Knee questions, answered

Usually from the story rather than the scan. Injury pain tends to start at an identifiable moment, often with a pop, swelling within hours, and a clear mechanism. Osteoarthritis tends to build over months to years, is worse after rest and better with gentle movement early on, and is often accompanied by stiffness in the first half hour of the day. The two also coexist — a knee injured in your twenties frequently becomes an arthritic knee in your fifties. An examination sorts it faster than guessing.

Often not. A weight-bearing X-ray is the right first study for suspected osteoarthritis, because it shows joint space, alignment and bone changes that an MRI is not needed for. MRI earns its place when a mechanical problem is suspected — a locking knee, a suspected ligament rupture, an unexplained effusion — or when the answer would change the plan. Imaging that will not change what happens next is not worth your deductible.

It is shorthand for severe loss of the space between the bones on an X-ray, which is how cartilage thinning is inferred, since cartilage itself does not show up on plain film. It describes the picture, not the person. Plenty of people with dramatic X-rays walk comfortably, and plenty with mild X-rays are in genuine pain. It is one input into a plan, not a sentence.

Frequently none of the alarming ones. MRI reports on knees over forty routinely describe degenerative meniscal tears, cartilage thinning and bone marrow changes that are equally common in people with no symptoms at all. Working out which finding, if any, matches your symptoms and your examination is one of the main jobs of the evaluation. Our glossary covers the terminology.

Going down loads the front of the knee eccentrically — the quadriceps lengthens under load while controlling the descent — and the force through the kneecap joint is higher than going up. Pain that is clearly worse descending points attention toward the patellofemoral joint and toward quadriceps capacity, which is measurable and trainable.

Good, in the right dose. Exercise is one of the few strong recommendations for knee osteoarthritis in the 2019 ACR and Arthritis Foundation guideline. The mistake is usually dose rather than activity: a long walk that flares the knee for two days is too much, while three shorter walks may be entirely tolerable. Soreness that settles within about 24 hours is generally acceptable; pain that climbs through the activity or swells the joint is a signal to adjust.

The evidence does not support the popular belief that recreational running causes knee arthritis. Pooled analyses have found recreational runners have lower rates of knee and hip osteoarthritis than sedentary people, while elite and high-volume competitive runners have higher rates. What matters more is the load you are conditioned for and how quickly you change it.

Whichever helps you, and neither is doing anything structural. Ice tends to suit an acutely swollen, irritable knee; heat tends to suit a stiff one before activity. Neither changes the course of osteoarthritis, and there is no need to agonize over the choice — use them as comfort measures alongside a program that does change something.

Because the load exceeded what the joint is currently tolerating, and the joint lining responded by producing fluid. It is a useful signal. A knee that swells consistently after a specific activity is telling you the dose is wrong, and the answer is usually to reduce that activity while building capacity rather than to stop moving entirely.

On its own, no. Crepitus is extremely common and correlates poorly with how damaged a joint is. Noise that comes with pain, swelling, catching or a sense of instability is a different matter and is worth examining.

Almost always, though usually not the same exercise at the same load. The aim is to find the version you tolerate — change the range, the load, the surface, the volume — rather than to stop. Complete rest reliably costs quadriceps strength, and quadriceps weakness is the single most consistent finding in a painful knee.

The 2019 ACR and Arthritis Foundation guideline makes a strong recommendation against glucosamine for knee osteoarthritis. Guidance on other supplements varies and the evidence is generally weak. They are unlikely to harm you, but if a supplement is the whole plan, there is no plan.

Intra-articular glucocorticoid injection is a strong recommendation for knee osteoarthritis in the 2019 ACR guideline, and its effect is typically temporary. Most practices limit repeat injections into one joint to roughly three or four a year — a convention based on caution rather than a firm rule. A knee that needs an injection every few months to be tolerable is a knee whose underlying plan is worth revisiting.

Guideline bodies disagree about them. The 2019 ACR and Arthritis Foundation guideline makes a conditional recommendation against intra-articular hyaluronic acid for the knee, while noting the recommendation is not intended to drive insurance decisions and that shared decision-making applies when other options have been exhausted. It is reasonable to ask any clinic offering one which guideline it is relying on.

They are different things entirely. A corticosteroid injection delivers an anti-inflammatory medication into the joint. PRP is a preparation made from a sample of your own blood, concentrated in a centrifuge and injected under image guidance in the same visit. Corticosteroid injection is a standard, guideline-recommended treatment for knee osteoarthritis; PRP is investigational and not FDA-approved for the treatment of any specific orthopedic condition. We describe what each one is and let the evaluation decide what is appropriate.

Weight loss carries a strong recommendation in the 2019 ACR and Arthritis Foundation guideline for knee osteoarthritis in patients who are overweight or obese, with benefit described from around a 5% change in body weight and continuing to increase beyond it. If that is part of your picture, our medically supervised weight management program is run by the same provider managing your knee. Whether it is appropriate for you is a clinical decision made at a consultation.

Tibiofemoral bracing is a strong recommendation for knee osteoarthritis in the 2019 ACR guideline, and cane use is strongly recommended where walking is limited. Which brace, on which knee, for which purpose is the part that actually matters, and it comes from the examination rather than from a shelf.

Six to twelve weeks, with the reassessment booked on day one. Strength changes take weeks. The important thing is that the decision is made against the same measurements taken at the start — range, strength, walking tolerance and the specific tasks you said mattered — rather than against a general impression.

Yes, and wanting one is entirely reasonable. We will look at your imaging, examine the knee and tell you plainly what we think — including, often, that the surgical recommendation is sound. What we will not do is talk you out of an appropriate operation in order to sell you something we perform. See who our program suits.

A surgeon's core work is deciding whether an operation is indicated and performing it. Our work is the non-surgical pathway — evaluation, a structured conservative plan, the procedures we offer in-house, and the coordination of referrals when something else is needed. The two are complementary, which is why we refer to orthopedics rather than compete with it.

Both knees can certainly be evaluated at the same visit, and a physical therapy program routinely addresses both. Whether anything procedural is done to both, and in what order, is a clinical decision made case by case.

Call (214) 233-3094 and we will find you the first suitable appointment. Innovare Tx is open Mon–Fri, 9:00 AM – 5:00 PM at 16901 Dallas Pkwy, Ste 210, Addison, TX 75001, just off the Dallas North Tollway with free on-site parking, and Charles Ortega, PA-C provides care in English and Spanish. For a knee that is hot, locked, unstable or acutely swollen, say so when you call — that needs a same-day assessment.