Treatment Options
Non-operative Treatment
The key for treatment is to decide the diagnosis. Often, there are more than one component causing pain: degenerative meniscal tear, osteoarthritis and/or bone stress reaction. If range of motion is maintained and there is minimal, or no swelling then conservative treatment is the first step. It may be helpful to discuss this treatment via a Knee Telehealth Consultation to plan conservative measures such as icing, acetaminophen or ibuprofen (if tolerated) and a gentle home exercise program which may be supplement with Physical Therapy. If the pain and swelling are more than mild then the first step would be a Knee Telehealth Consultation and possible referral for x-rays and MRI.
Surgery
If non-operative treatment doesn't relieve your pain, surgery may be the next option. Dr. Farr will recommend surgery if it's necessary.
Common Conditions after Knee Surgery
1.Instability after ACL reconstruction or revision ACL reconstruction. There are many different reasons for an ACL reconstruction or revision to fail to range from an unfortunate high energy reinjury to a weak graft (e.g., cadaver donor in the young) to the essential absence of meniscal function (prior meniscectomy). As there are so many variables, each component needs to be identified and then the knee treated using a wholistic approach. During the COVID 19 pandemic. elective treatment is not an option. However, it does make sense to pursue a Knee Telehealth Consultation and possible referral for x-rays, physical therapy and MRI.
2. Patellar instability after prior instability surgery. Patellar instability has many underlying causes. Without detailing the extensive list of all risk factors, the leading risks are age, injury to the medial patellofemoral ligament complex (MPFL), shallow or no femoral groove, a high riding kneecap, and maltracking. At times the prior surgery was performed correctly, but a severe injury resulted in another instability episode. In other cases, the surgery correctly addressed one risk factor, but other risk factors persist and now demonstrate that they need to be treated. During the COVID 19 pandemic. elective treatment is not an option. However, it does make sense to pursue a Knee Telehealth Consultation and possible referral for x-rays, physical therapy and MRI.
3. Focused pain as the site of document articular cartilage defect: with or without prior intervention. Articular cartilage damage is common in all age groups. In younger age groups, if there is persistent pain related to a cartilage defect, the treatment is to fill the defect using cartilage restoration techniques outlined here. It may be helpful to discuss this treatment via a Knee Telehealth Consultation to initiate conservative measures such as icing, acetaminophen or ibuprofen (if tolerated) and a gentle home exercise program which could be supplemented with a Physical Therapy. It the pain and swelling are more than mild then the first step would be a Knee Telehealth Consultation and possible referral for x-rays and MRI. This will allow a preauthorization letter to be sent to your insurance now as the preauthorization process often takes months. That is, it makes sense to begin this process even during the COVID-19 pandemic, so the cartilage restoration may be performed in a timely manner after elective surgery is allowed.
In older age groups, it is more often related to osteoarthritis. Knee osteoarthritis can involve one or more of the three knee compartments: inner (medial), outer (lateral) or kneecap (patellofemoral). Initial treatment is conservative, which could include OrthoBiologics. If conservative treatment fails, then if only one compartment is involved, partial knee replacement may an option, while if two or three compartments are involved them total knee replacement would be an option.
4. Pain after prior partial meniscectomy or meniscal repair. If there is pain after a prior meniscal repair, the goal is to assess for failure to heal or re-tear. Prior to planning an attempt at re-repair, the first step would be a Knee Telehealth Consultation and possible referral for x-rays and MRI.
If the pain is a result of the absence of a functional meniscus but no arthritis, then dependent on associated factors, a subset of patients may benefit from meniscal transplantation. To begin this process, the first step would be a Knee Telehealth Consultation and possible referral for x-rays and MRI. This will allow a preauthorization letter to be sent to your insurance now as the preauthorization process often takes months to reach approval. That is, it makes sense to begin this process even during the COVID-19 pandemic, so the transplantation may be performed in a timely manner after elective surgery is allowed.