Chronic Knee Pain Treatment

Dr. Shreedhar Archik

Chronic knee pain at a glance

• Chronic knee pain is damage or deterioration of the cartilage underneath the kneecap.

• One of the most common reasons for chronic knee pain is chondromalacia, and is also known as chondromalacia or patellofemoral pain syndrome.

• Chronic knee pain is commonly caused by repetitive stress on the knee, misalignment of the bones in the knee joint, and/or injury to the knee.

• The primary symptom of chondromalacia is pain that worsens when climbing stairs or sitting with the knees bent for long periods of time.

• Treatment for chronic knee pain includes rest, ice, wearing a supportive knee brace, over-the-counter pain relievers, exercise, or (in severe cases) knee replacement surgey. Talk to your pharmacist before purchasing anti-inflammatories as these medications may be contraindicated as they may interact with other medications and medical conditions.

Causes of chronic knee pain

While there is currently no known cause of chondromalacia, the condition is commonly associated with overuse of the knee during activities that involve running or jumping. In addition, trauma or injury may lead to chronic knee pain.

In some cases, constant knee pain may result from the misalignment of the knee or foot bones, causing stress to the knee structure.

Symptoms of chronic knee pain

The main symptom of chondromalacia is a dull ache in the front of the knee. This pain may intensify when climbing up or down stairs, kneeling, squatting, or sitting with the knees bent for long periods of time.

In some instances, there may also be a sensation of grinding or grating when the knee is fully extended.

Knee pain treatments

Applying ice and resting the knee can help treat chronic knee pain. Over-the-counter pain relievers like acetaminophen, aspirin, or ibuprofen may also be used to reduce the pain associated with chondromalacia.

A knee brace can provide greater support and stability to the joint during movement and minimize aggravating the condition.

A physical therapist may recommend stretches and special exercises to build strength in the muscles that support the knee as part of a long-term care regimen. The quadriceps, hamstrings, and hip abductors are generally the focus of this effort.

In addition, it may be helpful to switch to physical activities that put less strain on the knee, such as riding a bicycle or swimming, to help reduce the discomfort of chronic knee pain.

In severe cases, surgery may be necessary to remove and/or repair the damaged cartilage or to replace the knee joint.

If you experience chronic knee pain, contact us to schedule an appointment with our knee specialists to learn about the best treatment options to reduce your pain.

Knee Ligament Injuries & Tears Treatment

Ligament injuries and tears at a glance

• The keen joint has four ligaments; tough, flexible fibers that link the bones together that provide stability and control movement. Injuries to these ligaments may occur during sports activities or in trauma, such as a blow to the knee.

• Symptoms include intense pain, swelling, and a loud pop at the moment of injury. The knee joint may feel loose and unstable. It may be difficult to put weight on the affected leg.

• Initial treatment for ligament injuries and tears includes use of the RICE protocol : rest, ice, compression, and elevation of the affected knee. For severe tears, reconstructive surgery may be necessary to reattach or reconstruct the damaged ligaments.

Causes of knee ligament injuries

Two of the ligaments in the knee joint are known as cruciate ligaments. The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) connect the thighbone to the larger bone of the lower leg (tibia) in the knee joint.

The other two knee joint ligaments are known as collateral ligaments. Collateral ligaments control the side-to-side movement of the knee. The lateral collateral ligament (LCL) and the medial collateral ligament (MCL) connect the thighbone to the larger bone of the lower leg (tibia).

Mild ligament injuries, such as a knee sprain, involve stretching or minor tearing of some of the ligament fibers, while a severe ligament injury, such as a torn ACL involves the complete tearing of the ligament fibers.

Knee ligament injuries or tears commonly occur during sports activities like soccer, football, skiing, and gymnastics. Overextending the knee, stopping suddenly when running, twisting the knee when the foot is planted, or getting hit on the knee can lead to ligament injuries or tears.

Multiple ligaments (cruciate and/or collateral) may be injured in a single traumatic event.

Symptoms of knee ligament injuries

Symptoms of a knee ligament injury include severe pain, swelling, and an audible popping or snapping noise at the time of the injury.

Bending or putting weight on the knee usually increases the intensity of the pain, although there will usually be pain even when the knee is at rest.

