Knee Pain: Meniscus Tears vs. Arthritis

Rendering of knee

Meniscus tears are one of the most common knee injuries that can happen at any age. These tears have symptoms that are very similar to knee osteoarthritis, such as pain, swelling, and lack of mobility. For older patients with knee pain, it’s important to understand the differences between pain from a meniscus tear and pain from knee osteoarthritis in order to get proper treatment. In this article, we asked our founder, Dr. Robert Dean, to explain these differences and how meniscus tears and knee osteoarthritis are often connected.

Knee Pain: Torn Meniscus or Osteoarthritis?

“In younger individuals, a torn meniscus is most often the result of a sudden twist in the knee during activity,” says Dr. Dean.  “Tears can also happen as the meniscus wears down with age. Most people over the age of 60 have some degree of meniscus tearing, fraying, or degenerative thinning.”

To identify the root cause of knee pain, patients should first think about when the pain started. This, combined with the patient’s age and general activity level can help determine if the pain is due to a torn meniscus or osteoarthritis.

“If knee pain started suddenly, or after rigorous activity such as running or participating in sports, the pain may be the result of a meniscus tear,” says Dean. “But, if the pain has been increasing steadily over time and you can’t pinpoint an exact time or cause, the pain could be the result of arthritis.”

To put everything into layman’s terms, Dr. Dean explains it like this:

  • Meniscus tears and osteoarthritis can be confusing because both conditions affect cartilage in the knee.
  • The meniscus is a tough and rubbery cartilage that absorbs shock in the knee between the shin and thigh bones.
  • When a meniscus tear occurs, patients often feel an immediate sharp pain after the injury.
  • While some meniscus tears can be severe and require surgery, many cases can be treated with rest, ice, compression, and over the counter medications.
  • Knee osteoarthritis is the general term for the disease that wears down hyaline cartilage, which is the hard and slick coating that prevents the bones from grinding against each other. It’s the same cartilage you find at the end of a chicken bone.
  • Hyaline cartilage typically wears down in spots, which Dean describes as “tiny potholes in your chicken bone cartilage”. The medical term for this wearing is Chondromalacia.
  • As knee osteoarthritis worsens and the cartilage wears down more, this can cause a “bone on bone” diagnosis indicating that the cartilage is no longer providing a barrier between the bones, causing them to rub against one another.
  • Once you are diagnosed as bone on bone, this means you have no meniscus left and it cannot be the cause of your pain.
  • However, those with meniscus tears can still develop knee osteoarthritis and it’s important to watch for symptoms over time.

Diagnosing Your Knee Pain

“Whenever knee pain impacts your daily activities, it’s time to see your doctor,” says Dean. “Once you discuss the cause of your pain, your doctor may take X-Rays to properly diagnose the condition and recommend treatment. If for any reason you are told you must have surgery – always seek a second opinion.”

According to Dean, surgery may provide some patients with the relief they need while others can successfully treat the pain without the risks of surgery.

“At AROmotion, our treatment can stop pain from knee osteoarthritis fast and without surgery,” says Dean. “If you or a loved one has been told that your only option is total knee replacement surgery, I encourage you to seek another opinion first. At AROmotion, we offer free consultations where we can determine if you are a candidate for our minimally-invasive treatment as an alternative to surgery.”

If you are living with chronic knee, hip, or shoulder pain that’s preventing you from daily tasks and activities, you can complete the form below to request your free consultation with Dr. Dean to see if you are a candidate for AROmotion, which has helped more than 2,000 patients stop their joint pain fast without surgery.

Bone On Bone Knee Pain: Know Your Options

X-Ray of Bone On Bone Knee

One of the most common conditions that we treat at AROmotion in bone on bone knee pain. When patients are first diagnosed with this condition, many feel overwhelmed or unsure of the best path forward to manage the pain and prevent further joint damage. And, while many are told that total joint replacement surgery is their only option for relief, there are alternatives that are important to explore before making the commitment to invasive surgery. In this article, we talk with AROmotion’s founder Dr. Robert Dean to learn all about bone on bone knee pain, what to expect from total joint replacement surgery, and what options patients have to return to pain-free motion without surgery.

