Knee Pain
Knee pain is a widespread issue that can be caused by a variety of conditions, ranging from minor injuries to serious joint diseases. While occasional discomfort may be manageable, persistent or severe knee pain that affects daily activities, along with symptoms like swelling, tenderness, or redness, should prompt a visit to a healthcare professional. At Complete Orthopedics, we offer specialized care to diagnose and treat knee pain, with access to advanced treatment options and surgery when necessary. Our facilities in New York City and Long Island are equipped with state-of-the-art technology, and our team is dedicated to helping you find the best approach for your knee health.
How Common It Is and Who Gets It? (Epidemiology)
Knee pain is one of the most common musculoskeletal issues, affecting people of all ages and activity levels. It’s especially prevalent in individuals who are active in sports or physical activities, as well as in older adults experiencing conditions like osteoarthritis. Studies show that knee pain increases with age, particularly in individuals over 50, with over 20% of adults in this age group reporting chronic knee discomfort. Knee pain is also common in athletes and people who engage in repetitive movements such as running, squatting, or cycling.
Why It Happens – Causes (Etiology and Pathophysiology)
Knee pain can result from a variety of underlying causes. Some of the most common include:
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Ligament Injuries and Tears: Injuries such as an ACL (anterior cruciate ligament) tear are a common cause of knee pain, especially in athletes and active individuals.
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Osteoarthritis: This age-related condition leads to the wearing down of cartilage in the knee joint, causing pain, stiffness, and reduced mobility.
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Rheumatoid Arthritis: This autoimmune condition causes inflammation of the knee joint, leading to pain, swelling, and stiffness.
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Meniscal Tears: Tears in the knee cartilage, which provide cushioning, can cause sharp pain and limit movement.
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Patellofemoral Syndrome: Pain around the kneecap, often caused by misalignment or overuse.
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Osteonecrosis: The death of bone tissue due to interrupted blood flow can lead to pain and joint dysfunction.
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Trauma or Injury: Falls, accidents, or direct blows to the knee can result in fractures, bruises, or ligament injuries.
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Pigmented Villonodular Synovitis (PVNS): A rare condition causing the growth of abnormal tissue in the knee joint, leading to pain and swelling.
How the Body Part Normally Works? (Relevant Anatomy)
The knee is a hinge joint that connects the femur (thigh bone) and the tibia (shin bone), with the patella (kneecap) situated in front of the femur. The knee is stabilized by various ligaments and tendons, including the ACL, PCL, and collateral ligaments. The articular cartilage covers the ends of the bones, allowing them to glide smoothly, while the meniscus provides additional cushioning. The knee joint is responsible for supporting body weight and enabling a wide range of movements, including walking, running, squatting, and jumping.
What You Might Feel – Symptoms (Clinical Presentation)
Knee pain can manifest in different ways depending on the underlying cause:
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Pain: The primary symptom, ranging from mild discomfort to severe pain that worsens with activity.
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Swelling: The knee may appear swollen due to inflammation, fluid buildup, or injury.
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Stiffness: A feeling of reduced mobility or difficulty fully bending or straightening the knee.
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Instability: A sensation that the knee is weak or may give way, particularly during physical activity.
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Clicking or Popping: Sounds or sensations of the knee making audible noises, often associated with cartilage damage or misalignment.
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Difficulty Bearing Weight: Pain or discomfort that makes it difficult to put weight on the affected leg, leading to limping or favoring the other leg.
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Redness and Warmth: Signs of inflammation or infection, with the knee feeling hot to the touch and the skin appearing red.
How Doctors Find the Problem? (Diagnosis and Imaging)
Diagnosing knee pain involves a combination of medical history, physical examination, and imaging tests:
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Medical History: Your doctor will ask about your symptoms, activities, and any history of knee injuries or surgeries.
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Physical Examination: The doctor will check for swelling, tenderness, and range of motion, and may perform special tests to evaluate specific knee structures.
