Back of knee pain: Everything you need to know

Have you been experiencing discomfort or pain at the back of your knee? Back of knee pain, also known as posterior knee pain, can be quite concerning and can have various underlying causes.

This type of pain can range from mild to severe and may be accompanied by other symptoms such as swelling, stiffness, or limited range of motion. It's important to identify the cause of your back of knee pain to determine the appropriate treatment approach.

In this comprehensive guide, we'll explore everything you need to know about back of knee pain, including its causes, potential injuries it might indicate, treatment options, and essential tips for managing the discomfort.

Common causes of back of knee pain

The back of the knee is a complex area prone to various discomforts. Understanding the potential triggers behind back of knee pain is essential for effective management. From ligament injuries to underlying conditions, explore the diverse factors that could be contributing to your discomfort.

Posterior cruciate ligament (PCL) injury

The posterior cruciate ligament (PCL) is essential for the knee’s stability. This sturdy band of tissue connects your thigh bone (femur) to your shinbone (tibia), and helps prevent the tibia from moving too far backward in relation to the femur.

A posterior cruciate ligament injury can lead to significant discomfort and functional limitations. These injuries often occur due to traumatic events, such as car accidents or sports collisions, where a sudden and forceful impact is applied to the front of the knee. This force can cause the PCL to stretch, partially tear, or even completely rupture.

When the PCL is injured, it can cause symptoms like posterior knee pain, swelling, instability, and difficulty bearing weight on the affected leg. Mild PCL injuries may heal with rest, ice, and physiotherapy, while more severe cases might require surgical intervention.

Meniscus tears

Picture a crescent moon nestled between your thigh bone and shin bone, and you've got a pretty good visual of the meniscus. This cartilage serves as a vital cushion, absorbing shock and distributing your body weight evenly across the knee joint.

Unfortunately, the meniscus is prone to tears, especially during activities that involve sudden twisting or bending of the knee. Meniscus tears account for 70,000 hospital admissions per year in the UK. Athletes and sports enthusiasts are often familiar with this type of injury due to its occurrence in sports that require rapid changes in direction.

Anterior cruciate ligament (ACL) injuries

The anterior cruciate ligament (ACL) is one of the most commonly known knee injuries, occurring in about 1 in every 3000 people. While it's more often associated with front of knee pain, it's worth noting that an ACL injury can occasionally cause discomfort at the back of the knee as well.

This ligament plays a critical role in preventing the shinbone (tibia) from moving too far forward in relation to the thigh bone (femur). ACL injuries can lead to inflammation, swelling, and pain, which might be felt at the back of the knee due to the complex network of nerves in the area.

Baker's cyst (popliteal cyst)

You might not have heard of a Baker's cyst before, but it's this fluid-filled sac that can often cause discomfort at the back of the knee. Also known as a popliteal cyst, it typically develops as a response to an underlying knee condition, such as osteoarthritis or a meniscal tear.

The cyst forms when the knee produces excess synovial fluid, which is a substance that lubricates the joint. However, if this fluid accumulates, it can lead to the formation of a cyst that might cause sensations of tightness or discomfort when you bend or extend your leg.

Knee arthritis

Arthritis is a condition that causes pain and inflammation in the joints of the body. It affects millions of people in the UK. While arthritis becomes more likely as we age, it can occur in people of all ages, including children. Knee arthritis can cause a variety of symptoms including back of knee pain.

• Find out more about knee arthritis

Deep vein thrombosis (DVT)

Deep vein thrombosis (DVT) is a condition that warrants serious attention. While DVT often presents with symptoms like pain, swelling, and warmth in the calf, it can also lead to discomfort at the back of the knee, particularly if a blood clot forms in a specific location.

This condition occurs when a blood clot forms in a deep vein, most commonly in the legs. It's crucial to recognise the signs of DVT and seek immediate medical attention, as a clot has the potential to break loose and travel to the lungs, causing a pulmonary embolism.

Treatment and management of back of knee pain

Effective treatment and management strategies are crucial when dealing with back of knee pain. From conservative approaches like rest and physiotherapy to more advanced interventions, below we’ve listed a range of options available to alleviate discomfort, improve mobility, and regain your quality of life.

• RICE Method: Rest, ice, compression, and elevation (RICE) is a standard approach for managing various types of knee pain, including back of knee pain. Elevating your leg can help reduce swelling, while compression can provide additional support. Ice can be applied for about 15-20 minutes, several times a day
• Pain management: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain and swelling. However, it's essential to follow the recommended dosage and consult a healthcare professional if you have any underlying health conditions
• Physiotherapy: A physiotherapist can guide you through exercises to strengthen the muscles around your knee, improve flexibility, and promote healing
• Bracing and support: Depending on the cause and severity of your back of knee pain, your healthcare provider might recommend wearing a knee brace or using crutches to provide support and reduce strain on the joint
• Injections: In some cases, your doctor might suggest corticosteroid injections to reduce inflammation and provide temporary relief from pain

When is surgical intervention needed for back of knee pain?

