Did you know that the most common causes of knee pain are treated non-operatively? The most common cause of non-traumatic knee pain is due to patellofemoral pain or knee cap pain. This occurs in all age groups from teenagers to adults for different reasons. In teenagers, this is often associated with rapid growth during the teenage years that results in relative tightness of the knee cap. In middle-aged patients and older adult, this is caused by the cartilage on the underneath surface of the knee cap getting thinner, which is essentially the onset of arthritis.
Symptoms of patellofemoral pain include pain in the front of knee that is often made worse by squatting, going up and down stairs, getting up from a seated position or sitting “Indian Style.” Patellofemoral pain often presents spontaneously, without any obvious inciting event. No matter the age of the patient with patellofemoral pain, the vast majority of these cases can be successfully treated non-operatively with physical therapy.
Traumatic cases of knee pain include meniscal tears as well as ligament tears of the knee. In contrast to patellofemoral pain where the patient has no definable moment of injury, the exact moment of injury can be recounted with many meniscal tears or ligament injuries. The orthopedic surgeon will often work up these injuries with an MRI to allow visualization of the soft tissues of the knee, which are not visible on plain X-rays. Some of these injuries can be still treated non-operatively. For example, isolated injuries to the medial collateral ligament are usually treated non-operatively. Injuries involving large meniscal tears or anterior cruciate ligament injuries are usually treated operatively.
Arthritis of the knee is not always limited to a patient in their retirement years. Patients in their 20’s can experience symptoms of arthritis which can be associated with athletic injuries during their youth. Often times the diagnosis can be made with X-rays and MRI is unnecessary. In the early stages, arthritis can be treated with anti-inflammatory medications such as ibuprofen and exercise. Injections known as viscosupplementation are possible and involve the injection of a “lubricant like” substance into the knee. Cortisone injections are also used in knee arthritis and are often successful in delaying the need for surgery. Knee replacement, whether a partial or a total knee, is reserved for cases of arthritis that have failed conservative treatment.
There are many causes of knee pain. Some are easily treatable and others require more work for both the patient and the orthopedist. Your orthopedic doctor will always try to give you as many options to choose from in treating your troubled knee.
• Dr. Frank Moussa is a board certified, fellowship trained orthopedic surgeon specializing in sports medicine in Ahwatukee Foothills. Reach him at (602) 466-7581 or http://orthosurgeryaz.com/ahwatukee.