Transcription:
Treatment Options for Knee Pain

Melanie Cole (Host):  Knee injury is one of the most common reasons people visit their doctors. There are millions of patient visits every year because of common knee injuries such as fractures, dislocations, sprains and ligament tears. My guest today is Dr. Kyle Ritter. He's an orthopedic surgeon and sports medicine physician at Hendricks Regional Health. Welcome to the show, Dr. Ritter.  What are some of the most common things you see when people come in and complain of knee pain? What usually do you see is wrong with them?

Dr. Kyle Ritter (Guest):  Thank you, Melanie, for having me on the show. The most common knee injury that we typically see involves overuse type injuries and those are typically related to activities -- either people have been involved in for several weeks, several months, such as training for marathons, new exercise routines, but we also see acute injuries, as well, from some of those similar type activities. Sports is very common as is mowing the lawn, which potentially would cause you to have a twist and have a direct type of injury to that knee. Usually, trying to differentiate between having an overuse type injury or more of a structural problem is the first thing that we're looking for when we see patients in the office.

Melanie:  So, aside from acute injuries like an ACL tear in a girl soccer player or something along those lines, do you see more overuse injuries, typically?

Dr. Ritter:  We typically do. We see tendonitis, bursitis around the knee, and we also see arthritis and flare up of arthritis, which are very common. One of the most common reasons we see people for knee pain would be those flare-ups. When you have arthritis and that cartilage is abnormal, you're always at risk to have something go somewhat awry with regards to how your knee is feeling. Again, sometimes it's activities that you look back and realize, "Oh, yeah. I overdid it." Other times, it's just doing your normal, everyday activities at home that can be enough to cause people pain and dysfunction.

Melanie:  So, Dr. Ritter, when someone does come to you with knee pain, what's the first line of defense? Do you typically just have them wrap and ice? Do you try anti-inflammatories? What do you do first?

Dr. Ritter:  Sure. The first thing to determine in the office is how severe the injury is and, certainly, with most overuse type injuries, it certainly lends itself to initial conservative treatment which, a lot of times, includes anti-inflammatories which often can be prescription or over-the-counter. Oftentimes, we'll offer an injection that can be both for a flare up as well as some type of bursitis or tendonitis. But, if there's more of a structural concern, oftentimes, it'll involve more imaging such as an MRI to look at the details of the knee itself including the meniscus, the various ligaments, as well as to assess the cartilage within it before we initiate treatment.

Melanie:  So, there are a lot of "Weekend Warriors". People get out and run in the nice weather and their knees take so much of that hit. What do you tell them about prevention of knee injuries and maybe even the shoes that they wear that might help to prevent some of these injuries?

Dr. Ritter:  Sure. Certain activities and sports with those "Weekend Warriors" obviously have a higher rate of knee injury.  I think the biggest thing that I encourage patients and try to educate patients on are try to be those patients and those "Weekend Warriors" that don't just play one day on the weekend. That during the week, they do some type of a preventative maintenance exercise routine in order to make sure they maintain their strength. Sometimes, there can be some certain types of braces to help minimize that risk of injury, as well. But, all in all, it's a matter of knowing your body and know going into that weekend or into that activity if there are any issues to be concerned with--any issues that you should be a little bit cautious of with regards to what type of activities you're participating in.

Melanie:  So, let's speak about bracing a little. Do you advocate using a brace when they play tennis or do something like that or is that not giving the knee the support that you'd like it to?

Dr. Ritter:  A lot of it really depends on the type of issues that each patient and individual is having. It's very common for us to provide bracing for kneecap issues, which is a very common symptom and oftentimes does not require any type of surgery for treatment and will benefit from physical therapy and bracing and anti-inflammatories as well as some activity modification. However, there are people that have had previous injuries, that maybe have a knee that's a little bit more unstable, such as with a medial-collateral ligament injury. Because of that laxity in the knee, they may be one that benefits from a more rigid brace that will prevent them from having further injury with their activities.

Melanie:  Then, you mentioned possible cortisone shots. How many is somebody allowed to get? What about hyaluronic acid or any of those kinds of injections? People hear about these knee injectables all the time now.

