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Knee pain conditions

The Table below summarises several conditions that can cause mechanical knee pain:

		Symptoms	Signs	Management	Referral
Patellofemoral pain		Pain. Worse with activity. Pain or crepitus on patellar tracking.	Genu valgum. Hypermobility. Positive Clarkes test. Pronated forefeet.	Access Biomechanics and muscle balnce. 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 Johannsson 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.	NSAIDs, activity modification.	Physiotherapy.
Osteochondritis dissecans.	Pain, Locking. Weakness.		May be normal.	Analgesics.	Orthopaedics. Physiotherapy.
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.		Pain when knee extended.	NSAIDs.	Physiotherapy, Orthopaedics if severe or causing functional limitation.
Meniscal Injury	Locking. Giving way. Swelling.		Positive McMurray's test.	MRI to confirm.	Orthopaedics. Physiotherapy.