We hear the term “bone on bone” a lot when it comes to knee pain, but what exactly does this diagnosis mean?

This term is used to describe severe osteoarthritis in the joint, which is caused by a reduction in cartilage that results in inflammation. Most people are familiar with the term cartilage, but it’s important to understand what it is and what it does. Cartilage is a smooth, flexible, and resilient tissue that protects the ends of your bones at the joints – including your knees. Think of it as protective padding to help keep your knees moving properly! Osteoarthritis happens when this cartilage starts to wear down over time, eventually removing the padding between bones causing them to rub on one another. If not treated and managed properly, this can become very painful and drastically limit movement – which of course can impact the quality of your day-to-day life.

What can patients who receive a bone on bone knee diagnosis do to help manage the pain?

I always recommend that patients with this diagnosis work with their doctors to develop the best treatment plan so the condition does not continue to worsen. Remember, you don’t always feel the progression of osteoarthritis! That said, there are things that patients can do to help manage the pain such as managing their weight, as carrying extra weight can cause strain on your knee joints, following a steady low-impact exercise routine to strengthen and condition the impacted joint, and using over the counter medications and supplements to help reduce pain and inflammation.

What should patients do if they are told that total joint replacement surgery is their best or only option?

Patients should always get a second opinion before committing to any type of invasive surgery. There are risks and complications involved that, if possible, should be avoided if alternate treatments are available. Remember, total joint replacement surgery involves undergoing anesthesia, hospital stays, long recover times, and the risks associated with surgical implants. And total joint replacement surgery is not always a long-term solution. For patients that decide to proceed with total joint replacement surgery, it’s very important to know what questions to ask your surgeon, which I wrote about in a recent blog post.

Where can patients go for a second opinion?

While you can always seek out other reputable orthopedic specialists, patients should also look into non-surgical options to see if these will work. At AROmotion, we have treated many patients with a bone on bone knee pain diagnosis, and the first step we always take is to go through an in-depth free consultation to determine if the patient is a good candidate for our procedure. We have a very high success rate because of our careful screening process through these consultations, and if I feel that a patient would be better treated through surgery versus our procedure, I will let them know and give them that assurance they need.

For many patients, a bone on bone knee pain diagnosis feels pretty scary. What’s your advice for these patients?

I always tell my patients that aging is a gift, and we must approach it with gratitude but also with the understanding that we’ll have to make some lifestyle changes to stay healthy. This includes managing joint pain that comes with aging. Simple things like what we eat, getting daily movement that’s low-impact, and prioritizing self-care can go a long way to keeping us healthy and pain-free as we age. At the same time, if the pain is getting in the way of your day-to-day life, you should always be open and honest with your doctors so you can treat the pain before it worsens. Remember, attitude goes a long way when it comes to our health and wellness!

If you or a loved one has been diagnosed with bone on bone knee pain, AROmotion may be able to help you avoid invasive surgery. Contact us today to schedule your free consultation with Dr. Dean to see if you are a candidate for our non-surgical treatment that has helped more than 1,800 patients stop their joint pain fast.

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What Should You Expect After Having A Total Knee Replacement Surgery?

Young woman running outside

What Should You Expect After Having A Total Knee Replacement Surgery?

Total knee replacement is a hospital-based surgery. Essentially, what the surgeons are doing is opening up your whole joint (requiring about a ten inch incision), flipping over your kneecap, and cutting out both ends of the bone. This is where the hyaline cartilage has been compromised from chondromalacia, which are little worn out or divot potholes. Think of cavities in a tooth enamel. The nerve endings exposed from the cavity hurt!

Knee replacement surgery is similar to a dental cap or crown procedure, where the surgeon is cuts and grinds down the ends of your bones to create a “post” and then fasten the titanium implant like a cap or crown. Then they flip the knee back over, staple the incision, and voila! Your surgery is done.

