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Knee Osteoarthritis is the most common cause of knee pain and joint failure. It is a chronic and progressive condition with no cure. Knee osteoarthritis causes irreversible joint damage that eventually leads to pain and disability. In its early stages, most people are not aware that their joint is being damaged since symptoms are usually minimal for many years. Although there is no cure for knee OA, there are effective non-surgical treatments that can slow the progression of joint deterioration.
The symptoms of osteoarthritis include:
- Joint discomfort and or pain following certain activities
- Stiffness, especially after sitting for a prolonged period
- Loss of flexibility
- Cracking, grinding and/or popping
- Tenderness
- Swelling
The top four risk factors for developing knee osteoarthritis include:
- Prior injury or history of playing a competitive sport
- Being overweight
- Older Age
- Certain genetic traits
You’re also more likely to develop osteoarthritis if you play sports or work a job that requires you to perform repetitive motions.
To diagnose osteoarthritis, your Reflex Knee Specialists provider reviews your medical records, asks about your symptoms, and performs a physical exam. During the exam, they look at your knee alignment and also test range of motion and stability.
Your Reflex provider will also perform a diagnostic ultrasound which can assess the level of inflammation inside the joint and determine if there is damage to your cartilage. Ultrasound can also detect tendon or ligament strains, identify cysts, and see if your meniscus is damaged or extruded.
Meniscal Injury/Meniscus Tear: Most meniscal tears do not need surgery. And when people are taken to surgery for a meniscal tear, 95% of the time nothing is actually repaired — the surgeon just removes damaged tissue. This procedure — an arthroscopic partial meniscectomy (APM) — removes cushioning tissue and accelerates cartilage loss. People who have APM have a 3-5 times greater risk of needing a total knee replacement compared to those who don’t. Many patients have ongoing (sometimes even worse) pain following this procedure. Multiple research studies have demonstrated that surgery is no better than physical therapy for long-term outcomes in people with a meniscal tear.
Each of your knee joints has two C-shaped pieces of fibro-cartilage called menisci. The meniscus forms a cushion between your thigh bone (femur) and shin bone (tibia) and acts as a shock absorber, allowing you to walk, run, and climb stairs.
You might experience a torn meniscus if you step down awkwardly or forcefully twist your knee. Most meniscus injuries improve with conservative measures and non-surgical interventions. Most meniscal tears do not require surgery. Only very complicated tears that cause significant biomechanical issues will need to be referred to a surgeon.
Symptoms of a torn meniscus include:
- A popping sensation
- Knee swelling or stiffness
- Pain when bending or rotating your knee
- Difficulty straightening your knee
- Feeling like your knee locks
If you have a torn meniscus, you might also experience knee weakness that feels as if the joint is about to give way.
There are two types of meniscal tears: traumatic and degenerative.
A traumatic meniscal tear is caused by an acute injury. These types of tears are most common in athletes who play sports that involve twisting or pivoting, like basketball and soccer. Acute traumatic meniscal tears are more likely to be repaired surgically, especially if the person is younger than 35 years.
Degenerative tears occur after the meniscal tissue has destabilized over several years due to chronic inflammation. The tissue reaches a point of instability that a small tear can occur after a benign activity such as stepping off a curb or getting out of a vehicle. Degenerative tears never need surgery unless severe biomechanical issues are present (e.g. inability to bend or straighten the knee).
To diagnose a torn meniscus, your Reflex Knee Specialists provider asks about your symptoms and performs a physical exam. During the exam, they move your knee in different positions and might also ask you to squat or twist the knee.
What sets providers at Reflex Knee Specialists apart is the use of dynamic ultrasound testing. Reflex providers use diagnostic ultrasound to visualize the front and back of the meniscus (the anterior and posterior horns). With the ultrasound probe over the knee, they will passively flex, extend, or rotate the knee while looking at the meniscus with ultrasound to see if a defect is present.
These movements while the ultrasound probe is over the meniscus is called dynamic ultrasound testing and reveal how certain tissues perform when put into motion. All providers at Reflex Knee Specialists have been trained in dynamic ultrasound of the knee which is not provided in 99% of other clinics treating knee pain.
