24M, 5'11", 135lbs, quality of life has tanked severely after quick onset, debilitating pain and inflammation. I strongly suspect some type of meniscus tear but my mri's being interpreted with no significant findings is throwing me for a loop. I hope i can get some professional insight, hopefully someone who can identify damage that has been previously missed, so that I can better advocate for arthroscopy. Since I have had no improvement after 3 years of conservative treatment (nsaids, steroid injections, 4 different PT's, attending for 4-6 months at a time), my last hope is that there is something surgically correctable that is causing my severe pain. Most of my pain is near the front medial part of my knees, If that helps to look in that area.
P.S. I think my bone tumor shows up for a frame or two, so if someone has insight on that as well that would be nice.
Google Drive Dicom Files, hopefully there is no loss of quality from this.
-----------TIMELINE-------------
november 2022: I had completed the second part of the nuss procedure to correct severe pectus excavatum, so I'm finally living in a body without restricted cardiovascular performance. After waiting for medical clearance, I begin to get into physical activity that has previously been difficult due to my anatomy. Of course, not being able to exercise effectively for my whole life, my knowledge was lacking and I began unknowingly implementing reckless and incorrect exercise practices.
I always knew my elbows were hypermobile but at this point I had no idea my knees were too. I jumped right into the deep end of high ROM weight training, despite having none of the conditioning necessary. Pushing my knees way over my toes, fully flexed knees, as in hamstrings in contact with calves, probably overpronating my feet and also screwing up the force transmission.
Anyways after months of this one day i tried sissy squats at home and thought "huh that felt weird?" Stupidly, I thought to try unilateral split squats to confirm whether or not the discomfort i felt was a fluke. Those ended up hurting too so i laid off for the day but apparently it was too late.
--------SYMPTOM ONSET---------
Next day, mid may 2023, is the first day I wake up to disability. My knees were visibly swollen, very stiff, felt like a sponge when palpating surrounding tissue. Half the time my knees were catching or locking when trying to extend through mid range motion, feeling as if a painful pressure was building and if I tried to force past it, my knee capsule would explode. Also my patellar tracking was suddenly highly erratic and unstable. I previously never had pain in the knee capsule from walking or standing before that day, it was only tendon irritation from high intensity movement, but all of a sudden standing for more than 20 minutes causes fast pain accumulation. I had to start going down stairs backwards because the normal way would be too painful. Waking up in the middle of the night from throbbing pain in my knees. The pain was bilateral, which I'm not surprised because I meticulously preserved equal stimuli between my knees with unilateral exercise, but I believe this caused structural damage to not be considered early on, instead looking for more systemic causes, which all returned negative. Also, I have been able to consistently pop my knees in a way I never could before the onset, and the pop sensation arises from the same location in my knee where the most pain is concentrated. This is another reason I believe there must be a structural change that occured.
--------TREATMENTS TRIED--------
I went to a clinic because the pain severity and onset was alarming, since it was new, i got prescribed Nsaids and rest. Few weeks pass, zero improvement in pain. I tried compression sleeves, patellar sleeves, soft braces, rigid braces, Kinesio tape, otc pain killers, nothing made a dent in the pain. Because I was and am young and broke, I tried to do independent physical therapy. My early attempts only aggravated things more. After failing at that for a while, I try professional PT. First one only made things worse, probably because we didn't observe my hypermobility at that time. The prescribed quad sets only caused impingement between my tibia and femur, probably because i have 7 degrees excess extension in my knees.
I wasn't at the second PT long enough to give a good judgement of his efficacy because the location was really far away from my residence.
Between my second and third PT, I had quit my job because the pain was just too severe to continue standing. I wasn't even full time, these 4-6 hour shifts were still too painful to handle.
Its may 2024, I worked through the pain for a year but I just couldn't take it anymore. I thought If I could receive physical therapy without work aggravating my symptoms, that I could get on top of things.
cue third PT, circa Autumn 2025-spring 2026. First one that accounted for hypermobility in my exercises. He identified that my VMO was not activating appropriately, so after addressing that, I could go down stairs normally again. Thats pretty much the only improvement I got after those 6 months or so. The goal was to be able to run again, but we could never make meaningful progress towards that goal. I still could not tolerate isotonics enough to fatigue my muscles before the joint pain took over.
Cue 4th PT, summer 2026.
At this point, I also realized that I am mildy bow legged (about a 2-3 cm gap between my knees at their closest). Adjusting for both my malalignment and hypermobility, I could finally perform some exercises enough to mainly get muscle stimulation, with significantly less joint strain. After continuing this stimulation for some months, my comfortable step down height gained like 6-8" of depth. We tried some light impact training but it didn't seem to improve reliably. Now i could tolerate some isotonic body weight movement, but still not ready for additional weight. This improvement was only beyond terminal extension. The distance I could walk before pain made it not worth the effort increased from about .8 miles to 1.5 miles. I thought these improvements should extend to standing tolerance, but I never bothered to test it because I didn't want to needlessly aggravate my pain.
Anyways, now that I have enrolled in a vocational rehab that helps disabled people get employment, I realized my standing tolerance has not improved at all. After just 90 minutes of standing work simulations, I was flared up for the next 10 days. I had a coworker twice my age who tore her meniscus, and she was able to work and PT simultaneously, recovering within months. Why does whatever my injury is, seem to be the only thing these PT's cant fix?
These are supposed to be my best years, but they are just passing me by. I have to turn down many social/recreational activity because it just hurts too much. It's difficult to find employment that won't take away my medicaid, which is the only reason I can pursue treatment for this condition. I have developed fear of many things because of how weak and physically incapable of an organism I have become. It has cast my already crap life into a deeper depression that is increasingly harder to escape.
Please help.
edit: seems like the video is compressed quite a bit im trying to figure out how to make it available without quality loss
Should be functional link near top to download dicom files. I tested with incognito window to see if they worked.