Exploring Knee Osteoarthritis: Stages, Medial Compartmental OA, and the Mystery of Cracking Knees

Exploring Knee Osteoarthritis. Osteoarthritis (OA) is a degenerative joint condition that is characterized by the gradual breakdown of cartilage, which serves as a cushion between the bones in a joint. Among the various joints that OA can affect, the knee is one of the most commonly impacted, leading to pain, stiffness, and reduced mobility for many individuals.

Exploring Knee Osteoarthritis

Knee osteoarthritis manifests through a range of symptoms, but one peculiar and often overlooked sign is the sound of cracking or popping knees. This phenomenon, medically referred to as crepitus, is not exclusive to OA but can be an early indicator of the disease in certain cases. Crepitus may occur when the knee is in motion and is sometimes accompanied by a grinding sensation.

A subset of knee osteoarthritis is Medial Compartmental Osteoarthritis (MCOA), which specifically affects the inner part of the knee. The knee joint is divided into three compartments: the medial compartment (inside), lateral compartment (outside), and patellofemoral compartment (front). MCOA is characterized by the wearing away of cartilage and degeneration in the medial compartment, which can lead to localized pain and a unique set of challenges. How Movement Patterns Influence Osteoarthritis

In this exploration, we delve into understanding the intricacies of knee osteoarthritis, with a focus on the stages of the condition, the specifics of medial compartmental osteoarthritis, and the mysterious occurrence of cracking knees.

Stages of Knee Osteoarthritis

Exploring Knee Osteoarthritis: Stages, Medial Compartmental OA, and the Mystery of Cracking Knees

Overview of the Stages of Knee OA

Knee osteoarthritis (OA) is a degenerative condition that can progress through various stages, each characterized by a distinct set of symptoms and structural changes within the knee joint. Understanding these stages can provide insights into the management and potential interventions needed at each phase.

Early Stages (I & II)

Description of Symptoms: In the initial stages of knee OA, individuals may experience subtle signs that are easy to overlook. Symptoms might include minor pain that occurs after extensive activity, a mild sense of discomfort in the knees upon waking up, or occasional cracking sounds emanating from the knee joint. The pain is usually sporadic and does not significantly disrupt daily activities.

Explanation of Minor Cartilage Wear and Irregularities: At this point, the knee joint may show early signs of wear, with the cartilage exhibiting minor irregularities. However, the joint space, indicating the gap between the bones, usually remains normal, indicating that the bones are yet to undergo substantial damage.

Moderate Stage (III)

Introduction to More Significant Pain: Progressing to the moderate stage, individuals may start to notice an increase in the intensity and frequency of symptoms. Knee pain becomes more common and may occur during everyday activities like walking or squatting. The knee may also exhibit swelling, and the cracking sounds may become more frequent.

Examination of Cartilage Damage and Onset of Bone Spurs: During this stage, there is observable damage to the cartilage, and the joint space may appear reduced. Additionally, bone spurs, or small bony projections, may start forming at the edges of the bones, contributing to the discomfort and stiffness experienced by individuals.

Severe Stage (IV)

Description of Severe Pain: In the severe stage of knee OA, individuals often experience considerable pain that can hinder daily activities. The knee may be persistently inflamed, and movement may be severely restricted, making tasks like walking or standing up from a seated position challenging.

Analysis of Extensive Cartilage Loss and Bone Damage: At this advanced stage, the cartilage within the knee joint may have worn away substantially, causing the bones to rub against each other directly. Bone spurs may have grown larger, and the overall structure of the knee joint may appear altered due to the extensive damage.

Medial Compartmental Osteoarthritis

Explanation of Knee Compartments and Introduction to the Medial Compartment

The knee, one of the largest and most complex joints in the body, can be visualized as having three compartments or sections. These compartments are

  • The medial compartment (inside part of the knee),
  • The lateral compartment (outside part), and
  • The patellofemoral compartment (where the kneecap meets the thigh bone)

Each compartment is pivotal for smooth knee movement and is lined with a cushioning material called cartilage.

The medial compartment is of particular interest because it is frequently affected by osteoarthritis. This area of the knee bears a significant portion of the body’s weight, making it susceptible to wear and tear.

Definition and Specifics of Medial Compartmental OA

Medial compartmental osteoarthritis (OA) refers to the condition where the cartilage in the medial compartment of the knee starts to wear down over time. As the cartilage deteriorates, the bones may rub against each other, leading to pain, swelling, and limited movement in the knee. This specific form of OA is characterized by its location in the inner part of the knee joint.

The Mystery of Cracking Knees

Exploration of the Phenomenon of Knee Cracking

The sound of cracking knees is a familiar experience for many. Whether it occurs while standing up after sitting for a long time or during a workout, this peculiar sound can be both intriguing and concerning. But what exactly causes the knees to crack, and is it something to worry about?

Possible Causes and Its Association with OA

Knee cracking, medically referred to as “crepitus”, can be caused by several factors. These include the snapping of tendons or ligaments over the joint, the escape of gases such as nitrogen and oxygen from the synovial fluid within the knee joint, or changes in the joint surfaces. The phenomenon is not exclusive to older adults and can be observed in people of all ages.

