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Knee Pain Is the Malady—Not Osteoarthritis

Nortin M. Hadler, MD
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Requests for Reprints: Nortin M. Hadler, MD, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7280.

Ann Intern Med. 1992;116(7):598-599. doi:10.7326/0003-4819-116-7-598
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Osteoarthritis is a well-defined pathoanatomic entity readily demonstrable by modern imaging techniques. For a century, the pathology that is this disease has been ingrained in the mind of every medical student: inexorable progression from subtle biochemical alterations in articular cartilage through cartilage loss and reactive bone formation to the end-stage of eburnated bone and exuberant osteophytosis. We all shudder at the image of the patient suffering with end-stage osteoarthritis, bedeviled by a deformed, unstable, incapacitating, and painful knee. What physician can listen to the complaint of knee pain without conjuring up the image of such an outcome? What physician can


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