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How common is knee pain? | What causes knee pain? | Why can’t the knees stand up to the demands? | ACL Injuries | I have Pre-Patellar Bursitis, what is this? | After surgery: Joint Camp
How common is knee pain?
If you have knee pain, rest assured you are far from alone. Each year 5 million Americans seek medical help for painful knees. Even more self-diagnose and treat themselves with pills and home remedies.
The knee is a complex mechanism, which absorbs shock as we jump, and is extremely flexible, permitting change in direction while running at high speeds. It is made of ligaments, which provide support, and muscles for strength. It is a well-lubricated mechanism, which functions reliably unless unduly twisted, bruised, or broken. When this happens problems occur.
 It is not surprising of all the areas treated by orthopedic surgeons, the knee is the most commonly injured joint, representing 26 percent of orthopedic business, followed by the spine (17 percent) and hip (15 percent).
What causes knee pain?
Often knee pain is the result of an accident, such as a fall or a car crash. Fractures are common. According to the American Academy of Orthopedic Surgeons (AAOS), over a lifetime, each American will suffer two fractures. Many of which will occur at the knee. However, trauma represents a relatively small percentage of knee problems. The vast majority result from repetitive trauma, or wear and tear. In these cases, the cartilage or joint surfaces are slowly damaged over time. One such form of chronic injury is arthritis, which might be thought of as a “rusting” of the knee joint. It causes pain and robs the knee of flexibility. Indeed, half of all knee pain may be tied in some way to arthritis.
Why can’t the knees stand up to the demands?
Any mechanical device can and will fail if placed under undo strain.
Sometimes knee pain is the result of an accident, such as a fall down stairs or the knee being banged into a dashboard during a car accident. But this is in a relatively small percentage of cases. The vast majority of knee problems develop not from a single accident or fall, but rather over a period of years. In these cases, the knee becomes like a creaky or unstable hinge that doesn’t get better, either because components in the knee are weak or unstable, or the lubricating pads and bone surface have been damaged over time.
That’s the bad news. The good news is that of all the bum knees that come limping into doctors’ offices every year, only 20 percent will need surgery. Of those that don’t need surgery, most will get better with time.
What home remedies can I try for my knee pain?
Anti-inflammatories and specialized exercises that increase range of motion, flexibility, strength, and resistance to future knee strain are usually prescribed. Sometimes knee braces are also used. That’s positive news to focus on.
Aside from car accidents, slips, and falls, knees are injured  merely from hauling us around all day long. Although we want to stay active, Americans are eating more. The U.S. Government now estimates that 56 percent of Americans are now classified as overweight. This extra weight puts an extra load on aging knees.
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What about arthritis and knee pain?
Arthritis, a form of natural rust, can also cause knee pain. Arthritis is a nasty disease—often inherited and usually associated with aging—which erodes the natural flexibility of a joint. As mentioned, half of knee pain can be tied in some way to arthritis.
Arthritis: Osteoarthritis
This is a degenerative joint disease stemming from wear and tear on the knee usually affecting those in middle age and older. Osteoarthritis causes the cartilage to erode away. Symptoms include pain, stiffness, and swelling that at first happens once in a while but can progress to chronic pain. 
Arthritis: Rheumatoid Arthritis
Unlike osteoarthrits, this type of arthritis does not erode the cartilage slowly, rather it inflames the joint (usually many joints at one time) until the joints are ruined. Rheumatoid arthritis is most common in middle aged women, but can affect people of all ages.
Arthritis: Crystaline Arthritis
Inflammation of the joints can occur when a small granual of sodium urate (related to gout) or calcium phosphorate (related to chondrocalsinosis) gets lodged in the joint. The effect is similar to getting a piece of sand trapped in your eye. It irritates the surrounding inflammation. Middle-aged men are most prone to this sort of arthritis. [Top]
I have Pre-Patellar Bursitis, what is this?
Between the tendon and the skin are small sacs called bursae which allow the skin to smoothly and painlessly slide over bones. When the bursae become inflamed, any knee movement can cause pain. In the knees, one function of the bursae is to allow the knee cap to move around freely without pain. Repetitive kneeling and/or direct impact on the knee can cause the bursae to swell and cause pain.