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X-rays: Useful for identifying fractures, joint misalignment, or signs of arthritis.
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MRI: Provides detailed images of soft tissues, such as ligaments, tendons, and cartilage, and can help diagnose meniscal tears, ligament injuries, and osteonecrosis.
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CT Scan: A detailed imaging technique used in complex cases to evaluate bone structure and joint alignment.
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Joint Aspiration: A procedure where fluid is drawn from the knee joint to check for infection or other abnormalities.
Other Problems That Can Feel Similar (Differential Diagnosis)
Several conditions can cause symptoms similar to knee pain, including:
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Osteoarthritis: Joint degeneration leading to widespread pain and stiffness.
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Patellofemoral Pain Syndrome: Pain around the kneecap due to misalignment or overuse.
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Meniscus Tears: Pain and locking sensations due to damaged cartilage.
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Knee Ligament Injuries: Tears or sprains in the ACL, PCL, or MCL can cause instability and pain.
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Bursitis: Inflammation of the bursa, causing localized pain and swelling.
Treatment Options
Non-Surgical Care
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Rest and Activity Modification: Reducing physical activity and avoiding movements that worsen knee pain allows the knee to heal.
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Ice Therapy: Applying ice to the knee for 15-20 minutes several times a day reduces swelling and pain.
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NSAIDs: Over-the-counter medications like ibuprofen can help alleviate pain and inflammation.
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Physical Therapy: Tailored exercises to strengthen the muscles around the knee, improve flexibility, and reduce pain.
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Bracing: A knee brace or wrap may provide additional support and stability.
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Corticosteroid Injections: In some cases, steroid injections can reduce inflammation and provide relief from chronic pain.
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Hyaluronic Acid Injections: These can help lubricate the joint, reducing pain and improving mobility, particularly in osteoarthritis.
Surgical Care
If conservative treatments are ineffective, surgical options may be considered:
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Knee Arthroscopy: A minimally invasive procedure to repair or remove damaged tissue, such as meniscal tears or loose cartilage.
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Ligament Repair or Reconstruction: Surgery to repair torn ligaments, such as ACL reconstruction.
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Osteotomy: A procedure to realign the knee joint and reduce stress on the affected area.
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Partial Knee Replacement: Replacing only the damaged part of the knee joint while preserving the healthy portion.
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Total Knee Replacement: In severe cases, a total knee replacement may be needed to replace the entire knee joint with an artificial prosthesis.
Recovery and What to Expect After Treatment
Recovery depends on the type of treatment:
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Non-Surgical Treatment: For conservative care, recovery typically takes a few weeks, with physical therapy focusing on strength and flexibility.
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Surgical Treatment: Recovery time after surgery varies depending on the procedure. Knee arthroscopy may require only a few weeks of recovery, while total knee replacement may require several months of rehabilitation to regain full mobility.
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Physical Therapy: A crucial part of the recovery process, helping patients regain strength, flexibility, and joint function. Rehabilitation focuses on gradual reintroduction to weight-bearing activities.
Possible Risks or Side Effects (Complications)
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Infection: Any surgical procedure carries a risk of infection, which may require antibiotics or additional surgery.
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Blood Clots: Deep vein thrombosis (DVT) may develop after surgery, necessitating blood-thinning medications.
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Stiffness: Post-surgical stiffness or limited range of motion is possible but can be managed with physical therapy.
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Implant Loosening or Failure: In cases of knee replacement, the implant may loosen or fail over time, requiring revision surgery.
Long-Term Outlook (Prognosis)
With proper treatment, most knee pain conditions improve significantly over time. Conservative measures such as physical therapy and medication are effective for many individuals, especially in cases of osteoarthritis or minor ligament injuries. Surgical interventions such as knee replacement have high success rates, with many patients experiencing significant pain relief and improved mobility for years following surgery.
