An orthopedic doctor approaches chronic or acute knee pain with a systematic process aimed at restoring function and reducing discomfort. Their goal is to accurately identify the source of the patient’s pain and formulate a treatment plan that progresses from the least invasive options to surgical intervention only if necessary. This ensures every patient receives a tailored and effective pathway back toward full mobility.
Determining the Cause of Knee Pain
The first step an orthopedic doctor takes is a thorough patient history intake. The doctor asks detailed questions about the mechanism of injury, duration, specific location, and severity of the pain on a pain scale. Understanding if the pain was sudden (acute) or developed gradually (chronic) helps narrow down the potential structures involved.
Next is a comprehensive physical examination of the knee joint. The orthopedic specialist tests the knee’s range of motion, checks for swelling and tenderness, and performs stability tests to assess ligament integrity. Specific maneuvers, like the anterior drawer test for the ACL or the McMurray test for the meniscus, help pinpoint the damaged internal structure.
Diagnostic imaging is typically ordered to visualize the joint’s internal structures. X-rays evaluate the bony architecture, checking for fractures, misalignments, or the severity of joint space narrowing indicative of arthritis. If soft tissue damage is suspected, a Magnetic Resonance Imaging (MRI) scan provides a detailed view of structures like ligaments and cartilage.
In less common situations, the doctor may also order blood work or perform a joint aspiration, which involves drawing fluid from the knee. This is done if there is suspicion of an underlying systemic condition, such as an infection or inflammatory arthritis like gout or rheumatoid arthritis. Once all diagnostic information is gathered, the orthopedic doctor establishes a definitive diagnosis, which then guides the appropriate treatment strategy.
Non-Surgical Treatment Pathways
Initial treatment focuses on conservative, non-surgical methods aimed at pain management and functional improvement. Management for acute injuries often involves the RICE protocol (Rest, Ice, Compression, and Elevation) combined with over-the-counter Nonsteroidal Anti-inflammatory Drugs (NSAIDs) like ibuprofen to reduce pain and inflammation.
Physical therapy (PT) is a foundational element in non-surgical treatment plans. A physical therapist designs a personalized exercise program to strengthen the muscles surrounding the knee, particularly the quadriceps and hamstrings, which provides dynamic support to the joint. PT also addresses gait correction and flexibility to improve mechanical function and reduce undue stress on the joint cartilage.
Injection therapies provide targeted relief, especially for patients with osteoarthritis or localized inflammation. Corticosteroid injections deliver anti-inflammatory medication directly into the joint space, offering pain relief that can last for several months. Viscosupplementation involves injecting a hyaluronic acid-based solution into the knee to improve the lubricating properties of the joint fluid.
External supports may be recommended to improve stability. Bracing provides external stability, which is helpful for ligament instabilities or for unloading pressure from a specific compartment of an arthritic knee. Custom-fit orthotics, or shoe inserts, are sometimes prescribed to correct foot and ankle alignment, which can indirectly reduce abnormal rotational forces and stress on the knee joint.
Surgical Intervention Options
When conservative treatments fail to provide lasting relief, or for injuries involving severe mechanical disruption, the orthopedic doctor will discuss surgical options. Surgery is generally reserved for advanced joint disease, such as severe osteoarthritis, or for major traumatic injuries like a complete ligament rupture. The goal of surgical intervention is to repair or replace the damaged structures to restore normal knee mechanics.
Minimally invasive procedures use arthroscopy, allowing the surgeon to operate through small incisions using a camera and specialized instruments. Arthroscopy is used to address a torn meniscus by trimming or repairing the cartilage, reconstruct a torn ligament like the Anterior Cruciate Ligament (ACL), or remove loose fragments of bone or cartilage. Recovery from these procedures is generally faster than from open surgery.
For patients with advanced arthritis, a joint replacement procedure may be the most effective long-term solution. A Total Knee Replacement (TKR) involves removing the damaged ends of the thigh bone and shin bone and resurfacing them with metal and plastic prosthetic components. If arthritis is confined to only one compartment of the knee, a Partial Knee Replacement (PKR) may be an option, which preserves more of the patient’s natural tissue and typically allows for a shorter recovery time.
An osteotomy may be considered for younger patients with localized damage. This procedure involves surgically cutting and reshaping the bone, usually the tibia, to shift the weight-bearing axis away from the damaged area of the joint. This realignment can significantly reduce pain and potentially delay the need for a total joint replacement.
Rehabilitation and Long-Term Management
Rehabilitation is the final phase of treatment, whether following surgery or prolonged conservative care. Post-treatment physical therapy is necessary to regain the knee’s full range of motion, rebuild strength in the surrounding musculature, and ensure a safe return to daily activities. The therapist guides the patient through progressive exercises to prevent stiffness and restore balance and coordination.
Recovery timelines vary significantly depending on the procedure. Recovery from a simple arthroscopic procedure might take six to eight weeks, while a total knee replacement often requires a dedicated rehabilitation period lasting three to six months or longer. Early mobilization, often starting the day of or the day after surgery, is a key component to accelerate the healing process.
The orthopedic doctor provides long-term lifestyle recommendations focused on protecting the knee joint from future damage. Weight management is emphasized, as reducing body weight significantly decreases the load and stress placed on the knee joint. Patients are encouraged to adopt low-impact exercises, such as swimming, cycling, or walking, to maintain muscle strength and joint flexibility.