The knee is a vulnerable and potentially unstable joint. The femur is balanced on the tibia with 2 "shock absorbers" of cartilage (medial and lateral menisci), 4 ligaments and the surrounding muscles to maintain stability. The ligaments are the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) and lateral collateral ligament (LCL). In addition the patella slides over the anterior surface in a sesamoid joint. The joint takes the full weight of the body and considerable stress in activities such as running and jumping. It is very susceptible to problems.
Causes of Pain
The causes of pain in the knee can be divided into 6 different aetiologies:
· Primary arthritis in the knee
· Reactive arthritis from other diseases
· Disease of bone around the knee
· Mechanical problems of the knee
· Direct trauma
· Referred pain, usually from the hip
· Management must be holistic as simply prescribing analgesics is rarely enough.
· The standard treatment of acute trauma is rest, ice, compression, elevation and rehabilitation (RICER).
· Fluid may reform after aspiration and can be aspirated again. Aspiration of the knee speeds recovery and reduces muscle wasting around the knee. Blood damages joints as is shown by the state of joints in haemophiliacs.Knees that swell are considered in their own article.
· Physiotherapists often used bracing and taping of jointsin conjunction with building VMO. The way they work is uncertain and may have more to do with improving proprioception than improving inherent stability.
· Sportsmen in particular, should be given advice about rest and rehabilitation. They are impatient to return to activity and do not take kindly to being told simply to rest or to give up their favoured pastime. There is no reason why they should rest those parts of their body that are not affected but the injured parts require a gradual and controlled return to full activity. This is described more fully in the article on sports injuries.
· Analgesia may be required, usually in the form of NSAIDs. The usual caveats about at-risk groups apply.
· Specific diseases may require specific therapies such as DMARDs for RA, drugs to lower uric acid after the acute episode of gout has settled or antibiotics to treat gonococcal infection.
· Topical analgesics have no benefit over placebo.8 They may possibly give some benefit in OA for the first 2 weeks, but not thereafter.9
· Arthroscopy is a minimally invasive procedure that can be used for both diagnosis and sometimes treatment too. Torn cartilage can be removed and even ACL reconstruction undertaken.
· Arthritis may eventually require arthroplasty. Total knee replacement has now overtaken total hip replacement as the commonest form of joint replacement surgery.
Other Consulting Rooms:
The Linia Cromwell Hospital
82 High Street
Mr Araz MASSRAF qualified in 1988 He had high Specialist Orthopaedic Training in Glasgow. He is full time Orthopaedic Consultant in Peterborough, UK. seeing NHS and private patients.
His main interests are: Hip & Knee surgeries, Hip impingement decompression and labral repair, Birmingham hip resurfacing, Hip & Knee Keyhole surgeries, Hip & Knee revision arthroplasty.
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