Out-of-Pocket Costs
Medicare
CPT Code 29880 – Knee Arthroscopy (Meniscus/Loose Body Work): $134.30
CPT Code 29888 – Ligament Repair/Reconstruction (ACL): $229.85
CPT Code 27447 – Osteotomy (Proximal Tibial/Tibial Tubercle, often coded under TKA bundle rules): $303.02
CPT Code 27418 – Tibial Tubercle Osteotomy: $193.59
CPT Code 27446 – Partial Knee Replacement: $271.70
CPT Code 27447 – Total Knee Replacement: $303.02
Under Medicare, 80% of the approved amount for these procedures is covered once your annual deductible has been met. The remaining 20% is typically the patient’s responsibility. Supplemental insurance plans—such as Medigap, AARP, or Blue Cross Blue Shield—usually cover this 20%, leaving most patients with little to no out-of-pocket expenses for Medicare-approved knee surgeries. These supplemental plans coordinate directly with Medicare to ensure full coverage for the procedure.
If you have secondary insurance—such as Employer-Based coverage, TRICARE, or Veterans Health Administration (VHA)—it acts as a secondary payer once Medicare processes the claim. After your deductible is satisfied, these secondary plans may cover any remaining balance, including coinsurance or small residual charges. Secondary plans typically have a modest deductible, ranging from $100 to $300, depending on the specific policy and network status.
Workers’ Compensation
If your knee surgery is work-related, Workers’ Compensation will fully cover all treatment-related costs, including surgery, hospitalization, and rehabilitation. You will have no out-of-pocket expenses under an accepted Workers’ Compensation claim.
No-Fault Insurance
If your knee injury resulting in surgery is caused by a motor vehicle accident, No-Fault Insurance will cover all medical and surgical expenses, including arthroscopy, ligament repair, osteotomy, partial knee replacement, and total knee replacement. The only possible out-of-pocket cost may be a small deductible depending on your individual policy terms.
Example
Kevin, a 59-year-old patient with ACL injury and osteoarthritis, underwent ACL ligament repair/reconstruction (CPT 29888) and partial knee replacement (CPT 27446). His estimated Medicare out-of-pocket costs were $229.85 for the ACL surgery and $271.70 for the partial knee replacement. Since Kevin had supplemental insurance through Blue Cross Blue Shield, the 20% that Medicare did not cover was fully paid, leaving him with no out-of-pocket expenses for the surgeries.
Frequently Asked Questions (FAQ)
Q. What causes knee pain?
A. Knee pain can be caused by a variety of factors, including ligament injuries, osteoarthritis, meniscal tears, or patellofemoral pain syndrome.
Q. How is knee pain treated?
A. Treatment options include rest, ice, physical therapy, medications, and in some cases, surgery.
Q. When should I see a specialist for knee pain?
A. If knee pain persists despite home care or interferes with daily activities, it’s important to consult with an orthopedic specialist for proper diagnosis and treatment.
Summary and Takeaway
Knee pain can stem from a variety of conditions, each requiring a tailored approach to treatment. By seeking professional medical care, you can identify the underlying cause of your pain and take the appropriate steps to alleviate it. Whether through non-surgical methods or surgical intervention, there are effective options available to restore knee function and improve quality of life.
Clinical Insight & Recent Findings
A recent study provided a comprehensive review of chronic knee pain, focusing on the management of osteoarthritis (OA), one of the most common causes. The study highlighted a multifaceted approach to treatment, combining non-pharmacological measures like physiotherapy, weight management, and lifestyle changes, with pharmacological interventions such as NSAIDs, duloxetine, and tramadol.
For more severe cases, the study recommended minimally invasive treatments, including intra-articular corticosteroid injections, hyaluronic acid injections, and radiofrequency ablation of the genicular nerves, which demonstrated moderate to substantial effectiveness in managing pain and improving function.
The review emphasized the need for an individualized, multidisciplinary treatment strategy to optimize outcomes, especially for patients with refractory pain. (“Study of chronic knee pain management – See PubMed.“)
Who Performs This Treatment? (Specialists and Team Involved)
Orthopedic surgeons, physical therapists, and sports medicine specialists are the primary healthcare providers involved in diagnosing and treating knee pain.
