The knee is one of the most common sites of pain. It is a weight-bearing joint, so in addition to all the wear-and-tear that happens from moving it every day, it also has the forces of body weight and gravity acting upon it. When structures in and around the knee—bone, cartilage, tendons and ligaments—become damaged, the result is pain and sometimes even disability.
Knee pain has many potential sources. These can be:
- Knee osteoarthritis
- ACL injuries or injuries to other ligaments
- Meniscus injuries
- Tendinitis and tendinosis
Traditional nonsurgical therapies can only do so much, and knee surgery can be costly, invasive and painful. Luckily the knee is one of the best-studied and most receptive joints to the sorts of emerging treatments we perform at Carolina Orthobiologics.
Basic Knee Anatomy
The knee is one of the more complicated joints. It involves three bones—the femur (thigh bone), the tibia (shin bone) and the patella (kneecap)—as well as a number of ligaments and tendons. Articular cartilage wraps the ends of the femur and tibia so they glide together smoothly, while pads of cartilage called menisci (singular meniscus) act as shock absorbers between the femur and tibia. Cartilage can also be found on the underside of the patella.
Major tendons that attach muscles in the area to bone include the patellar tendon and the quadriceps tendon. The knee also has a number of ligaments that connect the femur and tibia to each other. These include:
- Anterior cruciate ligament (ACL)
- Posterior cruciate ligament (PCL)
- Lateral collateral ligament (LCL)
- Medial collateral ligament (MCL)
Types of Knee Pain
Knee osteoarthritis—Osteoarthritis, sometimes known as wear-and-tear arthritis, is the most common form of arthritis. Osteoarthritis occurs when the articular cartilage of bones in a joint breaks down, eventually leading to painful joint fluid environment. These tiny fragments of worn off cartilage cause an irritating chemical reaction in the knee fluid of the joint, which can be a large source of the pain. This explains why a joint that isn’t “bone-on-bone” can be quite painful and why a “bone-on-bone” knee can sometimes not hurt.
The knee is one of the most common sites for osteoarthritis. There is no cure for osteoarthritis, but its progression can be slowed. Traditionally, a total knee replacement was a patient’s only option for advanced knee osteoarthritis.
Meniscus tears—The menisci sit between the femur and tibia and act as a shock absorber for and secondary stabilizer of the knee. The meniscus can become torn due to age-related degeneration or trauma. Meniscus injuries are extremely common. Due to a lack of blood vessels in the area the meniscus cannot easily heal itself. Surgery to remove these torn areas is commonly performed, but when arthritis is also present, this surgery often proves ineffective.
Ligament injuries—Four ligaments—ACL, PCL, LCL and MCL—act as the primary stabilizers for the knee joint. ACL tears are a common source of knee pain, creating instability and preventing patients from engaging in rotational and side-to-side movement. ACL tears and other forms of ligament injuries can sometimes be treated without surgery, but full tears require a tissue graft to repair.
Tendinopathy—The quadriceps tendon, which attaches the quadriceps muscle to the kneecap, is the main tendon in the knee joint area. There is also the patellar tendon, but since it connects the kneecap to the tibia it is actually a ligament. Either or both of these tissues can become frayed and weakened through wear and tear, or torn by way of traumatic injury.
New Options for Treating Knee Pain
Nearly every form of traditional knee pain treatment—be it surgical or nonsurgical—has its problems. Some, such as corticosteroid injections, can be toxic to surrounding tissue. Others, such as ACL reconstruction and total knee replacement, are complex and invasive surgeries that require a long recovery. Some medications, including opioids, only treat symptoms rather than the root cause of knee pain and can be extremely addictive.
Each month researchers produce more scientific evidence pointing to the viability of stem cells and PRP for orthopedic pain conditions. What’s more, knee pain conditions are some of the most studied and most receptive in relation to this type of treatment.
ACL injuries—Traditionally, the only way to repair a torn ACL is through costly, invasive surgery. That may still be the most appropriate treatment option for some people, but with the advent of orthobiological treatment there is another effective, less invasive option. Stem cells have been shown in research to improve pain, function and structural integrity in treating ACL tears.
Knee osteoarthritis—Knee osteoarthritis is a lifelong condition that may eventually require a total knee replacement. Conventional treatments focus on reducing pain, but can carry complications. Both stem cells and PRP have been shown in research to improve pain, function, swelling and in some cases increase articular cartilage thickness.
Tendinopathy—Treatment for tendinopathy is limited to pain- and inflammation-reducing medication and surgical repair. Corticosteroids, a powerful anti-inflammatory drug that can reduce pain, can actually increase the risk of a tendon rupture when used to treat tendinopathy by weakening the tissue. PRP and stem cells can both improve pain and quality of life without the risk of further tendon injury, according to research.
Meniscus injuries—Meniscus injuries, while common, can be difficult to treat due to a lack of blood supply. Researchers have found that PRP can increase the formation of new blood vessels in and near the meniscus, which can speed healing and reduce pain. The use of stem cells have been shown in some studies to be effective in promoting meniscus regeneration as well.
If you are looking for an effective alternative to surgery for your painful knee condition, request an appointment with Carolina Orthobiologics. Through ultrasound-guided injections, Dr. Lehman can pinpoint the source of your knee pain and deliver safe, effective healing compounds from your own body.
18 Medical Park Drive
Asheville, North Carolina 28803