Knees Archive

The American Academy of Orthopaedic Surgeons (AAOS) in June released updated guidelines for treating osteoarthritis of the knee. Most of the recommendations are the same as those in the AAOS' 2009 guidelines, although the organization no longer recommends hyaluronic acid injections, which haven't been found to offer much pain relief.

The AAOS also isn't recommending glucosamine and chondroitin supplements or acupuncture for knee arthritis. Recommended treatments that are better supported by research include low-impact aerobic exercise and weight loss (in overweight individuals) to reduce excess pressure on the joint. For pain relief, the organization advises the use of acetaminophen (in doses of less than 3,000 mg daily) and NSAIDs.

Q. An MRI of my knee shows I have a torn medial meniscus and mild osteo­arthritis. What treatment options should I consider?

A. A torn meniscus is a common cause of knee pain, and meniscal tears are especially common in people with osteoarthritis (OA). Menisci are small cartilage pads within the knee that help pad the bones in the joint and provide smooth knee motion. Meniscal tears may cause knee pain in people with OA. If you have knee pain and both conditions are detected, it is common to attribute the pain to the meniscal tear and to recommend surgical repair through an arthroscope. A surgeon inserts the scope and instruments into the knee joint through tiny incisions and trims the torn meniscus in a procedure called partial meniscectomy. Whether this approach results in better function has been debated.

The idea of having a knee replaced is daunting. But what if both of your knees need repairing? Is one visit to the operating room better than two?

If you are otherwise in good health, it's a conversation worth having with your doctor and rehabilitation team. There are some benefits to replacing both joints during a single surgery (called simultaneous replacement). These include undergoing anesthesia only once, fewer days in the hospital, and only one (albeit prolonged) rehabilitation that lets you resume normal activities sooner than two separate ones. 

There are many treatments short of surgical replacement.

If your knees have become painful, tender, or swollen, are stiff first thing in the morning, or are making crackling noises, the probable cause is osteoarthritis, which affects more than two-thirds of women over age 60. Osteoarthritis results from the breakdown of joint cartilage, the tough, slippery tissue that protects the ends of bones (see "Anatomy of knee osteoarthritis"). Eventually, the cartilage may wear away completely, permitting bone to rub painfully against bone. The goals of osteoarthritis treatment are to reduce pain and stiffness, limit the progression of joint damage, and maintain and improve knee function and mobility.

About 5% of women in the United States over age 50 have had total knee replacement surgery, the recommended treatment when more conservative measures have failed and pain and disability are intolerable. The number of these procedures has more than doubled over the past decade, according to research presented at the 2012 annual meeting of the American Academy of Orthopaedic Surgeons (AAOS). This is partly because knee replacement works—more than 80% of patients say they're satisfied with the results. But experts say it's also a sign that people aren't fully utilizing the many noninvasive strategies that evidence suggests should be tried first—above all, weight loss and exercise.

I have a Baker's cyst in my right knee. It has been drained twice and recurred. Are there any other treatments for it?

Research we’re watching

A study found that knee buckling was associated with a higher risk of recurrent falls and significant injuries.

Knee buckling, caused by weakened muscles, is common in people who have osteoarthritis in their knees. To determine whether knee buckling leads to falls, researchers at the University of California, San Francisco, studied 1,842 participants enrolled in the Multicenter Osteoarthritis Study (MOST), 59% of whom were women. At a visit five years into the study, the researchers asked the participants if their knees had buckled in the past three months and whether they had fallen as a result. About 17% of participants said their knees had buckled, 20% of whom reported falling as their knees gave way.

In the Journals

Knee buckling in older adults may increase the risk of falling, according to a study published online Feb. 8, 2016, by Arthritis Care & Research. Buckling, often described as the knee "giving way," is a symptom of knee instability. It often affects older individuals, in particular those with knee pain and knee osteoarthritis. It also may be caused by leg muscle weakness or balance difficulties. When your knee buckles, you can lose your balance and fall, which raises your risk of injury and even fractures. Repeated incidents also can limit your ability to climb stairs.

Researchers studied 1,842 participants, 40% of whom were men, who were at high risk for knee osteoarthritis. After five years, 16.8% reported regular knee buckling, and over the next two years, those people were 1.6 to 2.5 times more likely to experience recurring falls, fear of falling, and poor confidence in their ability to balance.