Common Causes of Knee Pain

Knee pain is a symptom rather than a single diagnosis. The location of the pain, how it started, your age, activity level and whether you have swelling, catching or instability can all provide clues about the underlying problem.

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Pain in the front of the knee may be associated with patellofemoral pain, arthritis beneath the kneecap, quadriceps or patellar tendon problems, or irritation of other structures surrounding the kneecap.

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Pain along the inside or outside of the knee can occur with meniscus injuries, arthritis, ligament injuries, tendon problems and other conditions. Pain toward the back of the knee may sometimes be associated with arthritis, a Baker's cyst, hamstring problems or other causes.

The location of the pain alone, however, does not always identify the problem. Several knee conditions can produce similar symptoms, which is why an orthopedic evaluation can be helpful when pain persists.

Knee Arthritis vs. a Meniscus Tear

Knee arthritis and meniscus tears are two common causes of knee pain, and they frequently occur together.

Osteoarthritis develops as the structures within the joint change over time and may cause pain, stiffness, swelling and difficulty with activities such as walking or climbing stairs.

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A meniscus tear involves one of the cartilage structures that helps distribute forces across the knee. Meniscus tears can occur after an injury, but they are also commonly seen as part of the degenerative changes that occur within an arthritic knee.

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Finding a meniscus tear on an MRI therefore does not automatically mean that surgery is necessary. The entire clinical picture—including the examination, symptoms, arthritis severity and activity goals—should be considered when determining treatment.

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Do You Need an MRI for Knee Pain?

Not every patient with knee pain needs an MRI.

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Depending on your symptoms, physical examination and medical history, an evaluation may begin with X-rays and/or diagnostic musculoskeletal ultrasound. These studies can provide important information about arthritis, joint alignment, tendons, fluid collections and other potential sources of pain.

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MRI can be valuable when a more detailed evaluation of structures inside the knee is necessary or when the diagnosis remains unclear.

The goal is to use imaging when it is likely to provide information that will actually affect your treatment—not simply to order an MRI for every painful knee.

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Can Knee Arthritis Be Treated Without Surgery?

Many patients with knee osteoarthritis can be treated nonsurgically, particularly when symptoms and functional limitations do not yet warrant joint replacement.

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Treatment depends on the severity of arthritis and may include exercise and rehabilitation, weight management when appropriate, activity modification, knee bracing, medications and image-guided procedures.

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Injection options may include cortisone, viscosupplementation or gel injections, and regenerative treatments such as platelet-rich plasma (PRP) for appropriately selected patients.

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More advanced regenerative options may also be considered in selected cases.

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These treatments cannot make every arthritic knee normal or guarantee that a patient will never require surgery. The objective is to reduce symptoms, improve function and help appropriate patients remain active for as long as reasonably possible.

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What Is Ultrasound-Guided Knee Treatment?

Musculoskeletal ultrasound allows a physician to visualize many structures around the knee in real time.

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When ultrasound is used to guide an injection or procedure, the physician can watch the needle as it approaches the intended target rather than relying exclusively on surface landmarks.

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This can be particularly useful when treating structures such as tendons, bursae, cysts and other soft-tissue abnormalities around the knee.

At Carolina Nonsurgical Orthopedics, image guidance is an important part of many of the procedures we perform.

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PRP for Knee Pain and Knee Arthritis

Platelet-rich plasma (PRP) is a regenerative treatment prepared from a patient's own blood. The blood is processed to concentrate platelets, which contain signaling proteins involved in the body's healing response.

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PRP may be considered for certain knee conditions, including knee osteoarthritis and selected tendon or soft-tissue problems.

At Carolina Nonsurgical Orthopedics, our approach to PRP is not simply to inject every painful knee. We first identify the likely source of the symptoms and determine whether PRP is a reasonable treatment for that particular condition.

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PRP also should not be confused with a cortisone injection. Cortisone primarily works by suppressing inflammation and may provide relatively rapid symptom relief. PRP is intended to produce a different biological response, and improvement after PRP is typically more gradual.

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Learn more about our approach to PRP injections in Raleigh and Cary.

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What If You Have Been Told You Need a Knee Replacement?

A recommendation for knee replacement does not necessarily mean that every patient needs to proceed with surgery immediately.

The decision depends on several factors, including the severity of arthritis, level of pain, loss of function, response to previous treatment, overall health and personal goals.

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For some patients with advanced arthritis and significant disability, knee replacement may be the most appropriate treatment. For others who are still functioning reasonably well or would prefer to explore conservative care first, additional nonsurgical options may be worth discussing.

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A nonsurgical orthopedic evaluation can help determine whether reasonable alternatives remain or whether it is time to consider a surgical consultation.

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Staying Active With Knee Pain

Completely avoiding activity is not always the best long-term strategy for knee pain.

The appropriate amount and type of exercise depend on the diagnosis, but maintaining strength, mobility and cardiovascular fitness can be important for many knee conditions.

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Some patients temporarily tolerate lower-impact activities such as cycling, swimming or controlled strengthening better than running, jumping or repetitive high-impact exercise.

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The goal is generally not to stop moving indefinitely. It is to identify the problem, modify aggravating activities when necessary and develop a plan that helps you return to the activities that matter to you.

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When Is Knee Surgery Necessary?

Nonsurgical treatment is not appropriate for every knee problem.

Certain fractures, significant ligament injuries, mechanical problems, severe joint damage and other conditions may require surgical treatment. Patients with advanced osteoarthritis who continue to experience substantial pain and disability despite appropriate nonsurgical care may ultimately benefit from knee replacement.

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Our focus on nonsurgical orthopedics does not mean avoiding surgery when surgery is clearly the better option.

Instead, our goal is to help patients determine whether a reasonable nonsurgical treatment exists before proceeding with an operation.

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Can Knee Replacement Be Delayed?

Sometimes.

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A successful nonsurgical treatment may allow a patient to remain active and comfortable for a meaningful period before considering surgery. However, severe bone-on-bone arthritis associated with substantial pain, deformity, loss of function, or failure of reasonable nonsurgical treatment may ultimately be better treated with knee replacement.

The goal should be to avoid unnecessary or premature knee replacement—not necessary surgery.

Patients interested in exploring their options can learn more about our nonsurgical knee arthritis treatments, PRP injections, and MFAT treatment, or schedule an evaluation at Carolina Nonsurgical Orthopedics in Raleigh or Cary, NC.