The knee is a complex joint that facilitates movement and bears the body’s weight. Due to its structure and the high loads it sustains, the knee is susceptible to various injuries and diseases. When pain or loss of mobility occurs, understanding which specialized medical professional to consult is important for effective recovery.
Orthopedic Surgeons: The Primary Knee Specialist
Orthopedic surgeons are the doctors most commonly associated with knee treatment, specializing in the musculoskeletal system. They focus on conditions involving the bones, joints, muscles, ligaments, and tendons, often addressing structural damage. Orthopedic surgeons evaluate and treat mechanical problems, such as acute fractures, meniscal tears, and ligamentous injuries.
Orthopedic surgeons manage severe degenerative conditions, such as advanced osteoarthritis. Their training includes advanced surgical techniques for reconstruction and repair of the knee joint. Routinely performed procedures include arthroscopy, anterior cruciate ligament (ACL) reconstruction, and total knee replacement (TKA).
Many orthopedic surgeons pursue additional fellowship training after residency to refine their skills. Fellowships in Adult Reconstruction focus on complex total joint replacements and revision surgeries. Sports Medicine fellowships involve treating athletic injuries, including ligament repairs and cartilage restoration procedures.
Non-Surgical Management and Rehabilitation
Not all knee pain requires surgery; many conditions are managed by physiatrists, specialists in Physical Medicine and Rehabilitation (PM&R). Physiatrists diagnose and treat nerve, muscle, bone, and joint conditions without operative intervention. Their primary focus is rehabilitation and improving a patient’s quality of life.
The physiatrist’s approach is comprehensive, treating the whole person rather than focusing solely on the injured area. They design tailored rehabilitation plans, often prescribing physical therapy to strengthen muscles and restore range of motion. They also utilize non-operative pain management, such as prescribing medications and performing image-guided injections.
Physiatrists and orthopedic surgeons often collaborate, especially when a patient is recovering from injury or surgery. If conservative treatments fail to resolve pain, the patient may be referred to an orthopedic surgeon for evaluation. Physiatrists also play an important role in the post-operative recovery phase.
Specialists for Systemic and Inflammatory Knee Pain
For knee pain originating from a systemic disease rather than structural damage, a rheumatologist is the appropriate doctor. Rheumatologists are internal medicine physicians specializing in diagnosing and treating autoimmune and inflammatory conditions. These rheumatic diseases occur when the immune system mistakenly attacks its own tissues, causing joint inflammation.
Conditions such as rheumatoid arthritis, psoriatic arthritis, lupus, and gout frequently cause inflammation in the knee. A rheumatologist manages these diseases primarily with medical treatments, including disease-modifying drugs and immunosuppressants, to control the underlying inflammation. They focus on the body’s chemistry and immune function, rather than mechanical repair.
The distinction is based on the problem’s source: orthopedic surgeons treat mechanical issues, while rheumatologists treat inflammatory, systemic issues. A patient with knee pain accompanied by symptoms like fever, fatigue, or widespread joint stiffness may need to see a rheumatologist to rule out an autoimmune cause.
Navigating the Referral Process
For most people, the first point of contact for new or persistent knee pain is their Primary Care Physician (PCP). The PCP performs an initial assessment, takes a medical history, and may order preliminary imaging tests like X-rays. This initial evaluation helps determine if the pain is due to a simple strain, a mechanical injury, or a systemic inflammatory process.
If initial conservative treatments provided by the PCP—such as rest, over-the-counter medication, or short-term physical therapy—do not provide sufficient relief, a referral becomes necessary. Referral guidelines suggest consulting an orthopedic specialist when symptoms cause moderate to severe pain, limit daily activities, or if a structural problem is suspected.
If the PCP suspects an inflammatory disease, or if the diagnosis remains unclear despite initial testing, the patient will likely be referred to a rheumatologist. Starting with a primary care doctor ensures the patient sees the correct specialist—orthopedist, physiatrist, or rheumatologist—at the correct time, preventing delays in appropriate treatment.