When to See a Specialist?
If you experience persistent or worsening knee pain, or if your knee pain is affecting your ability to perform daily activities, it’s time to consult a specialist.
When to Go to the Emergency Room?
Seek emergency care if you experience sudden, severe knee pain, swelling, or injury, especially if there is visible deformity, open wounds, or signs of infection.
What Recovery Really Looks Like?
Recovery typically involves a combination of rest, rehabilitation, and gradual return to activity. Surgery recovery times vary depending on the procedure, with rehabilitation playing a crucial role in restoring knee function.
What Happens If You Ignore It?
Ignoring knee pain can lead to further damage to the knee joint, potentially resulting in long-term disability or the need for more extensive surgical procedures in the future.
How to Prevent It?
Prevent knee pain by maintaining a healthy weight, strengthening the muscles around the knee, using proper technique during physical activities, and wearing appropriate footwear.
Nutrition and Bone or Joint Health
A diet rich in calcium, vitamin D, and omega-3 fatty acids supports joint health and may reduce the risk of developing conditions like osteoarthritis.
Activity and Lifestyle Modifications
Incorporating low-impact exercises like swimming or cycling, while avoiding excessive strain on the knee, can help maintain joint function and prevent injury.
Do you have more questions?
How can I manage knee pain during activities like gardening or sports?
Using proper body mechanics, wearing supportive footwear, and taking frequent breaks can help reduce strain on your knees during activities like gardening or sports. Using knee braces or supportive devices may also provide added stability and protection.
Is there a difference between acute and chronic knee pain?
Acute knee pain typically occurs suddenly due to an injury or trauma and may resolve on its own or with treatment within a few weeks. Chronic knee pain, on the other hand, persists for an extended period, often due to underlying conditions like arthritis or repetitive stress on the knees.
Can weather changes affect knee pain?
Some individuals report that changes in weather, particularly cold and damp conditions, can exacerbate knee pain, especially for those with arthritis. While the exact reason for this is not fully understood, staying warm and maintaining mobility can help alleviate discomfort during weather fluctuations.
Can losing weight help with knee pain?
Yes, losing weight can reduce the load on your knees and alleviate pressure on the joints, which may help decrease pain and improve mobility. Even modest weight loss can have significant benefits for individuals with knee osteoarthritis.
Is knee pain common in older adults?
Yes, knee pain is a common complaint among older adults, particularly those with osteoarthritis or other age-related joint changes. However, it’s essential to seek medical evaluation to determine the underlying cause of knee pain and develop an appropriate treatment plan.
Can knee pain be hereditary?
While genetics may play a role in certain knee conditions like osteoarthritis, knee pain itself is not typically hereditary. However, family history can increase your risk of developing certain joint-related issues, so it’s essential to be proactive about maintaining joint health.
How can I make my home more knee-friendly?
Simple modifications like installing handrails, using a shower chair, or adding cushioned mats can make your home more knee-friendly and reduce the risk of falls or injury. Your orthopedic surgeon or physical therapist can provide recommendations based on your specific needs.
Are there any long-term consequences of untreated knee pain?
Untreated knee pain can lead to decreased mobility, muscle weakness, and joint damage over time, potentially resulting in chronic disability and reduced quality of life. It’s essential to address knee pain promptly and follow a comprehensive treatment plan to prevent long-term complications.
What can cause knee pain?
Knee pain has a wide array of different potential causes that include both pathology within the knee joint itself as well as pathology that presents with pain referred into the knee and felt in and around the knee joint. Example of this includes hip pain, lower back pain, and less commonly, pelvic pain.
Causes from within the knee joint include arthritis, meniscal tears, osteochondral defects, osteonecrosis, patella maltracking, patellofemoral syndrome, cruciate ligament damage, collateral ligament damage, and other rare causes such as pigmented villonodular synovitis (PVNS).
