Knee Pain / Arthritis
What causes knee pain?
Knee pain can occur from several anatomical structures. Muscles connect to the bones through tendons that can become inflamed, this is called tendonitis. When a tendon tears, like a quadriceps tendon, the function of the muscle may be compromised and bleeding in the joint can cause swelling that increases pain. Bursas are anatomic cushions at tendon insertions that can become inflamed and cause knee paint at their locations. Ligaments connect bones to bones in the knee and act as static stabilizers that can be injured, stretched, or torn. The four main ligaments in the knee are the ACL, PCL, MCL, LCL. When these ligaments are injured, the stability of the knee is compromised and can cause pain and swelling.
- ACL tears are often repaired by replacing the ligament with another ligament or similar tissue from the patient or a donor patient.
- Complete PCL tears in young active patients are often repaired.
- MCL tears are commonly incomplete tears and can heal with bracing and protection without surgery. Some complete tears require surgical repair.
Medial and Lateral Meniscus cartilage injuries can cause pain when they are torn in small or large areas. These cartilaginous shock absorbers are critical in the transfer of load across the knee and protection of the surface cartilage on the ends of bones. Articular surface cartilage damage from trauma, arthritis, infection, and osteonecrosis can cause pain, swelling, loss of motion, and deformity of the knee.
Arthritis is the general term for joint inflammation, in the knee this can be from many disease processes which include: osteoarthritis, rheumatoid arthritis, Psoriatic arthritis, gout, infection (bacterial, viral, fungal, lyme), osteonecrosis (most often from steroid use, alcohol use, sickle cell disease, and spontaneous), as well as joint trauma.
What makes someone a knee pain/arthritis doctor?
The doctor who is most educated in the evaluation, diagnosis, and treatment of knee pain, arthritis and injuries is an orthopaedic surgeon. This requires graduation from a 4-year program in medical school in the USA. Then the acceptance into, and completion of, an orthopaedic surgery residency program for 5 years in the USA. Many orthopaedic surgeons will then complete further specialization in a fellowship program after residency. In the case of knee surgeons, this is in joint replacement or sports medicine.
These surgeons are skilled at the physical examination of the knee, ordering and evaluating proper imaging studies (x-rays, MRI, CT Scans, ultrasound, bone scans), ordering and interpreting laboratory studies, creating management plans to treat knee conditions identified, referring patients for further evaluations by other specialists, and performing surgical procedures on the knee as required by the individual patient’s situation.
What are the symptoms of knee pain/arthritis?
The common symptom of knee pain from arthritis are:
• Pain in the knee that a person can point to on one side of the knee or the other, or just under the kneecap. (Patients that may be potential Partial Knee candidates)
• Pain that is located all around the knee, not on just one side or under the kneecap alone. (Patients that may be potential Total Knee candidates)
• Pain in the knee when walking.
• Pain getting up from a seated position.
• Pain going up and/or down stairs.
• Dull or aching pain
• Stiffness in the knee
• Swelling of the knee joint.
• Loss of motion in the knee.
• Decreased walk distance
• Reduction in activities of daily living
• Reduction in sports and exercise activities.
How do you treat knee pain/arthritis?
Knee pain from arthritis has many treatment options including non-surgical and surgical options. It is best to begin with the least invasive lowest risk options that give the greatest pain relief and improvement of function. When the less risky and less invasive options no longer provide relief, then more advanced treatment options are considered.
What do you recommend for knee arthritis pain management specifically?
I agree with the options that the American Academy of Orthopaedic Surgeons recommends in the management of osteoarthritis of the knee. Their recommendations are based on “outcomes-based medicine” from research conducted and reported in the peer review literature. I also believe in the advancement of medicine, and newer techniques and therapies available to knee surgeons. Some of these options include biologic treatments like stem cells and blood-derived growth factors, and some include advanced technology surgical treatments such as robotic-assisted surgery during joint replacement.
Can you leave knee pain/arthritis untreated?
Yes, you can leave knee osteoarthritis untreated. Unlike cancer or heart disease, osteoarthritis left untreated will not shorten your life. However, it will reduce your quality of life. Managing your quality of life, reducing pain and increasing function is what treating knee osteoarthritis is all about. There are non-surgical and surgical ways to treat knee osteoarthritis. As far as leaving knee pain in general untreated, first I believe you should diagnose the problem and discuss the treatment options with each patient. Only after discussing the options with the patient should we leave it up to the patient to decide how they wish us to help treat their condition, or not.