Since ultrasound is not able to visualize the entire meniscus, in some cases a patient may be referred to have an MRI if the provider feels further information is needed that may alter the treatment plan.
Treatment of a torn meniscus depends on various factors, including your age, the severity of your symptoms, and the level of your mobility and range of motion. Your Reflex Knee Specialists provider might recommend:
- Rest
- Ice
- Anti-inflammatory medication
- Physical therapy
- Joint Fluid Therapy
Ultimately, the goal of treatment is to relieve pain, reduce swelling, and enhance your mobility.
There are several things you can do to reduce the risk of a torn meniscus. The team at Reflex Knee Specialists recommends strengthening the muscles that support your knee, easing into new forms of exercise or sports activity, and wearing a knee brace if you have a weak or unstable knee.
In people with knee osteoarthritis, the meniscus is exposed to chronic levels of inflammation inside the joint. Over time, the inflammation weakens tissues including the meniscus and cartilage, causing them to break down over time. When a meniscus tear happens in the setting of osteoarthritis, it is called a degenerative tear. Non-surgical treatments such as hyaluronic acid reduce inflammation inside the joint and put the brakes on the degradation process, resulting in a healthier joint fluid so the meniscus will be less vulnerable to degenerative tears.
Diagnostic Ultrasound: Diagnostic Ultrasound is what differentiates Reflex from almost all other ortho and sports medicine clinics. Ultrasound allows our providers to visualize pathology involving tendons, ligaments, and portions of the menisci. We can also determine the level of inflammation in the joint by looking at the tissue lining the joint (synovium). And perhaps most importantly, our providers are able to visualize cartilage tissue on the end of the femur and determine how healthy or unhealthy the cartilage tissue appears. This allows the provider to diagnose osteoarthritis in its earliest stages, 15-20 years before joint damage shows up on Xray or MRI. Anyone over 40, or who has played competitive sports, or who has recurrent knee discomfort should have an ultrasound evaluation to rule this diagnosis out rather than waiting until they have a lot of symptoms (when irreversible joint damage is usually advanced).
A diagnostic knee ultrasound is a noninvasive test that uses sound waves to create images of the soft tissues inside your knee. The sound waves bounce off the inner structures of your joint and send real-time images of your knee to an external monitor.
Reflex Knee Specialists have dynamic ultrasound testing available on-site to diagnose the underlying cause of knee pain and other symptoms while your knee is in motion.
They also use advanced ultrasound technology for preventive knee evaluations to identify early cartilage damage in its earliest stages, before you even have symptoms.
Cartilage damage is irreversible and causes dysfunctional knee biomechanics and function. Limiting or preventing cartilage damage is essential to knee health and maintaining an active lifestyle.
Joint damage (destabilization and loss of cartilage tissue) can occur for years without any symptoms. This is called the ‘clinically silent’ phase of joint destruction. Once knee pain becomes a recurrent annoyance, irreversible damage to the joint has already occurred. Ultrasound is able to detect damage in its earliest stages when treatments are most effective in preventing the progression of joint damage and dysfunction.
Most athletes who played competitive sports in high school or college will have knee issues that develop years later. This is why the providers at Reflex Knee Specialists recommend that prior athletes have their knees evaluated with diagnostic ultrasound, even if they only have minimal symptoms.
Aging is another risk factor for developing knee problems, so the Reflex Knee Specialists recommend anyone over age 40 – even if they have no symptoms – to get screened by diagnostic ultrasound to see if knee damage is occurring so its progression can be slowed or halted.
Anyone with recurrent knee symptoms should have an evaluation with diagnostic ultrasound since damage to the cartilage is irreversible and, if ignored for too long, may result in the eventual need for knee replacement surgery.
Knee symptoms that should be evaluated include stiffness when standing after being seated for a prolonged period, pain with activities such as squatting or going up or down stairs, pain or discomfort with sporting activities, swelling, or a reduced range of motion.