It’s not quite that simple – obviously that is a summary, as this takes a few hours and requires a certain level of expertise by the surgeon when it comes to choosing the right implant, etc. Of course, this is done in a hospital because this is a large surgery. There are risks associated with anesthesia, infection, and more. After the surgery, you have to undergo rehab therapy. There’s incisional healing; the wound has to heal. The tissue inside the joint that has been cut and replaced has to heal. The muscles and ligaments will need to heal, and time is depending on how fit or how weak you were prior to having this knee replacement.

The goal of the surgery is to replace the hinge of the joint, by removing the ends of the bone where the nerve endings have been compromised. Everything else that might be causing you pain (the weakness in your quadricep muscles or your hamstrings or the different muscles that help you move your knee around) isn’t just going to magically disappear. You have to work hard at rehabilitating and strengthening those muscles. And it takes hard work and a lot of time to make sure that the implant bends close to 90 degrees and straightens completely. Most of the orthopedic studies that look at function and pain improvement after replacement surgery will wait six months to determine what someone’s new baseline pain and function is going to be. Sadly, a significant percentage of people who have this surgery, even if everything goes perfectly, end up with chronic pain that requires interventional and non-interventional pain management for the life of that joint.

But a total knee replacement isn’t your only option. If there is pain and you are walking with no or minimal assistance then it is likely that your joint is still in good mechanical condition. Chondromalacia – the thinning of the hard cartilage protecting the bones in the knee joint. The unprotected sensory nerve endings are the reason for your knee pain. When this hard cartilage wears down, the nerve endings in your bone are exposed, and it hurts when you walk or put pressure on them. This pain fuels the arthritis inflammation by releasing inflammatory proteins, sort of how heat fuels a hurricane. Without this heat the hurricane dissipates. This is why there are not hurricanes in the winter months. Because your knee is an encapsulated joint (a closed space), the more inflamed the joint gets, the more pressure is put inside of the joint, further compressing the sensory nerve endings causing more pain, which leads to more inflammation. It’s a vicious cycle. However, cutting out the bones to remove these nerve endings entirely is an extreme solution. If you can find a way to turn off the pain, you can stop the osteoarthritis cycle and heal the joint.

That’s what AROmotion is – a FDA approved microprocedure that combines the technologies of radiofrequency neurotomy, orthobiologics, and physical reconditioning to stop the pain, promote healing, and restore your motion. Our minimally invasive procedures can help you avoid a large joint replacement surgery if you are a candidate. To learn more about our treatments and what we do here at AROmotion, and to discover whether you qualify for our procedures, contact us to schedule a consultation or visit

Why Do People Have Knee Replacement Surgery?

Man running with knee pain

The first and most important thing to understand is that when possible a physician’s goal should always be to preserve and heal your natural joint. Knee replacement surgery is not able to accomplish that, and therefore should always be considered as a last resort (for reasons that we’ll explain later in this blog post).

The main reason someone has knee replacement surgery in the U.S. is to solve knee pain. Typically, knee pain is caused by something called “chondromalacia”. Chondromalacia is a medical diagnosis term used to describe the erosion of the hard cartilage that coats the surface of the bones making up the joint. This cartilage, which is made out of the same material you see on the end of a chicken bone, serves to protect the nerve endings and blood vessels that live inside of the bone underneath this hard, “Teflon like” coating.

When you have chondromalacia, it indicates that you have basically worn out parts of this hard cartilage, and the nerve endings are less protected or even exposed. Using your joint puts pressure on these nerve endings and results in pain, which in turn causes swelling and inflammation inside of the joint. This creates tightness and more pressure, causing even more pain….and this cycle or feedback loop is what we commonly refer to as “osteoarthritis”. Your knee joint is an encapsulated joint, so it actually becomes more and more tense as swelling and inflammation increases, and that puts more pressure on the nerve endings as well. This is a cycle that keeps going on and on for months and years, and pain is the driver – it’s not just a symptom, it is actually the underlying cause perpetuating the destructive “arthritis” inside of your joint.

