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Knee Pain

Knee pain is common at all ages.

In young active adolescents, overuse with sports or exercise is an important cause of anterior knee pain.

Children who are overweight are more prone to knee pain. 

Key points:

Anterior knee pain is common and encompasses a range of conditions that result in pain worse on exercise and likely relate to biomechanical factors such as patella tracking on flexion, leg alignment and foot posture.

  1. Osgood Schlatter's disease is common, especially in adolescent boys who are physically active (particularly those who play football or basketball) with tenderness over the tibial tuberosity which can be prominent. 
  2. Sinding-Larssen Johannson disease results in tenderness over the inferior pole of the patella.
  3. Chondromalacia Patellae tends to be more common in adolescent girls with retropatella crepitus and may associate with hypermobility, flat feet and genu valgum (knock knees).

The figure below shows common sites of tenderness with anterior knee pain

The photograph below shows a prominent tibial tuberosity in Osgood Schlatter's disease - this is also shown on the radiograph (arrowed).

Trauma in the knee can result in meniscal, or cruciate or collateral ligament injury. These injuries result after significant injury and there is likely to be bruising and even a swollen knee (haemarthrosis). The knee may lock or even be unstable. 

A Discoid meniscus is a congenital condition and may remain asymptomatic. It may only cause symptoms (locking or pain) after trauma. Loose bodies can result from injury and the knee may lock or be unstable.  Osteochondritis dissecans may result in a loose fragment / body but usually results in a tender femoral condyle (usually the medial femoral condyle).

The radiograph of the knee below shows loose bodies (arrowed) 

The Table below summarises the causes of several conditions that can cause knee pain 

Symptoms

Signs

Management

Referral

Patellofemoral pain / chondromalacia patellae

Pain

Worse with activity

Pain or crepitus on patellar tracking

Genu valgum

Hypermobility

Tibial torsion

Pronated forefeet

Physiotherapy

Activity modification

Physiotherapy

Patella Dislocation

Pain

Dislocated patella

Reduction of patella, Mobilisation

Physiotherapy, Orthopaedics if recurrent dislocation

Osgood Schlatter's disease 

Pain on activity

Pain on resisted extension

Tender (+/- swollen tibial tuberosity)

Ice

Activity modification

Physiotherapy 

Sinding-Larsen Johannson disease 

Pain lower pole patella

Tender lower pole patella

Worse on extension

Ice

Physiotherapy

Activity modification

Physiotherapy

Plica syndrome

Pain on flexion

May be tenderness

NSAID, activity  modification

Physiotherapy

Osteochrondritis dissecans

Pain, Locking

Weakness

May be normal

Analgesics

Orthopaedics 

Loose body

Pain, Locking

Giving way

Swelling

May be normal

Tenderness, effusion, joint restriction 

NSAIDs

Yes – may need arthroscopic removal of loose body

Haemarthrosis

Pain

Swelling (soon after injury)

Large, tense effusion

Hamstring spasm

May need MRI / Aspiration 

Orthopaedics

Fat Pad impingement

Pain, Swelling

Movement

Pain when knee flexed suddenly

NSAIDS, 

Physiotherapy

Orthopaedics if severe or causing functional limitation

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