Knee Conditions

 Chondromalacia patella (also called patellofemoral syndrome): Irritation of the cartilage

on the underside of the kneecap (patella), causing knee pain. This is a common cause of
knee pain in young people.
 Knee osteoarthritis: Osteoarthritis is the most common form of arthritis, and often affects
the knees. Caused by aging and wear and tear of cartilage, osteoarthritis symptoms may
include knee pain, stiffness, and swelling.
 Knee effusion: Fluid buildup inside the knee, usually from inflammation. Any form of
arthritis or injury may cause a knee effusion.
 Meniscal tear: Damage to a meniscus, the cartilage that cushions the knee, often occurs
with twisting the knee. Large tears may cause the knee to lock.
 ACL (anterior cruciate ligament) strain or tear: The ACL is responsible for a large part of
the knee’s stability. An ACL tear often leads to the knee “giving out,” and may require
surgical repair.
 PCL (posterior cruciate ligament) strain or tear: PCL tears can cause pain, swelling, and
knee instability. These injuries are less common than ACL tears, and physical therapy
(rather than surgery) is usually the best option.
 MCL (medial collateral ligament) strain or tear: This injury may cause pain and possible
instability to the inner side of the knee.
 Patellar subluxation: The kneecap slides abnormally or dislocates along the thigh bone
during activity. Knee pain around the kneecap results.
 Patellar tendonitis: Inflammation of the tendon connecting the kneecap (patella) to the
shin bone. This occurs mostly in athletes from repeated jumping.
 Knee bursitis: Pain, swelling, and warmth in any of the bursae of the knee. Bursitis often
occurs from overuse or injury.
 Baker’s cyst: Collection of fluid in the back of the knee. Baker’s cysts usually develop
from a persistent effusion as in conditions such as arthritis.
 Rheumatoid arthritis: An autoimmune condition that can cause arthritis in any joint,
including the knees. If untreated, rheumatoid arthritis can cause permanent joint damage.
 Gout: A form of arthritis caused by buildup of uric acid crystals in a joint. The knees may
be affected, causing episodes of severe pain and swelling.
 Pseudogout: A form of arthritis similar to gout, caused by calcium pyrophosphate crystals
depositing in the knee or other joints.
 Septic arthritis: An infection caused by bacteria, a virus, or fungus inside the knee can
cause inflammation, pain, swelling, and difficulty moving the knee. Although
uncommon, septic arthritis is a serious condition that usually gets worse quickly without
treatment.

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 tough band of tissue that extends from the
outside of your hip to the outside of your knee (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, osteoarthritis 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, rheumatoid arthritis is an
autoimmune condition that can affect almost any joint in your body, including your knees.
Although rheumatoid arthritis 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, pseudogout is caused by calcium-containing crystals that
develop in the joint fluid. Knees are the most common joint affected by pseudogout.
 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. Septic arthritis often occurs with a
fever.

Other problems

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 maltracking 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, including:
  Excess weight. Being overweight or obese increases stress on your knee joints, even during
ordinary activities such as walking or going up and down stairs. It also puts you at increased risk
of osteoarthritis by accelerating the breakdown of joint cartilage.
 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.

Shin splints

This injury often occurs after a sudden change in physical activity, such as increasing the level of
exercise performed each week. Shin splints occur when the muscle and bone tissue in the leg
become overworked by repetitive activity. Other factors can contribute to shin splints, including
improper footwear or abnormally rigid arches.

Stress fracture

A stress fracture is considered one of the most common injuries in sports — with those
participating in tennis, track and field, gymnastics, and basketball the most susceptible.
Typically, a stress fracture occurs when muscles become fatigued and are unable to absorb added
shock and transfers that shock to the bone. This causes a tiny crack in the bone, also known as a
stress fracture.

Unstable kneecap

When a kneecap (patella) works properly, it rests in a groove at the end of the thighbone. When
the knee bends, the patella moves within the groove. During a hard blow or fall, the patella slides
too far to one side or the other, causing a complete or partial dislocation, also known as an
unstable kneecap.

Patellar tendinitis

Overview
Patellar tendinitis is an injury to the tendon connecting your kneecap (patella) to your shinbone.
The patellar tendon works with the muscles at the front of your thigh to extend your knee so that
you can kick, run and jump.

Patellar tendinitis, also known as jumper's knee, is most common in athletes whose sports
involve frequent jumping — such as basketball and volleyball. However, even people who don't
participate in jumping sports can get patellar tendinitis.
For most people, treatment of patellar tendinitis begins with physical therapy to stretch and
strengthen the muscles around the knee.

Symptoms
Pain is the first symptom of patellar tendinitis, usually between your kneecap and where the
tendon attaches to your shinbone (tibia).

Initially, you may only feel pain in your knee as you begin physical activity or just after an
intense workout. Over time, the pain worsens and starts to interfere with playing your sport.
Eventually, the pain interferes with daily movements such as climbing stairs or rising from a
chair.

What is osteochondritis dissecans?

