Right knee medical history

This is part of an ongoing series of posts on what I have learned from an ongoing, chronic knee problem. This post describes how I injured my knee and has links to the posts I have written about other lessons I have learned.

This is a living post meant to outline the medical advice and treatments I have received since my initial injury in 2019.

• ACL tear Jan 2019
• No pain after tear, did prehab exercises prior to surgery
• ACL reconstruction surgery (BTB patellar graft) Mar 2019
• Patellofemoral pain immediately after surgery that is present to this day
  • Pain and stiffness are strongest in the last ~20º of extension
  • Pain walking, particularly on flat terrain
• Started losing extension during rehab, found cyclops lesion, had it removed Dec 2019
• Constant, disciplined PT 2019-2022.
  • Tried managing my pain as patellofemoral pain. Tried to keep pain 3/10 or lower and slowly built up strength, i.e. envelope of function approach.
  • Never able to restore normal function
  • Tried returning to agility/running but always ended up encountering large spikes in pain, and the movement never felt normal
  • Tried “knee-safe” activities like swimming, but the kicking was very painful for me
• Kaiser surgeons told me that long-term, unresolvable patellofemoral pain is possible with any ACL surgery, and more likely with my graft choice.
  • In my surgeries and MRIs, Kaiser PTs and surgeons noted cartilage wear behind my patella, suggested that was the cause of pain
• I became disillusioned with Kaiser, switched to Anthem to gain access to a broader set of doctors and institutions
  • Several surgeons point out the cartilage wear in my MRIs and suggested patellar MACI
• MACI harvest Aug 2022, implantation Sep 2023
• Was quickly evident that MACI had no impact on my pain, experienced same pain and stiffness as I have since initial ACL surgery
• Post-MACI PT, following envelope of function approach again
  • Unfortunately, pain levels continue to increase
• Paid out-of-pocket for an MRI of my good knee
  • Learned that I have the same cartilage wear in the same location on my good knee, which does not present with any pain
• Pain near extension worsened 2024-2025 to the point where even walking is quite painful
• Currently only able to cycle with a manageable amount of pain. Squats, hiking, swimming, even walking are all painful. Jogging and running are inconceivable.
• Renewed search for an orthopedic doctor who could help me figure out what is going on, new x-ray and MRI performed
  • X-rays look fine, MRI shows full delamination of the MACI graft and accelerating cartilage damage behind the kneecap.
• After hearing advice from many doctors, decided on continued physical therapy as the right path forward
• In June 2025, we started with the simplest possible PT for my knee: isometric open chain exercises and NMES. Anything else aggravated the knee.
• PT and I experimented with what hurts and what doesn’t hurt for several months.
• In January 2026, we had a functioning diagnosis: VMO/patellofemoral arthrogenic muscle inhibition and poor VMO phasic timing are the root cause of my knee troubles for all these years. We adjusted the PT to bring the VMO back online and try returning to pain-free walking. This requires a mix of neuromuscular control activities and targeted strength training.
  • Progress has been slow but steady. Having a real diagnosis that tracks with my lived experience has been amazing.

It’s now been over 7 years since the initial ACL reconstruction surgery and the subsequent complications. I cannot express in words how difficult this has been. The best case scenario is that I partially restore normal function in the coming years. By then, I’ll have spent a full decade of my life on this. I will be dealing with this in one form or another for the rest of my life.