Bone on Bone Knee Pain

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What is bone on bone knee pain?

Our knee is a hinged joint with a hard “teflon”-like coating that protects the bone as it slides back and forth. This hard, slick coating is called hyaline cartilage (it is different from the meniscus, which is a leathery pad that acts as an extra layer of cushion for activities such as running and jumping). The hyaline cartilage acts as a slippery tissue that allows the bones to glide smoothly over each other and helps absorb the shock placed on the joints with movement. When the cartilage wears away, that protection between the joints is lost, which is what we refer to as “bone on bone”. As the bones rub together, friction occurs, which interferes with the knee joint’s ability to move freely, wears down the surface of the bones, alters the bone’s shape, and causes bone spurs to form. Bone on bone arthritis can also cause tiny pieces of bone and cartilage to break away and float within the joint space, causing further damage and pain.


Bone on bone knee pain symptoms worsen gradually as the cartilage in the knee wears down. Besides knee pain, which can be quite severe, other symptoms include:

  • Stiffness, often worse after rest or sitting
  • Grating or crunching sensation and sound when moving the knee
  • Decreased flexibility and range of motion
  • Inability to bend the knee
  • Bone spurs, which form on the edges of the bones as our body’s natural response to degenerative changes as it rebuilds more bone to make up for the loss; this extra bone results in bony growths than can cause pain and sometimes be felt outside of the knee.

Why do I have bone on bone knee pain?

Bone on bone knee pain is the direct result of severe degenerative changes to the knee joint from osteoarthritis. When the cartilage in your knee joint has worn away, and the joint space has narrowed enough to leave the bones exposed, they will rub against each other, causing extreme pain and stiffness. Osteoarthritis has no singular cause, but there are several risk factors that can increase your chances of developing it.


Aging is the most common cause of bone on bone knee arthritis. Approximately 50 percent of people over 65 worldwide show some evidence of osteoarthritis in at least one joint. This is mostly due to the wearing down of knee cartilage over the years.

Other risk factors that can lead to “bone on bone” knee arthritis include:

  • Being overweight
  • Previous knee injury
  • Improperly formed joints
  • Medical conditions affecting the joints, such as dysplasia
  • Repetitive stress on the knee joint from certain sports and occupations
  • Family history of osteoarthritis


When the cartilage in the knee has worn away to the point of causing bone on bone knee pain, your doctor will be able to feel it and even hear it when manipulating your knee. Diagnosis will involve moving your knee to check range of motion and signs of degeneration and injury. Your doctor will also ask you questions about your medical history. This can include details of your symptoms and how long you’ve been experiencing them. Your doctor will also want to know whether or not you have a family history of osteoarthritis.

Imaging tests will be used to confirm a diagnosis of bone on bone osteoarthritis. These may include:

  • X-rays

    These images are able to clearly show damage in the bones, including bone spurs, and narrowing of the joint space associated with osteoarthritis.

  • Magnetic resonance imaging (MRI)

    This type of scan produces 3-D images that show the bones and soft tissues in great detail, enabling the doctor to diagnose damage to the soft tissues.

  • Blood tests

    Your doctor may order blood tests to help rule out the presence of infection and other types of arthritis.


Bone on bone knee pain treatments are the same as treatments for osteoarthritis of the knee.

AROmotion is a cutting-edge solution for pain caused by joint injuries and degenerative disorders. Our unique, minimally invasive treatment procedures are needle-based, meaning that there is no incision and no surgical recovery period. AROmotion preserves your original knee joint, promotes natural healing, and restores your mobility faster than other treatments!

Other treatment options include:

  • Weight loss

    This minimizes the load placed on your knee and other joints, which can relieve pain and help to lessen future damage on the joints. If you are overweight, losing just a few pounds can result in significant improvement of pain.

  • Pain medication

    Nonsteroidal anti-inflammatories (NSAIDs) and other pain relievers can reduce pain and inflammation.

  • Physical therapy

    Specific exercises can help improve flexibility and strength, as well as improve your range of motion.

  • Cortisone steroid injections

    A combination of cortisone and a numbing agent is injected directly into the knee for quick relief of pain and inflammation.

  • Hyaluronic acid injections

    These injections use a fluid similar to the thick fluid found in our joints that provide lubrication so the joint can move better.

  • Radiofrequency ablation

    Also known as denervation, this is a method of temporarily turning off or blocking the nerves from sending pain signals while other therapies have time to take effect.

  • PRP injections

    PRP, or platelet-rich plasma therapy, injects proteins called growth factors, which help support healing in injured areas.

  • Stem cell injections

    Physician directed stem cell therapy uses very powerful young cells to stimulate the patient’s own native repair mechanisms to regenerate new cartilage.

  • Surgery

    There are different types of surgical procedures to treat severe osteoarthritis in the knee: knee osteotomy (which realigns the bones in the knee), joint replacement or minimally invasive arthroscopic surgery. The last surgery is performed through a small incision using a thin, flexible camera. The type of surgery you have will depend on the extent of your damage and other factors, such as age and overall state of health.

If bone on bone knee pain is preventing you from moving freely, contact the skilled team at Advanced Regenerative Orthopedics to find out how we can help you get back to a pain-free life!