Osteochondritis dissecans is a joint problem. It occurs when an area of bone under a piece of
cartilage in the joint dies. This happens because of a loss of blood supply to the area. It can cause
a thin layer of bone and the cartilage to break loose. The loose piece may stay in place or fall into
the joint space. This makes the joint unstable. It causes pain and feelings that the joint “sticks” or
is “giving way.”

Osteochondritis dissecans most often occurs in the knees. It also may occur in other joints,
including elbows, ankles, shoulders, and hips. It is most common in children and adolescents.

Symptoms of osteochondritis dissecans

The symptoms of osteochondritis dissecans include:

 Pain in the joint, especially after activity

 Swelling of the affected joint
 Decreased joint movement, such as not being able to fully extend your arm or your leg
 Stiffness after resting
 A joint that “sticks” or “locks” in one position
 A clicking sound when you move the joint
 Weakening of the joint that makes it feel like it is “giving way”

These are all clues that you may have osteochondritis dissecans. See your doctor if you have any
of these symptoms, or if you have persistent pain or soreness in a joint.

What causes osteochondritis dissecans?

Doctors aren’t sure what causes osteochondritis dissecans. The loss of blood supply could be
caused by repeated minor injuries or stress to the bone that you don’t even notice. Children and
teens can get the condition when they spend months doing high-impact activities, such as
running or jumping.

Who gets osteochondritis dissecans?

Anyone can get osteochondritis dissecans. It happens more often in boys and young men 10 to
20 years of age who are very active. It is being diagnosed more often in girls as they become
more active in sports. It affects athletes, especially gymnasts and baseball players.

How is osteochondritis dissecans diagnosed?

Your doctor will do a physical exam. He or she will ask you about your symptoms and your
activities. They will check the joint to be sure it is stable. They will check for extra fluid in the
joint. Your doctor will consider all the possible causes of joint pain. These could include
fractures, sprains, and osteochondritis dissecans.

If osteochondritis dissecans is suspected, your doctor will order X-rays to check all sides of the
joint. If signs of osteochondritis dissecans are seen on X-rays of one joint, you may have X-rays
of the other joint to compare them. After this, you may have MRI (magnetic resonance imaging)
or CT (computerized tomography) imaging tests done. These tests can show whether the loose
piece is still in place or whether it has moved into the joint space.

Can osteochondritis dissecans be prevented or avoided?

Since the cause of osteochondritis dissecans is unknown, it can be hard to avoid it. Children who
are very active in sports can be taught how to reduce their chance of being injured. This includes
learning the proper techniques and mechanics of their sport. It also includes using protective gear
and participating in strength and stability exercises.

Osteochondritis dissecans treatment

A child with osteochondritis dissecans might not need much treatment. If the child is still
growing, the bone and cartilage will probably heal on their own. Your child needs to rest their
joint and avoid sports until their symptoms get better. This might mean they need to use a brace,
a cast, or crutches for a while.

For grown children and young adults, the problems can be worse. If the loose piece is stable (still
in place), home treatment can help with the symptoms. This can include:

 Resting the affected joint

 Bracing the joint when playing sports
 Treating pain and inflammation with an over-the-counter pain reliever and anti-inflammatory
medicine, such as ibuprofen (brand name: Advil)
If the loose piece is unstable (meaning it has moved into the joint space), you might need surgery
to remove it or secure it.

Do I have to stop sports activities?

If a nonsurgical treatment is recommended, you should avoid activities that cause discomfort.
You should avoid competitive sports for 6 to 8 weeks. Your doctor may suggest stretching
exercises or swimming instead as a means of physical therapy.

Living with osteochondritis dissecans

Can osteochondritis dissecans be cured?

Young people have the best chance of returning to their usual activity levels. But they might not
be able to keep playing sports with repetitive motions, such as pitching in baseball. Adults are
more likely to need surgery. They are less likely to be completely cured of the condition. They
are at higher risk of later developing osteoarthritis in the affected joint.

Although it's a fairly small part of the body, a lot can go wrong with your knee. Here's an
overview of just some of the conditions that commonly cause knee pain.

Arthritis: One of the most common causes of knee pain that doctors see is arthritis, says
Jonathan Shook, MD, an orthopedic surgeon in Indianapolis. There are several types of arthritis
than can cause knee pain:

 Osteoarthritis causes the smooth, protective layers of cartilage in the knee to become
worn, leading to damage in the bones in the knee.
 Rheumatoid arthritis affects the knee after the body's immune system attacks a
membrane within the joint, causing pain, inflammation, and damage to tissues in the
knee.
 Gout occurs when a substance called uric acid gathers in the knee, causing sharp pain.
 Pseudogout can strike the knees after crystals of calcium pyrophosphate build up in the
joints.
 Septic arthritis, in which bacteria attack the joint, causes severe pain, swelling, and
stiffness.
 Post-traumatic arthritis develops years after you have an injury in your knee, such as a
fractured bone or a damaged ligament.

Meniscal injury: Another common condition that triggers knee pain involves your meniscus,
Dr. