More about Knee Pain and Its Treatment

Meniscal Tear

Menisci are two wedge shaped pieces of cartilage present between the lower end of thigh bone and upper end of shin bone. They cushion the knee joint and act as shock absorbers. Meniscal tears are commonly caused due to traumatic injury in young athletes or due to degenerative processes in older adults. X-ray and MRI are helpful to detect meniscal tear.

The treatment of meniscal tear depends not only on the type of tear, but also the age and activity level of the patient. If the tear is small and your knee is stable, the RICE protocol is usually effective; that is rest, ice, compression and elevation of the leg above heart level.

Non-steroidal anti-inflammatory drugs help reduce pain and swelling. If the tear is large or you are not getting relief from conservative treatment, surgery may be recommended. The types of surgeries for meniscal tear are meniscectomy or knee arthroscopy.

Knee Bursitis

A bursa is a fluid filled sac that acts as a cushion and reduces friction between a tendon and a bone. Each of our knees has as many as 11 bursae. If the bursa, located just in front of the kneecap gets inflamed, the condition is called knee bursitis. Usually, the people who constantly kneel to work, such as plumbers, roofers, carpet layers and in athelets who are prone to direct, hard hit to their knees.

The knee bursitis is usually treated effectively by rest, applying ice, keeping the leg elevated and using medications such as aspirin or ibuprofen. If the inflammation is chronic and is not responding to conservative treatment, your doctor may aspirate the bursa with a needle to drain out extra fluid. In some severe cases, surgical removal of bursa may be recommended.

Patellar Tendon Tear

The patellar tendon connects the patella (kneecap) to shin bone. Patellar tendonitis is the inflammation of the patellar tendon and is common in people who are active in running or jumping. It is also known as jumper’s knee. Patellar tendonitis weakens the tendon and may result in patellar tendon tear. Very small or partial tears are treated conservatively by immobilizing the knee for 3 to 6 weeks. Physical therapy helps restore strength and range of motion. Surgical treatment is needed, if the complete tear has occurred. Surgical repair reattaches the torn tendon to the kneecap.

Arthritis

Arthritis, whether it is osteoarthritis, rheumatoid or post-traumatic is associated with pain, inflammation, stiffness and weakness of the knee joint. Physical examination and imaging studies are needed to diagnose arthritis.

There is a wide range of non-surgical and surgical treatment options for arthritis. Initial stages of arthritis can be treated with non-surgical methods which include:

  • Lifestyle modification—include weight reduction, changing activities and exercises that aggravate the condition.
  • Exercise—help reducing pain and improving the range of motion.
  • Other supportive devices—such as cane, braces, shoe inserts or knee sleeves.
  • Medications—several drugs are used to treat knee arthritis. Your doctor may recommend one or some of these according to your specific condition:
  • NSAIDs and COX-2 inhibitors—NSAIDs are non-steroidal anti-inflammatory drugs that help reduce pain and swelling. COX-2 inhibitors are special type of NSAID and are used if knee pain is moderate to severe. If you are taking a COX-2 inhibitor, you should not use a traditional NSAID.
  • Glucosamine and chondroitin—these are oral supplements that are helpful in the early stages of arthritis.
  • Corticosteroids—are powerful anti-inflammatory drugs and are used if pain is severe. However, the effects of corticosteroids are not long-lasting.
  • Gold salt injections—are special medical treatments for rheumatoid arthritis.
  • Viscosupplementation with hyaluronic acid—it is a procedure that involves injecting hyaluronic acid directly in the knee joint. Hyaluronic acid is a natural substance found in synovial fluid. It is helpful to those patients who did not respond to other drugs.

If there is swelling in the joint, your doctor may aspirate the extra fluid before injecting hyaluronic acid. These formulations of hyaluronic acid are available:

  • Euflexxa (1 % sodium hyaluronate)
  • Supartz (sodium hyaluronate)
  • Synvisc (Hylan G-F 20)
  • Synvisc One (Hylan G-F 20)
  • Orthovisc (high molecular weight form of hyaluronic acid)
  • Hyalgan (sodium hyaluronate)

If you do not respond to any of these non-surgical treatments of arthritis, surgical treatment may be needed which include:

  • Arthroplasty
  • Osteotomy
  • Cartilage grafting
  • Knee replacement


If you are suffering from knee pain, an orthopedic surgeon will diagnose and prescribe the best treatment plan for your knee problem.

 

 

Sources
American Academy of Orthopedic Surgeons www.aaos.org/
Mayo clinic www.mayoclinic.com/