Diagnosis and Management of Left Knee Pain with Edema and Crepitus

Diagnostic Evaluation

• The American Academy of Orthopaedic Surgeons recommends starting with simple radiographs of the knee, including AP, lateral, Merchant/sunrise, and tunnel views, for patients with knee symptoms and physical signs, as they are appropriate for evaluating osteoarthritis and other conditions 1, 2, 3, 4.
• Radiographs are suitable for patients with knee symptoms, such as pain, edema, and crepitus, and physical signs, such as effusion and limited mobility 1, 2.

Imaging Studies

• The American College of Radiology suggests considering MRI of the knee without contrast if radiographs are normal or non-diagnostic, to evaluate meniscal pathology, cartilage lesions, bone marrow edema, and other causes of chronic pain 5, 6.
• MRI can detect cartilage lesions, synovitis, bone marrow edema, and meniscal tears that may not be visible on radiographs 5, 6.

Management and Treatment

• The American Academy of Orthopaedic Surgeons recommends initial management consisting of conservative therapy with exercise, patient education, and analgesia with acetaminophen, with a strength of evidence level not specified 7.
• Acetaminophen (paracetamol) is recommended as the first-line oral analgesic, up to 4 g/day in adults, with appropriate dosing according to weight in pediatric patients if applicable 7.