Knee Pain

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 just like; 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

KEY RECOMMENDATIONS FOR PRACTICE

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: The combination of aerobic and strengthening exercises. Home programs have the same effect as supervised programs.

2-Weight loss: Should be encouraged for all patients with osteoarthritis and a body mass index greater than 25 kg per m2.

3-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.

4- 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

5- Braces and orthoses: Have limited effect

Treatment for Patellofemoral Pain Syndrome (PFS)

Physical Therapy: Quadriceps and hip 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: Non-steroidal anti-inflammatory drugs are effective for short-term treatment

Braces and Orthoses: Limited evidence suggests that the lateral patellar buttress brace may offer some relief for patellofemoral pain syndrome by providing support and stabilization to the patella.

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