DR SHIP: Mr V is a 57-year-old man who has
had knee pain for at least 30 years. He lives in Boston with his wife, with
whom he owns and runs a business. He has managed care insurance and sees his
primary care physician, Dr P, at Beth Israel Deaconess Medical Center.
Mr V dates the onset of his left knee problems to a soccer injury at
age 26. He was diagnosed with rupture of 2 ligaments and underwent a course
of physical therapy. His pain diminished over time, but he was aware that
his left knee was never again at "100%." He continued his active athletic
life, which included soccer, bicycle racing, and running at least 3 times
per week. About 15 years ago, however, pain in his left knee recurred and
became severe enough that he stopped running and moved largely to long-distance
cycling. Thirteen years ago he underwent an arthroscopic debridement. This
improved his level of function and decreased his pain for approximately 2
years, but symptoms subsequently recurred. He has since had several courses
of physical therapy but has found the recommended exercises to be so painful
that he could not complete them.