Depending on which type of ligament has been damaged, the pain symptoms may occur in different parts of the knee. If there is pain on the inner or outer portions of the knee, there may be damage to the collateral ligaments. If the pain is felt deep within the knee, there may be damage to the cruciate ligaments.

Treatment of knee ligament injuries

Immediately following a ligament injury or tear, follow the RICE protocol by resting the knee, applying ice to the injured area, wrap the knee in a compression bandage, and elevate the leg.

Taking over-the-counter anti-inflammatory medicine may help reduce pain and swelling associated with the injury. A knee brace can help stabilize the joint after injury. Talk to your pharmacist before purchasing anti-inflammatories as these medications may be contraindicated as they may interact with other medications and medical conditions.

Depending on the severity of the injury, a healthcare provider may recommend stretching and strengthening exercises to help to rehabilitate the knee.

In a severe collateral ligament injury, surgery may be necessary to reconnect the torn ligament.

Unfortunately, in a severe cruciate ligament injury, it is not possible to reconnect the torn ligaments. However, an orthopedic surgeon can perform reconstructive surgery to replace the damaged cruciate ligaments with tendons from another part of the body donated ligaments.

Meniscus Tears Treatment

Meniscus tears at a glance

• A meniscus is a c-shaped disc of cartilage located between the bones of the knee joint. There are two menisci that help distribute body weight evenly across the knee.

• General symptoms of a meniscus tear include pain, swelling, difficulty straightening the knee, and a popping sensation.

• Initial treatment for a meniscus tear includes the RICE protocol : rest, ice, compression, and elevation of the injured knee.

• In more severe tears, knee surgery may be necessary to restore knee function.
Causes of meniscus tears

Meniscus tears commonly occur when the knee is suddenly twisted or turned while bent and the foot is planted on the ground. Tears may also happen when kneeling, squatting, or lifting something heavy. The normal wear-and-tear of aging on cartilage may also make it easier for the menisci to tear.

Meniscus tears are categorized into three groups : minor, moderate, and severe.

Symptoms of meniscus tears

Symptoms of a meniscus tear depend on the severity of the injury. The symptoms of a minor tear are mild pain and swelling.

A moderate tear may develop more swelling over the course of a few days, and sharp pain may occur when squatting or twisting the knee. In a moderate tear, the pain is typically felt on the side or the center of the knee, and may come and go on its own for years if the tear is not properly treated.

After a severe tear, pieces of the torn disc interfere with joint function, causing the knee to catch, pop, lock, or be difficult to straighten. In addition to swelling and stiffness, the knee may feel unstable or give way unexpectedly.

Treatment of meniscus tears

Treatment for meniscus tears should include rest, ice, compression of the knee with an elastic bandage, and elevation of the affected leg. Physical therapy exercises may also be helpful or necessary to regain function.

Treatment options for more severe tears may depend on the location of the tear and the age of the injured person. Large tears near the outside of the knee may improve with surgery.

Surgery may be less effective at repairing large tears near the center of the knee, but for a younger person, the benefit of restoring the knee’s function may make surgery a worthwhile option.

Contact us to schedule an appointment with our knee specialists if you are experiencing symptoms and knee pain associated with a meniscus tear to learn more about your treatment optionsOsgood-Schlatter Disease Treatment

Osgood-Schlatter disease at a glance

• Osgood-Schlatter disease is inflammation of the tendon that connects the kneecap to the shin, frequently seen in adolescents involved in sports.

• Symptoms include a painful bump below the kneecap and discomfort that increases when the knee is used.

• Treatment for the symptoms of Osgood-Schlatter disease includes over-the-counter pain medicine, rest, ice, and the use of supportive braces. Talk to your pharmacist before purchasing anti-inflammatories as these medications may be contraindicated as they may interact with other medications and medical conditions.

Causes of Osgood-Schlatter disease

Osgood-Schlatter disease is caused by overuse of the tendon that connects the kneecap to the shin. The primary risks factors for developing OSD are age, gender and physical activity.

OSD typically affects younger teens around the beginning of their growth spurts that commonly accompany puberty (ages 11-14). Growth spurts make adolescents more vulnerable because their bones, tendons and muscles are growing quickly and not always at the same time.