If you start physical therapy or another treatment for an existing knee condition additional diagnostic knee ultrasounds will be performed during follow-up visits to ensure that the tissues inside the joint are responding appropriately to treatment.
Your provider at Reflex Knee Specialists may also recommend a diagnostic knee ultrasound if you have risk factors for arthritis or other conditions that break down your knee joint. A preventive ultrasound assessment can identify issues in the earliest stages when treatment is typically most effective.
The Reflex Knee Specialists team suggests you wear loose-fitting, comfortable shorts or pants that easily come up to the mid-thigh area for your appointment.
To start your ultrasound, you will be seated on the exam table or treatment chair. Your provider will apply ultrasound gel to your knee to transmit sound waves from the hand-held transducer into your knee joint. They move the transducer around your knee to check your muscles, tendons, ligaments, bones, and cartilage for damage.
During a dynamic ultrasound, you may also need to move your knee during testing, so your provider can assess your joint function in real time.
After your diagnostic knee ultrasound is complete, your provider will discuss the findings and make recommendations if treatment is needed. You may return to your usual activities without limitations or downtime. Ultrasound assessments are non-invasive and painless.
Knee-Focused Physical Therapy (PT) Specialists: although our PT providers are trained to treat any part of the body, they all have undergone specialized knee training and stay abreast of cutting-edge knee research. Injection treatments address the biochemical imbalance inside the joint; PT addresses the biomechanical issues that are contributing to the knee pain. Our skilled therapists are able to detect asymmetry in how people stand or walk due to compensation (patients are usually unaware of these changes) and work to restore fluidity and symmetry in motion. If the biomechanical dysfunction is not corrected, other problems up or down the kinetic chain (hip, low back, foot/ankle) start to arise.
Physical therapy uses a range of manual manipulation techniques, individual exercises, education, and other strategies to restore and optimize function in your knee.
The physical therapy services at Reflex Knee Specialists focus on getting you back to your usual activities with less pain and more confidence. The team also offers therapeutic resources to lower your risk for future knee injuries and pain.
As part of your treatment plan for knee pain and dysfunction, your provider may recommend that you participate in physical therapy sessions to optimize knee biomechanics and function for long-term benefit.
Physical therapy helps you safely return to work and other activities when healing from a knee injury or surgery. This type of therapy can also restore function in knee joints damaged by osteoarthritis or other chronic diseases.
The physical therapists at Reflex Knee Specialists provide educational resources to support your recovery path. They help you set and achieve goals to restore optimal function and improve strength in your knee joints.
There’s no clear-cut answer on how long you need physical therapy to enhance your recovery. Therapy plans vary from person to person, and many factors play a role in your recovery.
Your Reflex Knee Specialists provider discusses what you can expect from physical therapy during your initial evaluation. They customize a therapy plan based on your needs, the severity of your pain, and the nature of your condition.
In addition to on-site physical therapy sessions, the practice provides exercises you can do at home to keep your knee joint strong and healthy. You can continue these exercises long after your therapy sessions have ended to preserve your joint function and lower your risk for pain.
Joint Fluid Treatments
A joint fluid treatment, or viscosupplementation, is an outpatient procedure designed to reduce inflammation inside the joint and to relieve knee pain and stiffness caused by osteoarthritis.
During treatment, your Reflex Knee Specialists provider injects hyaluronic acid into your knee joint. When the thick fluid enters your body, it reduces inflammation and helps lubricate your joints, and provides protective cushioning over the cartilage. Once the levels of inflammation are diminished, most patients experience significant pain relief and improved mobility. Your provider may also recommend combining ozone therapy with hyaluronic acid since there is a synergistic effect when these treatments are combined.
The team at Reflex Knee Specialists often recommend joint fluid treatments if you have knee osteoarthritis since these treatments decrease levels of inflammation and improve the quality of the joint fluid, which can decrease pain and prolong the life of the joint.
If you experience knee stiffness or pain that prevents you from participating in the activities you love, the team at Reflex Knee Specialists can identify the underlying cause and create a treatment plan to help you feel better and be able to live a more active and fulfilling life.
