Knee conditions

Knee pain is very common and can present for several reasons including acute injury or as a symptom of a chronic medical condition. Pain may be acute or diffused throughout the area, and the treatment depends on the underlying cause such as whether the pain arises from a bony defect or soft tissue injury.

Common symptoms of knee pain include:

  • Difficulty walking or weight bearing due to the instability of the knee

  • Locking of the knee

  • Redness and swelling

  • Inability to fully extend the knee

  • Difficulty ascending and/or descending stairs

What causes knee pain?

  • Acute injury: fracture, torn ligament or meniscus

  • Medical conditions: Arthritis such as osteoarthritis or rheumatoid arthritis, infection

  • Chronic conditions: tendonitis or bursitis

Some common knee conditions include:

+ Meniscal tears

The meniscus are two dense rings of cartilage in the knee. There is both a medial and lateral meniscus, which provide stability and cushioning to the knee joint.

They are a dense soft tissue which support the knee during flexion, rotation and torsion. They can develop tears during acute accidents or with ‘wear and tear’ over time.

Some meniscal tears can heal, but they have a limited capacity to recover due to limited blood supply. Age and tear location are the key factors determining the outcome of a meniscal repair procedure, with younger patients generally having better blood supply to the cartilage. Whether a meniscal tear can be repaired is determined by the type of tear.

Limited horizontal tears

These tears can heal or at least have symptoms that improve over time. Analgesia, Physio and activity modification may be all that is needed.

Bucket-handle tears

These tears are large peripheral tears where the bulk of the meniscus flips into the middle of the knee. This can cause acute blocking or locking symptoms.

Radial tears

These tears can de-function the meniscus and early review can prevent excessive point loading in the knee.

Meniscal root tears

These tears may extrude from the joint causing pain and restrict range of motion. This can lead to point loading and rapid arthritic wear.

Some meniscal tears warrant urgent orthopaedic review and intervention to increase the chance of saving the meniscus and prevent long term complications.

+ Cartilage Injury

Articular cartilage is typically avascular, meaning blood supply is limited and as a result is extremely slow to repair, if it ever heals at all.

If the cartilage damage is too severe or chronic there are potential reconstruction options available including autograft (local tissue) or allograft (donated). Treatment will depend on the size of the defect. Smaller defects in specific locations can be treated with marrow-stimulating techniques, autologous chondrocyte implantation (ACI), or osteochondral autograft transfer.

Large defects may have a better outcome with a re-alignment procedure such as an HTO.

+ Arthritis – Osteoarthritis / Rheumatoid Arthritis

Arthritis of the knee can be extremely painful. There are over 240 different types of arthritis, the most common being Osteoarthritis followed by Rheumatoid arthritis, with each different type characterised by a unique set of symptoms. Osteoarthritis accounts for over 70% of all arthritis diagnoses and occurs when the cartilage degenerates and wears away, causing pain, stiffness and a loss of mobility in the affected joint.

The knee is made up of three separate compartments, medial, lateral and patellofemoral, and your treatment will depend on the number of compartments affected. A partial knee replacement is available if only one compartment is affected, while a total knee replacement is recommended if two or more compartments have arthritic changes.

+ Anterior Cruciate Ligament tears

The cruciate ligaments are four tendons that work together to stabilise the knee joint. Ligament injury is common on the sporting ground and can be isolated to one single ligament, or include multiple ligaments depending on the mechanism of injury.

The anterior (ACL) and posterior (PCL) ligaments form an X in the middle of the knee and prevent any forward-to-back sliding motion, while the medial (MCL) and lateral (LCL) cruciate ligament provide sport on the side of the knee, preventing side-to-side motion.

ACL Injury

The Anterior Cruciate Ligament (ACL) crosses from the back of the femur to the middle of the tibial plateau and prevents the tibia from sliding forward underneath the femur. ACL sprain or tear is one of the most common sports injuries and generally occurs when the person stops suddenly or pivots on a locked knee. As such, high risk sports include basketball and netball and are more commonly seen in women due to more mobile joints and slight differences in anatomy.