Author Affiliation: Dr Lonner is attending orthopedic surgeon, Pennsylvania Hospital, Philadelphia.
Clinical Crossroads Section Editor: Margaret
A. Winker, MD, Deputy Editor.
DR SHIP: Mr V is a 57-year-old man who has
had knee pain for at least 30 years. He lives in Boston with his wife, with
whom he owns and runs a business. He has managed care insurance and sees his
primary care physician, Dr P, at Beth Israel Deaconess Medical Center.
Mr V dates the onset of his left knee problems to a soccer injury at
age 26. He was diagnosed with rupture of 2 ligaments and underwent a course
of physical therapy. His pain diminished over time, but he was aware that
his left knee was never again at "100%." He continued his active athletic
life, which included soccer, bicycle racing, and running at least 3 times
per week. About 15 years ago, however, pain in his left knee recurred and
became severe enough that he stopped running and moved largely to long-distance
cycling. Thirteen years ago he underwent an arthroscopic debridement. This
improved his level of function and decreased his pain for approximately 2
years, but symptoms subsequently recurred. He has since had several courses
of physical therapy but has found the recommended exercises to be so painful
that he could not complete them.
Lonner JH. A 57-Year-Old Man With Osteoarthritis of the Knee. JAMA. 2003;289(8):1016-1025. doi:10.1001/jama.289.8.1016