The role of the family physician in managing knee pain is expanding as recent literature supports nonsurgical management for many patients. Effective treatment depends on the etiology of knee pain. Oral analgesics—most commonly nonsteroidal anti-inflammatory drugs and acetaminophen—are used initially in combination with physical therapy to manage the most typical causes of chronic knee pain. The American Academy of Orthopaedic Surgeons recommends against glucosamine/chondroitin supplementation for osteoarthritis. In patients who are not candidates for surgery, opioid analgesics should be used only if conservative pharmacotherapy is ineffective. Exercise-based therapy is the foundation for treating knee osteoarthritis and patellofemoral pain syndrome. Weight loss should be encouraged for all patients with osteoarthritis and a body mass index greater than 25 kg per m2. Aside from stabilizing traumatic knee ligament and tendon tears, the effectiveness of knee braces for chronic knee pain is uncertain, and the use of braces should not replace physical therapy. Foot orthoses can be helpful for anterior knee pain. Corticosteroid injections are effective for short-term pain relief in patients with osteoarthritis. The benefit of hyaluronic acid injections is controversial, and recommendations vary; recent systematic reviews do not support a clinically significant benefit. Small studies suggest that regenerative injections can improve pain and function in patients with chronic knee tendinopathies and osteoarthritis

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation Evidence rating References

Exercise-based therapy is the first-line treatment for knee osteoarthritis and patellofemoral pain syndrome, in addition to weight loss, if necessary, for those with osteoarthritis.

C

7, 23

Nonsteroidal anti-inflammatory drugs are effective for short-term treatment of knee osteoarthritis and patellofemoral pain syndrome.

B

7, 8, 25

Glucosamine/chondroitin supplementation has limited effectiveness in the treatment of osteoarthritis.

B

7, 15, 17, 48, 49

Active rehabilitation is as effective as arthroscopy at reducing pain and improving function in patients with nontraumatic degenerative medial meniscal tears without mechanical symptoms.

A

28, 29

Braces are a reasonable option for treatment of common knee overuse conditions, but should not replace treatments such as active rehabilitation.

C

21, 22, 26, 27, 33


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

Treatment of Knee Osteoarthritis:

1- physical therapy and weight loss: combination of aerobic and strengthening exercises. home program give same effect as supervised program. patella taping and ultrasound are effective.

Weight loss should be encouraged for all patients with osteoarthritis and a body mass index greater than 25 kg per m.

2-pain pills: tylenol and Non-steroidal anti-inflammatory drugs are effective for short-term treatment . Opioid analgesics should be used if conservative pharmacotherapy  therapy not working.

3- injections: Corticosteroid injections are effective for short-term pain relief in patients with osteoarthritis. The benefit of hyaluronic acid injections is controversial, and recommendations vary

4- Braces and orthoses: have limited effect

Treatment for patellofemoral pain syndrom

Physical therapy: Quadriceps and hips strengthening combined with stretching of quadriceps,hamstrings, hamstrings,hips flexors, and iliotibial band three times weekly for six to eight weeks is effective in reducing pain and improving functionality.

Pharmacotherapy: Ultrasonography and patellar taping have conflicting results but may be helpful adjuncts Non-steroidal anti-inflammatory drugs are effective for short-term treatment

Braces and Orthoses: there is a limited evidence for lateral patellar buttress brace

 follow following exercise:
Hamstering strech for patients with palletofemoral pain syndrom.

 

isometric quadriceps strengthening exercise
How to do: Leg Raises - Step 1