Knee Pain - Causes, Treatment, and Rehabilitation

Introduction

The knee joint is one of the synovial joints present in the body. A pair of long bones are articulated against one another, separated by a capsular ligament and articular cartilage. Like any mechanical component, the joint is prone to wear and tear depending on its use or abuse, especially in sports, athletics, old age, and arthritis.

What Are the Principal Contents of the Knee Joint?

The knee consists of three main bony components and an array of ligaments, cartilage, blood, nerve, and muscle supply. The components can be sub-classified as follows;

Bony Components.

• The thigh bone or femur.

• The shin bone or tibia.

• The kneecap or patella.

Ligaments.

• Anterior cruciate ligament.

• Posterior cruciate ligament.

• Medial collateral ligament.

• Lateral collateral ligament.

Cartilage.

• Medial meniscus.

• Lateral meniscus.

The joint is outlined by a layer of a fluid-filled membrane known as the synovial membrane.

1. Muscles.

2. Blood vessels.

3. Nerves.

When Does Knee Pain Occur?

The knee joint is among the most used body parts, prone to heavy stress and wear and tear for decades. The nature of the stress and the quality of the underlying bone determines the intensity of the pain. The common causes behind this are;

1. Tear in the ligaments.

2. Arthritis or inflammation of the joints.

3. Tear of cartilage meniscus.

4. Loss of blood supply to the bone.

5. Trauma or injury to the joint.

6. Increased body weight.

7. Fracture of the joint.

8. Repetitive strain or common overuse.

When to Consult a Specialist?

Knee pain is the principal cause for patients turning up to consult specialists in the field. Other symptoms may include;

1. Crackling sounds.

2. Discomfort while performing menial tasks like walking, climbing stairs, or getting up from a chair.

3. Swelling of the joints, which is not relieved by medication.

4. Locking of the joints.

5. Instability of the joint.

6. Loss of range of motion.

7. Stiffness.

8. Bow-legged knee deformity.

What Are the Diseases that May Necessitate a Surgical Procedure?

• Osteoarthritis is an age-related "wear and tear" type of arthritis seen in people around 50 years of age and older but may occur in younger people. The articular cartilage that acts as cushions between the bones soften and wear away with time. The friction between the bones leads to knee pain and stiffness.

• Rheumatoid arthritis is a disease where the synovial membrane surrounding the joint becomes inflamed, which can damage the cartilage and eventually cause cartilage loss, pain, and stiffness and is termed "inflammatory arthritis."

• Post-traumatic arthritis following a severe knee injury due to fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.

What Are the Treatment Modalities to Treat Knee Pain?

Knee pain can be treated with the help of the following modalities;

1. Nonsurgical pain management.

2. RICE protocol.

3. Knee reconstruction.

4. Knee replacement surgeries.

What Is the RICE protocol?

The RICE protocol is an effective treatment method for most sports-related injuries.

The term RICE stands for Rest, Ice, Compression, and Elevation.

• Rest: This requires taking a break from the activity responsible for the injury. Use of crutches or other orthopedic aids may be used to avoid putting weight on the knee joint.

• Ice: This requires using cold packs for about 20 minutes at a time, several times a day. Ice must not be directly applied to the bare skin.

• Compression: Additional swelling and blood loss can be prevented by wearing an elastic compression bandage over the affected area.

• Elevation: Reclining the patient when at rest and putting the leg up higher than the heart level.

What Are the Procedures for Knee Surgeries?

Knee surgeries are typically performed either under general or spinal anesthesia. First, an incision is made on the affected joint's surface skin. The damaged portion of the bone or cartilage is then removed, and suitable grooves are created to house the implants necessary. Following this, the implants are stabilized using either screw plates or cement. A plastic liner insert is placed between the two articulating bone surfaces to act as the cartilage.

In the case of ligament reconstruction surgeries, the hamstring tendon is used as a graft, coupled with drilling holes in appropriate places of the knee joint surfaces, then pulled through it. This is followed by stabilization, using screws or plates, and suturing to allow healing of the cartilage into the bone.

How Is Rehabilitation Done Postoperatively?

Rehabilitation postoperatively follows almost immediately. A physical therapist is appointed to train the patient with suitable exercises to help strengthen the joint to somewhat original capacity and restore adequate knee movements. Prosthetic devices such as a walker, crutches, or cane may be prescribed for a while until the joint regains its functionality. A continuous passive motion (CPM) machine may passively move the joint while the patient relaxes. An exercise program at home will also be prescribed to keep joint functionality intact.

What Are the Postoperative Complications?

1. Infection of the operative site.

2. Knee stiffness.

3. Blood clots or deep vein thrombosis.

4. Damage to nerve and blood vessels.

5. Implant loosening.

6. Wearing out of plastic liners.

7. Kneecap dislocation.

8. Injury to ligaments.

9. Addiction to Narcotic pain relief medication is usually provided short term.

What to Do at Home?

Surgical efficiency, however perfect, must be complemented with adequate home care for the patient during and after the recovery phase. The safeguards and measures taken at home can be as follows;

• Create a living space restricted to one floor at home.

• Install guard rails and handles wherever needed, such as in showers and stairways.

• Stable chair with cushion and footstool to elevate the joint.

• Arrange for a toilet seat riser with handles if the toilet height is short.

• Remove loose rugs and cords.

Conclusion

The knee joint is among the most used body parts, prone to heavy stress and wear and tear for decades. The quality of the bone and the nature of the exertions subjected to it cause significant stress to its components, resulting in a wide array of problems leading to knee pain. However, in most cases, patients experience a dramatic knee pain reduction and significant improvement in performing everyday activities of daily living.