Today we discuss the causes of knee pain. The cartilage of the knee is complex and is made of an elastic compressive structure. The normal articular cartilage is called hyaline cartilage. Hyaline cartilage provides a smooth, gliding surface to help in the motion of the joint. There are about 2 cc’s of synovial fluid inside the knee which helps in the motion and lubrication of the joint. Between the hyaline cartilage (articular cartilage) is the meniscus. The meniscus is shock-absorbing cartilage or cushion between the articular cartilage.
The hyaline cartilage has four layers:
- the superficial layer
- the middle layer
- the deep layer
- the calcified layer
After the calcified layer is the bone. These cartilage cells are supposed to live forever! Good cartridge cells are sterile and cannot make more cartilage if these cartilage cells are destroyed. If the cartilage is subjected to excessive wear, excessive trauma or injury, overuse, excessive weight or improper alignment, then the cartilage will wear away leaving bone to rub against bone. The cartilage cannot heal itself by hyaline cartilage, however, it does sometimes heal itself by an inferior type of cartridge called fibrocartilage, especially if the area that needs to be repaired is small.
Common Knee Problems
1- Patellar Chondromalacia
it’s chronic knee pain due to softening of the cartilage beneath the knee cap.
- Chronic knee pain from mild to complete in the back of the kneecap.
- Pain in the front of the knee
- Occurs more in young patients.
- Becomes worse from climbing up and down, stairs.
- Usually therapy
- NSAIDs(you may give Nana strudel surgery is rare)
2- Patellar Bursitis
Pain and inflammation are located over the front of the kneecap. The bursa becomes inflamed and fills with fluid at the top of the knee.
- Causes pain, swelling tenderness and a lump in the area on top of the kneecap.
Normal Knee Without Ligament Injury
You can see the medial and lateral collateral ligament and the ACL in the middle of the knee.
3- Ligament Injury
For an example of any injury, you can see the lateral collateral ligament injury. It usually occurs as a result of sports activities.
Medial Collateral Ligament Rupture
- Injury to the ligament on the inner part of the knee.
- The most commonly injured knee ligament.
4- Anterior Cruciate Ligament Tear
ACL ligament tear.
- Involves valgus stress to the knee.
- Usually, the patient will have swelling and hematoma.
Lockman’s Test is positive.
- MRI is diagnostic.
5- Patellar Tendonitis
- Inflammation and pain located inferior to the knee cap area.
6- Meniscal Tear
- The cushion protects the cartilage of the knee.
- The injury will cause pain on the medial or lateral side of the knee.
- Outer 30% of the meniscus has a blood supply.
- McMurray’s test is positive.
- History of locking, swelling, and instability of the knee.
7- Arthritis of the Knee Joint
- Characterized by progressive wearing away of the cartilage of the joint.
- The knee is a common part of the body that’s most affected by arthritis.
- Decreased joint space.
8- Backer’s Cyst
- Swelling in the back of the knee filled with synovial fluid.
- Cyst between the semimembranosus and the medial gastrocnemiusmuscles
Why Does My Knee Hurt?
What symptoms should you look for when you have knee pain?
It’s important to know whether there’s any swelling of the knee joint if there’s any giving way of the knee joint, whether there’s any associated pain that’s going further down the leg, or if the pain is actually coming from another area and it’s actually around the knee that you feel the discomfort. So if your knee pain is not resolving and not settling and it’s also there’s swelling of the knee, locking, catching giving way, then there’s something significant happening in the knee joint. A few clicks and bits of discomfort are a normal part of life but pain particularly related to activity and the associate features means there’s something more serious going on with the knee.
we always focus on what it does for our patients.
What Can Cause Knee Pain?
The cause of acute knee pain is often related to something that happens when you’re walking, or you twist your knee, or you’re playing a sport, and we think it’s important to assess, and see what happens especially, if the problem doesn’t go away, and it continues to bother you after about five or six weeks of rest and ice and physiotherapy, from your local doctor then we think it becomes an important injury to assess and treat. Equally, chronic knee pain tends to be pain that’s present either on the inside or the outside or even in the back of the knee and, it carries on for much longer and it gets to a point where all the things that you have done to try and improve it, taking painkillers, physiotherapy, exercises, all of it haven’t helped in which case the pain has now got to a point where something is going on and needs to be looked at and treated.
When Should We Seek Advice for Knee Pain?
If you have an acute knee injury what you can do is to initially. We think to consult this physiotherapist or A&E department to find out what might be the cause of an injury. If it’s not a fracture and we’re dealing mainly with a soft tissue injury, then we think it’s important to give some rest, some ice reduces the swelling come down. If possible if you can see a local GP or a physiotherapist to get some advice on how to rehabilitate yourself. But we think if the pain is not settling, it’s getting worse over a bit of time. Then I think it’s important not to neglect it and get back to doing things but seek help.
Does Knee Pain Mean Surgery is Needed?
Just because somebody has knee pain doesn’t necessarily mean they need an operation. Very often a knee pain can be managed without surgical treatment and that includes seeing somebody who can guide you with your exercises, what you should do and should not do, taking painkillers as required and finally if the sport that you’re doing is detrimental to your knee getting advice on other sports that you can do that’s less harmful to your knee.