Monday Medical: Understanding knee pain
Steamboat Springs — Stiffness, crackling, aching, catching, locking, giving way, swelling, pain…these are some of the many descriptions of knee symptoms that prompt individuals to seek medical care for their knees. In a town as active as Steamboat Springs, there is no shortage of individuals who have questions about knee pain, as it’s not always easy to know what type of knee pain or injury you may have.
Knee issues can be acute or sudden as a result of an injury or overuse, or become chronic when the acute problem continues untreated.
Chronic knee issues can also be a result of long-term progressive degenerative change in which some or all of the knee surfaces literally “wear out.” This can be the eventual long-term result of a significant knee injury, which is termed post-traumatic arthritis. In these cases, malalignment issues with the knees and kneecap can produce uneven wear pressures and cause the overloaded areas to deteriorate over time.
An individual may also be genetically predisposed to develop osteoarthritis (degenerative joint disease) in one or multiple joints, also compounded by body abuse and “time on earth.” This inherited component is similar to other predisposed conditions such as breast cancer, Type I diabetes or heart disease that are passed down through generations.
The complaint of “giving way” is usually associated with an injury causing a tear of the anterior cruciate ligament (ACL) which is an important stabilizer of the knee. However, “giving way” can also occur with a painful worn or damaged undersurface of the kneecap (patella) where our brain reflex mechanism essentially commands the loaded knee to let loose and drop us before we can register the specific sensation of pain. This same “giving way” reflex can occur with unstable meniscal cartilage tears that can catch momentarily.
ACL tears occur with a sudden forceful twist or plant of the leg, and are often accompanied by a noticeable “pop.” Bleeding will occur within the joint slowly and steadily and typically results in a progressively tense swollen knee over about 12 hours. ACL tears in our active populations usually require surgical repair and reconstruction as the ACL is necessary for stabilization of the knee against any sudden decelerating forces applied across the joint.
Acute knee joint swelling is usually very visible, filling up a large available space above and surrounding the kneecap. Chronic knee joint swelling can eventually cause an outpouching of the posterior capsule behind the knee joint (Baker’s or popliteal cyst), and this becomes the location where chronic swelling fluid can be parked long term and will continue until the irritant/injury in the joint is resolved. Patients describe this as a “fullness” in the back of the knee causing discomfort and stiffness. This sometimes is the only symptom experienced, although the source of the problem is usually an area of arthritis, or torn cartilage.
Common knee treatments include physical therapy, specific exercise programs, chiropractic acupuncture, rolfing, oral medications, various joint injections and bracing. Injections can involve several different medications. Injections can also include utilizing our own body cells such as concentrate platelets or stem cells, which can help temporarily with pain and swelling, but have not been scientifically proven to regrow or regenerate any of the torn or worn structures.
There are a myriad of surgical treatment options available when conservative treatment is either unsuccessful or not indicated and these can range from quite simple to very complex. These include minimally invasive arthroscopic techniques for repair/resection/transplantation of meniscal tears, ACL and PCL reconstruction and articular cartilage repair and restoration. Surgery also includes multialignment repair and reconstruction, osteochondral autograft and allograft transplantations, osteotomies to change malaignment, partial or total knee replacement and repair of fractures involving the knee joint.
Dr. Eric Verploeg is a Steamboat Springs orthopaedic surgeon at Orthopaedics of Steamboat Springs and Yampa Valley Medical Center’s New Mobility program. He underwent fellowship training in knee surgery and sports medicine with Dr. Richard Steadman of the Steadman Clinic.
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