Knee pain is one of the commonest musculoskeletal complaints, varying from the trivial and very common to the serious and uncommon.
Knee pain is one of the complaints which varies significantly with how old the patient is and their age can help guide the likely diagnosis amongst a variety of knee problems.
Osgood Schlatters Syndrome
Osgood Schlatters Syndrome includes pain and swelling over the tibial tuberosity, the lump on the top of the shin bone just below the knee joint. It occurs most commonly in sporty children and teenagers and is thought to be due to traction or pulling on the growth plate in the area, which takes the forces of the main knee muscles as the body is propelled in running and sports. Treatment is rest until the problem settles down and careful reintroduction of activity to avoid re-aggravating the problem.
In some cases an enlarged tibial tuberosity may persist and cause problems with kneeling on hard surfaces. This condition settles with rest and time.
Anterior Knee Pain
Anterior knee pain is a general term for pain felt round the front of the knee, usually during activity, relatively common in active teenagers and more common in females. Older people are also affected by this knee pain. The reason for anterior knee pain may be related to the mechanics of the patella as it glides across the surfaces of the lower thigh bone as considerable forces pass between the two joint surfaces.
Physiotherapy treatment involves strapping, stretching, strengthening, joint mobilisations, correction of poor lower leg posture and other techniques. Scientific research does not show that treatment is particularly helpful. Some patients come to knee surgery such as Fulkerson's procedure where the pull of the thigh muscles is realigned by moving the tibial tuberosity a small distance towards the inside. Physio rehabilitation is vital after this type of operation to restore full function.
Ligament injury is most common in late teenage years and the twenties, when people are performing active sports such as football, rugby and skiing. The medial collateral ligament in commonly injured by a blow to the outside of the knee and most treatment is conservative, i.e. splinting, crutches and physiotherapy.
Anterior cruciate ligament rupture is a common sporting injury where the knee swells immediately and significant pain is present. After a recovery period knee ligament surgery is commonly performed as without anterior cruciate ligament reconstruction the knee may remain unstable and suffer from accelerated arthritic change.
Cartilage tears are properly called meniscal tears and are tears of the flexible cartilage structure which sit between the main joint surfaces of the knee. A tear can occur in a sporting injury or due to a fall and in older people degenerative tears and fraying may occur. Knee arthroscopy is a common and successful treatment for this problem and arthroscopy can be done as a day case, allowing the patient to walk normally afterward and have a short rehabilitation period after, sometimes under physio supervision.
Osteoarthritis is the most common degenerative joint condition in the world, affecting tens of millions of people. It is an age related condition with the incidence rising steeply with each decade after age fifty. Knee arthritis is common and limits the person with pain, loss of movement an inability to walk and function normally. Knee replacement surgery is one of the most successful medical interventions for this problem and typically results in very high increased in quality of life.