Knee Pain Forum

A Patient’s Story:
Medial arthrotomy, Lateral arthrotomy, and Two Arthroscopies – Then Prolotherapy.
Recently we saw a 65 year old male patient with knee problems. The patient lived an active lifestyle playing sports, lifting weights, and traveling, unfortunately this also lead to chronic knee pain. His past medical history included four procedures on his right knee: medial arthrotomy, lateral arthrotomy, and two arthroscopies. He also had surgery on his left knee to repair a quadriceps rupture.
Read a patient’s story

Knee Pain Case History

FV is a 48 year old man with a 3 month history of bilateral knee pain.

The patient was initially seen by a rheumatologist, and given a steroid injection which gave him relief of his pain for 6 months. The pain; however, would return, and another steroid injection provided only minimal relief.

Plagued with pain, and searching for answers, the patient went to see an orthopedic surgeon who ordered an MRI, which revealed a right medial meniscus tear.

An Arthroscopy was recommended; however, FV did not wish to pursue a surgical treatment. Patient was therefore given mobic for symptomatic pain relief, and told to await his eventual need for a total knee arthroplasty.

Seeking alternative therapies, the patient came to the Darrow Sports & Wellness Institute, after a referral from a close personal friend and current patient of Dr. Darrow.

Upon his visit to our office, FV reported significant and worsening right knee pain, described as sharp, and worse with bending of the knee.

After examination, FV was thought to be an optimal candidate for treatment with prolotherapy. He underwent his first prolotherapy treatment into his right knee on 4/20/10.

On 4/29/10 patient returned for his second treatment and reported that the only pain he experienced had been one day prior to his visit at the gym, while running.

He reported a 70% improvement after his first treatment.

On 5/17/2010 patient returned for his third treatment of his right knee, and reported complete resolution of his knee pain.

Ligament Instability and Revision Total Knee Arthroplasty

Researchers writing in the medical journal Der Orthopäde examined how loose ligaments played a role in the need for follow up (revision) knee surgery.
Graichen H, Strauch M, Katzhammer T, Zichner L, von Eisenhart-Rothe R. [Ligament instability in total knee arthroplasty - causal analysis.] Orthopade. 2007 Jun 21;

The researchers examined 135 knee revisions and noted that

-In 32.6 % of all cases, ligament instability was the primary reason for revision.
-In another 21.6%, ligament instability was identified as a secondary reason for revision.

They concluded: Ligament instability is a common reason for revision total knee arthroplasty (TKA).

Prolotherapy as an option

Question: I have a knee that a couple doctors told that I should have a knee replacement surgery. It is pretty swollen and sore, I sure would like to avoid the knee surgery.

Dr. Darrow: With this process of Prolotherapy there is a very good chance of building up enough collagen and cartilage so that you can walk around, hopefully pain free after a few series of injections. Surgery is something, it seems to me, that is something that should be the last option.

Golfer’s Knee

Question: I am over 50, play a lot of golf and have been having a problem with my left knee, the pain comes and goes. I am over 50.

Dr. Darrow: This is typical in older golfers because when they were younger, they were taught to keep their feet parallel in their swing and then roll over the heel of their left foot. It’s not taught like that today because that technique puts great stress on the knee and ankle. Today there is more of a theory of opening up the left foot even to 45 or 90 degree angle so that during the follow through there is less stress placed on the left leg.

We use to do something called a “Reverse C,” where we would throw our heads way back, that was popular 20-30 years ago, and what that would do is torque the whole body and golfers would suffer from terrible back problems, terrible knee pain, terrible ankle pain, terrible foot pain.

We teach our patient golfers to open up that knee and prevent those problems. The nice thing about Prolotherapy is that it really helps with knee pain. It takes three four injections and typically we can help that pain.

Workout Knee

Question: I am 52 and have knee pain after working out. What can I do other than surgery?

Dr. Darrow: At 52 the Collagen in the body starts breaking down, actually it starts in our 40′s and even younger but we start to notice it in our 40′s as we start getting wrinkles around our eyes and on our faces.

As we see in the skin on our faces, the collagen in our knees starts to go and as we continue to work out there is obviously a stress on the joint.

Most knee pain that we see is called Chondromalacia patella. Malacia means break down, condro means cartilage, patella means the back of the knee bone, which is called the patella, (and there) is the thickest cartilage in the body. It starts rubbing the wrong way against the tract that it slides in and with repetitive use like running or stair climbing, things of that nature, any sport really, the repetitive use just wears out the back of that knee cap and begins the arthritis process and pain.

It is also made worse when you are sitting in a movie theater or you are in an airplane and stuck in one place for a long period of time. Often times people can have a little meniscus tear, the meniscus is a little cushion inside the knee. Prolotherapy helps grow back all of this tissue.

Before you decide on surgery, explore Prolotherapy, because of all the things Prolotherapy works on, it works fastest in the knees.

Exercise or Surgery for Chronic Patellofemoral Pain Syndrome?
Study says exercise program just as good as arthroscopy.

Researchers writing in the medical journal BMC Medicine examined the efficacy of arthroscopy in patients with chronic chronic patellofemoral pain syndrome. They split 56 patients into two groups. Those receiving knee arthroscopy and an 8-week home exercise program and those treated with the 8-week home exercise program only.

