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Knee pain

Knee pain can be debilitating, but there are effective treatment options available to resolve your pain

Doctor-consulting-patient-with-knee-painKnee pain can affect people of all ages, explains Dr Tahir Mahmud, Consultant Orthopaedic Surgeon at The Alexandra Hospital.

Common causes can be grouped according to a person’s age.

Common knee pain causes in younger people

Here are some of the most common causes of knee pain in a younger, physically active group of people — which includes teenagers and people in their mid-40s and 50s.

A torn meniscus

This injury is “probably the most common cause of knee pain,” says Dr Mahmud. The meniscus is a C-shaped shock-absorbing cartilage that sits between the thigh bone and the leg bone. The purpose of the meniscus is to protect the joint surface from shock or damage due to conditions like arthritis.

You may injure your meniscus when you twist your knee awkwardly or fall and twist on your knee. This injury causes pain and swelling to the knee.

Ligament injuries

Ligaments are bands of tough, elastic tissue that support the joints and limit their movement.

“The most commonly injured ligament in the knee is the anterior cruciate ligament,” explains Dr Mahmud. This injury can cause severe pain, making the knee give way and feel unstable.

The anterior cruciate ligament (ACL) is a ligament inside your knee, sitting diagonally in its middle. ACL injuries usually occur due to playing sports like football, rugby, netball, or basketball. Jumping up in the air and landing on a straight knee may over-straighten it and injure this ligament.

Injury to the articular cartilage

The articular cartilage, also called the chondral cartilage, is a shiny, hard, smooth surface covering the bone ends in all joints. It allows the bones in the joints to glide smoothly over each other.

An injury to the articular cartilage can be caused by direct impact on the knee, which may cause it to crack.

If this happens, Dr Mahmud explains, “an underlying bone or a piece of the joint surface and the bone can come away from the joint surface like a pothole in a road.'' This injury can result in severe pain, swelling, and a “locking” sensation in the knee — this is a sensation that the knee is stuck or jammed.

Chondromalacia patella

This condition is sometimes called runner’s knee or patellofemoral syndrome. It affects the cartilage of the kneecap (or patella), causing it to soften and lose its ability to absorb the pressure.

The condition results from overstressing the kneecap in too short a time. “We often see the classic [case] of someone who's usually not very fit but then suddenly decides they want to do the couch to 5k,” explains Dr Mahmud.

“They start doing some runs, having never run before, and they perhaps run three or four times a week for several weeks. And then the kneecap cartilage, unfortunately, can't keep up.''

As a result of the damage to the patella, the stress is felt in the underlying bone, often causing pain in the front of the knee.

Tendonitis

Tendonitis is inflammation of the tendons. Tendons are tough strings of tissue that connect muscles to bones.

The knee has two main tendons — the quadriceps tendon, which connects the quadriceps muscle (located on the front of the thigh) to the knee, and the patellar tendon, which connects the kneecap, or patella, to the shin bone.

Inflammation to the patellar tendon, or patellar tendonitis, is also called jumper’s knee. It tends to occur more in sports involving jumping, such as basketball, volleyball, hockey, and sometimes football or netball. Jumper’s knee can cause severe pain that may stop you from doing your favourite sport.

Kneecap dislocation

This occurs when your kneecap pops out of place, usually during a sports activity. This dislocation can cause an injury to the surface of the kneecap or a tear in the ligament that keeps the kneecap in place.

Kneecap dislocations, also called patellar dislocations, cause swelling and pain. Sometimes, bits of cartilage and bone may be knocked off the kneecap when it is put back into place. This may require a surgical procedure to treat. 

Common knee pain causes in older people

There are several potential causes of knee pain in older people, says Dr Mahmud. These include:

  • Arthritis
  • Age-related wear and tear
  • Previous injury to the knee
  • Genetic make-up

Knee arthritis

Knee pain in older adults can be caused by knee arthritis. Arthritis is the gradual wear and tear of the articular cartilage.

Osteoarthritis of the knee is the most common type of arthritis in this joint, and it is most common in older adults. Osteoarthritis is also the most common cause of disability in older adults.

Knee osteoarthritis can be primary or secondary. Primary osteoarthritis is the degeneration of the articular cartilage without an apparent or known cause. Secondary osteoarthritis results from another underlying cause such as after a trauma, or from rheumatoid arthritis (RA). It can also be caused by repeated injury to the joint or by being overweight, which puts stress on the knee.

Common symptoms of knee osteoarthritis include:

  • Knee pain that sets in gradually and gets worse with physical activity
  • Knee stiffness
  • Knee swelling
  • Pain after sitting or resting for a long time
  • Pain that gets worse with time

The level of severity of knee arthritis varies from person to person, and it tends to get worse with time. If the arthritis is severe, Dr Mahmud explains, the cartilage on the joint surface is thinned all the way to the bone.

Severe arthritis can cause:

  • Swelling
  • Pain at rest
  • Difficulty sleeping
  • Difficulty walking
  • Difficulty sitting in a long car journey
  • Loss of knee function
  • Deformity in the knee

Back of the knee pain: common causes

Several things can cause pain behind the knee.

Baker’s cyst

A very common cause of pain behind the knee is a cystic swelling in the back of the knee called Baker's cyst, or a popliteal cyst.

This cyst usually occurs due to another problem in the knee, such as a meniscus tear or severe arthritis. In these cases, “fluid that normally lubricates the knee joint can be pumped out of the knee gradually over time, into the back of the knee, and it's almost like a one-way valve,” explains Dr Mahmud.

