Knee
First of all, Knee pain does not mean Osteoarthritis all the time. It can be from structures inside the joint like bone, meniscus, cartilage and ligament or Extra articular meaning surrounding structures like muscle, tendon, bursa or ligaments.
It can be assessed clinically and confirmed with imaging like X ray, USG or CT/MRI.
Younger patients usually have soft tissue problems like overuse/ sports injury and older patients have osteoarthritis.
There is always a scope of conservative trial i.e. drugs, physiotherapy, rest and proper rehab programme. Failing this initial programme one can opt for ESWT/RSWT which can save the patient from the agony of surgery which is always a last resort to save the natural knee joint.
Various operations have been designed to salvage the knee. When osteoarthritis is in the grade 3 and beyond one opts for total joint replacement. This artificial joint has a life of its own and one needs to be careful and vigilant not to have excess of overloading so as to avoid revision of the joint.
Case-1: Osteochondritis Dissecans(OCD)
This young man of 27 years had knee pain due to affection of Medial Femoral Condyle and was advised surgery. He underwent ESWT in 1998 and responded with total regeneration of dead bone and cartilage. long term results is still good with minimal pain and able to carry on all activities of daily life and work.
Case-2: Os Good Schlater's Disease
This affects young adolescents and is inflammation and breakdown of Tibial Apophysis.surgery is advised in refractory patients. ESWT helps to resolve it soon with no medication/brace or limitaion of routine activities.
Case-3: PATB Syndrome
This commonly affects adults in middle age and is inflammation at the insertion of Hamasting muscle(Pes Anserinus) It is usually confused with osteoarthritis of knee. it can be successfully treated with RSWT.
Case-4: OSTEOARTHRITIS
The wear and tear of the cartilage of the joint is an aging process and usually starts around 60 years. The joint space appears reduced and osteophytes develop. The symptoms are pain, swelling and limp.
Typically a knee has 3 compartments: inner/medial, outer/lateral and kneecap/ patellofemoral.
Alignment changes and gait is affected.Medical management helps along with physiotherapy to strengthen surrounding muscles and alleviate pain.Surgery is both joint preserving and Total joint replacement according to the stage of the disease and the disability.
ESWT works in early stages when one or two compartments are involved. It regenerates the tissues and helps in rehabilitation. We have had good success when early medial compartment and patellofemoral compartments are involved. Being noninvasive there are no braces or medications which interferes with other comorbidities and early rehab can be instituted for speedy recovery.
WOMAC Score improves after r-ESWT and early stages recovers pretty well and patients disability improves allowing th4em to lead almost normal life and enjoy their routine. Regular follow up is a must as Osteoarthritis is an ongoing aging process and exercises and fitness needs to be monitored on regular basis.
