Most people will experience an episode of knee pain sometime in their life. Usually, these episodes are temporary and related to transient increases in activity (overuse syndrome). But, if symptoms don’t go away in a few days, then there may be something more serious to address.
Before reviewing common knee pain problems, a short review of knee anatomy is in order. The knee joint involves three bones. The thighbone or femur comprises the top portion of the joint. The tibia, provides the bottom portion of the joint. The kneecap or patella rides along the front of the femur. It acts like a pulley to straighten the knee when weighted. On the outside of the knee is the fibula. The fibula is not directly involved in the knee joint but is does provide stabilization by soft tissue attachments like an outrigger.
The knee joint’s main function is to bend and straighten for moving the body during locomotion. This is also depends upon various soft tissues such as muscles (prime overs), ligaments and tendons (stabilizers), and cartilage and bursa (shock absorbers) working together. Not surprisingly, these soft tissues can be unique pain generators. The knee bends like a simple hinge, but also rolls and rotates in complex ways. The balanced combination of bending, rotating, and rolling motions is essential for proper knee function. Injuries can affect these motions and, in turn, impede function and cause pain.
Collateral ligament strains, sprains, and ruptures
The collateral ligaments are located on the inside and the outside of the knee and provide stabilization in side-to-side movement. The medial collateral ligament (MCL) is the most commonly injured ligament in the knee. Like all ligaments, this ligament may be sprained or torn. A sprained ligament may be partially ruptured. A torn ligament is completely ruptured. Severe MCL sprains or tears often produce a tearing or ripping sensation along the inner joint line of the knee. You may also notice knee instability and swelling. A force from the outer (lateral) knee to the inner (medial) knee is typically responsible for this injury in contrast to the more rarely injured LCL, which is typically a result of an inner to outer force.
The cruciate (or crossed) ligaments are located deep inside the knee. Their function is to stabilize the knee in forward/backwards motions and prevent the thighbone from “rolling over” the tibia. An anterior cruciate ligament (ACL) injury is a common sports injury generally caused by a hard stop or a violent twisting of the knee. The posterior cruciate ligament (PCL) is stronger than the ACL and much less commonly torn. The PCL requires strong forces, such as those produced when the dashboard strikes the knee in a car accident, to tear.
Tendon strains, sprains, and ruptures
Tendons connect muscles to bones. The most common tendon injuries in the knee are the quadriceps and patellar tendon injuries. Both the quadriceps and patellar tendons may rupture partially or completely. Quadriceps tendon rupture typically occurs in recreational athletes older than 40 years and patellar tendon rupture typically occurs in younger people who have had previous tendonitis or steroid injections to the knee. Rupture of either the quadriceps or patellar tendon causes pain (especially when trying to kick or extend the knee). The patella is also often misaligned either upward (with patellar tendon rupture) or downward (with quadriceps tendon rupture). The patient can usually notice a difference in appearance when comparing his/her knees.
Cartilage tears and degeneration
There are go kinds of cartilage in the knee. The smooth, hard hyaline cartilage that lines the articular surfaces and the bones of the joint and the rubbery-hard fibrocartilage that helps makes this joint socket deeper and more stable. In the knee, this rubbery-hard cartilage is called the meniscus. Injuries to the meniscus are typically traumatic injuries but can also be due to overuse. Often, a piece of the meniscus will tear off and get pinched between the tibia and femur. Meniscal injuries may cause the knee to lock in a particular position or either click or grind through its range of motion. Meniscal injuries may also cause the knee to give way. Swelling typically accompanies these symptoms although the swelling is much less severe than with an ACL injury.
Osteoarthritis, also called degenerative joint disease, is a common disease of the joint that most people develop with advancing age. In fact, it is so common that some question whether or not it is a disease per se or a consequence of normal aging. Osteoarthritis is caused by degeneration of cartilage in the knee. In its extreme form, the menisci (cartilage) can be completely eroded, and the femur will rub on the tibia, bone on bone. Osteoarthritis (OA) causes a chronically painful knee that is often more painful with activity. It can be stiff with prolonged sitting and may become enlarged from new bone formation at the edge of the degenerated cartilage.
Non-Surgical Solutions for Knee Pain
All knee problems get worse with poor tissue healing and repair mechanisms. Supporting your body’s own natural tissue healing processes with diet, lifestyle, and adequate exercise can ameliorate many of these problems.
If you still have pain despite this, then consider a trial of precisely targeted regenerative therapies to the damaged or injured structure. These options include Super Concentrated Platelets (Regenexx SCP) and bone marrow derived mesenchymal stem cells (Regenexx Same-Day Stem Cell Therapy). Both of these treatments seek to restore joint health by assisting your body’s own ability to heal damaged tissue. The experts at Columbia Pain Management can help you decide if a regenerative therapy could help you reduce your pain and get your knee moving again.