Causes of knee pain

Most often, patients complain of pain in the front of the knee. At the same time, the knee often swells. The causes of knee pain are numerous.

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Chondromalacia patella

This condition is a common cause of knee pain. Young women are more often affected. Pain in the kneecap is noted after a long period of sitting. Characteristic features include palpation pain in the medial retropatellar region and pain when pressing on the patella and anterior thigh.

The diagnosis is usually made clinically, but if arthroscopy is successful, softening and/or fibrillary twitching of the patellar articular cartilage is detected. As therapeutic measures, exercises aimed at strengthening the broad medial muscle of the thigh are recommended - lying on the back with the foot rotated outward. Then it is recommended to raise the heel 10 cm above the floor up to 500 times during the day, in between, the muscles should be relaxed (these exercises themselves are unpleasant, but they relieve pain in 80% of cases). If the symptoms of the disease continue to bother the patient, despite performing the above exercises for a year, then arthroscopic release of the lateral patellar ligament can be tried. If the pain remains after this, then patellectomy should be considered.

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Lateral overpressure syndrome

In this case, palpation sensitivity and pain are noted on the "posterior" surface of the patella and laterally. Knee pain increases with physical activity. Special exercises for the vastus medialis muscle of the thigh rarely bring relief. During arthroscopy, the patella appears normal. Release of the lateral suspensory ligament relieves pain.

Bifid patella

This condition is usually detected by chance during an X-ray examination, but is often the cause of knee pain if the upper lateral fragment of the patella is mobile. In this case, pain during palpation is noted above the area where this fragment connects to the rest of the patella. Surgical excision of this fragment frees a person from pain.

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Recurrent patellar subluxation

In this case, a too tight supporting ligament causes lateral subluxation of the patella, which is accompanied by pain in its medial part and relaxes the knee joint. This is more common in girls with valgus knee joints. During examination, increased mobility of the patella in the lateral direction is noted, which can be accompanied by pain and reflex contraction of the quadriceps muscle of the thigh (i.e. there is a positive patellar locking test). If, after performing special exercises for the broad medial muscle of the thigh, the recurrence of subluxations does not stop, then, as a rule, releasing the lateral supporting ligament of the patella is effective. The need to move the patellar tendon occurs rarely.

Patellar tendinitis

The pathological process usually begins with a small tear in any part of the patellar tendon. Most often, this occurs in athletes (tendinitis at the attachment site of the patellar tendon; the so-called jumper's knee). Treatment: rest and taking NSAIDs. For those patients who cannot ensure bed rest, it is advisable to use corticosteroid injections around the tendon (not into it). Regarding Osgood-Schlatter disease.

Iliotibial tract syndrome

The synovial membrane, which runs deep along the ilnotibial tract, becomes inflamed where it rubs against the lateral femoral condyle. This is common in runners. Treatment: rest, NSAIDs, or local glucocorticoid injections.

Medial shelf syndrome

In this case, the synovial fold over the medial meniscus of the femur becomes inflamed. This syndrome causes knee pain in the superomedial region. A short-term blockade of the knee joint may occur (which imitates a meniscus tear). Diagnosis: arthroscopic. Treatment: rest, NSAIDs, local steroid injections, or arthroscopic dissection of the synovial fold.

Fat pad syndrome

Deep pain in the patellar tendon may be due to impingement of the fat pad at the tibiofemoral junction. This knee pain goes away with rest.

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