Advanced Clinical Management of Knee Pathology in Irvine

At Pacific Pain Clinic, situated in the heart of Irvine, Orange County, we employ a rigorous, scientifically grounded approach to the diagnosis and management of complex knee pain. Under the expert guidance of Dr. Cyrus Sedaghat, our clinical protocols move beyond superficial symptom management to address the underlying biomechanical and physiological drivers of joint dysfunction. We recognize that the knee is a complex hinge joint subject to immense axial loading and rotational forces, making it susceptible to a wide array of intra-articular and extra-articular pathologies. Our practice is dedicated to joint preservation, utilizing state-of-the-art diagnostic imaging and targeted interventional therapies to restore homeostasis to the knee complex. By distinguishing between degenerative, traumatic, and inflammatory etiologies, we customize treatment plans that may include regenerative medicine, neuro-ablative techniques, or viscosupplementation, providing patients with viable alternatives to total knee arthroplasty.

Osteoarthritis: Pathophysiology and Joint Preservation

Osteoarthritis (OA) of the knee is not merely a "wear and tear" phenomenon but a metabolically active, chronic disease characterized by the progressive degradation of the entire joint organ, including the articular cartilage, subchondral bone, synovium, and ligaments. The pathological process involves a disruption in the equilibrium between the synthesis and degradation of the extracellular matrix, specifically affecting type II collagen and proteoglycans. As the cartilage erodes, the subchondral bone undergoes remodeling, leading to sclerosis and the formation of osteophytes (bone spurs) which serve to increase the joint surface area in an attempt to stabilize the unstable joint. This cascade triggers the release of pro-inflammatory cytokines such as Interleukin-1 (IL-1) and Tumor Necrosis Factor-alpha (TNF-α) within the synovial fluid, resulting in synovitis, joint effusion, and significant nociceptive signaling.

• Interventional Strategy: At Pacific Pain Clinic, we combat this degenerative process through a tiered approach. We utilize Viscosupplementation, injecting high-molecular-weight Hyaluronic Acid to mimic the elastoviscous properties of natural synovial fluid, thereby improving shock absorption and lubrication. For patients with Kellgren-Lawrence Grade 3 or 4 OA who suffer from chronic, recalcitrant pain, Dr. Sedaghat may perform Genicular Nerve Ablation. This advanced procedure uses radiofrequency energy to thermally coagulate the sensory nerve branches seeking to innervate the knee capsule, effectively disrupting pain transmission to the brain without compromising the motor function of the leg

Meniscus Injury: Vascularity and Healing Dynamics

The menisci are critical fibrocartilaginous structures that function to deepen the tibial plateau, distribute compressive loads, and contribute to secondary joint stability. The management of meniscal tears is highly dependent on the vascular anatomy of the injured tissue. The "Red-Red" zone, located at the extreme periphery of the meniscus, is serviced by the perimeniscal capillary plexus and possesses a robust capacity for intrinsic repair. Conversely, the "White-White" zone, encompassing the inner two-thirds of the meniscus, is avascular and relies solely on synovial diffusion for nutrition, making spontaneous healing unlikely. At our Irvine facility, we meticulously differentiate between acute, traumatic tears—often seen in younger athletes involving longitudinal or radial patterns—and chronic degenerative tears associated with aging and osteoarthritis.

• Conservative and Regenerative Management: Rather than immediately defaulting to partial meniscectomy, which can accelerate the progression of osteoarthritis by increasing contact stress on the articular cartilage, we focus on preservation. We employ targeted rehabilitation to strengthen the quadriceps and hamstring muscle groups to offload the compartment. Furthermore, biologic therapies such as Platelet-Rich Plasma (PRP) can be utilized to introduce supraphysiological concentrations of autologous growth factors into the joint, potentially stimulating a reparative response in vascularized tears and modulating the inflammatory environment in degenerative cases.

Ligamentous Instability (ACL, MCL) and Proprioceptive Deficits

Ligament injuries jeopardize the static stability of the knee and often result in significant functional impairment. The Anterior Cruciate Ligament (ACL) is the primary restraint to anterior translation of the tibia, while the Medial Collateral Ligament (MCL) resists valgus forces. Injury to these structures disrupts the mechanoreceptors located within the ligament fibers, leading to a loss of proprioception—the body's ability to sense joint position in space. This proprioceptive deficit increases the risk of re-injury and accelerates secondary cartilage damage. While Grade III (complete) ruptures of the ACL often necessitate surgical reconstruction in active individuals, Grade I and II sprains (partial tears) present a unique opportunity for non-surgical healing.

