Ask the Expert: Dr. Beth Shubin Stein, Sports Medicine Surgeon, Answers Your Questions on Treating Knee Pain

by Dr. Beth Shubin Stein
Running injury - Man jogging with knee pain. Close-up view of ru

Answers written by: Dr. Beth Shubin Stein, Sports Medicine Surgeon

Q1. Is heat or cold therapy better to treat knee pain?

Heat is good for muscle tightness or soreness, but cold therapy is better to decrease inflammation (i.e swollen joints after exercise or after injury). It is important to consult with your physician.

Q2. Can both knees be replaced at the same time? I can’t afford to shut down work two different times. I had my left knee repaired in 1989 with a 14 hour surgery. Now they tell me it needs to be replaced. I have severe arthritis and the right knee is totally destroyed. 

Yes, depending on your overall health, both knees can be replaced at the same time. There are certain risks that are increased with doing both simultaneously and your doctor can go over these with you.

Q3. Can healthy adults function without ACL repair?

Yes, healthy adults can function without an ACL assuming their sport of choice is not an ACL-dependent sport that requires a lot of cutting and pivoting. Examples of highly ACL-dependent sports include football, soccer, lacrosse, field hockey, basketball and aggressive singles tennis. Less ACL-dependent sports are activities such as running, hiking, biking and swimming. Consult with your physician before you start exercising.

Q4. I run about 6-8 miles a day and like to run 10-15 miles on the weekends. My knee is beginning to hurt. How do I know if I just need a break or if I should seek help?

If you are developing knee pain that is activity related it would be beneficial to see a specialist. Often times there are specific exercises that you can add to your workout that will help with the pain or alleviate it so that you don’t have to limit or change your activities long term.

Q5. I had a partial meniscectomy on February 14. Since then, I am in constant pain. An MRI last week revealed Grade IV chondral loss on the posterior weightbearing third of the lateral femoral condyle. Chondromalacia involving the lateral facet of the patella, subtle marrow edema in the lateral femoral condyle and proximal tibia laterally are likely stress related. I can’t seem to get any answers as to whether the pain that I have will be chronic or will go away. What can I expect in the future? I would be grateful if any of the doctors would help me to better understand the diagnosis.

You are three months out from a meniscal debridement and in continued pain. The MRI describes a knee that has a significant amount of arthritis (chondral loss is another way of saying arthritis) and though the mechanical symptoms from the meniscus tear can be treated with an arthroscopy, the arthritis cannot. Non-operative treatment for arthritis includes physical therapy for strengthening, injections (cortisone, viscosupplementation-lubricant injections and in some cases PRP-platelet rich plasma) and anti-inflammatory medications. The surgical treatment for arthritis can aim at restoring the cartilage if the defect is small and the patient is young, or it can aim at replacing the affected parts with prosthetic parts such as plastic and metal with either a partial or total knee replacement, depending on how extensive the arthritis is. Consult with your physician to help determine what is appropriate for you.

Next week, Rebekah Wallach, physical therapist, will answer your questions on exercising with lupus. Write your questions below or email socialmediacontact@hss.edu.

Topics: Orthopedics
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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

Rosalie Busher says:

Knee pain is a common complaint that affects people of all ages. Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions — including arthritis, gout and infections — also can cause knee pain.

kerry anderson says:

Hi, I read your info on patellafemoral arthritis and partial knee replacement. I saw dr wickiewicz and he said I will need a replacement because I”m bone on bone but just under the patella he said arthroscopic surgery wont work I was so upset I am noticing that my other knee is starting to bother me in the same inner knee spot. I believe I have hip misalignment which may be a result of leg length discrepancy due to a congenital birth defect – club foot. I wish I had read the info on patellafemoral arthritis on your website prior to meeting with dr wickiewisz. I think and hope you may be able to help me. Your reply is most appreciated.

HSS on the Move says:

Hi Kerry thank you for reaching out. If you wish to seek care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Stella Martin says:

Good morning,
I have been told that my knees are shot, that I only need a knee cap replacement, except I am 39 yrs of age, the last joint specialist I saw said, that I will have a hard time finding a doctor that will do it at my age. I have been told that I have no tissue, cartilage under m kneecaps, and only my kneecaps have worn down. The joint specialist Dr. Roberts in Albany Ny, said I need it, but I”m to young… Sorry, but that doesn”t make any sense to me, I hurt, and I need help. I am a single mother of three children, and I cannot afford to be in a wheelchair soon, the way my knees, and back are going. Can you help me?

HSS on the Move says:

Hi Stella, thank you for reaching out. If you wish to seek consultation at Hospital for Special Surgery, please contact our Physician Referral Service at 877-606-1555 for further assistance. The HSS Physician Referral Service is designed to ensure that patients are connected with the physician that best meets their medical needs at HSS. For more information, visit http://www.hss.edu/physician-referral-service.asp.

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