Richard Cunningham, MD is a prominent knee surgeon treating patients in Vail, Frisco, Aspen, and Denver, CO. He has extensive knowledge to diagnose and treat acute and chronic knee injuries. His care philosophy is founded on a commitment to educate his patients for a better understanding of knee health, conditions and optimal treatments.

Anatomy of the Knee

The knee joint is a complex of precision engineering that handles the largest degrees of load and stress in the human body. The tibia (shin bone) and fibula (little bone in lower leg) join with the femur (thigh bone) at the knee. Both the lower and upper ends of our bones have a layer of cartilage that provides smooth range of motion in our joints. The patella (kneecap) sits over the front of the knee and glides over the front of the femur.

The thigh muscles connecting at the knee joint are the quadriceps muscles and hamstring muscles. The quadriceps muscles at the front of the thigh cause the knee to extend (straighten). The hamstring muscles on the back of the thigh cause the knee to flex (bend). Tendons connect these muscles to their corresponding bones. Knee joint ligaments connect a bone to another bone. Ligaments provide knee stability. The four main ligaments in the knee are:

• ACL – anterior cruciate ligament
• PCL – posterior cruciate ligament
• LCL – lateral (or fibular) collateral ligament
• MCL – medial collateral ligament

The elasticity and strength of each ligament allows for great loads and various motions to be placed across the knee while also providing knee joint stability. This allows us to engage in pivoting, sudden stopping, jumping, and all of the stress of a lifetime of walking, running, standing, sitting, and squatting.

What are Common Causes of Knee Pain?

Knee pain results from one of two potential causes: normal wear and tear over time, or acute injuries.

Some risk factors for knee pain from wear and tear include:

• Age – knee pain is more common in patients over 50
• Body mass – the higher the body weight, the greater the wear on the knee
• Female – a wider pelvis lends itself to some knee malalignment and accelerated wear in the knees
• Poor Diet – eating a lot of processed foods and animal foods high in saturated fat, cholesterol, and refined sugar causes arthritis to accelerate. Try to eat a naturally anti-inflammatory diet rich in whole plant foods
• Remote injury to the knee – traumatic injuries that damage the menisci (shock absorber cartilages) or articular cartilage (coating cartilage) can set the knee up for accelerated wear and early arthritis over time.
• Osteoarthritis – loss of the coating cartilage in the knee causing “bone on bone” resulting in pain and swelling.

Some of the most common causes of acute knee pain include:

• Meniscus Tear– tearing one of the shock absorber cartilages in the knee
• Sprain or tear of ligament – pain, instability and loss of function
• Patellar dislocation – knee cap partial or complete dislocation
• Fracture- fracture involving the femur or tibia of the knee joint.
• Tendinitis – pain resulting from overuse, often involving the patellar tendon
• Bursitis – fluid filled cushioning sac over the front of the knee can become painful when inflamed

Dr. Cunningham has extensive knowledge of the knee to provide a clear and concise diagnosis that will pinpoint the cause of knee pain.

What are Common Knee Pain Symptoms?

Common knee pain symptoms include:

• Grinding or popping sounds or sensations
• Limited range of motion, tightness and stiffness
• Knee instability or sense of the knee ‘giving out”
• Signs of inflammation – swelling, warmth, redness

In addition, a more severe set of symptoms may warrant immediate medical attention. These include:

• An injury event with a pop, pain, and/or immediate swelling
• Inability to bear full weight
• Severe swelling, redness, or warmth around the knee
• Loss of extension and flexion
• Change in gait or limping

No matter the symptoms of knee pain, Dr. Cunningham has the expertise to diagnose and treat the knee such that patients can soon return to an active lifestyle.

How to Diagnose Knee Problems

Dr. Cunningham is able to offer a accurate diagnosis of knee pain utilizing a combination of taking a good history, doing a comprehensive physical examination, and utilizing diagnostic imaging. As for the patient history, it is important to learn how the injury occurred and what the current symptoms are. Dr. Cunningham will perform a detailed exam of your knee to assess for redness, bruising or swelling. He will then assess your ligament stability as well as determine if your pain is located over a meniscus. Examining how the patella tracks is also important.

In addition, diagnostic tools will likely be ordered. This can include:

• X-ray – to view if there is any evidence of arthritis or fracture or loose bodies.
• MRI – to image the soft tissues of the knee, including ligaments, tendons, and muscles.
• CT Scan – provides great detail than an x-ray in the event there is a complex fracture
• Ultrasound – utilized if a blood clot or other vascular disorder is suspected

Once a diagnosis is made, Dr. Cunningham will provide a treatment plan to the patient in order to achieve an optimal outcome.

How to Treat Knee Pain

Treatment of knee pain depends on the diagnosis. Treatment plans are broadly classified as non-surgical or surgical. For chronic wear and tear pain and many types of muscle or tendon injury, a non-surgical treatment plan is recommended. This typically involves:

• Rest, ice and/or heat therapy, elevation, and compression when appropriate
• Activity modification
• Anti-inflammatory and/ or pain medications depending on the condition
• Physical therapy to strengthen the supporting or injured muscles around the knee and to modify muscle imbalances contributing to certain conditions.
• Injection therapies including platelet rich plasma (PRP), corticosteroid, and hyaluronic acid
• Use of various types of knee braces
• Weight loss efforts if indicated
• Eating an anti-inflammatory diet
• Alternative supplements and topical pain relievers

Following certain acute injuries or for certain conditions where non-surgical treatments have not been successful, surgery may be recommended. Dr. Cunningham is a knee expert with specialized training in the knee and over 20years of surgical experience.

Dr. Cunningham is an expert in arthroscopic surgery of the knee. This is a minimally invasive method where a small telescopic camera and small specialized tools are inserted in the knee to repair a great number of different knee injuries. Patients experience much less pain and a quicker recovery following arthroscopic surgery compared to open knee surgery, where a large incision is made and the whole inside of the knee joint is exposed. Some common arthroscopic knee surgeries are reconstruction of ACL tears and meniscus repairs.

Richard Cunningham, MD is a highly regarded knee specialist who utilizes the latest techniques to restore knee function for his patients. If you live in Vail, Frisco, Aspen, or Denver, CO, and are suffering from knee pain, contact Dr. Cunningham and his team today: 970-569-3240.