Since the knee is such a complex joint, there are many different things that can potentially go wrong with it, although some issues are more common than others.
Here are some of the main reasons why patients experience knee pain and subsequently visit the orthopaedic team here at Circle Reading Hospital.
Osteoarthritis is the most common type of arthritis affecting the knee joint. Characterised by the degeneration of the cartilage covering the joint, osteoarthritis occurs when the ends of the bones rub together, causing friction, pain, inflammation and damage to the bone.
It is most often seen in older people, but can affect the younger generation too, particularly if a patient is overweight or performs repeated movements that accelerate the wear and tear on the joint.
This causes a range of debilitating symptoms, the most notable of which is pain. This pain may begin sporadically but often becomes persistent. The severity of your osteoarthritis pain may also vary, with many patients noticing that it is worse directly after a period of being still, and in cold weather.
Stiffness is another key symptom of osteoarthritis. This happens because as the cartilage wears away, the joint can no longer move as smoothly as before, causing it to stiffen.
People with moderate to advanced osteoarthritis of the knee will almost certainly find that their knee becomes increasingly stiffer until they undergo treatment. At this point, a knee replacement is usually recommended.
“There is little point waiting for the stiffness in your knee to increase before undergoing a knee replacement”, explains Dr Pollard, “particularly since a knee replacement will only restore your pre-operative range of movement and little more. It’s a highly effective treatment to prevent your symptoms from worsening and maintain your current mobility”.
Sprains and strains
Sprains and strains are also extremely common, and usually occur as a result of a minor accident or injury, such as a fall, sudden blow to the knee or it twisting incorrectly during a slip.
When this happens, the ligament experiences dozens of tiny micro-injuries that cause the symptoms most often associated with sprain or strain. These include:
- Mild to severe pain that should be controlled with over-the-counter pain relief, and should ease as the injury heals
- Swelling and inflammation of the knee
- Difficulty walking
Most sprains and strains will heal themselves, but patients will need to take extra care of the joint while this happens.
This may involve using a support bandage on the knee, avoiding physical activity as much as possible, controlling inflammation using heat/cold and anti-inflammatory medications, and getting plenty of rest.
Arthroscopy for ligament tears
If a ligament has been torn as a result of the accident, it will need to be repaired. Your orthopaedic surgeon will carry out a short surgery to stitch it back together. This is usually performed as keyhole surgery, or arthroscopically.
Arthroscopy is where a long, thin tube is inserted into a small incision in the knee and is used to repair the damage. The benefit of this type of surgery is that it is minimally invasive, helping patients to experience less post-operative pain and recover more quickly.
Once the ligament has healed, your knee pain should subside.
Tendonitis can occur anywhere in the body where there are tendons — the thick cords that attach bone to muscle — including in the knee. It can cause severe knee pain, particularly pain inside the knee.
This condition generally occurs when repetitive motion, such as running, squatting or jumping, causes the tendons to become irritated and inflamed. When this happens, it can cause joint pain, stiffness and affect how the tendon moves, which may limit the mobility of someone who experiences it.
The knee may also be swollen, hot, or red to the touch, and you may notice a creaking or crackling sensation when you try and move it.
Most cases of tendonitis in the knee affect athletes, and people who are physically active day-to-day, such as those who lift and carry as part of their job.
Although you can manage and treat the condition yourself at home, many people who experience chronic tendonitis seek the advice and support of an orthopaedic specialist. This referral is also essential if the damage to the tendon is severe enough for it to rupture.
At-home care for tendonitis can include methods like over-the-counter pain relief, hot/cold compresses, wearing a support on the affected knee, and plenty of rest.
However, if these do not provide enough relief from your knee pain, your orthopaedic consultant may recommend other treatments to help. These can include:
- Steroid injections, which work by reducing inflammation in the area
- Platelet-rich plasma (PRP) injections, which can accelerate healing
- Surgery to remove any damaged tissue and repair the ruptured tendon
As with ligament repair, tendon repair can often be performed arthroscopically, which will help you to recover from knee pain quicker.
A dislocated kneecap is a fairly simple injury that occurs when the patella (kneecap) that usually sits over the front of the knee, comes out of the groove that usually keeps it in place. It is a key cause of knee pain, particularly pain on the outside of the knee.
Most dislocated kneecaps happen when there is a sudden trauma to the knee, such as blunt force applied to it, or you suddenly change direction while your legs remain in place, such as when playing sport.
Dislocated kneecap symptoms
The symptoms of a kneecap dislocation include:
A popping sensation in the knee at the time of the dislocation
- Severe knee pain
- Swelling and inflammation
- Being unable to straighten the knee
- Being unable to bear weight on the knee, or walk
While a kneecap can pop itself back into place, it’s still advisable to speak to an orthopaedic doctor, particularly if it has happened more than once. It could be that there is an issue with the groove that usually keeps the kneecap in place, or another type of weakness. Further investigation in the form of an x-ray may be necessary.
Knee dislocation treatment
If professional intervention is needed to fix a dislocated knee, your doctor should be able to manipulate it back into place — something which is known as a reduction. If necessary, you may be given pain relief before this manipulation is carried out.
You may also need some physiotherapy to help accelerate your recovery. If any additional damage has occurred as a result of your dislocation, such as a fracture or a ligament tear, surgery may also be recommended, and your orthopaedic consultant will discuss this with you.