Diagnosis and Management of Common Knee Problems

Overview of Knee Pain Conditions

This podcast episode discusses three common knee pain conditions: osteoarthritis of the knee, patellofemoral pain, and meniscal tears. Osteoarthritis affects about 12% of adults globally, patellofemoral pain mainly affects younger people under 40, and meniscal tears can occur in both young and older adults. The epidemiology of each condition varies based on age and cause of injury.

Diagnostic Criteria for Knee Pain Conditions

The diagnosis of knee osteoarthritis is primarily clinical, based on symptoms and signs such as activity-related knee pain in individuals over 45 years old. Radiographs are usually not recommended for routine diagnosis. Patellofemoral pain can be diagnosed by the presence of anterior knee pain during a squat, while meniscal tears are diagnosed with a combination of the McMurries test and joint line tenderness. The podcast provides an accompanying video demonstrating the meniscal tear examination.

Treatment Approaches for Knee Pain Conditions

The first-line management for osteoarthritis of the knee focuses on therapeutic exercise, promoting physical activity, weight loss if overweight, and self-management programs. Patellofemoral pain is usually managed with hip and knee muscle strengthening, foot orthoses, and patellar taping. Non-operative exercise therapy is recommended for most meniscal tears, with surgery reserved for severe cases where the knee is unstable or locked. Pharmacotherapy options include anti-inflammatories as the first-line analgesic, with caution regarding potential toxicities and comorbidities in older adults. Acetaminophen and opioids are typically not recommended due to limited efficacy and potential harms. Intra-articular corticosteroids may provide short-term relief for knee osteoarthritis.

Total Knee Replacement and Prognosis

Total knee replacement is indicated for end-stage knee osteoarthritis, with severe pain, functional loss, and failed conservative treatments. However, before considering surgery, factors such as minimal radiographic change, low pain, and specific psychosocial comorbidities should be assessed to determine whether alternative treatments may be more appropriate. Patellofemoral pain generally has a favorable prognosis with appropriate treatment, although there is a slightly higher risk of developing patellofemoral osteoarthritis in the long term. Most meniscal tears, whether acute or degenerate, respond well to non-operative management with exercise therapy. Exercise therapy has been shown to be as effective as arthroscopic surgery when compared directly.

JAMA Clinical Reviews

Diagnosis and Management of Common Knee Problems

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Quick takeaways

Deep dives

Overview of Knee Pain Conditions

Diagnostic Criteria for Knee Pain Conditions

Treatment Approaches for Knee Pain Conditions

Total Knee Replacement and Prognosis

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