Knee Pain And The Injured Knee

The knee joint is the largest in the human body. It supports nearly the entire weight of the body. There are many problems associated with the knee, and these can significantly impact one’s quality of life by limiting mobility.

Knee pain is relatively common, and it presents itself very often in clinical practice. This is more so because any number of the components that make up the knee joint can become damaged by sporting activities, from overuse, and wear and tear of the aging process.

Knee pain can occur medially or laterally, and it can affect one knee(unilateral) or both knees(bilateral). Nevertheless, the location of your knee pain can provide clues to the clinician as to what might be wrong and as such, help to arrive at a definitive diagnosis.

Most common causes of knee pain

Anterior (Front) of knee

• Jumper’s Knee
• Patellofemoral Pain Syndrome

Posterior (Back) of Knee

• Baker’s Cyst
• Biceps Femoris Tendonitis

Lateral (Outside) of Knee

• Lateral collateral Ligament (LCL) Injury
• Lateral Meniscus Tear
• Iliotibial Band Syndrome

Anterior knee pain

What is causing pain in the front of my Knee?
Several conditions can cause pain in the front of the knee. These include maltracking or dislocated patella, muscle imbalances, or tight muscles. However, in most instances, anterior knee pain arises from problems with your patella(kneecap) and patella tendon.

• Patellofemoral Pain Syndrome (PFPS)-This condition is also referred to as Runner’s knee or Inferior knee pain. It is used to describe pain located in front of your kneecap. It usually occurs when your kneecap comes into contact and rubs against your femur (thigh bone). It is very common in Runners, and it is an overuse injury as well.
• Jumpers Knee- Also known as Patellar tendonitis is a very common disorder located on the front of the knee, just below the kneecap. This type of injury results from the patellar tendon being overstretched and overused resulting in painful inflammation, stiffness, and crepitus if not treated. Various braces and Patellar straps are often prescribed to alleviate the pain and swelling associated with this condition.

Posterior knee pain

This is pain located behind the kneecap(popliteal). Knee pain occurs less often in this compartment of the knee.

• Biceps Femoris Tendonitis (Hamstring Tendonitis) is an overuse injury located at the back of the knee and is thought to be the most common.
• Bakers Cyst also referred to as a Popliteal cyst is observed as a swollen bulge at the back of the knee. It usually occurs because of arthritic changes or cartilage tear.
• Other causes of posterior knee pain include:
  • Gastrocnemius tendonitis (calf muscle swelling)
  • Tennis Leg

Lateral knee pain

There are three (3) main causes of lateral knee pain. Lateral knee pain in essence refers to soreness that occurs on the outer part of your knee closest to your hands.

Lateral Collateral Ligament (LCL): Injury is one of the most common causes of pain on the outside of the knee. A sudden impact or trauma to the inside of your knee is the main cause. This may occur during a tackle or twisting motion that puts pressure on the outside of your knee and causes the LCL to stretch or tear.

Iliotibial Band Syndrome (ITBS):  is a quite common knee injury in long-distance runners and cyclists, which causes pain in the outer knee. Generally, this knee pain and inflammation build up over time and is most prevalent when participating in irritating activities.

Lateral Meniscus Tear: this is another injury that results from a sudden force or twist of the knee, although this can sometimes occur as a result of the aging process. In addition to lateral knee pain, a lateral meniscus injury may cause swelling, locking of the knee, or instability.

Medial knee pain

Medial knee pain is pain occurring on the inside of your knee and can be due to several conditions, which include medial collateral ligament(MCL) injuries and medial meniscus tears.

An MCL injury occurs when there is a direct force on the outer knee. One will likely experience swelling, instability, and catching or locking of the knee.

Medial Meniscus Tear: Like the lateral meniscus, the medial meniscus can also be torn from similar causes, with synonymous symptoms, with the exception being that the pain will be located on the inside of the knee as opposed to the outside.