The number of joint fluid treatments you need depends on how much inflammation and damage is present inside the knee. Usually, the team at Reflex Knee Specialists recommends a series of three to five injections spaced one week apart. In most patients these treatments usually control the inflammation and pain for about 6 months, at which time another series of treatments is repeated. After each round of injections, your provider monitors your progress and make adjustments as necessary.
Joint fluid treatments affect everyone differently, based on the degree of inflammation and cartilage damage in the knee. Some people experience significant relief from knee pain about a month after their first series of injections; for others who have advanced damage and high levels of inflammation, it may take longer. Viscosupplementation is a cumulative treatment, meaning that the pain relief is often greater and lasts longer after each treatment series over time.
Joint fluid treatments have been used to treat knee osteoarthritis for decades and have a robust safety profile. That said, after a joint fluid treatment, patients may experience some redness, swelling, and mild discomfort at the injection site.
These reactions are typically mild and improve within a day or two. If they persist or worsen, contact your provider immediately.
You can return to work and other activities the next day but avoid strenuous exercise or lifting for 2-3 days following treatment.
Knee Bracing
Knee bracing is an effective way to relieve pressure on your knee joint and reduce inflammation and pain. An offloading brace reduces contact forces over the area of the knee where there is damaged cartilage or meniscus. Bracing can also stabilize your knee joint and improve your alignment and gait, reducing your risk for injuries and chronic pain.
The experts at Reflex Knee Specialists offer comprehensive knee bracing consultations to identify what’s contributing to your knee pain and other symptoms.
The team helps you find the most appropriate knee brace to accommodate you and your lifestyle.
Are you suffering from chronic knee pain? Maybe you have osteoarthritis and have just learned you need to have knee surgery. Or perhaps you’re just curious about the acute, persistent pain in your knee. Regardless of what brought you here, we know facing chronic knee pain can be a tough period in your life, and you’re likely to have a few questions. We hope our list of frequently asked questions can leave you feeling a little more knowledgeable about this condition.
First, it’s important to know that you’re not alone. Many adults, particularly athletes and active adults, suffer from chronic knee pain – and the leading cause, osteoarthritis, affects over 27 million adults in the United States alone. While this condition can affect any joint in the body, it is found most often in weight-bearing joints like the knee. The CDC estimates that 46% of people will develop osteoarthritis or knee pain symptoms in their lifetime. Since there is currently no cure for these symptoms, it is important to diagnose and manage the condition as soon as possible.
Frequently asked questions
At Reflex Knee Specialists, we consider knee replacement surgery as a last resort. Once this decision is made, patients have very few options if they continue to experience pain (which happens to 25-30% of patients after a knee replacement). For this reason, we recommend that people with knee pain first see how well they respond to non-surgical treatments before making this irreversible decision. Our team has helped many patients postpone or prevent the need for a total knee replacement (TKR).
If you would like to make an appointment for a comprehensive knee evaluation and to learn about what non-surgical options are available to you, call the nearest office in Portland, Oregon; Bellevue, Washington; or Tempe, Arizona, or book online today.
The Reflex Knee Specialists team only recommends total knee replacement (TKR) surgery for patients who don’t respond to less-invasive, non-surgical treatments, or if their stage of joint dysfunction is so severe that non-surgical options are unlikely to be beneficial.
The Reflex Knee Specialists team only recommends total knee replacement (TKR) surgery for patients who don’t respond to less-invasive, non-surgical treatments, or if their stage of joint dysfunction is so severe that non-surgical options are unlikely to be beneficial.
Published studies have shown that 25% of people are dissatisfied following TKR, and up to 50% have residual symptoms. Serious complications are rare (1-2%), but since there are one million TKRs performed in the U.S. every year, this represents 10,000 to 20,000 cases of postoperative complications such as infection (the hardware is then removed) or blood clots (blood thinners needed).
Schedule a knee evaluation and one of our providers will thoroughly evaluate your knees and discuss your treatment options.
Call and schedule your evaluation today.