While Osgood-Schlatter disease is more common in boys, occurs in young girls is on the rise.

Sports activities that require quick changes in moving direction, running, or jumping such as ballet, soccer, ice skating, or basketball often contribute to the development of Osgood-Schlatter disease.

Symptoms of Osgood-Schlatter disease

The primary symptom of Osgood-Schlatter disease is a painful, bony lump that appears below the kneecap, on the upper shinbone. Additional symptoms include pain in one or both knees that worsens with movement, and tightness in the thigh muscles (quadriceps).

The severity and tendency of symptoms vary from person to person. Pain may come and go for weeks or months, and may continue until the child stops growing.

Treatment of Osgood-Schlatter disease

The symptoms of Osgood-Schlatter disease typically go away when the child’s bones have finished growing. Over-the-counter pain medication may help relieve the pain, as well as icing the knee and resting.

Children may continue to participate in sports if the physical activity does not cause too much pain. It may be helpful to use supportive braces or straps while exercising or participating in sport activities.

However, symptoms will get better faster when physical activity is limited. Switching to low-impact physical activities, such as swimming or bicycling, can also reduce stress on the knee.

Contact us to schedule an appointment with our sports medicine specialists and learn more about treatment options for Osgood-Schlatter.
Runner’s Knee Treatment

Runner’s knee at a glance

• Runner’s knee is a general term used to describe several disorders caused by overuse of the knee joint.

• Symptoms include pain around or behind the kneecap, swelling, and a grinding feeling in the knee.

• Initial treatment for runner’s knee should include the RICE protocol : rest, ice, compression, and elevation of the knee. Over-the counter pain medication may also be used. Talk to your pharmacist before purchasing anti-inflammatories as these medications may be contraindicated as they may interact with other medications and medical conditions.

• Severe cases of runner’s knee may require surgery to treat.

Causes of runner’s knee

Runner’s knee is caused by overuse and strain of the knee joint. Causes of runner’s knee include sports activities that require repetitive bending motion in the knee, usually running, and are commonly seen in sports medicine. This irritates the nerves in the kneecap or over stresses the tendons that connect muscle to bone in the knee joint. Trauma to the knee (such as from a fall or direct blow) and weak thigh muscles can also cause runner’s knee symptoms. Runner’s knee may also result from the misalignment of the bones in the joint, which can cause the weight of the body to be distributed unevenly in the knee. Flat feet, also known as fallen arches, may contribute to runner’s knee by overstretching the tendons in the lower leg.
Symptoms of runner’s knee

People with runner’s knee typically experience pain around or behind the kneecap, swelling, and a grinding sensation in the knee. Pain from runner’s knee usually increases when walking down a flight of stairs or up an incline, such as a ramp.

Treatment of runner’s knee

Runner’s knee is commonly treated with rest, ice, compression, and elevation. Over-the-counter pain medication may also be helpful for managing the pain associated with runner’s knee.

A healthcare provider may suggest special exercises or stretches that can help treat runner’s knee. For those with flat feet, arch supports may be inserted into the shoes to reduce the strain put on the tendons.

In severe cases, surgery may be necessary to remove damaged cartilage or correct the position of the kneecap.

If you experience knee pain and symptoms associated with runner’s knee, contact our orthopedic specialists to learn more about your treatment options.

Osteochondritis Dissecans in the Knee

Osteochondritis dissecans at a glance

• Osteochondritis dissecans is a condition in which small cracks develop in the cartilage and / or bones of a joint. If the cracks begin to fragment, the joint may become jammed or locked.

• This condition commonly occurs in the knee, but can also occur in the elbow, shoulder, hip, or ankle. Osteochondritis dissecans is typically caused by repeated, minor trauma between the bones of a joint.

• Symptoms include pain, swelling, tenderness, and grinding or locking in the joint.

• Treatment includes rest, physical therapy, and avoiding activities that strain the affected joint. In some cases, surgery may be necessary to reattach or remove loose fragments.

Causes of osteochondritis dissecans

Osteochondritis dissecans occurs when the blood supply to part of the cartilage or bone in the knee (or other joints) is lost. That portion of cartilage or bone can develop small cracks or even break off entirely. In some cases, the fragment of bone or cartilage may lodge itself in between the bones of the joint, making movement difficult or impossible.

