An orthopedic doctor specializes in the musculoskeletal system, focusing on conditions that affect the bones, joints, ligaments, tendons, and muscles. When a patient presents with knee pain, the orthopedic specialist’s objective is to systematically identify the underlying cause and develop a targeted management plan. Knee discomfort can stem from a wide array of issues, including acute injuries, degenerative conditions like arthritis, or chronic overuse syndromes. The process involves a thorough investigation that progresses from initial examination to advanced imaging. Treatment implementation often begins with non-invasive methods.
Establishing the Diagnosis
The diagnostic process begins with a detailed patient history, where the orthopedic doctor seeks specific information about the pain’s location, its onset, its duration, and any mechanism of injury. Understanding how the injury occurred, such as a sudden twist or a fall, can immediately suggest damage to specific structures like the anterior cruciate ligament (ACL) or meniscus. The doctor also asks about the pain’s severity, whether it affects sleep or daily activities, and what factors tend to alleviate or aggravate the symptoms.
This historical context is immediately followed by a comprehensive physical examination of the knee. The specialist observes the patient’s gait for any limp and visually inspects the joint for signs of swelling, bruising, or deformity. They manually palpate the joint to check for tenderness, warmth, and the presence of excess fluid, known as an effusion. The physical exam includes specific stability tests, such as the Lachman test for ACL integrity, and maneuvers to assess meniscal tears, while also measuring the knee’s active and passive range of motion.
To confirm the clinical findings and visualize the internal structures, diagnostic imaging is utilized. X-rays are typically the first imaging study ordered, as they are highly effective at revealing issues related to bone, such as fractures, bone spurs, or the degree of joint space narrowing that signifies osteoarthritis. If the initial assessment suggests soft tissue damage—like a ligament tear or a complex meniscal injury—a magnetic resonance imaging (MRI) scan is often requested. The MRI provides detailed images of cartilage, tendons, and ligaments, which are not visible on an X-ray, allowing for a diagnosis of the injury’s extent.
Non-Surgical Management Strategies
Once a diagnosis is established, the majority of knee pain is managed conservatively, beginning with a prescription for physical therapy (PT). PT aims to reduce pain and restore function by strengthening the musculature surrounding the joint, especially the quadriceps and hamstrings, which provide dynamic stability. Therapists use targeted exercises to improve flexibility and range of motion, often complemented by techniques like manual therapy or modalities like heat and ice.
Activity modification involves temporarily adjusting movements to avoid high-impact actions that place excessive stress on the damaged joint structures. The doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to manage pain and reduce localized inflammation within the joint. These medications are often used in conjunction with other therapies to create a window of opportunity for rehabilitation.
If oral medications and physical therapy do not provide sufficient relief, the orthopedic doctor may proceed with specific injection therapies. Corticosteroid injections deliver a powerful anti-inflammatory medicine directly into the joint space, which can significantly reduce swelling and pain for several weeks to months. This temporary relief can be especially helpful for patients experiencing an acute flare-up of arthritis.
Viscosupplementation involves injecting a hyaluronic acid-based substance into the knee joint. Hyaluronic acid is a naturally occurring component of the joint fluid that provides lubrication and shock absorption. The injection aims to supplement the joint’s diminished fluid, reducing friction between the worn cartilage surfaces and improving mobility. In certain cases, platelet-rich plasma (PRP) therapy may be considered, which involves injecting a concentrated solution of the patient’s own platelets to potentially stimulate tissue repair and healing.
Surgical Interventions and Decision Points
Surgery becomes a consideration when conservative, non-surgical management strategies have failed to alleviate pain, or when the underlying condition involves acute structural instability or severe joint damage. Persistent, debilitating pain that interferes with daily life, coupled with radiographic evidence of significant joint deterioration, signals the need for intervention. For younger patients or those with specific types of injuries, surgery may be the initial recommendation to prevent long-term damage.
Arthroscopy is a minimally invasive procedure. The surgeon inserts a small camera and specialized instruments through tiny incisions to visualize and operate within the joint. Arthroscopy is typically used for joint preservation, such as repairing a torn meniscus, reconstructing a damaged ligament like the ACL, or removing loose fragments of cartilage or bone. Recovery from this procedure is generally quicker due to the minimally invasive nature, focusing on repairing the existing joint components.
In cases of advanced degenerative joint disease, the orthopedic doctor may recommend a joint replacement, or arthroplasty. A total knee replacement involves removing the damaged ends of the thigh bone (femur) and shin bone (tibia) and resurfacing them with artificial components made of metal and plastic. A partial knee replacement is an option when the damage is isolated to just one compartment of the knee. This procedure is a major intervention providing long-lasting pain relief and functional improvement when all other options have been exhausted.