“When the fluid collects outside of the knee, it doesn't come back into the joints.” Gradually, this swelling filled with fluid increases and causes pain.

Other back of knee pain causes

Other common conditions that may cause back of the knee pain include:

  • Calf muscle tear
  • Hamstring muscle tear
  • Hamstring tendon injury
  • Hamstring tendon inflammation called tendinitis

In rare cases, an aneurysm to an artery in the back of the knee called the popliteal artery can also cause pain behind the knee.  

Pain inside the knee: common causes

Several things typically cause inner knee pain. These include:

  • Arthritis
  • A meniscal tear
  • A tear, rupture, or injury to the ACL
  • Osteochondral injury — the situation where a piece of bone or cartilage comes away from the joints
  • Gout
  • Rheumatoid arthritis

Very rarely, an infection in the knee joint may cause inner knee pain.

In Dr Mahmud’s opinion, a few main symptoms require medical attention. These are:

  • Swelling in the knee
  • Inability to bear weight in the knee
  • Locking sensation or instability
  • Knee pain that doesn’t go away with simple painkillers

The decision to see a doctor also depends on whether the knee problem is acute or chronic.

Acute knee problems

“With acute problems, such as a sporting injury, I would always recommend someone seeks advice from a specialist knee surgeon, particularly if they have sustained an injury that's resulted in significant swelling in their knee joint,” advises Dr Mahmud.

This is to make sure you obtain treatment in due time and avoid an acute problem turning into a chronic, long-term one.

If the knee doesn’t bend or straighten fully or if you feel like something is jamming the knee joint, Dr Mahmud suggests that it should be looked at urgently. These symptoms usually indicate a torn meniscus, which requires surgery.

Chronic knee problems

If you have osteoarthritis and it is starting to affect your quality of life, you should seek treatment, Dr Mahmud advises, as there are many treatment options available.

Some of these involve surgery, but others do not. For younger patients, many treatment options do not include knee replacement surgery. They will help restore a person’s mobility, helping them stay fit and active, and continue to enjoy their favourite sports or activities.

A repeated history of injuries or the sensation that the knee is giving way are good reasons to see a consultant right away. “I would recommend that anyone with a history of twisting injury that results in pain and swelling and instability should seek medical advice urgently,” says Dr Mahmud.

The main reason for this is that repeated injuries further damage the knee, resulting in early arthritis over the years if left untreated.

“There's no need to live and struggle and suffer with knee pain, because there are really good treatment options available that can be successful and can reliably reduce pain, improve mobility and function, and most importantly — improve your quality of life.”

If you see a consultant for your knee pain, they may recommend the following first line of treatment:

  • Pain relief such as NSAIDs and paracetamol
  • Physiotherapy
  • Weight loss for people with osteoarthritis and a body mass index greater than 25 kg per m2

If the above does not work, your consultant or general practitioner may prescribe the following non-surgical treatments:

There are also a variety of surgical treatments available, depending on the nature and severity of the knee pain.

There are many treatment options for knee pain at The Alexandra Hospital in Manchester, including:

Choosing the right treatment option will depend on factors like a person’s age and what is causing their knee pain.

For example, Dr Mahmud explains, if you are 45 years old and have knee arthritis because of a meniscus tear when you were 15, a preserving procedure such as knee osteotomy may be the best choice. In this surgery, the weight-bearing stress is shifted from the worn-down part of the knee into a healthier part of the knee, restoring function and relieving pain.

Further down the line, if you develop more severe arthritis when you are older, knee replacement surgery may be the answer. “Knee replacement surgery can be highly successful,” Dr Mahmud says, if performed promptly and when necessary.

Meniscus repairs can preserve and repair the damaged tissue if the patient comes to the clinic early.

When needed, ACL reconstruction surgery can stabilise the knee, giving you back your active lifestyle. 

A combination of three main elements makes the Alexandra Hospital a top private healthcare institution:

  • Friendly, dedicated staff
  • Highly specialised consultants with excellent expertise
  • The latest technological advancements in treatment and diagnosis

The staff will always go to great lengths to ensure patients have the best possible experience, from the nursing staff to the consultants.

Highly trained knee specialists & the latest treatments

The Alexandra Hospital “selects the best consultants in their area of expertise,” says Dr Mahmud. There are nearly 40 highly trained specialists who offer knee pain treatments at The Alexandra Hospital.

The latest MRI scanners give knee specialists the most detailed imaging to start the right treatment as quickly as possible.

Treatments will draw from the latest evidence available, offering platelet-rich plasma injections for example, which is a recent treatment for knee osteoarthritis.

Operating theatres use cutting-edge surgical equipment to ensure highly accurate and safe procedures. For example, surgeons at The Alexandra Hospital use the Mako® robotic system to assist in knee surgery. This technology enables the team “to be extremely precise and accurate [...] which can potentially give a patient a knee replacement that feels as close to a normal knee as possible,” Dr Mahmud explains.

“[The Alexandra Hospital] is a busy place but it has a nice vibe to it. It's a friendly place and I think patients enjoy coming there. And I think that's why it's still the number one hospital for private healthcare in the northwest.”

– Dr Tahir Mahmud

Cost is an important part of your treatment journey, and a key factor that may help you decide whether to choose private healthcare services.

The Alexandra Hospital offers fixed price packages that include an initial consultation, treatment, and aftercare. There are several ways you can pay for your private healthcare —  you can pay yourself, use private health insurance, or pay in instalments.

Circle Health Group provides flexible payment options, which make healthcare more affordable than you might think. 

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