Nonsurgical Treatments for Knee Pain and Injury

Knee pain is a common problem for people of all ages. It may be caused by an injury, overuse or arthritis. Knee pain can develop in the knee or as the result of an orthopedic condition of the hip, ankle or low back. Sometimes surgery is the best answer but not always, and some patients may wish to avoid surgery.  Nonsurgical treatments are intended to ease muscle and joint pain, swelling and stiffness and improve quality of life.

Nonsurgical treatment involves PRICE – Protection, rest, ice, compression, elevation. Additionally, immobilization, activity modification, injections and pain management with over-the-counter anti-inflammatory medications (NSAIDS) will help address symptoms. Physical therapy is necessary to maintain or restore mobility and strength. The goal is to reduce inflammation, pain and stiffness, and to regain function without surgery.

Conditions amenable to nonsurgical treatment

Acute injures

Sprains and Strains, pulled muscles, meniscus tears

• Ligament strains in the knee occur when the ligament is overly stretched or torn. They can be acute due to trauma or caused by overuse and repetitive stress.
• Trauma and overuse can tear the Meniscus. Meniscus tears are often found with ACL tears. Treatment for a meniscus tear depends on the size and location of the tear. Often nonsurgical treatment can resolve symptoms.
• Pulled hamstring and quadriceps muscles are common sports injuries.

Overuse injuries

Bursitis, Tendonitis and Tendinosis, Iliotibial Band syndrome

• Tendinitis is inflammation of a knee tendon usually caused by jumping. The knee can be rehabilitated with nonsurgical treatment.
• Bursitis is inflammation of the bursae causes stiffness, swelling and redness. Bursae are fluid filled sacs that reduce friction in the knee and provide smooth movement.

ACL ruptures

A ruptured anterior cruciate ligament (ACL) is a common injury that usually affects young and physically active people injured during a sports activity but can also result from an accident at home. It often results in an unstable knee that increases the risk of continued knee damage. In just 10% of cases the ACL tear is an isolated injury. The rest often combine an ACL rupture with damage to collateral ligaments, bone and the meniscus.

An ACL injury is characterized by joint instability that results in decreased physical activity and can lead to a poor-quality life. The goal of treatment is to restore stability. The choice of treatment is surgical stabilization or nonsurgical treatment. Conservative treatment may be adequate to treat an ACL tear for patients who are not high-level athletes. It will include rest, icing, compression and elevation along with the use of a knee brace for stability and to unload pressure on the knee and knee cap. Cortisone injections may be offered to reduce pain and swelling.

Additionally, a progressive rehabilitation program that has as its goal reduced pain and improved stability, muscle strength and balance is essential to restore function and mobility. Some people who undergo conservative treatment may continue to suffer with an unstable knee. Should that occur, the patient may choose to undergo ACL reconstruction.

Knee Osteoarthritis (OA)

OA is a chronic, degenerative condition that leads to pain, stiffness and disability and affects about 20% of the American population over age 45. Patients may not be candidates for surgery, and some may prefer to avoid surgery. Patients with mild to moderate OA can be managed conservatively.

Nonsurgical treatment of knee OA includes strengthening exercises, low impact aerobics, aquatic exercises, weight loss and NSAIDS to relieve pain and inflammation. Cortisone injections may be beneficial. Prescription pain medications are also available.

Viscosupplementation is injections of hyaluronic acid. This FDA approved treatment has been shown to be very effective at alleviating painful osteoarthritis of the knee and facilitating improved knee movement.

Patella fractures (A broken kneecap)

If the fracture is stable and bones are in the correct position surgery may be avoided. Instead, you PRICE plus a splint or cast can relieve pain and prevent knee movement while the broken bones heal.

Dislocated kneecap

Most dislocated kneecaps will be treated nonsurgically. In addition to PRICE, physical therapy, NSAIDS, crutches or a cane and a knee brace may provide protection and allow the injury to heal.

Dr. Jonathan Godin is the orthopedic surgeon of choice for top professional athletes and fortunately also for recreational athletes who love their sports, including young adults and geriatric patients. To receive the same expert orthopedic care contact Dr. Godin at Vail Orthopedic Surgery in Colorado. Schedule a consultation and learn about your condition and all treatment options.