If you suffer from a painful knee, it could be due to a few reasons. You may have suffered a sports injury in the past which is now causing you problems. It could be related to degeneration of the joint over several years.

These problems may arise they can be due to damage to the cartilage layer which covers the lower part of your thigh bone (femur) and the top part of your shin bone (tibia). It can also involve your ligaments or muscles.

An important structure within your knee joint is the meniscus, and if you sustain a tear in the meniscus then you can experience pain but functional deficits such as locking of the knee joint in a flexed (bent) position or giving way (feeling that the knee joint is unstable).

I would fully assess you and then proceed to further imaging by way of X-rays and MRI scan of the knee. Depending on the outcome of the examination findings and investigations I would then advise further management. This could include Arthroscopic (keyhole) surgery where we do a day case procedure. This involves the patient coming in the morning and then going home after the procedure the same day.

The procedure involves me making 2 small cuts (portals) on either side of your knee cap. One portal allows me to insert the fibreoptic camera to see inside the knee joint and the other portal is used for the instruments to either repair or remove the torn part of the meniscus.

You should be able to mobilise fully weight bearing usually unless I tell you otherwise. You may require crutches to help you initially which the physiotherapist will provide. You may also feel the knee feels swollen, this is normal as we use fluid into the knee joint so we can see inside. You will normally have one stitch in each portal which will need removing at 2 weeks, the hospital will arrange the appointment for this. I would then see you usually 6 weeks later in clinic to assess your progress.

There has been a recent increase and interest in biological treatments for musculoskeletal treatments, mainly injections. There is a large variety of treatments on offer including stem cells, platelet rich plasma (PRP), hyaluronic acid (Ostenil) and others.

It is important for patients to be aware about the pros and cons of these therapies. In consultations with my patients, I make it very clear as to the efficacy of such treatments and the evidence within the medical literature. After analysing the various treatments available for musculoskeletal conditions such as osteoarthritis (degenerative joint disease), I have a very specific indication for each of the therapies I offer.

If you are someone who has only very mild to moderate symptoms of joint pain/ discomfort I will usually offer you PRP injections in combination with Physiotherapy, which includes hydrotherapy. If you have any sports injury or a tendinopathy (such as trochanteric bursitis) I will usually offer you PRP injections as well. I would usually offer a course of 3 injections rather than a single injection as the effectiveness of 3 is better than 1 injection, as per the medical literature. In my opinion the PRP injection works to reduce inflammation within the structure it is injected in and hence can provide relief of symptoms.

If you suffer from moderate degenerative changes in your joints then a synthetic injection of Hyaluronic acid such as Ostenil may benefit you. This is a single injection and the manufacturer advises that it may be effective for up to 6 months. It enhances the synovial fluid within the joint, so that it functions better and can hence provide more support to the joint during any activity. This may result in reduced joint reaction forces and hence provides symptomatic relief.

In my opinion if you have end stage arthritis or degenerative joint disease, i.e. You have bone on bone change on your X-rays and you have significant pain, then I would advise for a steroid (cortisone) injection. This is certainly not a biological treatment but works as an anti-inflammatory which I feel has a role to play in this group of patients.

The role of stem cells still needs to be proven and hence I do not utilise these in my practice.

This is a group of injuries which can affect any person throughout their lifetime. It can be either a tendinopathy (inflammation of a tendon), sprain (tear of a tendon), muscle sprain (tear), degeneration of labrum (hip) or meniscus (knee) or degeneration of the cartilage layer of the concerned joint (hip, knee or ankle).

Depending on the history and findings on examination I will then advise further imaging if appropriate. This may be in the form of X-rays, MRI, Ultrasound or CT scans.

Once my expert radiologist has reported on the imaging I will usually see the patient again and advise further management. This may include physiotherapy with hydrotherapy, injection therapies, arthroscopic surgery or joint replacement surgery.

I always advise my patients when they proceed with physiotherapy (even if they have done it in the past) that it takes a minimum of 2-3 months for physiotherapy to work. Only after this time will they see a change and then their symptoms should improve. My specialist physiotherapy team have various modalities at hand to achieve the desired outcome. One very useful adjunct is the use of taping (Rhino taping) and therabands (of various colours) in order to support the rehabilitation process.

One must always remember that everyone’s body heals differently. But on the whole acute injuries can take anywhere between 6-8 weeks to improve and a total of 12 weeks to completely resolve, give or take. Chronic injuries can take more effort to treat and may therefore take more time to resolve.