Evaluation and Treatment of Knee Pain

Abstract

ImportanceApproximately 5% of all primary care visits in adults are related to knee pain. Osteoarthritis (OA), patellofemoral pain, and meniscal tears are among the most common causes of knee pain.ObservationsKnee OA, affecting an estimated 654 million people worldwide, is the most likely diagnosis of knee pain in patients aged 45 years or older who present with activity-related knee joint pain with no or less than 30 minutes of morning stiffness (95% sensitivity; 69% specificity). Patellofemoral pain typically affects people younger than 40 years who are physically active and has a lifetime prevalence of approximately 25%. The presence of anterior knee pain during a squat is approximately 91% sensitive and 50% specific for patellofemoral pain. Meniscal tears affect an estimated 12% of the adult population and can occur following acute trauma (eg, twisting injury) in people younger than 40 years. Alternatively, a meniscal tear may be a degenerative condition present in patients with knee OA who are aged 40 years or older. The McMurray test, consisting of concurrent knee rotation (internal or external to test lateral or medial meniscus, respectively) and extension (61% sensitivity; 84% specificity), and joint line tenderness (83% sensitivity; 83% specificity) assist diagnosis of meniscal tears. Radiographic imaging of all patients with possible knee OA is not recommended. First-line management of OA comprises exercise therapy, weight loss (if overweight), education, and self-management programs to empower patients to better manage their condition. Surgical referral for knee joint replacement can be considered for patients with end-stage OA (ie, no or minimal joint space with inability to cope with pain) after using all appropriate conservative options. For patellofemoral pain, hip and knee strengthening exercises in combination with foot orthoses or patellar taping are recommended, with no indication for surgery. Conservative management (exercise therapy for 4-6 weeks) is also appropriate for most meniscal tears. For severe traumatic (eg, bucket-handle) tears, consisting of displaced meniscal tissue, surgery is likely required. For degenerative meniscal tears, exercise therapy is first-line treatment; surgery is not indicated even in the presence of mechanical symptoms (eg, locking, catching).Conclusions and RelevanceKnee OA, patellofemoral pain, and meniscal tears are common causes of knee pain, can be diagnosed clinically, and can be associated with significant disability. First-line treatment for each condition consists of conservative management, with a focus on exercise, education, and self-management.

Review of Evaluation and Treatment of Knee Pain—Reply

“…In Reply We appreciate Dr Misseri and colleagues’ interest in our Review article . They raise a relevant point about RFA as a potential treatment option for managing knee osteoarthritis pain.…”

Self-Administered Acupressure for Probable Knee Osteoarthritis in Middle-Aged and Older Adults

“…Knee OA is associated with long-term health consequences, such as reduced physical fitness, low quality of life, and increased health care utilization . Conventional analgesic medications, such as nonsteroidal anti-inflammatory drugs and acetaminophen, are effective for the treatment of knee OA . However, the use of these agents is limited due to concerns regarding potential gastrointestinal adverse effects.…”

“… 2 , 3 , 4 Conventional analgesic medications, such as nonsteroidal anti-inflammatory drugs and acetaminophen, are effective for the treatment of knee OA. 5 However, the use of these agents is limited due to concerns regarding potential gastrointestinal adverse effects. Nonpharmacological treatments such as patient education, exercise, weight loss, and physical therapy produce substantial benefits, 6 but the delayed therapeutic effects and requirement of significant changes in behavior discourage individuals from receiving such therapeutic measures.…”

Composite Zonal Scaffolds of Collagen I/II for Meniscus Regeneration

“…It absorbs loads from the knee and provides lubrication by distributing synovial fluid throughout the knee joint . Because of its role in knee function, meniscus is prone to tears that cause pain and disability. , Trauma, sports injuries, aging, and degenerative diseases are common causes of meniscus damage, which is treated depending on the injury via rest, icing, physical therapy, palliative care, and surgery …”