Sports activities that require jumping, sudden changes of direction, or throwing can cause osteochondritis dissecans. These repetitive motions can cause small injuries that may go unnoticed until symptoms appear.

Over time, the repeated trauma of the bones hitting each other can cause cracks or fragments to occur in the bone or cartilage of the joint.

Symptoms of osteochondritis dissecans

Symptoms of osteochondritis dissecans include pain and soreness in the joint that intensifies with movement. The loose fragments of cartilage or bone in the joint may interrupt the range of motion, or pop or lock in place. The affected joint may become swollen and tender to the touch.

Treatment for osteochondritis dissecans

With time and rest, the affected bone and cartilage may heal on its own. Physical therapy exercises that stretch and strengthen the muscles around the knee joint can help restore the knee’s range of motion.

In some cases, surgery may be necessary to remove loose pieces of bone from the joint, or to repair tissue that has separated from the bone.

Contact us to request an appointment with our knee specialists if you are experience symptoms and pain associated with osteochondritis dissecans to learn more about your treatment options.

Anterior Cruciate Ligament (ACL) Injury : Tears, Ruptures & Sprains

ACL injury at a glance

• The ACL is one of the ligaments connecting the thighbone (femur) with the shinbone (tibia) inside the knee joint.

• During an ACL injury, the ligament may be torn, ruptured, or separated from the bone.

• ACL injuries frequently occur during sports or work activities, when the knee is bent backwards, twisted, or hit with force.

• Symptoms of an ACL injury include pain and swelling on the outside and back of the knee, and instability or limited movement in the knee joint. A loud popping sound is often heard at the time of injury if the ACL tears or ruptures.

• Treatment for an ACL injury initially includes rest, ice, elevation, and compressing the knee with elastic bandages. Pain medication that reduces swelling, such as ibuprofen, may help reduce the symptoms. Talk to your pharmacist before purchasing anti-inflammatories as these medications may be contraindicated as they may interact with other medications and medical conditions.

• Physical therapy exercises, rehabilitation, and/or surgery may be necessary for some ACL injuries.

Causes of ACL tears

ACL injuries are one of the most common injuries seen in sports medicine. ACL tears, sprains or ruptures most often caused by sports that require quick changes of direction, jumping or pivoting, such as soccer, basketball, tennis, and skiing. Contact sports like football can also cause ACL injuries, when the knee is hit with direct force.

It is possible to injure the ACL during everyday activities as well. Falling off a ladder or skipping a step when walking up or down stairs can cause the ligament to tear. Since ligaments weaken with age, people over age 40 are more likely to experience ACL tears during normal activities.

Symptoms of ACL tear or rupture

During an ACL injury, primarily with an ACL tear or rupture, you may hear or feel a loud pop in the knee. Other symptoms include intense pain, swelling, and difficulty moving the joint. The pain is typically felt most in the back or outside of the knee.

While it may be possible to walk, the affected knee may feel unstable, as if it might give out during use.

Treatment of ACL tear or sprain

At the time of the injury, the knee should immediately be treated with the RICE protocol : Rest, Ice, Compression (with an elastic bandage) and Elevation of the knee above the level of the heart. Non-steroidal anti-inflammatory medication (such as Advil or Aleve) may help reduce the pain and swelling.

An ACL tear is a serious injury that should be evaluated by a physician or orthopedist. Physical therapy will be necessary to rehabilitate the injured knee. Rehabilitation will include exercises that stretch and strengthen the knee and surrounding muscles. It may be necessary to immobilize the knee with a brace, and/or to use crutches.

Surgical options for reconstructing ACL

For patients who wish to return to a high level of physical activity, ACL reconstruction surgery ¬may be necessary. Because it is not possible to repair the torn ligament, a piece of tendon from the patient’s leg will be used to reconstruct the ACL.

Several months of rehabilitation will be necessary following the reconstructive surgery.

If you have recently experienced an ACL injury, contact us the schedule an appointment with our knee specialists in the San Francisco Bay Area to begin your road to recovery.

