Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, progressive bilateral knee pain, exacerbated by weight-bearing activities and prolonged standing. History is significant for prior trauma to the bilateral lower extremities [specify injury, e.g., ligamentous tear/fracture]. Pain is described as aching, associated with morning stiffness lasting <30 minutes, and mechanical symptoms including crepitus and intermittent locking. Previous conservative management includes NSAIDs and physical therapy with partial relief.
Clinical Examination Findings
Bilateral knee examination reveals visible joint line tenderness, mild joint effusion, and palpable crepitus during range of motion. Range of motion is restricted in flexion and extension. Ligamentous stability testing (Lachman, Varus/Valgus stress) is negative for acute instability. Gait analysis demonstrates an antalgic component. Radiographic imaging confirms joint space narrowing, subchondral sclerosis, and osteophyte formation consistent with post-traumatic osteoarthritis.
Treatment Protocol
Initiate multimodal conservative therapy: 1. Activity modification to low-impact exercises (swimming, cycling). 2. Pharmacological management with scheduled NSAIDs or topical analgesics. 3. Physical therapy referral for quadriceps strengthening and gait training. 4. Consider intra-articular injections (corticosteroids or hyaluronic acid) if symptoms persist. 5. Weight management counseling if BMI is elevated.