Knee osteoarthritis (OA) is the leading cause of knee pain in adults, with roughly 250 million people affected by it worldwide .
It occurs when the smooth and thin lubricating layer which covers the ends of bones (also known as articular cartilage) wears away. The degradation of this cushioning cartilage reduces the shock absorbing benefits available, causing the joint lining at the knee to be inflamed. In severe cases of knee osteoarthritis, the bones may rub directly against each other causing great pain and disability.
Additionally, knee osteoarthritis can also result in the formation of bone spurs, smooth hard bumps of extra bone at the joints, which can cause pain if they press against nerves.
How is osteoarthritisof the knee treated?
Physiotherapy is an essential part of non-surgical treatment of osteoarthritis. Your physiotherapist may use heat treatments, range of motion exercises as well as targeted muscle strengthening to improve the function of your knee. While there is no evidence that this can help to slow down or reverse osteoarthritis, it can lessen the symptoms of osteoarthritis, and allow better knee function.
Osteoarthritis can impact many aspects of your life. Learning to cope with the changes brought about by osteoarthritis can help to alleviate symptoms, and can sometimes prevent injury. Modifications in your lifestyle are hence an important part of osteoarthritis treatment.
These can include,
- The use of a walking aid, such as a stick or modified umbrella
- Weight management via changes in diet, and control of metabolic diseases such as diabetes
- Engagement in moderate age appropriate exercise
- Modification of the home environment to improve comfort and safety for patients with knee problems
Your doctor may prescribe pain medications such as non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol (Acetaminophen/Tylenol/Panadol).
These medications can be used to alleviate most of the pain caused by osteoarthritis, but should be used judiciously due to possible side effects such as stomach ulcers and kidney damage for NSAIDs. Do not take more than the prescribed dosage and frequency, and inform the doctor if you feel unwell after taking such medications.
If you find yourself relying too much on such medication, consider other forms of treatment, as pain medications alone cannot heal your knee, and may not be sufficient to control your pain.
There are a variety of oral supplements available for the treatment of osteoarthritis. Unfortunately, there is currently no evidence that shows that taking any oral supplements can heal knees affected by osteoarthritis. Some patients may however find that their knee pain is slightly relieved after taking these supplements. Most of such supplements are safer than traditional pain medication, and your doctor may suggest that you try these supplements to see if it helps in relieving your knee pain.
Knee Injections for the treatment of pain
- Intra-Articular Hyaluronic Acid (IAHA)
Intra-Articular Hyaluronic Acid Injections, are injections filled with Hyaluronic Acid, that is injected into the joints.
Hyaluronic Acid is a thick fluid. It is similar to the fluid in your body that naturally lubricates the joints.
This helps patients feel less pain, improve mobility and reduce stiffness in joints. These results may last as long as 6 months.
However, the specific ways of how it manages to do so are still unclear, and study results have been mixed about the effectiveness of this treatment.
Cortisone is a hormone that is naturally produced in your body, and is often used to reduce inflammation.
It is effective for short-term pain relief in Osteoarthritis patients, however, Cortisone injections may worsen joint damage over time, so this option may not be suitable for all patients.
- Autologous blood protein injections
Autologous protein solutions (APS) injections are a newer category of knee injections that are derived from your own blood. This technique concentrates anti-inflammatory factors which are used to prevent inflammation in the knee. Current evidence suggests that inflammation in the knee is one of the factors that exacerbates the worsening of knee OA. The benefit therefore of injecting APS solutions into the knee is that it may slow down the development of more severe knee OA.
- Offloading Braces
In most patients with knee OA, the body weight is carried on the inner portion of the knee joint. Consequently, most patients with knee OA suffer from medial (inner) compartment knee OA. Such patients would benefit from the shifting of their bodyweight, so that the weight is borne on the outer part of the knee instead. This can be achieved by a category of knee braces known as offloading braces. Depending on your specific needs, your surgeon may prescribe these braces as part of your treatment.
