A patient with five years of lateral knee pain had several structural abnormalities on imaging. His symptoms and movement nevertheless changed during treatment. This case explores why recognising irreversible changes should not stop us looking for factors that may still improve.

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MRI, X-ray and ultrasound showed extensive abnormalities in this patient’s painful knee, including meniscal damage, cartilage loss and osteoarthritis. Yet his symptoms and clinical examination told a more complicated story. Dr Win Huang reflects on an important question: when treating chronic knee pain, what are we actually trying to change?

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