KNEE PAIN

Possible Cause

Injuries

A knee injury can affect any of the ligaments, tendons or fluid-filled sacs (bursae) that surround your knee joint as well as the bones, cartilage and ligaments that form the joint itself. Some of the more common knee injuries include:

• ACL injury An ACL injury is the tearing of the anterior cruciate ligament (ACL) — one of four ligaments that connect your shinbone to your thighbone. An ACL injury is particularly common in people who play basketball, soccer or other sports that require sudden changes in direction.
• Torn meniscus The meniscus is formed of tough, rubbery cartilage and acts as a shock absorber between your shinbone and thighbone. It can be torn if you suddenly twist your knee while bearing weight on it.
• Knee bursitis Some knee injuries cause inflammation in the bursae, the small sacs of fluid that cushion the outside of your knee joint so that tendons and ligaments glide smoothly over the joint.
• Patellar tendinitis Tendinitis is irritation and inflammation of one or more tendons — the thick, fibrous tissues that attach muscles to bones. Runners, skiers, cyclists, and those involved in jumping sports and activities are prone to develop inflammation in the patellar tendon, which connects the quadriceps muscle on the front of the thigh to the shinbone.

Mechanical problems

Some examples of mechanical problems that can cause knee pain include:

• Loose body Sometimes injury or degeneration of bone or cartilage can cause a piece of bone or cartilage to break off and float in the joint space. This may not create any problems unless the loose body interferes with knee joint movement, in which case the effect is something like a pencil caught in a door hinge.
• Iliotibial band syndrome This occurs when the ligament that extends from the outside of your pelvic bone to the outside of your tibia (iliotibial band) becomes so tight that it rubs against the outer portion of your femur. Distance runners are especially susceptible to Iliotibial band syndrome.
• Dislocated kneecap This occurs when the triangular bone (patella) that covers the front of your knee slips out of place, usually to the outside of your knee. In some cases, the kneecap may stay displaced and you'll be able to see the dislocation.
• Hip or foot pain If you have hip or foot pain, you may change the way you walk to spare these painful joints. But this altered gait can place more stress on your knee joint. In some cases, problems in the hip or foot can refer pain to the knee.

Types of arthritis

More than 100 different types of arthritis exist. The varieties most likely to affect the knee include:

• Osteoarthritis. Sometimes called degenerative arthritis, it is the most common type of arthritis. It's a wear-and-tear condition that occurs when the cartilage in your knee deteriorates with use and age.
• Rheumatoid arthritis. The most debilitating form of arthritis and is an autoimmune condition that can affect almost any joint in your body, including your knees. Although it is a chronic disease, it tends to vary in severity and may even come and go.
• Gout. This type of arthritis occurs when uric acid crystals build up in the joint. While gout most commonly affects the big toe, it can also occur in the knee.
• Pseudogout. Often mistaken for gout, it is caused by calcium-containing crystals that develop in the joint fluid. Knees are the most common joint affected.
• Septic arthritis. Sometimes your knee joint can become infected, leading to swelling, pain and redness. There's usually no trauma before the onset of pain. It is often accompanied with fever.

Other problems

Chondromalacia patellae (patellofemoral pain syndrome) is a general term that refers to pain arising between your patella and the underlying thighbone (femur). It's common in athletes; in young adults, especially those who have a slight misalignment of the kneecap; and in older adults, who usually develop the condition as a result of arthritis of the kneecap.

Risk Factors

A number of factors can increase your risk of having knee problems:

• Excess weight Being overweight or obese increases stress on your knee joints, even during ordinary activities such as walking or climbing stairs. It also puts you at increased risk of osteoarthritis by accelerating the breakdown of joint cartilage.
• Biomechanical problems Certain structural abnormalities — such as having one leg shorter than the other, misaligned knees and even flat feet — can make you more prone to knee problems.
• Lack of muscle flexibility or strength A lack of strength and flexibility are among the leading causes of knee injuries. Tight or weak muscles offer less support for your knee because they don't absorb enough of the stress exerted on the joint.
• Certain sports Some sports put greater stress on your knees than do others. Alpine skiing with its rigid ski boots and potential for falls, basketball's jumps and pivots, and the repeated pounding your knees take when you run or jog all increase your risk of knee injury.
• Previous injury Having a previous knee injury makes it more likely that you'll injure your knee again.

Complications

Some knee injuries and medical conditions, such as osteoarthritis, can lead to increasing pain, joint damage and disability if left untreated. And having a knee injury — even a minor one — makes it more likely that you'll have similar injuries in the future.

Care and Treatment

The following suggestions may help forestall injuries:.

• Maintain a healthy weight Every extra pound puts additional strain on your joints, increasing the risk of injuries and osteoarthritis.
• To prepare your muscles for the demands of sports participation, take time for conditioning. Work with a coach or trainer to ensure that your technique and movement are the best they can be.
• Weak muscles are a leading cause of knee injuries, you'll benefit from building up your quadriceps and hamstrings, which support your knees. Balance and stability training helps the muscles around your knees work together more effectively. And because tight muscles also can contribute to injury, stretching is important. Try to include flexibility exercises in your workouts.
• If you have osteoarthritis chronic knee pain or recurring injuries, you may need to change the way you exercise. Consider switching to swimming, water aerobics or other low-impact activities — at least for a few days a week. Sometimes simply limiting high-impact activities will provide relief.

When to Call the Doctor

• Can't bear weight on your knee.
• Have marked knee swelling.
• Are unable to fully extend or flex your knee.
• See an obvious deformity in your leg or knee.
• Have a fever, in addition to redness, pain and swelling in your knee.
• Feel as if your knee is unstable or your knee "gives out".