Problems with the knee range from knee pain to instability and include other symptoms such as locking, catching or giving way. Knee problems can present acutely after an injury or be present for a very long time. They can be intermittent such as catching or be present with every step you take.
A careful history will provide the diagnosis of the knee pain more than 90% of the time. When combined with a careful examination and then imaging an exact treatment plan can be created for your knee.
Younger patients tend to have more acute injuries and often require arthroscopic surgery. The injuries range from meniscus tears to cartilage injuries and of course ACL injuries or ruptures. Patella instability or dislocation is also generally found in younger people which might require treatment with an MPFL reconstruction. An arthroscopy allows any intra articular damage to be inspected at the same time.
Arthritis of the knee is generally seen in older patients but can also be present in a younger patient with post-traumatic arthritis or some form of inflammatory arthropathy such as Rheumatoid arthritis. Arthritis is a slowly progressive disease which leads to increasing pain and decreasing mobility of the knee. Non surgical treatment of arthritis is always tried first and combines weight loss with exercise and pain relieving medications. Surgery is generally only considered when the person is able to walk 5-10minutes only and is being woken by the pain most nights.
If there is arthritis in one side of the knee only then a unicompartmental knee replacement might be considered and while it is a smaller operation with a more rapid recovery it is also more likely to fail and require further surgery. In younger patients with arthritis on one side of their knee they can consider a High Tibial Osteotomy where the bone is broken and set at a different angle to take the pressure off the worn part of the knee. This operation tends to fail over about 10 years but keeps the patient much more active than they would be otherwise. A knee replacement can then be performed.
ACl injuries are very common with side stepping sports. The knee buckles as they sidestep and there is often a pop or crack heard. It will be difficult to stand and walk afterwards and then swelling will develop. The extent of injury is documented on an MRI scan before considering surgical intervention. The majority of people will not restore stability to knee for sport without undergoing an ACL reconstruction.
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