There are three bones that come together to form your knee joint: the thigh bone, the shinbone and the kneecap. The leg muscles (the quadriceps, hamstrings and calf) work as a group to flex the knee joint. The leg muscles are held onto the bones by tendons. And the three bones that form the knee are held together by ligaments. Because all these parts work together in harmony, if one of them is hurt, it can cause knee pain. As an orthopedic doctor and knee specialist, I see patients with many different knee conditions. These include:
- Knee fractures
- Rheumatoid Arthritis
- Post Traumatic Arthritis
- Meniscus tears
- Ligament or muscle tears
Knee fractures can happen in any of the bones of the knee including the kneecap, shinbone or thigh bone. These fractures can occur due to sports related injuries, auto accidents, falls, and direct blows to the knee bones. Older adults with osteoporosis are more susceptible to knee fractures.
Symptoms of a knee fracture can include pain, bruising, swelling, the inability to put weight on your leg, or bend your knee, increased pain with movement, or a grating feeling in the leg when moving. To diagnose a knee fracture an x-ray or MRI will be ordered. Depending upon the type of fracture and where the fracture is, surgery may be necessary to put the bones back into the right position. Your knee may be put in a splint, brace or cast to keep it from moving while it is healing. Typically knee fractures will take 4 to 6 weeks to heal.
Rheumatoid arthritis (RA) is an autoimmune disease which means the immune system attacks its own tissues. In the knee it causes the membrane that covers the knee to swell. As it swells it causes stiffness and knee pain. Pain and swelling can be worse in the morning and after sitting or resting. But vigorous activity can also cause pain to increase. RA is a symmetrical disease meaning that it usually affects the same joint on both sides of the body.
Initial treatments of RA are non-surgical and aim to reduce the pain and swelling and ensure stability while walking. When RA progresses and becomes disabling, a number of different types of surgical procedures may be recommended including partial or total knee replacement.
Osteoarthritis causes wear and tear on the knee joint. It causes cartilage to wear away and become rough. The space between the bones narrows. As this occurs, bones rub on bones and painful bone spurs occur. As with RA osteoarthritis causes swelling of the joint, stiffness and knee pain. The pain usually develops over time, but sudden onset is also possible. RA and osteoarthritis are both diagnosed through a physical exam, x-rays, an MRI or CT Scan, and blood tests to determine the type of arthritis.
There is no cure for arthritis. As with RA non-surgical treatments are used to relieve pain until walking becomes too difficult. Then surgical options are explored.
Posttraumatic arthritis can form in the knee joint after an injury to the knee such as a broken bone, meniscal tear or ligament injury. Injuries can cause instability on the knee joint. With instability wear and tear can occur and this can lead to arthritis.
Osteonecrosis of the Knee
When blood flow is interrupted to a bone in the knee, the bone will die due to lack of oxygen and gradually collapse. The cartilage covering the bone will also break down and if not caught early will lead to debilitating arthritis. Osteonecrosis of the knee can affect anyone but is 3 times more likely in women then men and more common in people over age 60.
The symptoms of osteonecrosis of the knee is typically pain on the inside of the knee. The pain can come on suddenly or be triggered by a specific activity or injury. As the disease progresses, standing, putting weight on the knee and moving the knee are all painful. Patients typically experience swelling, sensitivity to touch and limited range of motion.
If osteonecrosis is diagnosed early, it is possible to treat the lack of blood flow and improve function of the knee. If not caught early, partial or total knee replacement may be required.
Between your shinbone and thighbone are two wedge-shaped pieces of cartilage that act as shock absorbers. These are your meniscus. Meniscus tears often occur due to sports related injuries but can also occur from twisting the knee the wrong way. Older adults may experience degenerative meniscus tears as the tissue ages and weakens. Symptoms of meniscus tears include pain, swelling, stiffness, the feeling that your knee is giving way, or the inability to extend your knee fully. If the meniscus tear is small it may resolve itself with rest, ice, compression and elevation. If it is large, it may require surgical meniscus repair.
There are four ligaments in the knee. They are the anterior cruciate (ACL), the posterior cruciate (PCL), the medial collateral (MCL) and the lateral collateral (LCL). The ACL is the most common ligament to be injured. You will often hear athletes say they have a torn ACL. The ACL is torn when the feet are facing one way and the knees turn the other way. All knee ligament tears will cause pain, swelling, instability and a reduced range of motion to some degree. Depending upon the extent of the tear, ligament tears may either be treated with physical therapy, a knee brace, or surgery.
Diagnosing Your Knee Pain
If you are suffering with knee pain, contact my office today to schedule an appointment. Call (719) 632-7669.