Bone on Bone In The Knee

By Ron Salazar, MPT

What is Bone on Bone In The Knee?

Bone on Bone in the Knee is a phrase used to describe a condition in the knee joint which involves cartilage loss and the damage is closely associated with osteoarthritis or degenerative joint disease.  This condition is very painful with walking, squatting and kneeling.  Often patients report popping and grinding within the knee joint.  So, in this article we will look at this condition and find ways that we can help you!

Man holding his knee due to knee pain from bone on bone in the knee. JOI Rehab

Man Holding his Knee due to Pain from Bone on Bone in the Knee

Knee Anatomy and Bone on Bone

The involved anatomy of the knee joint includes the lower end of the femur (thigh bone) and the upper end of the tibia (shin bone). The cartilage of the knee lies between these bones. There is a type of cartilage that covers the end of these bones. Its surface is smooth and allows the joint surfaces to glide over each other with low friction and stress during knee movement. Another type of cartilage is the meniscus. This type of fibrocartilage is located on top of the tibia. Its function is to absorb shock at the knee joint.

What is happening when one has Bone on Bone in the Knee?

In Bone on Bone, the joint cartilage is worn down or lost to the point that when the knee is moved, the bones contact each other with high friction stresses. These joint stresses cause joint inflammation. In addition to more wearing down of the knee joint surfaces through bone on bone. This pain is due to undesired contact. This contributes to degenerative joint disease or osteoarthritis.  The longer you go without seeking out medial attention, the more damage occurs at the joint.

Signs and Symptoms

The signs and symptoms of bone on bone in the knee joint are:

  • Severe, sharp pain- especially with activity
  • Swelling
  • Decreased function for stair ambulation, squatting, walking, doing household chores, and standing up after prolonged sitting/driving.
  • Joint stiffness
  • Sensation of weakness
  • Clicking, grinding, and popping sensations
Man holding an x-ray image of his knee highlighting his knee pain. JOI Rehab

Knee Pain from Bone on Bone

Treatments for Bone on Bone in the Knee

Here are a few treatments for this condition which can help you.

Weight Loss– Excess bodyweight puts more stress on the knee and contribute to cartilage degeneration. In obese individuals, excessive fat cells can negative affect the body’s making of insulin which can lead to long lasting inflammation in the body, including the knee joints. Studies show that reducing bodyweight can decrease pain from this knee condition.  Start off with a small goal of losing 5 to 10 pounds and then keep going.  Even small amounts of weight loss can make a big difference in your knee.

Non-steroidal anti-inflammatory drugs (NSAIDS)– Can be over the counter or prescribed by physician. Can be in tablet or topical cream forms. Naproxen, Diclofenac, and Ibuprofen are examples.  Always consult with your physician before starting to take any medication.

Knee braces/Assistive devices for ambulation– Unloader braces or Off loader braces can take pressure off the bones of the knee.  They can reduce knee pain and inflammation to improve function. Walking aids like canes and walkers help to do the same.

Physical Therapy and Exercise– General exercise to help reduce excessive bodyweight and improve or maintain good, general health as long as it is pain free at affected knee. Physical Therapy intervention can include aerobic exercise, flexibility exercises, range of motion exercises, joint mobilizations, soft tissue mobilizations, strengthening exercises, and patient education.  Modalities like moist heat, ice packs, electrical stimulation can also decrease pain and inflammation as needed.

Image of the 4 stages of osteoarthritis in the knee

Stages of Knee Osteoarthritis

Injection Treatments by Physician

Your physician may also treat you with injections.  Injections vary depending on your condition and your physician.  Here are some types of injections.

Cortisone Injection– anti-inflammatory medication

Viscosupplementation– a gel containing Hyaluronic acid is injected into the injured Knee to manage inflammation and lubricate the knee joint. Durolane, Synvisc, and Gel-One are types of hyaluronic gel injections.

Platelet Rich Plasma Injection (PRP)– plasma from the individual with Bone on Bone in the Knee/ Knee Osteoarthritis is taken from their own blood and are injected. The platelets in the plasma contain substances that reduce chronic inflammation in the joint tissue. Research has found that PRP injections administered together with Hyaluronic acid injections are very effective in managing pain/inflammation in a Bone on Bone Knee with cartilage loss.

X-ray of human knee showing syringe giving an injection. JOI Rehab

Injections are a treatment option to lesson symptoms of Bone on Bone in the knee.

Surgical Treatment 

If the conservative treatment of your knee fails, your physician may recommend surgery.

Knee Arthroplasty or Knee Joint Replacement– surgical procedure which involves cutting and removal of the worn out, severely damaged knee joint and implanting a new knee joint made of artificial materials like titanium and plastic. The goal of this surgery is to relieve Bone on Bone in the Knee/Osteoarthritis/Degenerative Joint Disease pain and to restore function of the affected knee. Physical therapy is often needed after surgery to address post op knee impairments like pain, edema, joint mobility deficits, range of motion deficits, scar tissue mobility deficits, decreased ambulation/walking ability, decreased strength, and decreased daily living activity capacity for sitting, standing, walking, transfers, driving, squatting, stair/step/curb ambulation, and doing household chores.

We hope that this article can help you and your knee pain.  JOI and JOI Rehab are here to assist you in any way possible.  If you have questions, please give us a call.

Written By: Ron Salazar, MPT

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Please watch this video from The Jacksonville Orthopaedic Institute on Why Knee Pain Can’t Wait!

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