The complexity of the knee joint means that there are many potential causes of knee pain.
However, there are some that are much more common than others, and it will be these that are first considered during your consultation with your Circle Health Group orthopaedic consultant.
Osteoarthritis
By far the most common cause of knee pain, osteoarthritis is a degenerative condition that occurs when the cartilage that usually covers the end of each bone starts to break down.
When this happens, the bones no longer glide softly off of each other when you move. Instead, they rub together, creating friction that triggers pain, inflammation and even damage to the bones themselves.
Osteoarthritis most often affects the older generation, but it can be seen in patients of all ages. It is also more common in people who are overweight or obese, or who perform repetitive movements at work or during leisure activities, such as painting or rowing, that accelerate wear and tear on the joint.
Many people don’t realise that they have osteoarthritis at all. “I see many patients for another type of knee injury, and only uncover the arthritis as a result of our investigations into this injury,” says Mr El-Tawil.
Osteoarthritis symptoms
Osteoarthritis can be painful and debilitating for those who suffer from the condition. The pain of osteoarthritis often starts off mild but gets progressively worse and can morph from sporadic to consistent. Many patients find that their arthritic pain gets worse in colder weather, and after they have spent a long period of time sitting still.
Patients with osteoarthritis also experience another key symptom — stiffness. Stiffness is a natural part of the degeneration of the joint, because as the cartilage starts to break down, the joint becomes unable to move as smoothly as before. As time goes on, they may find that their knee gets progressively stiffer until it becomes hard to move around.
“The longer a patient goes without treatment, the stiffer their knee is likely to become,” explains Mr El-Tawil.
Fortunately, there are a variety of treatments for osteoarthritis, ranging from anti-inflammatory medications to surgery to replace the entire knee joint. Your orthopaedic consultant will be able to advise you on the best course of action to treat your osteoarthritis.
Strains and sprains
Slips and trips are very common accidents and when they happen, we can find our knees put under excessive or sudden strain.
When this happens, it can cause the connective tissues of the knee to overextend. This creates countless micro-injuries in the ligament that result in symptoms including pain, stiffness, swelling and inflammation, limited range of motion and more.
Most sprains and strains will heal themselves, but patients will need to take extra care of the joint during their recovery. This may mean using a support bandage on the joint, getting plenty of rest and controlling inflammation using heat/cold and anti-inflammatory medications.
Ligament tears
In some cases, an accident can actually result in a ligament tear. If this happens, it won’t be possible for it to heal without surgical intervention. Your orthopaedic consultant will do this arthroscopically.
“Arthroscopic surgery is minimally invasive and uses just a couple of small incisions rather than performing open surgery. This means less scarring, less risk of complications, faster healing and less pain,” explains Mr El-Tawil.
The ligament is simply stitched back together and left to heal, which should reduce your knee pain and eventually restore your full range of motion.
Tendonitis
Unsurprisingly, tendonitis affects the tendons, which are the thick, fibrous cords that attach bone to muscle.
Tendonitis is characterised by irritation and inflammation of the tendons, which is usually caused by repetitive strain. For example, if you cycle, you will be repeatedly bending and straightening your legs as you pedal. This movement can put excessive strain on the tendons in the knee, causing pain, stiffness and limited mobility.
Some patients find that their knee looks red or feels hot to the touch. Others may hear an audible creaking sound when they try to move their knee.
Tendonitis management
Tendonitis can be managed at home using hot/cold techniques, anti-inflammatories and knee supports.
However, if you suffer from regular episodes of tendonitis, or you aren’t able to ease your symptoms sufficiently yourself, it’s a good idea to seek a referral to an orthopaedic consultant. They can offer more specialised treatments such as:
- Steroid injections, which work by counteracting inflammation
- Platelet-rich plasma, or PRP, which uses platelets from your own blood to accelerate the healing process
- Surgery to repair a damaged/ruptured tendon
Again, where possible, any surgery will be performed arthroscopically.
Dislocated kneecap
The kneecap, or patella, is usually positioned within a groove in the femur. However, an accident or injury, such as a sudden pivot or a crush injury to the knee, can push it out of place. This is known as dislocation and can be extremely painful.
Other symptoms of knee dislocation include:
- Swelling and inflammation
- An audible ‘pop’ in the knee at the time of dislocation
- Being unable to bear weight on the knee, even for a moment
- Being unable to straighten the knee
While it’s not unheard of for a dislocated patella to naturally slip back into position, it is still advisable to speak to your orthopaedic consultant. They will be able to help carry out investigations to determine why the dislocation happened, identifying any weaknesses that could lead to further dislocations in the future.
If your knee doesn’t go back into position by itself, you’ll need medical support to resolve it. Fixing a dislocated knee is known as a reduction and requires a short forceful manipulation.
Don’t worry — you’ll be given pain medication before the manipulation is performed. Most patients who’ve had a dislocation will require physical therapy to support their recovery. Your orthopaedic specialist will be able to refer you to a suitable physical therapist.