foot.
bottom line is go see an orthopod.