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General information about Orthopedics Knees

What does a knee orthopedist do?

A knee orthopedist diagnoses and treats problems in the knee joint: cartilage wear (osteoarthritis), meniscus tears, ligament injuries, pain around the kneecap, fractures and sports injuries.

Most orthopedists in the field focus on one of two directions. Some deal with sports injuries and arthroscopy, meaning minimally invasive surgery through small incisions, for example to repair ligaments or the meniscus. Others focus on joint replacements, partial or total, for people whose knee has worn out. Some doctors work in both areas.

A large part of the treatment is non-surgical. For most people with knee osteoarthritis, the main treatment is tailored exercise and muscle strengthening, and weight loss if needed.

When should you see a knee orthopedist?

When knee pain doesn't improve after a few weeks, despite measured rest and adapted activity.
The knee "locks", "gives way" or feels unstable.
There are painful clicks (clicks without pain are a normal phenomenon).
The pain limits you when walking, climbing stairs or playing sports.
You injured your knee during activity, for example in a sharp turn or when landing from a jump.
Your family doctor or physiotherapist recommends a specialist assessment.

Frequently asked questions about Orthopedics Knees

Do I need an X-ray or MRI to diagnose knee cartilage wear?

Not always. Contrary to the common belief that the wear must be seen on an image before treatment can begin, current medical guidelines state that in most cases imaging tests are not needed to diagnose cartilage wear (osteoarthritis). In people aged 45 and over who describe typical knee pain that appears during activity or weight-bearing, and who have no morning joint stiffness lasting more than half an hour (or no stiffness at all), the doctor can diagnose the condition accurately based on the conversation and the physical examination alone.

The reason is simple: X-rays and MRI scans of the knee often reveal natural changes that occur with age – such as mild cartilage wear or degenerative meniscus tears – that are not related at all to the pain the patient is experiencing. Incidental discovery of such findings does not change the conservative treatment plan (which is based in any case on muscle strengthening, physiotherapy and adapting activity), and sometimes only causes unnecessary worry. Therefore, the orthopedist will refer you for an X-ray or MRI mainly when the symptoms are atypical and another problem in the joint is suspected, after significant trauma, or when conservative treatment has been exhausted and an intervention such as knee replacement surgery is being considered.

I have a meniscus tear. Do I need arthroscopic surgery?

The answer depends mainly on your age and how the tear occurred. In people around age 35 and over, most meniscus tears are not the result of a single injury but part of the knee joint's natural wear process over the years (a degenerative tear) – a very common finding that appears on MRI scans even in people with no knee pain at all. Large-scale studies have found that in such situations, arthroscopic surgery has no advantage over conservative treatment and muscle strengthening in physiotherapy. Therefore, international medical guidelines recommend avoiding surgery in most cases of a degenerative tear, even when you feel clicks, popping or a slight "catching" sensation in the knee.

The picture is different in the case of an acute tear caused by an injury or a sharp twisting movement, a situation typical mainly of young people and athletes, or in cases where part of the torn meniscus moves out of place and causes true "locking" of the joint (inability to fully straighten the knee). In these specific situations, minimally invasive surgical intervention (arthroscopy) to repair the meniscus or remove the blocking part may be the right and most effective solution for restoring knee function.

When is knee replacement surgery considered?

When the wear significantly affects quality of life, because of pain, stiffness, limited function or deformity of the knee, and non-surgical treatments are not helping enough. According to the guidelines, age, sex, smoking, excess weight or underlying conditions should not be a reason not to refer for a surgical assessment, if the other conditions are met.

There are two main types: total replacement, in which all the joint surfaces are replaced, and partial replacement, when the wear is limited to one area of the knee. Recovery from a partial replacement is usually shorter.