Knee arthroscopy / Arthroscopic Surgery
Knee arthroscopy is a minimally-invasive surgical procedure. A small optic tube (arthroscope) with a light attached will be inserted into the joint through a small incision. Images of the inside of the joint are then projected onto a screen.Knee scopes help to assess changes caused by arthritis in the joint. In early knee OA, knee scopes can be used to treat menisceal tears and small holes in the cartilage.This procedure may be suitable for your stage of knee OA. Please seek help from your surgeon to determine if this is the surgery for you.
Subchondroplasty is a relatively new procedure which was developed to treat pain in the knee arising from damage caused by OA to the bone of the shin or thigh bones. The loss of knee cartilage removes the protective effect of cartilage. As a result, patients often develop micro-fractures in the bone marrow/spongy bone of the shin or thigh bones. These so-called bone marrow lesions are partly responsible for the pain patients experience from knee OA. During the procedure, the affected area is drilled, and bone cement is injected into the lesion in order to treat it.
Subchondroplasty is beneficial because it helps patients reduce knee pain and improve their knee function, acting as a good alternative to joint replacement surgery. It is also minimally invasive (done with only small cuts and a few stitches), and patients are usually discharged on the same day as the surgery. This can lead to a faster recovery and quick return to normal activities. Lastly, if the patient needs to get total knee replacement in the future, Subchondroplasty will not hinder it as well.
If bone marrow lesions are the primary source of pain in your knee, this procedure may benefit you. However, this procedure may not work for everyone, so you should discuss this option with your Orthopaedic Surgeon before making a decision.
Knee realignment surgery
In this surgery, part of the shin or thigh bone is sawed and the alignment of your leg is changed in such a way as to remove pressure on the part of the knee that has OA changes. This helps to relieve some of the pain from Osteoarthritis. This surgery helps as patients can avoid or delay going for a Total Knee Replacement Surgery.
It is not suitable for all patients, and a strict criteria is used to determine if you are suitable for such surgery. In general, patients who are younger (below 60 years old), lead active lifestyles, and only have OA in one area of their knee can consider this procedure.
After realignment surgery, the bones will be fixed with metal plates and screws, and these implants will maintain the realignment till the bone heals. This can take up to 6 months. During the recovery, you will be required to undergo regular physiotherapy treatments.
Partial knee replacement
In this procedure, your surgeon will only replace the most damaged portion of your knee with a metal and plastic partial knee prosthesis.This acts as an alternative to total knee replacement in patients who have knee OA in only some parts of the knee.
As this surgery is conducted through a smaller incision, and a smaller part of the knee is excised and replaced, the pain experienced is less than traditional total knee replacement. Patients heal faster, and generally experience quicker recovery after partial knee replacement. It has also been shown that patients treated in this way have less complications compared to total knee replacement.
However, not all patients are suitable for this type of knee surgery. There is also a risk that the knee implants may wear out, or that significant knee OA can develop in other parts of the knee, necessitating subsequent total knee replacement surgery (10 to 12 years).
Total knee replacement
This is a procedure where your surgeon will cut away damaged bone and cartilage from your thigh bone, shinbone and kneecap, replacing it with a prosthetic joint made of metal alloys, high-grade plastics and polymers. This is the gold standard treatment for late-stage knee OA.
The procedure takes about 2 hours, and rehabilitation and recovery from surgery can take 3 to 6 months. In general, most patients find themselves walking unaided after 6 weeks post-surgery. The knee prosthesis that is inserted in this way is long-lasting and sturdy, with implants surviving up to 25 years in some international studies.
Because of implant survivorship, it is recommended that only patients above the age of 60 undergo this procedure. This surgery is sometimes offered to younger patients especially if they already have end stage knee OA.
