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What Is Arthritis of the Knee?
Arthritis of the knee is most often osteoarthritis, a degenerative disease where cartilage in the joint gradually wears away. In rheumatoid arthritis, which can also affect the knees, the joint becomes inflamed and cartilage may be destroyed.1 Arthritis not only affects joints, it may also affect supporting structures such as muscles, tendons, and ligaments.
Osteoarthritis may be caused by excess stress on the joint, such as from repeated injury, deformity, or if a person is overweight. It most often affects middle-aged and older people. A young person who develops osteoarthritis may have an inherited form of the disease or may have experienced continuous irritation from an unrepaired torn meniscus or other injury. Rheumatoid arthritis usually affects people at an earlier age than osteoarthritis.
What Are the Signs of Knee Arthritis and How Is It Diagnosed?
A person who has arthritis of the knee may experience pain, swelling, and a decrease in knee motion. A common symptom is morning stiffness that lessens after moving around. Sometimes the knee joint locks or clicks when the knee is bent and straightened, but these signs may also occur in other knee disorders. The doctor may confirm the diagnosis by performing a physical examination and taking x rays, which typically show a loss of joint space. Blood tests may be helpful for diagnosing rheumatoid arthritis, but other tests may be needed as well. Analysis of fluid from the knee joint may be helpful in diagnosing some kinds of arthritis. The doctor may use arthroscopy to directly visualize damage to cartilage, tendons, and ligaments and to confirm a diagnosis, but arthroscopy is usually done only if a repair procedure is to be performed.
How Is Arthritis of the Knee Treated?
Most often osteoarthritis of the knee is treated with analgesics (pain-reducing medicines), such as aspirin or acetaminophen (Tylenol):* nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Nuprin, Advil); and exercises to restore joint movement and strengthen the knee. Losing excess weight can also help people with osteoarthritis. Rheumatoid arthritis of the knee may require a treatment plan that includes physical therapy and use of more powerful medications. In people with arthritis of the knee, a seriously damaged joint may need to be surgically replaced with an artificial one. (Note: A new procedure designed to stimulate the growth of cartilage using a patient's own cartilage cells is being used experimentally to repair cartilage injuries at the end of the femur at the knee. It is not a treatment for arthritis.)
What Are the Causes of Injury to the Cruciate Ligaments?
Injury to the cruciate ligaments of the knee is sometimes referred to as a "sprain." The anterior cruciate ligament is most often stretched, torn, or both by a sudden twisting motion (for example, when the feet are planted one way and the knees are turned another way). The posterior cruciate ligament is most often injured by a direct impact, such as in an automobile accident or football tackle.
What Are the Symptoms of Cruciate Ligament Injury? How Is Injury Diagnosed?
Injury to a cruciate ligament may not cause pain. Rather, the person may hear a popping sound, and the leg may buckle when he or she tries to stand on it. To diagnose an injury, the doctor may perform several tests to see if the parts of the knee stay in proper position when pressure is applied in different directions. A thorough examination is essential to the diagnosis. An MRI is very accurate in detecting a complete tear, but arthroscopy may be the only reliable means of detecting a partial tear.
How Are Cruciate Ligament Tears Treated?
For an incomplete tear, the doctor may recommend that the patient begin an exercise program to strengthen surrounding muscles. The doctor may also prescribe a protective knee brace for the patient to wear during activity. For a completely torn anterior cruciate ligament
in an active athlete and motivated patient, the doctor is likely to recommend surgery. The surgeon may reattach the torn ends of the ligament or reconstruct the torn ligament by using a piece (graft) of healthy ligament from the patient (autograft) or from a cadaver (allograft). Although repair using synthetic ligaments has been tried experimentally, the procedure has not yielded as good results as use of human tissue. One of the most important elements in a patient's successful recovery after cruciate ligament surgery is following an exercise and rehabilitation program for 4 to 6 months that may involve the use of special exercise equipment at a rehabilitation or sports center. Successful surgery and rehabilitation will allow the patient to return to a normal full lifestyle.
What Is the Most Common Cause of Injury to the Medial Collateral Ligament?
The medial collateral ligament is more easily injured than the lateral collateral ligament. It is most often caused by a blow to the outer side of the knee, which often happens in contact sports like football or hockey, that stretches and tears the ligament on the inner side of the knee.
What Are the Symptoms of Collateral Ligament Injury? How Is Injury Diagnosed?
When injury to the medial collateral ligament occurs, a person may feel a pop and the knee may buckle sideways. Pain and swelling are common. A thorough examination is essential to determine the nature and extent of injury. To diagnose a collateral ligament injury, the doctor exerts pressure on the side of the knee to determine the degree of pain and looseness of the joint. An MRI is helpful in diagnosing injuries to these ligaments.
How Are Collateral Ligament Injuries Treated?
Most sprains of the collateral ligaments will heal if the patient follows a prescribed exercise program. In addition to exercise, the doctor may recommend that the patient apply ice packs to reduce pain and swelling and wear a small sleeve-type brace to protect and stabilize the knee. A sprain may take 2 to 4 weeks to heal. A severely sprained or torn collateral ligament may be accompanied by a torn anterior cruciate ligament, which usually requires surgical repair.
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