Degenerative Knee Disease

Persistent knee pain in the middle aged person frequently results in a visit to the doctor. This grumpy knee pain often gradually builds and starts to impact on daily activity and exercise. Commonly, a person with persistent knee pain above the age of 35 years can be met with the terms: ‘middle aged knee’ or ‘degenerative knee disease’ (Siemieniuk et al 2017). This often leads to knee imaging and investigation and a trip to the physiotherapist or specialist for consultation.

Degenerative knee disease is a diagnosis that can include a number of internal knee changes. Often imaging shows early stages of osteoarthritis where there is a narrowing of the knee joint space and ‘wear and tear’ of the articular cartilage. The articular cartilage lines the surface of the knee joint and allows the knee to slide easily between bent and straight positions by reducing friction. Late stages of osteoarthritis can include a hardening of the bone at the joint surface (sclerosis) and bony overgrowth. These changes can make it harder for your knee to slide and glide through motion, especially when your knee has been sitting still for a prolonged time.

The other common finding on imaging in those with persistent knee pain is degenerative meniscal tears. The knee has two menisci which are crescent shaped wedges of fibrocartilage that aid shock absorption, joint stability, joint nutrition and lubrication (McDermott 2006). A degenerative mensicus tear can occur over time with activity and results in a gradual development of pain.

Previously, a common treatment for the middle aged person with degenerative knee disease was a knee arthroscopy. This surgery can include a clean out of the knee, shaving the degenerative meniscus tear or debridement of the frayed articular cartilage.  Current guidelines into this area recommend against arthroscopy in favour of conservative treatment (Brignardello-Petersen et al 2017; Thorlund et al 2015). The research now shows only a small difference in pain, function and quality of life measures up to 3-6 months post-arthroscopy but no difference one year after surgery when compared to individuals who were managed conservatively (Brignardello-Petersen et al 2017; Thorlund et al 2015).

Conservative treatment for degenerative knee pain includes physiotherapy, exercise, monitoring, weight loss and medication prescribed by your doctor like anti-inflammatories (Siemieniuk et al 2017). The aim of physiotherapy treatment for degenerative knee disease is targeted towards pain relief, education on the type of degenerative knee, monitoring for knee changes, and providing a comprehensive exercise program to improve knee stability, flexibility and strength. Often, the best way forwards is to continue your exercise with some modifications.

While conservative management for the degenerative knee should be the first method of treatment, arthroscopy can be more effective in some cases where the knee locks or persistent painful knee catching is present. For further information and guidance, book an appointment to see your physiotherapist.

References

  • Brignardello-Petersen et al (2017). Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ Open Vol 7(5).
  • McDermott, ID (2006). Meniscal tears. Elsevier 20: 85-94.
  • Siemieniuk et al (2017). Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ 357:j1982.
  • Thorlund et al (2015). Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ 350:h2747.