Does knee pain always require surgery?
Dr Andrew Dutton discusses the common treatment modalities for individuals with knee pain - from conservative to more invasive approaches
The patient needs an assessment, as there may be multiple issues that are going on, Dr Dutton says. “If it's an acute injury, rest, ice, compression, and elevation and then we often will give a short course of an anti-inflammatory. Following that we will then send them for rehabilitation, often with a physiotherapist and depending on what sort of issues, we will then focus the rehabilitation on correcting the problem that has been causing the pain.”
In general, most patients will improve, some of them may need a knee guard or a brace as well and that's usually enough for most patients. Other options for certain ligament or muscle tears are injections: platelet rich plasma or PRP injections, whereby we draw blood from the patient, we spin it, take the serum and the platelets, which hold the concentrated growth factors, and then we inject it into the injured tendon or the ligament. That is now an FDA and HSA approved method of accelerating healing of those structures. I've performed this in a lot of sprinters and runners for rehabilitation.
For damage to the cartilage, there are injections - sort of like an oil injection - into the knee that decrease friction. In the laboratory, testing has shown these injections can improve the cartilage cells. For patients with mild to moderate cartilage damage or arthritis we will recommend these injections and that can help anywhere from six months to two years.
Then of course there's arthroscopic surgery, which is keyhole surgery that we can do for ligament reconstructions or repairs of the meniscus. Lastly for those that have severe established arthritis, there is knee replacement surgery and now we can perform that as computer guided or robotic knee surgery as well. This is the latest technology and essentially allows you to optimise the alignment of the implant to allow maximal durability of the implant.
Dr Andrew Quoc Dutton is a USA fellowship-trained consultant orthopaedic surgeon with subspecialty interests in keyhole and sports surgery, knee and hip replacements, cartilage regeneration and stem cell therapeutics in orthopaedics. He is in private practice at SMG Orthopaedics and can be contacted at +65 6887 5000.
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