Knee Issues: Do You Need Arthroscopy for Osteoarthritis?

Osteoarthritis

Hello Dr.
Lee: I am 45 years old and have been hiking intensively for the past two and a half years.
After a year of hiking, I noticed a loud popping sound when bending or straightening my knee, and sometimes the kneecap does not align properly and requires adjustment to get into place.
I consulted a rehabilitation specialist who diagnosed me with early-stage osteoarthritis and recommended glucosamine.
I then saw an orthopedic surgeon who took X-rays and said that my kneecap is naturally positioned closer to the outside and that I do not have osteoarthritis, advising me against hiking.

Despite this, I continued to hike but reduced the frequency and distance to less than one-third of what I used to do, always wearing knee braces and taking glucosamine daily.
I also started swimming, but I cannot do the breaststroke because I hear a loud noise from my knee while swimming that style.
My condition remained manageable for another year.
Since the knee issues began, I have almost stopped running, but six months ago, I had to run downhill in a hurry over a short distance with large steps, similar to stadium bleachers.
As a result, my right knee became very painful, and the next day after hiking, the pain was even more pronounced.
It took a month of rest for the pain to lessen, but it has not fully healed, and I still experience mild pain to this day.
This incident alarmed me, and I began to consider treatment, completely stopping hiking.
Someone introduced me to arthroscopic surgery, which can address issues within the knee joint, but my family opposes it, believing that I can still move normally and that the outcome of surgery is uncertain.
I have been indecisive, so I went to a large hospital for another orthopedic consultation.
The doctor there assessed my condition as acceptable and mentioned that after arthroscopic surgery, I might never be able to hike again.
I would like to ask the doctor, what exactly is wrong with my knee joint? Is arthroscopic surgery necessary? Does arthroscopic surgery have therapeutic effects? What are the failure rates and potential complications of arthroscopic surgery?

Xiao Lin, 40~49 year old female. Ask Date: 2012/02/28

Dr. Li Wenlin reply Orthopedics

Hello, your condition appears to be patellar malalignment accompanied by chondromalacia.
Patellar malalignment may be congenital, leading to uneven stress on the medial and lateral cartilage of the patella, with the lateral side bearing most of the load.
After the age of 25, the rate of cartilage regeneration significantly decreases each year, which is why symptoms may gradually appear.
Climbing and hiking place six times the load on the knee joints compared to walking on flat ground, thus significantly increasing the burden; it is advisable to avoid such activities.
If conservative treatment is ineffective, surgical options can be considered to release the lateral patellar ligament, allowing it to return to a central position.
Both traditional open surgery and arthroscopic techniques are viable, with high success rates.

Reply Date: 2012/02/28

More Info

Based on your detailed description, it seems you are experiencing a complex situation with your knee, particularly related to patellar tracking issues and potential early osteoarthritis. The sounds you hear when bending or straightening your knee, as well as the feeling that your kneecap (patella) is not aligning properly, suggest that there may be underlying issues with the cartilage or the alignment of the patella itself.

Understanding Your Condition
1. Patellar Tracking Issues: The patella should glide smoothly in a groove at the end of the femur (thigh bone) when you bend or straighten your knee. If it is not tracking properly, it can lead to pain and discomfort, especially during activities like climbing or descending stairs, which put additional stress on the knee joint.

2. Early Osteoarthritis: Although one doctor suggested that you have early osteoarthritis, the other indicated that your patella is naturally positioned closer to the outside of your knee. This anatomical variation can lead to uneven wear on the cartilage, potentially resulting in pain and the symptoms you are experiencing.

3. Impact of Activities: Engaging in high-impact activities like hiking can exacerbate knee issues, especially if there is an underlying problem. The increased load on the knee joint during such activities can lead to further irritation and damage to the cartilage.

Arthroscopy Consideration
Arthroscopy is a minimally invasive surgical procedure that allows doctors to visualize, diagnose, and treat problems inside a joint. Here are some points to consider regarding whether you need this procedure:
1. Indications for Arthroscopy: Arthroscopy is typically recommended when conservative treatments (like physical therapy, medications, and lifestyle modifications) fail to alleviate symptoms. If your knee pain persists and significantly impacts your quality of life, arthroscopy might be warranted to assess the joint's condition directly.

2. Potential Benefits: The procedure can help identify issues such as cartilage damage, meniscal tears, or loose bodies in the joint. If any of these are found, they can often be treated during the same procedure, potentially leading to improved function and reduced pain.

3. Risks and Recovery: While arthroscopy is generally safe, it is not without risks. Complications can include infection, blood clots, and persistent pain. The recovery time varies, but many patients can return to normal activities within a few weeks, although full recovery may take longer depending on the extent of the issues addressed.

4. Impact on Future Activities: Concerns about not being able to hike again post-surgery are valid. While many patients return to their previous activity levels, some may need to modify their activities or avoid high-impact sports altogether, especially if they have significant underlying issues.

Recommendations
1. Further Evaluation: Before deciding on arthroscopy, consider obtaining a second opinion from an orthopedic specialist who focuses on knee issues. They may recommend imaging studies like an MRI, which can provide more detailed information about the cartilage and soft tissues around the knee.

2. Conservative Management: Continue with conservative treatments, including physical therapy focused on strengthening the quadriceps and improving patellar tracking. This can sometimes alleviate symptoms significantly.

3. Activity Modification: Given your history of knee pain, it may be wise to limit activities that place excessive strain on your knees, such as running downhill or prolonged hiking, until you have a clearer understanding of your knee's condition.

4. Monitoring Symptoms: Keep track of your symptoms, including any changes in pain levels or functionality. This information will be valuable for your healthcare provider in determining the best course of action.

In conclusion, while arthroscopy can be beneficial for diagnosing and treating knee issues, it is essential to weigh the potential benefits against the risks and consider all conservative options first. Consulting with a specialist who understands your specific situation will help you make an informed decision about your knee health and future activities.

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