• Rehabilitation and Stabilization: Our treatment protocols for ligament injuries prioritize the restoration of neuro-muscular control. By utilizing bracing to protect the healing collagen fibers and implementing specific eccentric strengthening exercises, we facilitate the alignment of new collagen deposition along the lines of stress. In cases of chronic ligament laxity, Prolotherapy or regenerative injections may be considered to induce a controlled inflammatory response that stimulates fibroblast proliferation and collagen synthesis, thereby tightening the lax ligament and restoring joint tensegrity.

Patellofemoral Pain Syndrome and Biomechanical Alignment

Patellofemoral Pain Syndrome (PFPS) is a prevalent condition characterized by retropatellar or peripatellar pain resulting from physical and biomechanical changes in the patellofemoral joint. The etiology is often multifactorial, involving abnormal tracking of the patella within the femoral trochlear groove. This maltracking is frequently driven by an imbalance between the dynamic stabilizers of the patella—specifically, weakness or delayed activation of the vastus medialis obliquus (VMO) relative to the vastus lateralis—and tightness in the lateral retinaculum or iliotibial band (ITB). This imbalance increases contact pressures on the lateral facet of the patella, leading to chondromalacia patella, a softening and fissuring of the articular cartilage.

• Comprehensive Correction: Effective management requires looking up and down the kinetic chain.
• ‍Dr. Cyrus Sedaghat evaluates patients for contributing factors such as femoral anteversion, increased Q-angle, and foot hyperpronation. Treatment extends beyond the knee to include strengthening of the hip abductors and external rotators to control femoral internal rotation, alongside orthotic management to correct foot mechanics. This holistic approach ensures that the root cause of the maltracking is addressed, rather than simply masking the symptoms.

Bursitis and Tendinopathy: Extra-Articular Inflammation

Pain localized to the anterior or medial aspects of the knee is often attributable to inflammation of the bursae or tendons rather than the joint itself. Prepatellar bursitis, often caused by repetitive kneeling, and Pes Anserine bursitis, located at the proximal medial tibia where the sartorius, gracilis, and semitendinosus tendons insert, can mimic intra-articular pathology. Similarly, patellar tendinopathy ("Jumper’s Knee") involves micro-tearing and degenerative changes within the tendon matrix due to chronic eccentric overload. Unlike acute inflammation, chronic tendinopathy is characterized by angiofibroblastic hyperplasia—a failed healing response.

• Precise Delivery of Therapeutics: Accurate diagnosis is paramount, as the treatment for tendinopathy differs significantly from arthritis. We utilize high-resolution ultrasound guidance to visualize the pathology in real-time. This allows Dr. Sedaghat to perform peritendinous or intrabursal injections with sub-millimeter precision, delivering corticosteroids or regenerative solutions exactly where needed while avoiding direct injection into the load-bearing tendon, which could otherwise weaken the structure and predispose it to rupture.

Advanced Interventional Treatments at Pacific Pain Clinic

For patients in Irvine and the greater Orange County area, Dr. Cyrus Sedaghat provides a suite of advanced non-surgical options designed to delay or eliminate the need for surgery:

Ultrasound-Guided Injections Real-time imaging ensures 100% accuracy in delivering therapeutics to the joint space, bursa, or tendon sheath, maximizing efficacy and minimizing procedural pain.

Regenerative Medicine (PRP) For suitable candidates, we utilize autologous Platelet-Rich Plasma (PRP) to introduce high concentrations of growth factors (PDGF, TGF-beta) directly to the site of injury, promoting the natural healing of cartilage and ligamentous tissue.

Genicular Nerve Blocks and RF Ablation For chronic, recalcitrant knee pain, we target the superior medial, superior lateral, and inferior medial genicular nerves. A diagnostic nerve block is first performed; if successful, Radiofrequency Ablation (RFA) can provide long-term pain relief by thermally deactivating the sensory nerve branches.