shutterstock_131694011

Introduction:

If you have sustained an injury or developed a sudden serious problem with your knee, please initially see your GP or the accident and emergency department depending on the urgency of the problem.

If you have developed a significant non-urgent problem with your knee, you should initially see your GP.

The following are some of the non-urgent conditions for which your GP may refer you to an orthopaedic surgeon for further assessment or intervention. They include arthritis, other causes of knee pain and ligament or cartilage damage which is not necessarily apparent at the time of an injury but becomes troublesome subsequently.

Osteoarthritis

shutterstock_183158951Symptoms:

The knee is a common site for the development of arthritis and pain. The common wear and tear kind of arthritis is called osteoarthritis. This involves degeneration and wearing away of the hard cartilage covering the surface of the joints.  This results in gradual onset of pain and stiffness with an accompanying reduction in walking distance.  If the condition becomes quite severe, some deformity or bending of the knee to one side or the other may be noted. It may also become difficult to fully straighten or fully bend the knee and pain may be felt on walking and weight bearing.  Pain can progress to also be present at night and disturb sleep.

Initial treatment:

If the patient is overweight, weight reduction will help greatly with the degree of pain as less load is then put through the knee.

Otherwise, your GP may initially recommend painkillers, physiotherapy exercises and the use of walking aids.

Injections of steroid for pain relief can also be administered into the knee.  These can provide quite effective pain relief in the early stages. Injections can last a variable length of time, usually from a few weeks to a few months.  The response to the injection diminishes if the degree of osteoarthritic change progresses. Injections may be administered by your GP or you may be referred to have them in the hospital.

Keyhole surgery for osteoarthritis:

In the interim stages of progression of arthritic change it is possible that some loose areas of cartilage can produce more severe pain with certain movements and sometimes cause the knee to suddenly give way or to lock.

If this is the case, injection and physiotherapy may help or alternatively a keyhole operation (arthroscopy of the knee) may be performed to remove the loose cartilage that is responsible.

This procedure will not address the underlying wear and tear changes and therefore there may well still be some residual symptoms that remain but it can improve matters in certain cases so that the patient can persevere for longer before any further intervention is required. For further details please see the section on “knee arthroscopy” (click here).

Knee replacement surgery:

This operation can be performed for severe and advanced cases of Osteoarthritis (or other forms of arthritis).

As a brief guide, a knee replacement may be worthwhile in the following situations:

  • Pain is sufficient to disturb sleep
  • Pain prohibits walking far enough to be able to attend to essential everyday needs
  • Taking all the painkillers that one can safely take is not sufficient

The Oxford Knee Score can help to quantify the severity of the condition. For further information see section on knee replacement (click here).

Meniscal Tear (Cartilage Tear)

The meniscus is the soft cartilage of the knee which lies between the hard cartilage of the two bony surfaces either side of the joint.  The meniscus is commonly injured or becomes worn and degenerate.

Tears of the meniscus may occur in an otherwise healthy knee as a result of injury.  In this case there may be swelling and pain at the time of the injury which subsides but the knee intermittently gives way, locks in one position or causes pain on one or the other side of the knee with weight bearing and activity. If these symptoms are significant, an “Arthroscopy” (keyhole operation of the knee) may be performed to deal with this.  Please see the section on “Knee Arthroscopy”.

Sometimes tears of the meniscus can occur without a significant injury.  This is referred to as a “Degenerate Tear” of the meniscus and occurs in situations in which some arthritis is beginning to develop. Initially the substance and integrity of the cartilage is made softer by the arthritic process and the meniscus becomes more fragile.  Thus it can tear with an otherwise minor incident.  Sometimes patients notice this after a long walk maybe on uneven ground.  If symptoms are sufficiently troublesome, “Arthroscopy” (keyhole operation of the knee) is possible.  Please see section on “Knee Arthroscopy”.

Ligament Tear

Ligaments of the knee stabilise the joint. They can be damaged if a significant injury is sustained and the patient may then present to A&E. However, the Cruciate ligament of the knee may be injured during sport or a fall and only feel like a sprain at the time. Sometimes the presence of the injury only becomes apparent sometime later when swelling subsides and the patient resumes activity.  It may be noticed that the knee feels less stable and has a tendency to giving way or collapsing. This may only occur under strenuous activity if the patient returns to sport but not necessarily during everyday activity.

The treatment for a cruciate ligament tear is initially a course of physiotherapy.  If the degree of instability is marked, if the patient is keen to return to strenuous activity or sport at a high level as soon as possible or if physiotherapy has been completed but the knee remains unstable, it is possible to carry out surgery to stabilise the knee.