Overview: The knee joint is created by the femur (thigh bone) and the tibia (shin bone). Within the knee joint is a cartilage lining over the bones called the meniscus. The meniscus serves to protect the joint, balance the load of the joint and as the attachment site for ligaments.
Causes: Any activity that involves rotation or twisting of the knee while placing weight on the same side can cause a tear within the meniscus.
Symptoms: Pain in the knee with popping or clicking of the joint are common complaints. Swelling and difficulty straightening the knee may also occur.
Treatment: Patients that have the clinical signs and symptoms of labrum damage may be further evaluated with advanced imaging, such as MRI or CT scan. When an accurate diagnosis has been made, treatment options depend on the severity of the meniscus tear. For those with mild to moderate symptoms, anti-inflammatory medications and physical therapy can be very helpful. Regenerative Medicine can be used to heal the cartilage tear. Surgical intervention is reserved for cases that don’t respond to more conservative measures or those with significant functional impairment.
Patellar Tendinitis (Jumper’s Knee)
Overview: The patellar tendon is an extension of the quadriceps muscles that crosses over the patella (kneecap) and attaches to the tibia (shin bone). It helps to extend the knee and allows activities such as running and kicking.
Causes: Repetitive stress such as running, squatting and jumping are risk factors for developing patellar tendonitis. Footwear and training errors can be factors, as well as inflexibility and malalignment of the leg, ankle and foot (abnormal Q angle).
Symptoms: Pain is felt just below the kneecap. There can be tenderness to the area, and the pain can worsen with increased activity.
Treatment: Anti-inflammatory medications and topical agents can be effective. Bracing can allow the tendon to rest and help better align the patella for improved biomechanics of the knee. Physical therapy can provide education on how to appropriately stretch and strengthen the legs to correct muscle imbalance. A local steroid injection into the region can be performed. A safer option is to place platelet-rich fibrin (PRF) into the injured portion of the tendon to promote healing and reduce inflammation and pain
Overview: Bursa are fluid-filled sacs that are found in several places within the body. They reduce friction and improve movement. The prepatellar bursa is one of several bursa that surround the knee joint and is located between the patella (knee cap) and the skin.
Causes: Bursa may become irritated and inflamed when excessive stress is placed on them. Direct trauma to the bursa or repetitive minor trauma, such as kneeling, can cause inflammation of the bursa. Other potential causes include gout, alcohol abuse, diabetes and autoimmune disorders.
Symptoms: Tenderness and pain directly over the patella are frequent. Swelling and pain with knee range of motion may also occur.
Treatment: Oral or topical anti-inflammatory medication can be used to decrease inflammation. A PRF or steroid injection into the bursa under ultrasound guidance may be pursued. Surgical removal of the bursa is reserved for severe cases of bursitis that have failed more conservative measures.
Overview: A Baker’s cyst is a sac of fluid that arises from the back of the knee joint.
Causes: The cyst is created when fluid from a weak part of the joint leaks into the surrounding tissue. This is due to over-production of joint fluid following knee joint pathology, such as meniscal tears or arthritis. Thus, the cyst is secondary to an underlying primary joint issue.
Symptoms: The cysts are typically painless. However, when the cyst becomes very large, local pain and difficulty with full flexion and extension of the knee are noted.
Treatment: Most cysts can be monitored if they are not causing any symptoms. Cysts that are painful can be aspirated under ultrasound guidance, followed by a PRF or steroid injection into the site to limit the recurrence of the cyst. Treatment of the underlying knee pathology is the best way to prevent further cyst formation.