Those in professions (such as masonry, house cleaning, carpet laying and other manual trades) where the knees are often bent are more likely to experience post-patellar bursitis. At other times, the condition can occur when the sacs become infected. Usually for this ailment surgery is not necessary (although may be called upon in extreme cases) and treatment includes avoiding bending of the knees and relieving pressure to the knee cap.
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ACL Injuries in Athletes
Peter A. Looby M.D.
The anterior cruciate ligament provides rotational stability and anterior movement of the tibia from the femur. Up to 10% of the population can function athletically without an ACL. People with ACL deficiencies tend to have feelings of instability, giving away and shifting. ACL injuries frequently occur without physical contact.
Jerry Rice is one of the best-known and most beloved players in the NFL. He is also one of a number of very visible examples of how high-level athletes can recover from ACL reconstruction surgery to participate in sport at a world-class level. Other well-known athletes who have successfully returned after ACL surgery include Rod Woodson and South Dakota's own Brian Schwartz.
Tearing of the anterior cruciate ligament or ACL, is one of the most frequent serious sports-related injuries of the knee. The ACL is a bundle of tough fibrous tissue approximately one inch in length and one-half inch in diameter in the center of the knee. The main purpose of the ACL is to prevent the two main bones in the knee, the femur and the tibia, from slipping or rotating abnormally.
 ACLs are commonly injured during athletic activities such as football, basketball, skiing, and soccer. This can happen during contact like blocking and tackling or with non-contact twisting injuries of the knee such as those that occur when cutting and pivoting on a basketball court or falling while skiing. The athlete who tears their ACL usually experiences pain and may feel or hear a "pop" at the time of the injury. Knee swelling typically begins that same day.
The majority of people with torn ACL will experience knee instability. While twisting or pivoting, the knee with a damaged ACL will "give way" or "go out." The athlete may feel the two bones in the knee slip or separate. Sometimes the knee instability is so severe that a person may experience this giving way during nonathletic activities such as getting in or out of a car or walking on uneven ground.
While the importance of a functioning ACL has been appreciated for many years, it was not until the 1970's that an effective treatment for torn ACLs was developed. Called ACL reconstruction, this surgery involves using another piece of tissue from the body to make a new ACL. Tissues commonly used for this purpose included a portion of the patellar tendon and one or two of the hamstring tendons.
Rehabilitation after ACL reconstruction is extensive. Weight-bearing and walking on the knee can in many cases begin the day after surgery. At the Orthopedic Institute - Sports Medicine Center we usually have our patients back to running approximately three months after surgery and returning to full sports participation four to six months following ACL reconstruction.
This content is not intended as a substitute for professional medical care. Only your doctor can diagnose and treat a medical problem.
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After surgery: Joint Camp
A program is available for patients having total knee and total hip replacements. This program is available only at Avera McKennan Hospital and emphasizes education and wellness. The surgeons of Orthopedic Institute in connection with Avera McKennan Hospital have developed the Total Joint Center, also referred to as Joint Camp.
Surgeries are scheduled for Mondays and Tuesdays, with patients typically being discharged to their own homes, not another facility or step-down unit, on Thursdays and Fridays. Therapy is delivered in a group setting on the unit, which facilitates camaraderie among the patients. In addition to the therapists working with the patients, each patient has a coach who helps with the recovery. Coaches may be a family member, friend or volunteer. Patients stay in a designated wing of the hospital on the orthopedic unit.
Emphasis on patient education occurs before and after surgery. Patients are given a notebook before surgery and are expected to attend a class. Pre-op education prepares the patient for the surgery, hospitalization, rehabilitation and return to functional activities. Every day at Joint Camp patients receive newsletters with updates on what to expect. Prior to going home, patients are giving videos and handouts explaining what to expect in the days ahead.
Surgeons and staff of Joint Camp believe that patients requiring total joint replacements are often in good overall health. Therefore, there is a wellness approach in the care that is provided. Patients are expected to dress in their own clothes, (loose-fitting) not hospital gowns. Lunches are eaten in the dining area with other campers and coaches.
If you are interested in Joint Camp, visit with your surgeon at Orthopedic Institute to determine if this experience is right for you.
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