Pes Anserine Bursa: This occurs when the bursa becomes inflamed. The bursa is a small, fluid-filled sac that helps decrease friction. It is located at the bottom of the MCL. In addition, this condition develops when your bursa becomes irritated and produces too much fluid due to overuse, causing it to swell with resultant pressure on the anterior medial knee.

Medial Plica Irritation: Medial plica are very thin folds of your joint lining or synovial tissue. These folds cover the medial part of the knee. However, at times, this area becomes inflamed due to repeated flexing and extension of the knee. The result being that the plica tissues thicken, making them more prone to getting caught on your thigh bone and kneecap.

Symptoms associated with an injured knee

• Pain
• Swelling
• The feeling of instability (knee giving way)
• Stiffness

Diagnosing the cause(s) of knee pain

During the physical examination, the physician will do the following:

• Inspect your knee for swelling, warmth, pain, tenderness and bruising
• Push on or pull the knee joint to ascertain the integrity of your knee structures
• Observe to see how you can move your leg(lower) in different directions

Imaging and lab tests

In some instances, depending on the symptoms the patient presents with, your physician might order the following:

X-ray: This may be the first imaging study ordered. X-rays help detect fractures and degenerative bone diseases.

CT scan: CT scan creates cross-sectional images of the inside of your body after combining X-rays taken from many different angles. CT scans help to diagnose bone problems and very subtle fractures. A dual-energy CT scan (DECT) can also detect gout in a patient even when there are no clinical symptoms.

Ultrasound:  This uses sound waves to produce images of the soft tissue within and around your knees.

MRI (magnetic resonance imaging): This technology does not involve X-rays but rather radio waves and a magnet to produce 3D images of the interior of your knee. This technology is very diagnostic for ascertaining soft tissue injuries such as tendons, cartilages, ligaments, and muscles.

Lab test: If there is a suspicion of an infection or inflammation, your doctor should order blood tests. Also, a procedure referred to as an arthrocentesis may be done. In this procedure, a small amount of fluid is extracted from your knee joint with a needle, under sterile conditions and sent to the lab for analysis.

Treatment

The choice of treatment is determined by the underlying cause of your knee pain.

Medications: Simple analgesics both oral and topical, are all that’s needed at times to relieve knee pain. If other conditions such as gout and rheumatoid arthritis are implicated, then specific medications for these conditions will be warranted.

Rest: to reduce repetitive strain on your knee, you should take a break from your normal activities, thereby giving the injury time to heal to prevent further damage.

Ice: Applying ice usually reduces pain and inflammation.

Compression: This reduces the build-up of fluid in the tissues that have become damaged and maintains stability and knee alignment without compromising circulation. The use of ACE bandages is indicated here.

Elevation: keeping the injured knee elevated helps to reduce swelling and the associated pain and discomfort.

Injections: in several instances, your physician with your consent, may inject medications or other substances into the knee joint. These include:

Corticosteroids: steroid injections injected into the knee may help alleviate or reduce symptoms of arthritis and provide pain relief for several months.

Platelet Rich Plasma: this contains many different growth factors. When injected into the knee tends to decrease inflammation and promote healing.

Surgery: in quite several instances, knee surgery is one of the best instances. Patients should always consider the pros and cons of non-surgical and surgical interventions. The options for surgery may include:

Arthroscopic surgery: fiber optic camera and long narrow tools are inserted through small incisions in the knee. Arthroscopy can be employed to remove or repair cartilage that has become damaged, reconstruct torn ligaments, and remove loose bodies from the knee joint.

Osteotomy: in this procedure, bone is removed from the thigh bone or shin bone to better align the knee and relieve arthritic pain. The benefit of this type of surgery is that it may help one delay or avoid a total knee replacement (TKR).

Conclusion 

Knee pain can arise from many factors, such as wear and tear, inflammatory conditions, and injuries. Effective treatment hinges on accurately diagnosing the underlying cause. To book an appointment with Dr. Winston Isles, please call +1 345 325 9000