How to diagnose knee pain?
Any knee pain that is persistent and refractory to over-the-counter analgesia, exercise, rest or sustained physical activity should be brought to the attention of a healthcare professional. Our specialist orthopedic surgeons would be happy to see you in consultation for any knee pain that you may be having.
The process begins with a formal history and physical examination, which will include discussion of the knee pain and its duration, nature, characteristics and exacerbating or alleviating factors. We will then perform a physical examination of the knee joint and arrange for you to undergo plain film radiographs, x-ray studies that will give us more information about the anatomy of your knee and potentially give us the diagnosis at that point.
If at this point the diagnosis is still unclear, then further imaging studies such as a CT or MRI scan may be ordered in order to ascertain exactly what is causing the underlying knee pain based on the clinical suspicion from the history and physical examination.Depending on the cause, in some cases your knee pain may be able to be diagnosed in the office during your first visit, but for other causes that are less clear-cut it may require you to undergo a further scan of some kind and return to the office when the scan has been completed for us to discuss the results with you.
What can I do for knee pain?
The first line treatment for any type of joint pain should be rest of the affected joint for a short period of time. Over-the-counter analgesics such as Tylenol or nonsteroidal anti-inflammatory medications are also the first protocol for analgesia.
If neither of these strategies are effective then you may require a full course of dedicated physical therapy and if this does not work either then, at this point, consultation with a healthcare professional in regards to your knee pain is essential to investigate the underlying diagnosis so that appropriate treatment can be initiated.
Do knee braces help with knee pain?
Bracing of the knee is indicated in a number of conditions that include both osteoarthritis and patellofemoral causes. If your healthcare provider feels that you would benefit from a course of bracing, they will inform you as such as give you recommendations as to the best type of brace for you to purchase.
It is worth mentioning, however, that braces will only provide relief from knee pain for the duration that they are worn. Many patients find that with some of the bulkier braces, they are uncomfortable and find they are unable to tolerate them for significant periods of the day. This leads some patients to not wear their brace and if this is the case then clearly bracing is not the appropriate intervention for these patients, as not wearing the brace defeats the purpose of the bracing strategy for treating the patient’s complaint.
Can knee pain cause hip pain?
Although it is possible for alteration in a patient’s gait pattern as a result of knee pain to adversely effect other joints as part of the gait cycle (these do include both the hip, lower back and even in some cases the ankle) it is actually more common that pathology in the hip can present with knee pain.
This is well known to be the case in younger patients who sustain injuries known as a slipped capital femoral epiphysis (SCFE). These patients will often present with knee pain and have their knee extensively investigated only to reveal no major clinical abnormality responsible for the ongoing pain and these critical injuries can often go missed causing long-term problems with the hip and leading to surgical intervention much earlier on in life than it would have been necessary had the hip pain been investigated at an earlier stage.
Therefore it is important to bear in mind that while you may be feeling the pain in and around the knee joint it is the responsibility of your treating healthcare practitioner to investigate both the joint above and below and, if done properly, this will reveal pathology within the hip that is presenting as referred pain in the knee. This can also happen in certain cases with osteoarthritis.
What kind of doctor should I see for my knee pain?
Although many patients choose to begin with their regular family physician to investigate their knee pain, and this is entirely appropriate, our specialist orthopedic surgeons who have years of experience treating common and complex knee complaints will be more than happy to see you in consultation for any knee pain that you may be having.
They will utilize their specialist expertise to achieve a definitive diagnosis for your knee pain and will be happy to explain all of your potential treatment options including any surgical procedure or if nonsurgical procedures are more appropriate, we will offer those or offer a referral to practitioners who provide them for you.
What can cause knee pain without injury?
There are multiple reasons that can cause knee pain without injury. This may include inflammation of the tendon, gradual long-standing injury to the articular cartilage or the meniscal cartilage, inflammation of the plica inside the knee joint, inflammation of the capsule, inflammation of the surrounding muscles and tendons etc.
