Patient: He underwent internal fixation surgery in 2007.12 and internal fixation removal surgery in 2008.9. He recovered well at the last review in 2008.10. At present everything is normal, the muscle strength of the injured leg is recovering, not yet able to complete the whole set of movements of the injured leg squatting on one leg, but can do partial half squatting standing. Sometimes when I extend and flex the knee, there is a small sound like a crunching sound in the knee joint without pain or a feeling of being stuck; when I sit with my leg flexed for a long time and get up, there is a slight pain in the knee joint. Are these two phenomena normal? What are the causes? How can I improve them? After the last review in 2008.10, I took a flat film and left Beijing for Shanghai due to a job transfer and have not been to any hospital for review. Doctor: Thank you. The single-leg squat is a demanding set of movements, requiring not only the strength of the quadriceps, but also pain in the patellofemoral joint and other parts of the body. Where is the slight pain you are referring to? Is it located around the patella? Also, most of the small rattling sounds in the joint are related to the scarring after the surgery, so it is not a concern. You can put your hand on the patella and do knee flexion and extension activities at the same time to feel whether there is friction in the patella during the sliding process, this method can tell you whether there is wear in the patellofemoral joint, sometimes the sound in the joint may be related to the wear of the patellofemoral joint. However, for your age, there is no need to be too concerned. At this point I think the main thing is to regain muscle strength and return to your pre-injury level of motion as much as possible, and it should be beneficial for you to do exercise. Patient: Occasional knee pain when rising from a sedentary position is roughly medial to the patella (assuming an outward to medial direction from the patella to the articular fossa). It seems that this micro-pain has been absent for the last month. Dr. Zhang Hui would be a night owl, 3:00 a.m. and still come to the Internet to take a look, you are in the East 8 time zone, right? You are in the eastern time zone, right? Thank you for the detailed reply, I am currently strengthening my exercise, ready to go to Tibet in the Spring Festival to exercise, then I will pray for you in Everest! Doctor: I’m glad to see that you said “I don’t seem to have this micro pain for the last month”, which may suggest to me that your condition has improved further. Go ahead and do your exercises with confidence. I suggest you get yourself a thicker knee brace, as it can sometimes be a little more difficult to move around at high altitudes. Patient: Maybe I didn’t make myself clear, my first surgery was done by Dr. Geng XS and Wang XS, the nail removal surgery was done by you, if I didn’t wear contact lenses, you would have shown me the surgery “video”. 😛 I have 2 questions, 1) If I sit with my injured leg on my good leg, i.e. stretched leg, for a longer period of time, when I put my leg down, it hurts when I straighten my knee, but it gets better after a short while, what is the reason? (2) online information on my disease seems to be about 5-10 years ago academic information, as if the statistics of minors this disease is high probability. I am an adult skiing injury, ligaments are not broken, but cancellous bone is fractured, why? My ligaments are tougher than bone? What is the probability of this disease in adults? Sorry, I always have a lot of questions, I hope the doctor doesn’t mind, even if it’s medical literacy, lol. (P.S. This reply won’t be at 3am again, will it? :-P) Take care of yourself! Doctor: 1) When you change from a bent knee position to a straight one, do you experience a little stiffness in the knee joint? In other words, the knee joint is not flexible enough when moving? Or do you have a little bit of a stuck feeling when you move the joint? Both of these conditions can cause the symptoms you mentioned, but if the symptoms are not severe, you can ignore them. (2) The information you read is correct, as minors have a higher rate of avulsion fractures due to the presence of epiphyses, which are cartilaginous in nature and less strong than ligaments. Compared to adults, the ratio of avulsion fractures is relatively low. In our ward, the ratio of ACL to avulsion fractures is 8-10:1, but the incidence is not low, averaging 1-2 cases per week. This time the response is in the morning, lol. Patient: I had the last question 1: Sometimes when I bend my knee and straighten it, the knee is a little stiff, especially when I bend it for a long time (15 minutes or more) and then straighten it, but I can’t straighten it immediately, so I need to move it a little. As for the feeling of not being stuck, there is no such thing. The stiffness is also felt after sitting for a long time on the healthy leg, but the injured leg is less tolerant and can be a little stiff for a shorter period of time. How can I improve it? Question continues:? Regarding anesthesia, I wonder if you can answer this question as a primary surgeon rather than an anesthesiologist. During the 2 surgeries of 2007.12 when the nail was inserted and 2008.9 when the nail was removed, I felt that the anesthesia was done a little differently. In the second surgery, the anesthesiologist seemed to have left a catheter in place after the lumbar anesthesia was injected and covered my back almost with a large non-woven tape, which you and the other surgeon removed from my back after the staple was removed in the lateral position. However, I was under the impression that the catheter was not left in the posterior lumbar anesthetic injection port and covered with large tape for the first surgery. I wonder if my feeling is correct – the two surgical anesthesia operations did differ? Doctor: According to your description, this symptom should be very mild, so I suggest you do more physical activities to see if this condition will improve after activity; also you can try hot compresses or hot springs to see if it will improve; because I feel like your condition is functional. Regarding anesthesia, the two surgeries were performed in different ways. According to your description, the first surgery was performed with “lumbar anesthesia”, and the second surgery was performed with “lumbar anesthesia + continuous epidural”, and a very thin catheter was left in the anesthetized area to facilitate additional anesthesia. -This has to do with the anesthesiologist’s habits, and the anesthesiologist will also choose the right type of anesthesia depending on the time of surgery and the type of surgery – and there are many types of anesthesia available. I personally believe that the doctor has authority in treatment, but authority should be felt by the person being treated, not imposed by force, so I will try to explain the cause of the disease, the diagnosis, the basis for the diagnosis, the treatment plan and the results of the treatment, so that the person can fully understand his or her situation and what the doctor can and cannot do. I will recommend the best course of treatment and explain why it is the best course of treatment, but I never force my clients to choose my course of treatment – it can be really time consuming, but the results are usually better. In fact, to use an analogy, like when I go to fix my car, I want to know what’s wrong with my car and how to fix it – I want to know how to fix it best, not to mention that the person I’m treating is concerned about their own health. Also I try to avoid using words like “patient or patient”, especially when the treatment is over and I’m healthy again!