Understanding knee pain: causes, diagnosis, and treatment options

Knee pain can be felt by people of all ages and backgrounds. Knee pain can be the result of a sudden injury, wear-and-tear over time, or chronic conditions like arthritis. The cause of knee pain isn’t always apparent to the patient, which means they won’t know the best way to treat the pain until they have a formal diagnosis. In this article, Mr Gareth Staples, a leading orthopaedic knee surgeon, goes over the possible causes, diagnosis process, and treatment options for knee pain.

What are the knees?

The knee is the body’s largest joint, at the junction of the thigh bone (femur) and the tibia (shin bone), topped by the kneecap (patella), and contains an assortment of muscles, ligaments (like the anterior cruciate ligament, commonly referred to as the ACL), and cartilage (such as the meniscus).
Knees are a fundamental structure for human movement. They enable walking, sitting, crouching, dancing, jumping, cycling… knees are used constantly in daily life. They support a lot of the body weight, and help maintain balance. So, when something goes awry, it can be quite debilitating.

What causes knee pain?

Knee pain can be temporary and sudden, likely due to injury, or it can be long-term or reoccurring. Knee pain can manifest near the patella (above or behind), which can indicate an issue with the muscles, tendons, or ligaments, or deeper inside the knee, which can indicate an issue with the bones or cartilage. There could also be concurrent pain in other part of the knee and leg.

The pain may be accompanied by swelling, a reddening of the skin around the knee, stiffness, bruising, or popping sounds.

Possible causes of knee pain are:

• Wear-and-tear, which is what happens when the knee has been overused and the joint has become strained. This can happen to those who do a lot of physical activities, like athletes, dancers, or people who are on their hands and knees often. This can cause runner’s knee (patellofemoral pain), jumper’s knee (Osgood-Schlatter disease), tendinitis, and bursitis.
• Arthritis, which is when the joint becomes inflamed due to a deterioration or infection of the cartilage. Common kinds of arthritis are osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.
• Injuries, which can happen during accidents, strenuous activities, or even just mundane daily tasks. Sport injuries are a common source of knee pain. Types of knee injuries include sprains, hyperextends, ligament tears (like an ACL tear), meniscus tears, dislocations, or broken bones.

If the pain is accompanied by an unusual lump and occurs with know reasonable cause, then it may be synovial sarcoma, a type of cancer of the joints. This can be treated with surgery to remove the tumour, or chemotherapy to attack the tumour, provided it is detected in an early stage and has not had the chance to spread.

How can knee pain be treated?

If you know how and when the pain started, then knee pain can usually be treated at home with a pause from physical activities and over-the-counter pain medications. This is suitable for if you’ve had a simple fall or banged your knee on the corner of a table. You can follow the RICE method:

• Rest
• Ice the pain
• Compress to help with managing swelling and blood flow
• Elevate the knee above the level of the heart

If the pain stems from another condition or issue, then the diagnostic process will likely start with a physical examination from your doctor to test the function and mobility of the knee (unless physically not possible or too painful to move).

Afterwards, the doctor will usually use a diagnostic scan like an X-Ray, MRI, or CT scan to get a visualisation of what is going on in the knee and see if the problem can be spotted.

There are surgical and non-surgical options for treating knee pain.

Non-surgical options include knee braces can be used to support the knee and keep it in alignment whilst healing occurs, or just to maintain the correct form. Physical therapy is suggested for arthritis and injury recovery, in order to strengthen the muscles and improve stability; it should result in pain relief.

There are several surgical options for pain relief, and which one that is performed will depend on what the issue is and what would be the best way to treat it. Surgery is only recommended for extreme pain and when other methods have not been fruitful.

An arthroscopy is one of the most common procedures for the knees. Using a few small incisions around the knee, a surgeon is able to access the internal structures with instruments and the camera/lighting tool that is the arthroscope. From there, they are able to assess and address the damage to the knee. This procedure can also be part of the diagnostic process if imaging scans were inconclusive. Arthroscopy can be used in the treatment of many issues, such as fractures, torn meniscus, or tendonitis. Grafts can also be performed with arthroscopies, where donated tissue is used to repair damage – for example, an ACL repair.

For very severe damage to the knee, there is the option of a knee replacement, where bone components of the joint are replaced with artificial implants made of plastic, silicone, and metal. The worn or faulty tops of the leg bones tend to be what is replaced, where they are cut off and implanted with the prothesis and the kneecap is put back in place.

If you are dealing with knee pain and would like to book a consultation with Dr Staples, you can do so via his Top Doctors profile