What can cause pain in the back of the knee?
Pain in the back of the knee can be caused by tendonitis, strain of the muscles of the back. It can also be caused by degenerative changes in the knee causing a formation of cysts in the back of the knee. Occasionally, meniscal tears can present with pain in the back of the knee. Unusual cause of pain there may be a clot in the vein or injury to the ligament.
Where is the knee VMO muscle?
VMO means vastus medialis Obliquus. It’s the lower part of the inner side of the quadriceps muscle. This muscle helps in the last stages of straightening of the knee joint and is very important in the function of the knee joint. This is the first muscle to weaken and the last muscle to strengthen in patients of injury of the knee joint.
Is walking good a bad knee?
Walking is a good exercise for knee pain. It should be done as much as possible, without aggravating the knee pain. It helps not only in general body exercise, but also strengthening muscles of the knee joint, which help in decrease in pain throughout the knee.
Is running bad for your knees?
Running, especially on hard surfaces, can be bad for the knee. Especially if they are already injured or have degenerative changes. Person should have proper shoe and should try not to run on hard surfaces. They should also do dedicated knee muscle strengthening exercises as well as warm up before the running.
What is patellar tendonitis of the knee?
Patellar tendonitis means inflammation of the patellar tendon which is found between the kneecap and the leg bone called tibia. It does usually involve the upper part of the tendon where it attaches to the kneecap. It is usually treated with rest, ice, compression, and elevation along with anti-inflammatory medication. Patient is advised not to involve in contact sports and avoid activities that will worsen the pain. Bracing may help also.
What is Plica Syndrome?
There are soft tissue reflections inside the knee joint called plica. The knee joint has multiple plica bands in the knee, the most remarkable being on the inside, and on the upper part of the kneecap. They are usually present and do not cause any problems. Sometimes, a plica may be thickened or inflamed and may start rubbing on the articular surface and cause pain. In these patients, they are initially treated with anti-inflammatory medications, ice, elevation, and rest followed by physical therapy. If they are not improved with conservative management, then surgical treatment may be required.
How do you treat tendonitis in the knee?
Tendonitis in the knee is usually treated in the same way as it is in any other part of the body, by using the RICE protocol (rest, ice, compression and elevation). The patient can also be sent for physical therapy as well as use anti-inflammatory medications. Bracing may also help.
What is the IT band?
The IT band, or the iliotibial band is a thickening of soft tissue, which extends from the hip to the knee joint. It functions in stabilizing the hip as well as the knee joint and also functions in the movement of the knee joint.
What is IT band Syndrome?
IT band syndrome is caused due to rubbing of the IT band over the outer part of lower thigh bone leading to inflammation and causing pain. It usually occurs in runners and cyclists. It is usually relieved with rest and anti-inflammatory medications. Occasionally a steroid shot may help.
How do you reduce fluid in the knee?
Fluid in the knee is usually reactionary to some other pathology in the knee like injury to the ligament, the meniscus or the cartilage. To decrease the fluid these pathologies are to be taken care of accordingly. In an acute setting, if the fluid is causing pain and discomfort, the fluid can be aspirated by needle from the knee joint. Cortisone injection may also be given at the same time if appropriate which may help in decreasing the swelling and pain.
Dr. Sebastian Heaven
I provide Orthopaedic patient care at several different locations, including a Regional Joint Assessment Centre, a Level 1 Trauma Centre and a District General Hospital. My scope of practice is broad and includes Trauma, Arthroplasty and Sports Orthopaedics.
My areas of special interest include Primary and Revision Arthroplasty, Periprosthetic Fracture Management and general orthopaedic trauma management in isolation and in the context of complex polytrauma patients. I also have clinical research interests in these areas, as well the development of interprofessional relationships between trauma team members and fellow healthcare professionals.
I have personally written all or most of what's on this page for Complete Orthopedics, and approve the use of my content.
