The knee is the largest and strongest joint in the body, sustaining large loads to support weight bearing and movement. The knee joint can be separated into three distinct “compartments” which each have unique patterns of disease, the medial (inside), the lateral (outside), and patellofemoral (front). One feature the three compartments share is the presence of smooth, slippery lining called articular cartilage that protects and cushions the bones when the knee moves. The medial (inside) and lateral (outside) compartments additionally have tissue called the meniscus which functions to stabilize the bones and serve as a shock absorber. The knee joint is also surrounded by a lining called the synovium which is like a sheath that provides fluid to lubricate the moving surfaces and reduce friction.
Osteoarthritis is the most common form of arthritis in the knee and is commonly known as “wear-and-tear” arthritis. The “-itis” part of osteoarthritis indicates an inflammatory process of the joint, which is where the body’s enzymes and cell signaling chemicals contribute to the breakdown of the cartilage lining of the knee. It is also this inflammation that causes pain. While it is true that mechanical factors such as high chronic loads to the joint can contribute to breakdown of the tissues, the factor that accelerates destruction of the cartilage is the process of inflammation.
Osteoarthritis is diagnosed based on a combination of clinical factors such as pain, examination of the knee, and imaging findings. As the osteoarthritis advances, radiographs (X-rays) have characteristic findings. Some of these findings including loss of the joint space (the gap between the bones narrows, hence the term “bone-on-bone” arthritis), sclerosis (hardening of the bone from the lost padding), cysts (tiny cavities where in the bone where little holes form), and osteophytes (spurs). In milder cases, an MRI is needed to see the process because it has not advanced to the point that X-rays look different. On MRI, the cartilage lining has thinned, and bone edema (swelling) is evident (fluid reaction under the joint where the cartilage has been lost). The most sensitive way of knowing if osteoarthritis is present in the knee is via arthroscopy, where a camera can physically inspect the cartilage lining of the knee. Using live videography, the cartilage is observed, and evidence of fraying, cracks, or loss of the cartilage suggests the presence of osteoarthritis. During a consultation with our team at LALL Orthopedics +, we can help determine which approach is best for you to diagnose knee arthritis.
Pain in the knee is the cardinal symptom of osteoarthritis. As the disease progresses, pain may be present at night, at rest, and with progressively more simple activities such as walking, getting up the stairs, and sitting for prolonged periods. Sometimes the knee will feel as though it is buckling or giving out.
Treatment for osteoarthritis depends on the severity of the pain, the chronicity of symptoms, and the degree of functional impairment. For mild forms of osteoarthritis, initial therapy include: lifestyle changes, physical therapy, anti-inflammatory medications, regenerative medicine injections such Stem-Cell Therapy and/or Platelet-Rich Plasma (PRP), and bracing. For more advanced forms of osteoarthritis, surgery in the form of minimally-invasive robotically guided partial or total knee replacement is considered the gold standard for knee osteoarthritis.
Dr. Ajay C. Lall is a former dual sport NCAA collegiate athlete (football and track & field), American board certified, triple fellowship-trained expert orthopedic surgeon who specializes in hip arthroscopy, robotic hip replacement and cutting-edge regenerative medicine such as platelet-rich plasma (PRP) and Stem-Cell therapy. He treats non-athletes and athletes at all levels of play from collegiate to professional to the Olympic level. Dr. Lall is a world-renowned orthopedic surgeon who cares for all patients like family. Contact LALL Orthopedics + to schedule a consultation, receive the correct diagnosis, and undergo state-of-the-art treatment options.
At a Glance
Ajay C. Lall, MD, MS, FAAOS
- Board Certified – Orthopedic Surgery
- Triple Fellowship Trained
- Performs over 750 Surgeries Per Year
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