Anterior cruciate ligament tear accelerates joint degeneration and leads to osteoarthritis in a high proportion of patients. While successful in stabilizing ACL deficient knees, ACL reconstruction has not been shown to conclusively reduce OA risk.Can you repair an ACL in an arthritic knee? ›
ACL reconstruction is considered the treatment of choice for symptomatic ACL-deficient patients and can assist in full functional recovery. Furthermore, ACL reconstruction restores ligamentous stability to normal, and, therefore, can potentially fully reinstate kinematics of the knee joint.Can ACL surgery cause degenerative knee? ›
New research suggests a connection between ACL injuries and osteoarthritis and that it has to do with how much force and weight people put on their affected knee post surgery. This reduced joint loading may lead to cartilage breakdown, making the joint susceptible to damage and degeneration in the long-term.Why does my knee hurt years after ACL surgery? ›
Arthritis of the Joint
A 2017 study found that about 75 percent of people who underwent ACL reconstructive surgery had arthritis findings on x-rays of their knee within 10-15 years of the time of surgery. This is a frightening finding, considering many ACL tears are treated in the teens and twenties of young athletes.
- Apply ice or heat to help ease stiffness, pain and swelling.
- Lose weight (if necessary) to help reduce stress on the knees.
- Keep moving with activities like swimming, biking or walking.
- Try physical therapy. ...
- Consider acupuncture or massage for pain relief.
Knee function after ACL repair depends on a lot of factors, which can vary — sometimes a lot — from one person to another. After surgery, you can expect to begin physical therapy fairly quickly. Physical therapy helps your knee regain flexibility and strength while also promoting healing of the joint tissues.What happens if ACL is not reconstructed? ›
Without surgery, your ACL will remain torn. The knee might heal—the swelling and pain will stop. But a torn anterior cruciate ligament does not reattach or heal itself.Is your knee stronger after ACL reconstruction? ›
Conclusion: An ACL graft after a reconstruction surgery is initially stronger, but over time becomes weaker, and eventually is almost as strong as your original ACL. These changes occur as a result of the body's natural reaction to the new ACL graft.Why is ACL reconstruction not repaired? ›
The most common cause of ACL failure is a technical error in the first surgery. The two most common technical errors are placing the ACL reconstruction graft on the femur too anterior (away from the back wall) or placing the tibial tunnel too posterior (posterior to the anterior horn of the lateral meniscus).Does ACL surgery damage cartilage? ›
An ACL tear can also result in cartilage damage in the knee. Knee cartilage naturally has poor blood supply and is less amenable to healing.
If you have osteoarthritis of the knee, you will probably feel your knee is painful and stiff at times. It may only affect one knee, especially if you've injured it in the past, or you could have it in both. The pain may feel worse at the end of the day, or when you move your knee, and it may improve when you rest.Is your knee weaker after ACL surgery? ›
Quadriceps weakness is commonly reported after ACL injury and reconstruction. This weakness and associated dysfunction have been implicated as a source of reduced knee related quality of life, increased risk of knee osteoarthritis, and long-term functional disability.Can you ever fully recover from ACL surgery? ›
Although ACL surgery recovery can be challenging, most people make a full recovery and return to normal activity, especially if they remain committed to physical therapy and diligently follow their healthcare provider's instructions.How long will a reconstructed ACL last? ›
Reconstruction is here to stay
Expect the new tendon to hold up for decades. To be safe, surgeons will inform patients of any complications to expect, regardless of age and activity. For more information regarding ACL reconstruction options and surgical treatment, speak with a healthcare provider.