There is an ongoing debate among medical professionals regarding the direct association between knee cracking and osteoarthritis (OA). While knee cracking can sometimes be a symptom of OA, especially if accompanied by other symptoms such as pain or swelling, it is not always indicative of the condition.

Analysis of Whether Knee Cracking is a Reliable Early Sign of OA

The relationship between knee cracking and the onset of OA is complex. While some studies have suggested a correlation, it is important to note that knee cracking can occur in the absence of pain or other symptoms of OA. Hence, the mere presence of a cracking sound in the knees is not a definitive or reliable early sign of OA. A comprehensive examination and assessment are necessary to diagnose and determine the underlying cause of knee cracking.

Management and Treatment

Brief Overview of Treatment Options for Knee OA and Medial Compartmental OA

Effective management and treatment of knee osteoarthritis (OA) and medial compartmental OA involve a multi-faceted approach. By incorporating various strategies, individuals can aim to alleviate pain, slow down the progression of the condition, and maintain or enhance mobility and quality of life.

Discussion on Lifestyle Modifications, Physical Therapy, Medications, and Surgical Options

Lifestyle Modifications:

  • Weight Management: Maintaining a healthy weight is crucial as it helps reduce stress on the knee joints (1).
  • Regular Exercise: Engaging in low-impact exercises like swimming, walking, and yoga can improve flexibility and strength around the knees.
  • Diet: A nutritious diet rich in anti-inflammatory foods can support overall health and potentially mitigate symptoms.

Physical Therapy:

  • Strengthening Exercises: Physical therapy often includes exercises that focus on strengthening the muscles around the knee to provide better support and stability.
  • Flexibility Training: Regular stretches can help in maintaining the range of motion of the knee.
  • Pain Management Techniques: Therapists may use techniques such as heat or cold therapy to manage pain and swelling.


  • Pain Relievers: Over-the-counter pain relievers such as acetaminophen or ibuprofen can be helpful in managing pain (2).
  • Topical Treatments: Creams and gels containing anti-inflammatory medications can sometimes provide localized relief (2).
  • Injections: For more severe pain, corticosteroid or hyaluronic acid injections might be considered (3).

Surgical Options:

  • Arthroscopy: This is a minimally invasive procedure where a surgeon can remove damaged cartilage or loose fragments from the knee joint (4).
  • Osteotomy: This procedure involves realigning the bones to redistribute weight and relieve pressure on the damaged area.
  • Total or Partial Knee Replacement: In cases of advanced OA, replacing the damaged parts of the knee with artificial components can be an effective solution.

Choosing SDM for Knee OA

Exploring Knee Osteoarthritis: Stages, Medial Compartmental OA, and the Mystery of Cracking Knees

Structural Diagnosis and Management (SDM) is a specialized manual technique renowned for being one of the best approaches in physiotherapy for addressing knee osteoarthritis. This technique encompasses an array of therapeutic modalities including manipulation, muscle activation, stretching, muscle press pull, strengthening, and joint mobilization. By meticulously combining these elements, SDM offers a comprehensive approach to alleviate pain and enhance function in individuals suffering from knee osteoarthritis. At the Agrani specialized manipulation therapy centre, patients should choose this treatment for its holistic approach that not only aims at symptom relief but also works towards restoring optimal joint function. The centre is distinguished for its expertise in SDM, ensuring that patients receive tailored interventions that target the root cause of their discomfort, paving the way for effective and lasting relief.


This understanding underscores the need for awareness among people of all ages and walks of life. Recognizing early signs can lead to a timely diagnosis and allow individuals to manage the condition proactively, potentially delaying or mitigating the more severe impacts of the disease. The options for managing knee OA are varied, ranging from changes in lifestyle and physical therapy to medications and, in more advanced cases, surgery. The emphasis here is on a comprehensive approach that takes into account the unique needs of each individual.

Yet, our understanding of knee OA is not complete, and there is ample opportunity for further research to deepen our knowledge of this condition and its various manifestations. It’s important to encourage everyone to seek personalized medical advice and consultations. Everyone’s experience with knee OA is different, and understanding one’s own body, symptoms, and risk factors can lead to more effective and tailored care.

In conclusion, by piecing together the relationships between knee cracking, medial compartmental OA, and the stages of knee OA, we move closer to empowering individuals with the knowledge they need to lead healthier, more comfortable lives. By promoting awareness, advocating for early diagnosis, and emphasizing proactive management, we can improve the quality of life for those navigating the complexities of knee OA.


1. Messier, S.P., Gutekunst, D.J., Davis, C. and DeVita, P., 2005. Weight loss reduces knee‐joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis & Rheumatism, 52(7), pp.2026-2032.https://onlinelibrary.wiley.com/doi/abs/10.1002/art.21139

2. Hochberg, M.C., Altman, R.D., April, K.T., Benkhalti, M., Guyatt, G., McGowan, J., Towheed, T., Welch, V., Wells, G. and Tugwell, P., 2012. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis care & research, 64(4), pp.465-474.

3. Bellamy, N., Campbell, J., Welch, V., Gee, T.L., Bourne, R. and Wells, G.A., 2006. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane database of systematic reviews, (2). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005321.pub2/abstract

4. Thorlund, J.B., Juhl, C.B., Roos, E.M. and Lohmander, L.S., 2015. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. bmj, 350.

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