Knee Arthritis and Treatment Options " Simon a 41-year-old male recreational hockey player "

Case study ( 6511 views as of May 28, 2023 )

Simon is a 41-year-old male recreational hockey player who visits his physician complaining of medial right knee pain. The knee feels stiff in the mornings, and is sore after running, but not so much with hockey. He had a previous ACL tear and reconstruction 20 years ago in college. He has some swelling after activity, but no locking or giving way. He has an old custom-made knee brace, but hasn’t worn it in years.

On exam, his knee is slightly swollen, with tenderness over the medial joint line. He has some limitation in flexion and extension, and some atrophy of his quads and hamstrings. His ACL graft feels stable.

Simon could benefit from seeing a physiotherapist to work on his strength, and to reduce his pain. He might benefit from a new custom knee brace to include offloading of his medial side. He might also benefit from a viscosupplement or platelet rich plasma injection, to reduce pain and improve function.


Conversation based on: Knee Arthritis and Treatment Options " Simon a 41-year-old male recreational hockey player "

Knee Arthritis and Treatment Options " Simon a 41-year-old male recreational hockey player "

  • Osteoarthritis is basically the breakdown and wearing out of the cartilage between the joints. Over the counter anti-inflammatories are the one treatment option for the pain of osteoarthritis.Physiotherapy on the knee and leg muscles can improve the symptoms of osteoarthritis.
    • Osteoarthritis is a degenerative disease that can affect any joint in the body. Osteoarthritis in the finger joints and hands most commonly effect women between the ages of 45-65. People who suffer from Osteoarthritis of the hands can lose grip strength in their hands.
  • 10% of patients are not satisfied at all with the outcome of their knee replacement surgery.
    • As a patients osteoarthritis progresses the use of NSAID's (non-steroidal anti-inflammatory drugs) are often used. Osteoarthritis is not most common in young people. The maximum dose of acetaminophen (ASA) that should be taken per day is 4000 mg/4g.
    • The most common treatment of osteoarthritis is acetaminophen (ASA).
    • An X-ray is the key diagnostic tool when determining whether a patient is eligible for hip replacement surgery.
    • A patient may need to see an orthopaedic surgeon if their hip pain is worsening at rest, the pain presents at night and interferes significantly in normal daily activities.
  • A colleague of mine was recently diagnosed with tendinitis of the knee. He doesn't play sports and his doctor theorizes that his injury is due to wearing shoes that are lacking in support. I don't think this is something that is talked about enough until you are injured
  • I think that sounds cornet , its my understanding, platelet-rich plasma injections promote anti-inflammatory action at the injection site. My understandings is that they might require multiple injections over period of time. I could be wrong thought and it would be best to talk to the doctor.
    • An MRI is the best tool to diagnose the severity of osteoarthritis in the hip joint.
    • After surgery patients can resume normal activities, such as golf, swimming and walking almost immediately.
    • PRP does not seem to be widely popular, however there is lots of literature out there to speak to its benefits, and I think we will continue seeing this type of therapy used in more cases. There are some articles that suggest that PRP could be useful in rheumatoid arthritis, and that would definitely be something to address with your family doctor or rheumatologist, in order to understand if you would be a candidate for this treatment.
    • Would this treatment work for conditions like Rheumatoid Arthritis as well ?
    • @K.Michael, my understanding is that PRP injections were developed to build upon the pain management effect of cortisone injections, and PRP injections have the added benefit of helping the healing process of damaged tissue. I would assume this means a treatment plan would include either cortisone or PRP injections, depending on the extent and type of injury being treated. A good question for a sports medicine physician...
    • Would this be done in connection with cortisone shots ?
  • In order to prevent further injury to his knee, this hockey player should work on increasing his overall activity level in order to properly strengthen the surrounding musculature of his knee. This is a common pattern with 'weekend warriors' and adult hockey players are often just playing hockey once a week while they continue to work their office jobs. It's noted this man has weak quads and hamstrings. Finding a qualified personal trainer who understands the nature of his injury, he could start working on an appropriate strengthening program.
  • How stable is an ACL reconstruction ? I know that I've heard that knee replacements have a 10-15 year life span. Do most people have to have their ACL's fixed again after a period of time ?
  • It doesn't indicate what he does for a living. It would be interesting to know if he is on his feet a lot at work. He might want to get a stride assessment to make sure his running shoes give him the support he needs while he works to resolve the issue
    • After knee replacement surgery it is completely normal for the outside of the knee to be completely numb for an extended period of time.
    • This is a good point. If he requires orthotics due to his instabilities, the proper fitting could help reduce extra strain on his knee that could be contributing to pain.
  • A physiotherapist would be a good idea in addition to seeing his family doctor to assert whether his pain and stiffness is due to age or sport. Also, his old knee brace probably isn't effective anymore, so he could benefit from having a new knee brace constructed.
    • That's a very good point about the knee brace. I would imagine that your knee and leg would change greatly in 20 years and his brace might not be supporting him as he now needs.
  • How do you know if the Knee Arthritis is caused mainly due to the injury opposed to aging ? Are there any exercises one can do to help prevent arthritis ?
    • Arthritis is an inflammatory disease that is often generic but can certainly be brought on by excessive repetition to a joint being used incorrectly. talk to your doctor for the eight diagnosis.
    • I agree if you do squats properly they should not hurt the knees but the problem is in doing a proper squat with all the sitting we do. Sitting puts the pelvis in a.bad position and makes doing a proper squat very.hard. I would see a trainer so that they can watch.your technique.
    • Done properly squats should not cause any knee pain
    • Wouldn't squats put more pressure on the knees ?
    • It's my understanding that having strong legs and doing lots of stabilizing exercises like squats can keep the knee stable and help you to heal injuries quicker
  • A brace-specialist can help create a specialized knee brace to aid in relieving some of the pressure on his knee.
  • I have seen several clients who have knee or hip arthritis in their 40's. Most often, they had a significant injury to the joint in their younger years, and arthritis has slowly set in. I agree with the suggestion to consider a proper knee brace, and I would encourage physiotherapy to work on the strength and conditioning of his knee. I would consider an injection more of a last resort option, and would consult with a sports medicine physician on the appropriateness of this treatment option.
    • From my understanding, platelet-rich plasma injections promote anti-inflammatory action at the injection site and seem to be quite effective. If an individual opts for this treatment, would they require multiple injections over a certain period of time, or would a single injection suffice as treatment?
    • This makes a lot of sense. I've always been told that if you significantly injure a joint in your 20's your likelyhood of developing arthritis doubles - if not triples. Many people hesitate to seek out medical assistance until it is too late.
  • It sounds like the pain and stiffness he is experiencing in his knee could be age related rather than injury
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