Knee pain is a common complaint and it has many causes. At Penn Medicine, teams from orthopaedics, sports medicine, radiology, and physical therapy and rehabilitation work together to help patients find relief from knee pain.
An accurate diagnosis of the cause of the knee pain is the first step in developing the appropriate treatment plan.
Getting the Whole Picture
X-rays are usually the first step in diagnosing knee pain or injury. When a patient shows up with knee pain, he or she is evaluated by a Penn orthopaedic specialist who performs a focused exam that matches the symptoms to what is seen on film.
“X-rays are good screening tools for assessing the bones and structures,” said Nancy Major, MD, from Penn Radiology. “We get multiple views of the knee joint and almost always move forward with an MRI that lets us see inside the knee joint.”
Magnetic resonance imaging, or MRI, allows the radiologist and orthopaedic specialists to look inside the joint at cartilage, ligaments and tendons. It may even show small fractures that don’t show up on the X-ray.
“The X-ray and MRI can help the physician and the patient determine the best way to manage the knee pain,” Dr. Major said.
If reducing pain is the primary goal of treatment, joint preservation is the next priority, according to John Kelly IV, MD, Penn sports medicine specialist.
“We look for ways to treat the patient and the knee,” Dr. Kelly said. “A stronger knee often means a reduction in the stress that causes pain. Weight reduction and physical therapy may help alleviate the pain and improve the patient’s health.”
If strengthening is not enough, Dr. Kelly said the least invasive treatment methods are often the best, especially for younger patients.
“People are living longer so a knee replacement for someone in his or her 40s may have to last 50 years,” Dr. Kelly said. “If we can treat the pain with injections or arthroscopic (minimally invasive) surgery and postpone major surgery for a few years, the patient stands a better chance of long-term success.”
Joint Replacement Improves Quality of Life
Often, joint replacement surgery is the best solution for managing debilitating knee pain or injuries. Undoubtedly one of the greatest medical advances for improving patients’ quality of life over the past 40 years, knee replacements have been performed in millions of Americans, easing pain, improving range of motion, and keeping them active.
“Younger people aren’t ready to slow down and they are not going to let their pain dictate their activities,” said Craig Israelite, MD, orthopaedic surgeon at Penn Presbyterian Medical Center. “It used to be we wouldn’t even consider joint replacement for a patient under the age of 60. But now, with new materials that are more durable and longer lasting, we can help younger patients and get them back to their life.”
In addition to performing a large number of surgeries, Penn orthopaedic surgeons also perform more complex and complicated knee replacement procedures, as well as many minimally invasive procedures. They are also continually working to improve the fit and function of joint replacements. The ultimate goal is to make the replacement feel and act as normal as possible, especially for knees.
Back in Action
Every patient experiencing knee pain finds themselves in physical therapy at some point during their treatment. The ultimate goal is to return to normal activities without pain and physical therapy builds strength in the knee and improves the range of motion.
“The first thing we do with knee patients is an evaluation of the problem, what are the pain levels, whether or not they have had surgery and what type of surgery and what is the normal activity level to which the patient needs to return,” said Brian Leggin, PT, DPT, OCS with Good Shepherd Penn Partners Penn Therapy and Fitness.
Extension, range of motion of the knee and strengthening the thigh and hip muscles are key components to rehabilitation, according to Leggin. Without full extension—being able to straighten the leg without a bend at the knee—patients will walk with a limp.
As the range of motion improves, the therapy focuses on activities that make the leg stronger. Studies have demonstrated that improving strength leads to better function. Leggin also said studies show that following surgery, patients make the biggest gains in the first three months of therapy and after six months, most return to a normal level of activity.
People experiencing knee pain from arthritis or injury can find more information or schedule an appointment with a Penn orthopaedic specialist at PennMedicine.org or by calling 800-789-PENN (7366).