We see patients every day with knee pain, and although every patient is an individual with a unique problem, conceptually, we approach each problem specifically.
A patient’s history is the most essential component of the evaluation process.
During this process, we will want to know:
details of the onset of pain,
the location of pain,
the duration of symptoms,
the characteristic of the pain (sharp, dull, aching),
any alleviating or exacerbating factors,
how they’ve tried to manage their pain and disability so far, and
specifics of all previously attempted treatments.
Next, a physical examination is performed to identify the cause of the symptoms. In the setting of knee pain, it’s important to rule out other sources, like the spine, as contributing to the clinical symptom complex.
Once a thorough history and physical have been obtained, we will order and review imaging that can tell us a lot about the patient’s condition and what treatments might be appropriate. Nearly every patient needs an x-ray, and some patients will benefit from a particular type of MRI we get called a T2 wetmap cartigram that looks directly at the condition of the cartilage in the knee. These unique images come from integrated GE software on the MRI and are only available in a very few centers nationwide but are paid for by your insurance carrier just like a regular MRI would be.
Once we have a diagnosis for a patient, we approach each problem with the most conservative treatment options first, which are usually the least expensive and typically covered by insurance carriers. Most of our patients are either bow-legged or knock-kneed, which contributes to knee joint overload, advancing the damage caused by arthritis. Physical therapists can create heel wedge orthotics (custom shoe inserts). The physical therapist specializing in gait and construction will individualize the shoe inserts, and the patient takes home the insert the same day. The value of physical therapy cannot be over-emphasized. Many patients benefit from a home exercise program and/or formal physical therapy to improve the condition of their joints.
Some patients will benefit from unloader bracing, and we obtain prior authorization from their insurance company for coverage. These braces play a significant role in the immunobiologics procedures we perform routinely and are worn for approximately 12 weeks after the procedures are completed.
Some patients will benefit from arthritis creams, anti-inflammatory drugs, corticosteroid injections, and hyaluronic acid, which insurance carriers typically cover.
In the appropriate setting, we may offer orthopedic immunobiologic (OI) procedures like platelet-rich plasma (PRP) and bone marrow concentrate (BMC) that use your own cells and tissues to create an anabolic healing environment in the joint and in the bone. While most insurance providers do not yet cover these off-label or ‘experimental’ procedures, some, like the military insurance TriCare®, have begun seeing the obvious benefits for their patients and covering the procedure fully. We’re hoping the pendulum continues to swing that way because the clinical value of OI cannot be over-estimated, and many patients have been able to avoid knee replacement surgery by virtue of the experimental procedures.
Some patients are not candidates for conservative management and are most appropriate for knee replacement surgery. We know who those people are and will tell you if that’s you. We want everyone to have the most appropriate treatment and be pleased with their treatment outcome, no matter what it is. Questions are always encouraged and answered, and we make sure our patients agree with the treatment plan before leaving our office.