The main symptoms commonly associated with osteoarthritis (OA) of the knee are:
- Knee aches and pain that worsens when you are active and improves with rest
- Stiffness, especially in the morning and when standing up
- Cracking and popping when moving the knee
Although it’s difficult to be absolutely certain of the specific cause of OA in your knee, some contributing factors are:
- Previous injury
- Wear and tear on the knee over many years
- Advancing age
- Excessive weight
- Genetics: It may “run in the family”
- Gender: Women are more likely than men to have OA of the knee
Diagnosis of osteoarthritis is simple and non-invasive. A physician will perform a physical exam of your knee to check for the range of motion and ask about any pain you feel. They will also ask questions about family history and levels of activity. An X-ray is used to look at the knee joint for misalignment and check the cartilage that promotes healthy movement of the knee. An ultrasound can also be performed to examine additional structures of the knee such as the meniscus, ligaments and tendons.
Osteoarthritis (OA) of the knee is a chronic condition that gradually worsens over time. Athletes, in particular, are at a higher risk for developing OA due to increased pressure on load-bearing joints. The levels range from mild: slight pain when walking or moving the joint, to severe: debilitating pain.
The best solution is treatment of the condition to manage pain, reduce damage in the future, and promote the full range of motion of the knee. It is recommended to be as proactive as possible about treatment to ensure sustained ability to compete. See a physician if you ever feel pain in your knee for more than a couple of weeks, regardless of age. The earlier you seek treatment the easier it is to prevent excessive damage to the knee joint, which can prevent the need for eventual knee replacement.
Treatment is different for every patient. It is important to consult with a physician to find the best treatment for you. Simple changes, such as diet and exercise, can be an effective form of treatment for very mild cases of knee pain. In most cases, medical treatment of some kind is required.
Medical treatments vary by severity. For many patients, incorporating a knee brace into activities is a great option to promote the proper range of motion. Viscosupplementation, the injection of healthy fluids into the knee joint, is also commonly used. Physical Therapy is often used in conjunction with one or both treatments above.
At Reflex, we believe in preventing or postponing the need for knee replacement surgery as long as possible. Given other less invasive options, it is important to explore available treatments with one of our physicians.
Hyaluronan is a natural substance found in the fluid that surrounds a healthy knee. This fluid is called synovial fluid and it helps cushion, lubricate and protect the knee. In people with chronic knee pain or Osteoarthritis, the synovial fluid becomes thinner and less able to do its job. This requires supplementation to reinvigorate the knee and provide needed nutrients to the joints.
When Hyaluronan is injected into the knee it replenishes the fluid in the knee and helps restore the ability of the synovial fluid to cushion, lubricate and protect the knee. It also provides long-term reduction of inflammation in the joint. This Joint Fluid Therapy is designed to safely help reduce knee pain.
Most patients do not express feeling any pain during the injection or after the procedure. It will feel similar to a flu shot, with only mild discomfort.
Viscosupplementation is another name for our Joint Fluid Therapy. It is the injection of fluids into a joint to alleviate and repair damage done to the knee through wear and tear.
No referral is necessary for an initial knee consultation for most insurance companies. Please contact us directly to set up your initial evaluation, or fill out our appointment form.
A typical first-time consultation will last about 60 minutes here at Reflex, but this can vary depending on the physician. A typical injection-only appointment will last 15 minutes.
Reflex knee injection treatments are covered by most insurance providers. The process of obtaining reimbursement varies from plan to plan. Reflex will contact your insurance provider on your behalf before you begin treatment to find out if Joint Fluid Therapy is covered by your insurance plan. Our financial associate will go over the expected costs based on personal insurance at the end of your initial evaluation.
Yes. Reflex knee injection treatments are eligible for reimbursement by Medicare.
We hope our list of Osteoarthritis frequently asked questions has been helpful to you. Please let us know if you have any more questions about the condition or possible treatments.
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Don’t wait until the pain is too much to bear, have your knee(s) evaluated before symptoms even begin. Treatments are most effective in the early stages.
