Common Knee Problems
For the knees to work properly, they are dependent on parts such as bones, cartilage, muscles, ligaments and tendons – all of which are subject to wear and tear, disease and injury.
What are some of the common knee problems?
Osteoarthritis of the knee in various degrees and severity forms the bulk of the cases. Meniscus tears, either due to degeneration or trauma as a result of sports injuries, come next. Another common injury, especially among soccer players, is torn anterior cruciate ligament, one of the four major ligaments of the knee.
Why do knee problems occur?
Degenerative conditions are more common in individuals with mal-aligned knee joint and patella, or the kneecap. They usually affect patients above 50 years.
If one has a varus knee (bow legged), excessive pressures will be subjected to the inner aspect of the knee. A valgus knee (knock kneed) or tilted patella (knee cap) will similarly be subjected to excessive stresses at certain parts of the joint. It does not help when one pounds the knee joint during activities such as playing basketball or soccer, or even prolonged running on hard surfaces.
Are there permanent cures for the various knee problems?
There is a solution for most of the degenerative conditions or injuries. We must accurately diagnose the condition in order to treat it effectively.
Physiotherapy, minor adjustments to lifestyle, knee braces, orthotics and anti-inflammatory medication or even local steroid injections usually bring permanent relief.
Joint injections with natural lubricants are useful for early osteoarthritis. PRP (platelet rich plasma) and even stem cell injections into the knee are newer developments in encouraging cartilage to regenerate.
An operation becomes necessary when the knee has a structural problem, such as a meniscus tear or torn ligament.
Can glucosamine cure knee problems?
Glucosamine is the building material needed to repair worn-out joint cartilage, just like calcium is needed to build strong bones. Crystalline glucosamine is generally more effective as it is better absorbed by the body.
A paper published in the medical journal Lancet in 2001 has proven that cartilage growth does occur with prolonged consumption of glucosamine.
While many patients with knee problems have found glucosamine useful, some have been disappointed. This is because sometimes the knee joint is badly worn out and requires the consistent use of glucosamine for more than six months before any effect is noticeable.
When is surgery recommended for knee problems?
Many knee conditions can be treated more conservatively. Surgery will be advised only if all the conservative treatment measures fail.
What are the risks involved in knee surgery?
The risks depend on the age of the patient, any pre-existing medical conditions like diabetes or heart problems. These relate to the risk of anaesthesia and infection. Specific local risks include deep-vein thrombosis, post-surgery stiffness as well as risks of neuro-vascular injuries. These complications are rare and preventable.
Is a long period of convalescence needed before one can start walking again following a knee operation?
It depends on the type of surgery. Patients with arthroscopic or key-hole surgery generally can walk the very next day. Even with total knee replacement, patients can start walking with the help of aid devices the next day.
What is total knee replacement? Who benefits from it?
In general, the surgery consists of replacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee.
Total knee replacement can be a life-transforming surgery. Patients who are in wheelchair can walk unaided after surgery.
If there are no medical contra-indications, this surgery will benefit everyone. However, we usually advise patients not to do the replacements yet if they are below 60 years of age as the implant generally lasts about 15 years.
How can you prevent knee problems that are associated with ageing?
Degeneration of the knee comes from overuse, abuse and from mal-alignment. If you have a mal-aligned knee, you will need foot orthotics to redistribute and even out the stress across the knee. It will be best to avoid pounding your knee with robust exercises. Glucosamine is essential.
Stretching of the muscles and ligaments around the knee will reduce stress across the joint. Quadricep-strengthening exercises, especially of the vastus medialis obliquus (a muscle of the quadriceps), will help realign forces across the patello-femoral joint (one of the knee joints).
What are the do’s and don’ts when it comes to knee-related exercises?
In general, any excessive pressure on the knee is not good for the knee. Climbing stairs is a good form of calorie-burning and cardio-exercise but it puts too much stress on the patella-femoral joint. Squatting or extension curls have the same effect.
Safe knee exercises include the stepper, leg press and cycling (with the seat as high as possible). If you have knee pain, swimming or aqua-aerobics is best.
Common knee problems in Singapore include Osteoarthritis of the knee & meniscus tears. Orthopaedic surgeon Dr Tho Kam San is based in Mount Alvernia Hospital and is an expert on common knee problems.
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