The knee is the largest single joint in the body. It is a hinge joint comprised of the femur (thigh bone) and tibia (shin bone). There is cartilage on each bone with the meniscus in between that acts as a shock absorber and cushion. There are four ligaments that provide stability and a joint capsule. Finally, there are many different muscles and tendons that surround the knee which bends the knee back and forth and provide dynamic stability while you are active.
Knee pain is a very common complaint for patients of all ages. It can be caused by acute injuries such as a ruptured ligament, mechanical problems such as a torn meniscus, or with chronic wear and tear over time as in osteoarthritis.
Some of the risk factors for developing knee pain include the following:
The location and character of knee pain symptoms may vary and give us clues as to what is causing the problem. These include:
At your initial consultation your physician will take a comprehensive history and physical exam. These are the most important pieces of information to help narrow down all of the causes of your pain
Next, an x-ray of the knee is important to understand the boney contours and alignment of the joint. You can identify misalignment of the joint, fractures, dislocations, and subluxations, and osteoarthritis, to name a few conditions that cause knee pain.
A CT scan is a more advanced kind of x-ray that gives much more detailed information about the bones and joint spaces. You can also get more information about soft tissue structures like muscles or blood vessels than with standard x-rays
An MRI uses magnetic fields to better detail all of the soft tissues structures of the shoulder like muscles, tendons, ligament, nerves, and blood vessels. You also get details on the quality of the cartilage and if there is stress in the bone potentially causing symptoms
Ultrasound is an imagined modality that uses sound waves to create pictures of all of the superficial structures in the knee. The advantage of this modality is to get real-time information about the knee; both while you are sitting still and while you are moving. All of the above image modalities cannot provide any of the same information an ultrasound can while you are moving!
Blood work can sometimes be useful to determine if there is an underlying medical issue causing your knee pain, such as autoimmune conditions or infections.
Preventing knee injury by addressing risk factors: This includes excessive weight and correcting muscle imbalances and weakness. Being overweight increases stress on the knee by a factor of 10 or more even during routine activities. It has been correlated with accelerated osteoarthritis. Certain sports place higher demands on your knee. By building the appropriate strength, conditioning, and flexibility throughout the body before playing your sport, risk to injuring your knee can be significantly decreased.
Physical Therapy: Once you have a knee problem, physical therapy is vital in understanding how you body moves and compensates for the knee problem, and what exercises need to be practiced to help reduce pain and improve function. Physical therapists can also use different modalities like ultrasound or E-stim to help reduce pain and swelling to facilitate activity
Pain Medication: At times symptoms may be severe enough to warrant taking medications. NSAIDs like ibuprofen or naproxen are the medications of choice to treat the inflammation of knee pain.
Steroid Injections: When oral medications aren’t enough, a corticosteroid injection, as well as an aspiration of joint fluid, may be needed to reduce symptoms. Corticosteroids are strong anti-inflammatory medications used to treat inflammatory pain associated mainly with arthritis.
Hyaluronic Acid: Another option to use for arthritis is hyaluronic acid, or “gel” injections. These injections mimic normal joint fluid in the knee and help lubricate the joint. It may be beneficial at times to combine a steroid injection with hyaluronic acid to get a greater effect.
Regenerative medicine: PRP, Stem Cells, and Microfragmented Adipose injections are some of the regenerative medicine techniques that can be used to treat a variety of knee complaints. These medications are derived from the patient’s own body, minimally processed to isolate concentrated growth factors to stimulate healing when injected back into the site of injury.
Surgery: Ultimately, there are some knee problems that require surgical intervention.
Dr. Niteesh Bharara
Director of Regenerative Medicine
Orthopedic Specialist - Non-Surgical Sports Medicine
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