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Clinical Crossroads
Clinician's Corner
February 26, 2003

A 57-Year-Old Man With Osteoarthritis of the Knee

Author Affiliations

Author Affiliation: Dr Lonner is attending orthopedic surgeon, Pennsylvania Hospital, Philadelphia.

 

Clinical Crossroads Section Editor: Margaret A. Winker, MD, Deputy Editor.

JAMA. 2003;289(8):1016-1025. doi:10.1001/jama.289.8.1016

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.

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