The knee joint is a very complex joint. It is a common cause of pain for all people of all ages. There are many causes of knee pain ranging from acute/traumatic injuries to chronic wear and tear of the joint. This article will briefly discuss some of the more common causes of knee pain that may require orthopedic evaluation.
The knee is made up of many different structures. The ligamentous structures include the ACL, PCL, MCL, and LCL. These structures help keep the knee structurally stable and help it function properly. These ligamentous structures are commonly injured due to high impact injuries. They are very common in athletes, but can also occur in any age group from falls, motor vehicle accidents, etc. These injuries can range anywhere from mild sprains to complete tears and are treated according to complexity. Depending on the structure that is injured, the location of the pain can vary. Quite often, conservative treatment, including rest, ice, elevation, physical therapy and/or bracing, will help these types of injuries. Occasionally surgical intervention is required if there is a complete tear of one of the above structures.
The menisci are 2 c-shaped structures that act as a cushion for the knee joint between the femur and tibia bones. Meniscal tears, like the above mentioned ligaments, are common in athletes and high impact injuries, but can also occur in people of all ages during twisting injuries or falls. Degenerative tears are also common and are due to wear-and-tear of the knee joint. A degenerative meniscus tear is commonly associated with knee osteoarthritis (see below). Meniscus tears are frequently associated with pain on the side of the corresponding meniscus tear as well as a knee effusion. Patients usually describe a â€˜locking' or â€˜catching' sensation in their knee as well as the knee â€˜giving out' on them. Occasionally, conservative measures (physical therapy, injections, etc.) can help relieve symptoms of a meniscus tear, but commonly surgical intervention is required.
Arthritis of the knee joint is a very common cause of knee pain. Osteoarthritis occurs when you lose the smooth articular cartilage of the knee joint causing “bone on bone.” It is a chronic wear-and-tear of the knee joint. It cannot be reversed once you have it, but there are many conservative treatments you can try to relieve your symptoms and improve your quality of life. Swelling of the knee joint can occur with osteoarthritis and can be mild to severe. One sequela some patient's notice is a large lump or cyst in the back of their knee. This is known as a Baker's cyst and is a joint fluid-filled mass that is connected to the knee joint. Some conservative treatments for osteoarthritis include physical therapy, weight loss, anti-inflammatory medications, effusion drainage, steroid injections and viscosupplementation injections. Once all conservative options are exhausted and if the arthritic pain has not improved, the next step would be a total knee replacement.
Iliotibial Band Syndrome
The iliotibial band (IT band) is a ligament that runs along the outside of your thigh from your hip to your shin bone. The band crosses over the knee joint and assists it with stability. IT band syndrome is very common in cycling and running and is considered an â€˜overuse' injury. It causes pain on the outside of your knee. IT band syndrome is treated conservatively with rest and physical therapy. It is also important to learn proper mechanics of running and other ways to prevent this from occurring again.
There is a structure in the front of the knee called the â€˜prepatellar bursa,' which can cause a condition known as prepatellar bursitis. This is usually seen in individuals who do a lot of work on their knees (carpenter, etc.) or can occur with blunt trauma to the front of the knee. The bursa is a fluid-filled sac that becomes inflamed and can cause significant pain in the front of your knee. It can become quite swollen and look like there is an egg or half-baseball on top of your knee cap. Although it may look bad, prepatellar bursitis usually goes away on its own by stopping the offending activity. Occasionally it needs to be drained and rarely needs to be surgically removed. It this area becomes red, hot and swollen, it could mean infection to the prepatellar bursa, in which case you should seek treatment immediately.
Quadriceps Tendon Rupture
A quadriceps tendon rupture is a very serious injury and should be treated immediately. The quadriceps tendon attaches your quad muscle in the front of your thigh to the top of your knee cap. This structure, when intact, allows you to straighten/extend your leg at the knee joint. Quadriceps tendon ruptures commonly occur in those greater than 40 years of age and recreational athletes/weekend warriors. Symptoms include severe knee pain, swelling and bruising. The symptom that is most indicative of a quadriceps tendon rupture is the inability to extend your leg at the knee joint. This injury requires immediate surgical intervention.
There are many additional causes of knee pain other than the ones listed above. If you are experiencing any of the above symptoms, or any other type of knee pain, call Three Rivers Orthopedic Associates and make an appointment. Knee pain can become very debilitating and can cause a significant decline in your quality of life. Our elite doctors and staff would be happy to help you try to get you back to your full-functioning, pain-free self.
By Bethany Wink PA-C