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Managing Knee Pain

Rubino lgBy L. Joseph Rubino, MD, an orthopedic surgeon at Atrium Medical Center.

Q. What causes knees to ache occasionally — or constantly? When should you see a doctor? What treatments are available?

A. Aching knees are a common source of pain in adults. Knee pain comes most commonly from inside the joint itself, but it can be caused by problems outside the joint, too.

Many structures inside the knee joint can be injured. Damage to the cartilage—the smooth surface that surrounds the bone—is most common. A cartilage tear can happen with an acute injury. However, cartilage damage that occurs with aging, also known as osteoarthritis, is much more common. In this process the normally thick, soft and smooth cartilage surface becomes thin and irregular. It can be associated with pain, swelling and stiffness.

Other common causes of pain inside the knee are tears of the meniscus and/or injury to the knee ligaments. The meniscus sits between the femur (thigh bone) and the tibia (calf bone). It helps share the stress of weight bearing more uniformly throughout the joint. A tear in the meniscus can be a source of sudden and, in some cases, long-term pain. Meniscus tears can occur with aging and are associated with the presence of osteoarthritis. They also occur with trauma to the knee, particularly when people are squatting and twisting.

Four main ligaments in the knee are important for knee joint stability. Injuries to one or more can cause significant trauma. Anterior cruciate ligament (ACL) injuries are more common in younger, athletic people but can happen to anyone. 

One final source of pain inside the knee is patellofemoral syndrome. This complex problem is associated with knee cap tracking and the alignment of the lower leg. It’s particularly common in women. Although there are many possible causes of patellofemoral syndrome, all create pain in the front of the knee.

Pain outside the knee joint is typically caused by bursitis, tendonitis or stiffness. Knee bursitis can be the result of trauma to the front of the knee. It’s often extremely painful to touch and to bend the knee too far. The swelling that is seen with bursitis can become infected, but usually it is an inflammatory problem that will quiet down with time and anti-inflammatory medications, such as ibuprofen.

Most often the result of overuse, tendonitis causes pain in the front of the knee, especially with activity. The pain is a bit less than with bursitis. It commonly involves the patellar tendon, just below the knee cap. Tendonitis responds well to rest, ice and anti-inflammatory medications.

Stiffness can also be painful, and it may make it difficult to walk normally, particularly when the knee cannot be fully straightened. There are many reasons that someone can get a stiff knee. This condition nearly always responds to an aggressive course of physical therapy.

Any of these problems can cause occasional or even constant pain. The first treatment for non-traumatic knee injuries should include anti-inflammatory medications (assuming no allergies), ice and avoidance of the aggravating activities. If these steps don’t work, make an appointment to see your doctor. Always try to avoid going to the emergency room for these conditions.

Traumatic knee injuries, such as fractures and dislocations, require more immediate medical attention. In this scenario you should go to the emergency room. Otherwise, schedule an appointment to see your doctor.

Physicians have many options to treat knee pain: formal physical therapy, prescription-strength anti-inflammatory medications, cortisone injections and, in some cases, surgery. Knee arthroscopy (or a knee scope) is a minimally invasive surgery that can be used to treat conditions causing pain inside the joint. The surgeon makes two small nicks in the skin and inserts a camera through one incision to thoroughly evaluate the joint. Through the other small incision, the surgeon uses tiny tools to treat most problems.

Knee replacement surgery typically is reserved for severe and painful arthritis. Surgery may also be appropriate when damage to the joint is extensive due to other factors, such as fractures and dislocations.

Remember, knee pain is common, especially in adults. It’s important to understand the possible causes of knee pain as damage inside or outside the knee joint could be the culprit.

This information is for educational purposes only. It is not intended to replace guidance from your physician on your specific health needs. Please talk to your physician for advice in all matters related to your health.

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