They found that “Both groups showed marked improvement during the follow-up,” but they added, “In this controlled trial involving patients with chronic PFPS, the outcome when arthroscopy was used in addition to a home exercise program was no better than when the home exercise program was used alone.”

Kettunen JA, Harilainen A, Sandelin J, Schlenzka D, Seitsalo S, Hietaniemi K, Malmivaara A, Kujala UM. Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: a randomized controlled trial. BMC Med. 2007 Dec 13;5(1):38

More about Chondromalacia patella

Knee Braces or NSAIDs for Chronic Patellofemoral Pain Syndrome?

Researchers writing in the medical journal American Family Physican say “there is little evidence to support the routine use of knee braces or non-steroidal anti-inflammatory drugs. Surgery should be considered only after failure of a comprehensive rehabilitation program. Educating patients about modification of risk factors is important in preventing recurrence.”

Dixit S, DiFiori JP, Burton M, Mines B. Management of patellofemoral pain syndrome. Am Fam Physician. 2007 Jan 15;75(2):194-202.

Revision Ligamentoplasty of the Anterior Cruciate Ligament

Recent research examined patients who underwent revision ligamentoplasty of the anterior cruciate ligament (ACL) to assess the functional outcome after this type of surgery”

Rollier JC, Besse JL, Lerat JL, Moyen B. [Anterior cruciate ligament revision: analysis and results from a series of 74 cases.] Rev Chir Orthop Reparatrice Appar Mot. 2007 Jun;93(4):344-50.

DISCUSSION: The functional outcome (of revision) is not as good as after first-intention repair, especially if the initial plasty was done with a synthetic ligament and the knee presented meniscal or cartilage damage.

Do You Recommend Knee Braces?

In our practice we stress the following points on the patient when they request a prescription or recommendation for a brace understanding that we very rarely recommend the use of braces.

First, that the brace must never be thought of as a replacement for a medical treatment.

Second, that the patient must not be allowed to feel a sense of security that the brace will allow them, by itself, to return to a normal active life style.

Third, that perhaps with the exception of the Unloader/Osteoarthritis Brace, and only in certain situations, should a brace ever be used for any extended length of time.

Fourth, in our opinion, rehabilitation for medically treated knees must allow for increased movement and circulation to the knee, two important factors that maybe curtailed with improperly fitted or extended wear of a brace.

Knee pain in the 55 year old skier

We recently had a 55 year old female patient come in, she had bilateral knee pain, both her knees were very painful for about a year. She is a very active person, an avid skier who races during the winter season. It was following last season she started having the knee pain.

She first tried to rehabilitate her knees with physical therapy and did not get good results. She had X-rays of the knees which really didn’t show anything, I just wanted to mention that X-rays mostly just show the bones, they are not great at finding soft tissue issues.

She may have needed an MRI had she gone to another doctor, but came to our office first. You have to be very careful if you get an MRI because they don’t necessarily show where the pain is coming from. They give false positives very often, they may show something that looks terrible but is not the generator of the pain.

Secondly, we did not get the MRI because it is very expensive, we wanted to see how the Prolotherapy worked first.

After the second injection she noticed an improvement in both her knees and decreased pain even after climbing step hills.

She had a third Prolotherapy session and she is doing much better. For knees it is usually the third or four visits, sometimes one time depending on the extent.

Do I need to get an MRI of this person to find out what is going on if she feels great? No, we don’t need too. We occasionally do it when someone does not have great results with their treatment.

Injury To The Meniscus

The meniscus or menisci are the thick, strong cartilage-like shock absorbers that cushion and pad the knee between the thigh (femur) and shin (tibia) bones. Shaped like the letter “C,” the meniscus of each knee provides stability in carrying the weight of the body or in gliding through the knee’s many range of motions.

Knee Pain Treatments In Older Adults

Researchers writing in medical journal Rheumatology (Oxford, England) examined the way older adults with knee pain were treated in primary care. What they found was “Interventions recommended as core treatment for knee pain in older adults were underused-in particular, exercise, weight loss and the provision of written information. There appeared to be early reliance on pharmacological treatments with underuse of non-pharmacological interventions in early treatment choices.”

What the researchers noted:
201 adults were interviewed.
These pateints had each been advised:
1. heat and ice (84%)
2. paracetamol (non-opioid analgesic) (71%)
3. compound opioid analgesics (59%)
4. non-selective non-steroidal anti-inflammatory drugs (59%).

“Three core treatments forknee pain(written information, exercise and weight loss) were advised to 16%, 46% and 39% of the participants, respectively.”

“Referral to surgery was commonly initiated before more conservative options had been tried.”

Porcheret M, Jordan K, Jinks C, Croft P; Primary Care Rheumatology Society. Primary care treatment of knee pain–a survey in older adults.Rheumatology (Oxford). 2007 Nov;46(11):1694-700. Epub 2007 Oct 15.

Another Option

A very conservative treatment we specialize in is Prolotherapy because it works on most knee problems with excellent results. Prolotherapy is a simple injection of dextrose and a local anesthetic, like those used in dentistry work. What the dextrose does is start a very small inflammatory response in the body. Inflammation kicks up the immune system, the immune system brings up fibroblasts which are small cells that produce collagen. In other words the collagen metabolism spoken of before is stimulated. A few injections is of course a lot less invasive than surgery, not to speak of the rehabilitation effort following surgery in comparison.