Treatments for knee pain have included anti-inflammatory medication like Advil, Motrin, Aleve, Cortisone steroid shots, and maybe even hyaluronic acid viscosupplementation, but these solutions are band aids designed to treat the symptoms rather than break the underlying cycle of pain and inflammation.

The orthopedic solution to this problem is to remove and replace the joint. Total knee replacement surgery is essentially cutting out both ends of the bone and replacing or “capping” them with a titanium and Teflon hinge. That sounds like a really big jump, and it’s something that happens a lot in medicine. However, it’s really the only surgical option to treat it. Think about it…if you have a painful cavity in your tooth, you will likely be offered a filling or maybe a root canal. Grinding the tooth down to a post and placing a cap or crown is only used as a last resort if the tooth is beyond repair. Well, that’s essentially what joint replacement is – grinding the ends off of the bones, thus removing the painful nerve endings and creating a post, then gluing an implant like a dental cap or crown to reconstruct the joint.

Here’s why that is the only available surgical option: as you wear out little potholes in the hard and protective hyaline cartilage (the areas of thin cartilage) and put pressure on those nerve endings beneath, it hurts! Surgically, we have two tools we can use to resolve joint pain; 1) arthroscopy and 2) total joint replacement. An arthroscope is a cutting/grinding instrument. If you have a symptomatic torn meniscus, and the meniscus tear is flapping around and getting stuck like a rock in your shoe, it hurts. An orthopedic surgeon will use arthroscopy to trim away the tear. The way surgeons repair a symptomatic meniscus tear is by cutting out the piece that’s flip-flopping and getting stuck. If you have potholes, or worn out areas of the hard hyaline cartilage coating the surfaces of the bone in the joint, an arthroscopy won’t work. It’s a cutting/grinding instrument that cannot address the potholes. So there’s nothing you can do arthroscopically to treat chondromalacia, or potholes in this hard Teflon cartilage.

However, when total joint replacement is performed, the whole joint is cut out, removing the ends where the hyaline cartilage is and where the nerve endings live. So if your knee hurts, the only solution to fix your “knee pain”, in an orthopedic surgeon’s office, is to remove those nerve endings surgically and then place a new implant or “cap” on top so your joint can function.

Total joint replacement is a drastic solution, a major surgery to treat knee pain, and that’s why good orthopedic surgeons always attempt all other less invasive options first. However, once you have that surgery, your knee anatomy will be permanently changed. You’re going to have a mechanical implant sitting on top of the post created by grinding down the ends of the bone for a knee joint. If all goes well and you follow the restrictions published by the implant manufacturer, it should last 10-15 years. Remember, per the implant manufacturer, there are many restrictions on activities and how you can function with that joint: twisting, torquing, tennis (you’re not supposed to play tennis if you have knee replacement surgery) – and more!

There are other nonsurgical options, though. If for the most part you are suffering from knee pain and stiffness, then it is likely that your joint is mechanically functioning and chondromalacia is the only thing causing your knee pain. When that is the case, a total joint replacement is unnecessary; the good news is that you don’t have to cut out your joint and replace it with an implant! AROmotion is an FDA approved microprocedure that breaks the cycle of osteoarthritis by “turning off” the nerve pain. This helps normalize the environment inside of the joint capsule so you can begin healing.

When you come in for a consultation, you will see one of our Board Certified Physical Medical Doctors who will discuss this FDA approved microprocedure designed to mitigate the pain and break the cycle of arthritis. They will also review the different types of orthobiologics that can be used to augment this natural healing process.

After the AROmotion microprocedure, one of our Board Certified Physical Medicine and Rehabilitation Doctors will prescribe and supervise your customized reconditioning program, so that the muscles and ligaments which move the joint return to proper form and function.

Contact us today for a free consultation or visit our website, , to learn more!