by: Dr. Michael A. Castillo
We use our legs every day and knee pain is common. The first thing we need to understand is what is wrong with the knee. There is need for a physical exam and an MRI. There can be injury to the internal knee and the external knee. There can be three approaches to the knee: internal injections with hyaluronic acid (roster comb), external injections with steroid or natural anti-inflammatory injections, regenerative medicine, and surgery (endoscopic and total knee arthroplasty). I do not suggest injection of steroid as we now know it increases degeneration of the joint. It may be used as a bridge to a total knee replacement.
The internal knee can be broken do to four things: meniscus, articulating cartilage, anterior cruciate ligament (ACL), and posterior cruciate ligament (PCL). Treating the internal knee without treating external knee pain does no good.
The external knee: outer ligaments (medial and lateral collateral ligaments), patella and patellar ligaments (knee cap and attachments), tendons (attach the muscles of thigh to the lower leg), bursae (water packets under ligaments and tendons), nerves (geniculate nerves), tibia/fibula joint, and Baker’s Cyst (abnormal pocket of fluid behind the knee). Treating external knee pain without treating the internal knee pathology does no good.
Medicare and insurance companies allow for hyaluronic acid injections to the inside of the knee. I believe and treat the external part of the knee at the same time with traumeel, a natural anti-inflammatory. This is covered by insurance and Medicare at this time.
Regenerative medicine is directed to the need. We can treat the inside and outside elements. We are now treating the femur (thigh bone) and the tibia (shin) with decompression (hole in the bone) and implanting blood, fat cells, and exosomes (growth factors). This allows for regrowth of the bone. This is not covered by insurance at this time.
Endoscopic Knee Surgery allows for debriding (removing loose fragments) and implanting cadaver or natural ligaments (from another body ligament). Surgeons also put in artificial knees (total knee arthroplasty (TKA)). This is covered by insurance or Medicare.