After ACL surgery, the knee requires systematic training and progression to get back to 100% jumping form. Therefore, the sooner you can return to safe jump training, the sooner you can return to CrossFit, running, skiing, mountain biking, bouldering or whatever your sport may be.What triggers osteoarthritis flare ups? ›
The most common triggers of an OA flare are overdoing an activity or trauma to the joint. Other triggers can include bone spurs, stress, repetitive motions, cold weather, a change in barometric pressure, an infection or weight gain. Psoriatic arthritis (PsA) is an inflammatory disease that affects the skin and joints.What aggravates knee osteoarthritis? ›
Although everyone with osteoarthritis is different, Halpern says that exercises that tend to aggravate knee osteoarthritis are deep squats, lunges, and any movement that pounds on the joint.What are the long term effects of ACL surgery? ›
knee pain – affects some people who have ACL surgery and is more likely to occur when the patellar tendon is used as graft tissue; you may have pain behind your kneecap or when kneeling down or crouching. knee weakness and stiffness – some people experience long-term weakness or stiffness in their knee.Is arthritis common after ACL surgery? ›
ACL reconstructions are among the most common orthopaedic procedures performed in the United States. However, despite surgery intended to stabilize the joint, individuals who undergo an ACL reconstruction have a 3 to 5 times greater risk of developing posttraumatic arthritis of the knee.Why does my knee still hurt 6 months after ACL surgery? ›
ACL surgery can cause damage in many different parts of the knee. This damage can happen due to removing stem cells that the knee needs to stay healthy, damage to the ligaments that hold the meniscus in place, and damage to the knee tendons. These areas of surgery-induced damage can also cause pain after ACL surgery.
ACL injury treatment aims to restore knee function, eliminate knee pain and swelling, and reduce potential further damage to the knee, especially meniscus tears. Surgery is the best way to treat an ACL injury for competitive athletes who must return to their sport at a high level.Can you live an active life without an ACL? ›
It is possible to go through life without an ACL. Eventually, scar tissue builds and will contribute to some knee stability. However, it is not the same stability that an ACL provides. Whether or not you are a physically active individual or casually active, it is possible to maintain your quality of life successfully.Are squats bad for torn ACL? ›
This is based on the suggestion that as you drop into a squat, your anterior cruciate ligament (ACL for short) is placed under stress — and that this stress can lead to damage. Research has shown that the force placed on your ACL actually decreases the more your knee is bent.What is the weakest point after ACL surgery? ›
ACL grafts are weakest 5 to 12 weeks after surgery. You may feel stronger, but your knee is months from full recovery.What is the hardest part of ACL recovery? ›
Full immobilization is the worst thing you can do after ACL surgery.o avoid this, make sure to begin rehabilitation right away and begin weight-bearing with your crutches and your brace to promote healing. Anterior Knee Pain: The front of your knee hurts, generally around your kneecap.What is the strongest ACL surgery? ›
The strongest option is the BTB graft. The graft incorporates more solid into the bone due to the bone plugs on either end of the tendon. However, BTB grafts have been known to have the slowest recovery time when it comes to meeting rehab milestones and returning to sport.What is the failure rate of ACL grafts? ›
Unfortunately, ACL graft failures are reported in up to 34.2% in athletes, representing a traumatic and career-threatening event. It can be convenient to understand the various risk factors for ACL failure, in order to properly inform the patients about the expected outcomes and to minimize the chance of poor results.What is the gold standard for ACL repair? ›
It is the graft with the longest track record and is consider by many to be the “gold-standard” for ACL reconstruction. In most circumstances this is the graft recommended for professional athletes and in any young active individual.
Symptoms of ACL graft failure
Patients may complain of a limp while walking and a feeling of looseness in the knee. There may be knee pain that may increase with activities. Patients may complain of knee stiffness, knee swelling, or instability while activities of daily living.
Broken Bones Heal Better Than Ligaments and Tendon
The short answer is because the bone has plenty of blood supply to it compared to ligament/tendon, which has very little and ligament/tendons are more complex to rebuild. Wounds generally heal more slowly if blood can't circulate properly.