Dr. Ritter:  Sure. They are very common and they can be very effective. Arthritis is the probably the number one reason why we do injections. Steroid injections work very well for acute flare-ups. They can work well for bursitis and tendonitis as well but, by far, arthritis flare-ups are when we primarily use those. I educate my patients, as far as the frequency and how often you can have those that you could potentially have a steroid injection once every three or four months. Those are looking at more of the patients that have arthritis. We know that there's not necessarily a non-surgical cure for that but they can certainly help them on the ball field or keep them doing their exercises they want on a week-to-week basis. You can repeat those once every three or four months, would be the recommended timing of that as long as you're noticing improvement with that. Also, on that same line, as you mentioned hyaluronic acid or viscosupplementation. Those are for patients that have mild to moderate arthritis, they're not ready for surgical treatment, they continue to have some achy, kind of constant, nagging-type pain despite anti-inflammatories. Those are given typically once a week for three weeks, although there are some single-injection formulations that you can use, as well. While neither of those injections changes the structural dynamics of the knee, they act a lot like an anti-inflammatory that you take by mouth. So, they're just another weapon, if you will, in the arsenal of treating overuse inflammation arthritis.

Melanie:  So, tell us just a little bit about surgical intervention, Dr. Ritter. When is that necessary and what do you do?

Dr. Ritter:  Sure. There are several different surgeries that you can do when you're talking about knee injuries. Certainly, if you're looking on the sports medicine side, an acute knee injury, again, is typically diagnosed with the help of an MRI. The most common knee surgery that we do is for a meniscus tear. Typically, that lends itself well to an arthroscopic surgery which is minimally invasive. It's usually about a 30-minute surgical time. It's an outpatient surgery where you're able to go home the same day. I typically recommend some formal therapy after that to improve their overall recovery time and get their motion and their strength back. So, that's kind of the baseline surgery we do with regards to knees. There can be bigger surgeries, certainly. As you mentioned previously, ACL tears are our big injuries in our athletes in our pivoting sports. Those, while a little bit different surgery, a little bit more involved, are also outpatient and minimally invasive. They do take a little bit longer on the recovery side.

Melanie:  Is arthritis inevitable in the knee, Dr. Ritter?

Dr. Ritter:  It's not and there are several patients that are into their 6th, 7th, 8th decades of life that have excellent looking knees; have no signs of arthritis in them. However, we do typically see that in our aging population, as people get older. If you've had previous injuries as a teenager or as a young athlete, those certainly put you at risk for developing arthritis compared to a normal knee. Genetics plays a big factor in that and that's one of those things that you can't change. So, you know, a lot of my patients with arthritis, they can look to their mom and dad and brothers and sisters and they also relay a history of arthritis in the family.

Melanie:  Give us your best advice for people in protecting their knees with just such a basis of our support and tell them what you really want them to know about keeping healthy, strong knees.

Dr. Ritter:  Sure. I think the biggest thing to maintain your knee health and to minimize the risk of injury is to try to maintain a regular routine with regards to exercise. Obviously, maintaining your weight is important as well. That goes hand-in-hand with that exercise routine. The other important thing is not just to exercise but is to exercise properly and to know good exercises for your knee, to know exercises that may potentially cause you some irritation. That can be where sometimes people will go wrong as they think that just every exercise is good for their knee, in which case it actually causes them some discomfort and doesn't help them in their overall activities. I think it's also important to realize when something is going off the norm. You know, we all have aches and pains and soreness and, oftentimes, those will get better within a few days. It's when you have some red flags, such as a lot of swelling, or instability, or locking and giving way of the knee, that would probably necessitate further evaluation.

Melanie:  In just the last few minutes, Dr. Ritter, tell us why patients should come to Hendricks Regional Health for their sports medicine care.

Dr. Ritter:  You bet. The one thing that's great with Hendricks Orthopedics and Sports Medicine is we've got a great continuity of care whether it's from a baseline evaluation from a physical therapist or from one of our primary care sports medicine doctors on up to our orthopedic surgeons. We're able to care for a vast array of ailments. The majority of patients we see don't end up requiring surgery, which is great. Those that do, we're perfectly capable and willing and enjoy treating patients all the way from your standard meniscus surgery all the way up to ACL tears and knee dislocations. So, certainly being able to go to one place to obtain therapy, sports medicine which is non-surgical, and your orthopedic surgery, if needed, Hendricks is a great place for that.

Melanie:  Thank you so much. What great information. You're listening to Health Talks with HRH. For more information, you can go to hendricks.org. That's hendricks.org. This is Melanie Cole. Thanks so much for listening.