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No Knee Pain? Joint Damage Occurs Before Pain Begins

Oct 29, 2022
The most common cause of knee pain is osteoarthritis.
One aspect that makes knee osteoarthritis such a terrible disease is that in its earliest stages, this joint-destroying process usually causes no symptoms. By the time symptoms arise, irreversible structural damage has already occurred.

Knee Osteoarthritis is an incurable disease that slowly destroys a joint over time.  The joint most commonly affected is the knee, followed by the hand and hip.

One of the most common causes of knee OA is a prior injury (such as an ACL tear or torn meniscus), or an accumulation of 'microtraumas' experienced during sports or occupational activities.  Other risk factors include aging, obesity, and family history.

In its earliest stages, knee osteoarthritis is 'clinically silent' which means a person with this condition may not experience any symptoms for years, even when tissues inside the joint are under attack and being damaged.

Stiffness after sitting for prolonged periods is one of the earliest symptoms of knee osteoarthritis.  It is usually ignored since it tends to resolve after walking a short distance.  By the time a person starts to experience knee pain on a regular basis (usually after playing sports, climbing stairs, or squatting), irreversible damage has already occurred.

Although there is currently no cure for osteoarthritis, there are effective ways to slow its progression.  By definition, knee osteoarthritis is characterized by chronic inflammation inside the joint.  Specifically, pro-inflammatory proteins accumulate in the joint (synovial) fluid, transforming it into a toxic 'inflammatory soup' that weakens cartilage and meniscus tissue over time.

Cartilage is a highly specialized tissue that covers the ends of bones. Because it is avascular (has no blood supply), the health of cartilage is completely dependent on the quality of the joint (synovial) fluid.  

When healthy, cartilage allows smooth articulation (movement of bones in the joint) and proper joint function.  When damaged, cartilage cells start producing more pro-inflammatory proteins that are released into the joint (synovial) fluid, creating a vicious cycle of inflammation and tissue breakdown.  As the level of inflammation increases, knee pain becomes worse, limiting activity and leading to disability.  If no intervention is made, the joint eventually fails and a total knee replacement (TKR) surgery is needed.

The good news is that there are non-surgical treatments for knee osteoarthritis that can effectively shut down the production of the destructive pro-inflammatory mediators and improve the quality of the joint (synovial fluid).   Since treatments are most effective in the early stages, it is paramount to be diagnosed with osteoarthritis early.

Diagnostic Ultrasound of the knee includes an assessment of cartilage tissue inside the joint.  This cutting-edge technology is able to detect early breakdown of cartilage that is too subtle to be seen on Xray or MRI.   It is a pity that so few clinicians utilize this tool which has the capability of diagnosing osteoarthritis before significant structural damage occurs.  All providers at Reflex Knee Specialists have undergone rigorous training and have specialized expertise in knee ultrasound and cartilage assessment.

Knee symptoms, even when mild, should be evaluated by a knee expert who can diagnose knee osteoarthritis in its earliest stages so progression can be slowed or prevented. 

If you are an athlete or played sports in high school or college, or if you have knee stiffness or pain with certain activities, call and schedule a comprehensive knee evaluation with one of our providers.  We can pinpoint the cause of pain, assess the condition of your cartilage, and discuss non-surgical treatments that can protect and preserve cartilage and improve the overall health of the knee. 

Russ Riggs, MD

 

 

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