Knee Fracture Treatment

Knee fracture at a glance

• Several injuries may be considered part of a fractured knee, including a broken kneecap (patella), or breaks close to the knee joint in the bones of the upper or lower leg.

• Knee fractures are often caused by forceful twisting or wrenching of the knee, falling onto a hard surface, or by direct trauma such as car accidents or contact sports.

• Symptoms of a fractured knee include intense pain, swelling, visible deformity of the knee, and difficulty moving the affected joint.

•Treatment of a broken knee will depend on the location and severity of the injured bones and surrounding tissue. Treatment may include immobilization, rehabilitation, pain medication, and/or knee reconstructive surgery.

Causes of a knee fracture

Falls, accidents, and other types of trauma commonly cause knee fractures. When a powerful force directly impacts the knee, as in a car accident or contact sport, the thighbone (femur) or shinbones (tibia or fibula) may break close to the knee joint.

Falls onto hard surfaces or from a great height can cause the kneecap (patella) to break or shatter.

Additionally, people who have osteoporosis or cancer may have weakened bones that are more likely to break.

Symptoms of a knee fracture

Symptoms of a fractured knee include severe pain, swelling and visible deformity. Pain may worsen with movement or pressure. It may also be difficult or impossible to walk or put weight on the affected leg.

Treatment of a knee fracture

A fractured knee is a serious injury that requires immediate medical attention. Until help arrives, try not to move the knee, and apply ice to the injured area to keep swelling down.

Treatment for a fractured knee will depend on the severity of the injury, and the location of the broken bone(s). Typically, the knee will be immobilized in a cast while it heals. In some cases, surgery may be necessary, especially if the kneecap is shattered.

Physical therapy and rehabilitation will help restore strength and movement to the affected areas once the break has healed.

Contact us to schedule an appointment with our knee specialists to learn about your treatment options.
Dislocated Knee Treatment

Kneecap dislocation at a glance

• The kneecap (patella) is the part of the knee that most commonly dislocates, or moves out of its natural position.

• In rare cases, the ligaments that connect the thighbone (femur) and the shinbone (tibia) can both become torn, causing the entire knee to become dislocated.

• Knee dislocation is often caused by direct force, such as sports injuries, falls, or car accidents.

• If the kneecap is already partially dislocated (subluxated) from the ligaments and tendons around the kneecap becoming weakened, it is more likely to dislocate completely when force is applied.

• Symptoms of a dislocated knee include intense pain, swelling, visible deformity of the knee joint, and loss of joint mobility.

• Treatment for a dislocated kneecap includes reduction (putting the bone back into its correct location), immobilization with a brace, and physical therapy.

• Depending on the extent of the nerve, cartilage, ligament, and tendon damage from a knee dislocation, reconstructive knee surgery may be necessary, followed by rehabilitation.
Causes of kneecap dislocation

The kneecap (patella) normally moves up and down when the knee bends. Abnormalities in a person’s walking or running form (gait) can cause the kneecap to move out of its natural track over time, causing it to become partially dislocated, or subluxated.

Complete dislocation of the kneecap occurs when the patella moves to the outside of the knee, causing visible deformity of the knee joint and significant pain and swelling.

In rare cases, the entire knee can become dislocated. In a knee dislocation, the ligaments that connect the thighbone and the bones of the shin (the anterior cruciate ligament, or ACL and the posterior cruciate ligament, or PCL) are both torn.

Symptoms of knee dislocation

A dislocated knee or kneecap is a serious, painful injury. Symptoms include severe pain, swelling, and difficulty walking or bearing weight on the affected leg. The joint will become visibly misshapen, and it may be impossible to bend or straighten the knee. The kneecap may feel loose, and the knee may feel unstable or give out.

Treatment for dislocated knee

Treatment for a dislocated kneecap includes reduction, or moving the patella back into place. The knee may then be placed in a brace to keep it from moving for several weeks. After the kneecap has healed, physical therapy will help restore strength and functionality to the knee.

If the kneecap continues to dislocate over time, surgery may be necessary.

In the case of a full knee dislocation, surgical repair and reconstruction is usually required.

Contact us to schedule an appointment with our orthopedic surgery specialists to begin treatment for your dislocated knee.
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