ST asks: I was diagnosed a little over a year ago with a condition in my knees. My knee caps do not sit properly. I was sent to physical therapy for two months, but it did not help.

I had fluid immediately fill up in my knees from running and after an hour of sports, I can barely walk because my knees were stiff and sore.

I am 27 years old and sometimes feel as though I am much older because of my knees. I can not squat down without having troubles pushing myself back up using just my legs.

I have chronic popping in both of my knees. Is there anything else I can do to stretch out those tendons so my knee caps sit where they are suppose to sit?

I understand that I have already lost a good portion of the cartilage in my left knee, and I’m sure I’m losing cartilage in my right knee. Can I stop the loss of cartilage and get back to leading an active life without having to deal with the stiffness, fluid and pain in my knees?

Dr. Patel writes: From what you are describing, it appears that you have a long history of patellar instability.

Patellar instability most of the times causes the knee cap to dislocate out of the joint to the outside. This imbalance can be mutli-factorial including tight outer ligaments and loose inner ligaments.

If you have chronic tracking problems of the knee cap, the cartilage can wear down very quickly. Physical therapy can help sometimes but if you have significant instability then you need to have the mal-tracking of the knee cap corrected.

I do perform an all arthroscopic procedure to tighten the loose ligaments and also release (loosen) the tight outer ligaments. It is not indicated on everyone, and it is hard to say if you would be a candidate for that until you are examined and your x-rays are reviewed.

I would also recommend an MRI to assess the loss of cartilage in you knees. If the knee cap mal-tracking is corrected, it may help delay the loss of cartilage. Also, fluid in the knee in not a good sign.

Dr. Manish Patel has extensive training in treating shoulder, elbow and knee injuries, and performing arthroscopic surgery. He is the principal medical practitioner in the offices of Southampton Orthopaedic and Sports Medicine Center, on the campus of Southampton Memorial Hospital. Submit questions about sports medicine, injuries and treatment for this column to sports@tidewaternews.com, or call Patel at 562-7301.