Kneecap pain (patellofemoral pain) is the scourge of ACL rehabilitation. Sometimes the kneecap is damaged with the original injury but more often than not, the kneecap pain is a secondary event because of tightness of the tissues on the outer half of the knee and weakness of the quadriceps which develops after surgery.What muscles are weak after ACL surgery? ›
Quadriceps and hamstrings weakness can persist when an individual returns to activity after many ACL injuries and especially an ACL reconstruction surgery. The weakness that is associated with these injuries is believed to be a “reflexive shut-down” as a response of the nervous system to protect the injured joint.What can be mistaken for osteoarthritis? ›
PsA is often undiagnosed and can be misdiagnosed for rheumatoid arthritis (RA) or osteoarthritis (OA), especially in a non-rheumatologic setting [7–9]. RA is a chronic inflammatory arthritis typified by pain, swelling, and stiffness of the joints, particularly symmetric small-joint synovitis of the hands and feet .What are 2 symptoms of osteoarthritis? ›
Pain can be localized or widespread. Joint stiffness, usually lasting less than 30 minutes, in the morning or after resting for a period of time. Joint changes that can limit joint movement. Swelling in and around the joint, especially after a lot of activity or use of that area.How serious is osteoarthritis of the knee? ›
Any joint in the body may be affected by the disease, but it is particularly common in the knee. Knee arthritis can make it hard to do many everyday activities, such as walking or climbing stairs. It is a major cause of lost work time and a serious disability for many people.Does knee injury lead to osteoarthritis? ›
The odds of having knee osteoarthritis after joint trauma are 3 to 6 times higher than an individual without a history of knee injury (6, 7).What can a torn ACL lead to? ›
People who experience an ACL injury have a higher risk of developing osteoarthritis in the knee. Arthritis may occur even if you have surgery to reconstruct the ligament.Does tearing your ACL have long term effects? ›
Long-term knee instability
If you wait too long to treat a torn ACL, you're at risk of developing chronic knee pain and knee instability. Waiting to get treatment may mean that surgery is your only option. Or you may need to cope with ongoing instability by modifying your activities and giving up intensive sports.
If your cartilage trouble began after an accident or injury, like a broken bone or a torn ligament, it can lead to a type of OA known as posttraumatic arthritis. Experts estimate that it's the cause of 10%-15% of osteoarthritis cases.What causes knee osteoarthritis to flare up? ›
The most common triggers of an OA flare are overdoing an activity or trauma to the joint. Other triggers can include bone spurs, stress, repetitive motions, cold weather, a change in barometric pressure, an infection or weight gain.
While any of these components could incur an injury, the 3 most common injuries are patellar tendonitis, a ligament injury (ACL, MCL, LCL, PCL), or a meniscus (cartilage) injury.
If nothing is done, the ACL injury may turn into chronic ACL deficiency. Your knee may become more and more unstable and may give out more often. The abnormal sliding within the knee also can hurt cartilage. It can trap and damage the menisci in the knee and can also lead to early osteoarthritis.Why is a torn ACL so serious? ›
Without an ACL, the knee is very unstable (and weak) during lateral movement. This is why some players that depend on quick, rapid side movements can't play with an injured ACL, while others who move mainly forward and backward with less lateral motion have a better chance to wear a brace and continue play.How does an ACL tear affect the brain? ›
“Special nerve fibers that live in the ACL send information about knee position to the brain. When the ligament is torn, the brain has trouble coordinating muscle movement to prevent the knee from giving way further,” Lajam said.Does your ACL come back stronger after you tear it? ›
Conclusion: An ACL graft after a reconstruction surgery is initially stronger, but over time becomes weaker, and eventually is almost as strong as your original ACL. These changes occur as a result of the body's natural reaction to the new ACL graft.Does osteoarthritis affect ligaments? ›
Osteoarthritis (OA) induces inflammation and degeneration of all joint components including cartilage, joint capsule, bone and bone marrow, and ligaments.How fast does osteoarthritis progress? ›
Osteoarthritis is generally a slowly progressive disorder. However, at least 1 in 7 people with incident knee osteoarthritis develop an abrupt progression to advanced-stage radiographic disease, many within 12 months.Does knee arthritis hurt all the time? ›
In most but not all cases, the symptoms of knee osteoarthritis come and go, becoming gradually worse and more frequent over a number of years. There may be a persistent, dull ache, accompanied by flare-ups of more intense pain after certain activities that strain the knee joint (such as walking up stairs).