While many cases of back of knee pain can be effectively managed through non-surgical treatments, there are instances when surgical intervention becomes necessary to address the underlying issues causing the discomfort.

Consulting with a qualified orthopaedic surgeon and thoroughly discussing treatment options will help individuals make informed decisions about the best approach for managing their posterior knee pain and restoring their quality of life.

When surgical intervention is recommended:

Surgical intervention is generally considered when non-surgical treatments have proven ineffective in providing relief or when the underlying condition is severe and significantly impacting a person's quality of life. Factors that may lead a healthcare professional to recommend surgery include:

• Unresponsive pain: When pain persists despite attempts at non-surgical management
• Functional limitations: When back of knee pain prevents normal daily activities and compromises mobility
• Structural damage: Presence of structural damage such as ligament tears, extensive cartilage loss, or joint instability
• Degenerative conditions: In cases of advanced osteoarthritis or other degenerative joint conditions where joint surfaces are significantly compromised
• Traumatic injuries: Severe traumatic injuries causing fractures, dislocations, or extensive tissue damage

Types of surgical interventions

The type of knee surgery you are recommended will depend on the cause of your knee problems as well as factors personal to you such as your age and fitness level.

Knee arthroscopy

Arthroscopic surgery, also known as knee arthroscopy, is a minimally invasive procedure that involves using a tiny camera and specialised instruments to visualise and repair damage within the knee joint. It is commonly used to treat conditions such as meniscus tears, ligament injuries, and cartilage damage. During the procedure, small incisions are made, and the camera allows the surgeon to assess the problem and make necessary repairs.

Ligament reconstruction

Severe cases of posterior knee pain caused by ligament injuries, such as ACL or PCL tears, may require surgical reconstruction. This procedure involves replacing the damaged ligament with a graft taken from another part of the body or a donor. Ligament reconstruction aims to restore stability to the knee joint and improve overall function.

Meniscus repair

Tears in the meniscus, the cartilage cushioning the knee joint, can lead to significant discomfort. Depending on the type, size, and location of the tear, a surgeon may either repair the meniscus by stitching it back together or remove the damaged portion through a partial meniscectomy. The goal is to reduce pain and restore knee function.

Synovectomy

In cases where inflammation of the synovial lining (synovitis) is causing persistent pain and swelling, a synovectomy may be recommended. This procedure involves removing the inflamed synovium to alleviate discomfort and prevent further joint damage.

Total knee replacement

For individuals with severe degenerative joint conditions, such as advanced osteoarthritis, total knee replacement (TKR) might be considered. During a TKR surgery, the damaged joint surfaces are replaced with artificial components. While this procedure is typically performed to treat wider damage to the knee joint as a whole, it may also be relevant for individuals experiencing chronic posterior knee pain due to extensive joint damage.

The surgical process

Before undergoing surgical intervention, individuals will undergo a thorough evaluation, including medical history review, physical examination, imaging studies, and sometimes diagnostic procedures like magnetic resonance imaging (MRI). This evaluation helps determine the most appropriate surgical approach and treatment plan.

Surgical procedures for back of knee pain are performed by orthopaedic surgeons with expertise in knee joint conditions. Depending on the type of surgery, the procedure may be done through open surgery or minimally invasive techniques.

Surgical recovery and rehabilitation:

Recovery after surgical intervention varies depending on the type of procedure performed. Patients are typically prescribed a customised rehabilitation program that includes physiotherapy exercises aimed at restoring strength, flexibility and range of motion in the knee joint. Following the surgeon's post-operative guidelines and committing to rehabilitation is essential for achieving successful outcomes.

When to seek medical attention for back of knee pain

While minor cases of posterior knee pain might resolve with rest and self-care, it's essential to consult a healthcare professional if:

• The pain is severe, persistent, or worsening
• You have difficulty bearing weight on the affected leg
• The knee joint is visibly swollen or deformed
• You experience symptoms of DVT, such as swelling, warmth, and redness in the leg
• The pain is accompanied by other concerning symptoms, such as numbness, tingling, or weakness

Remember that early intervention and a proactive approach to your knee health can lead to a quicker recovery and improved overall well-being.

Call us or book online to speak to one of our orthopaedic consultants and discuss which of our treatment and management options is right for you.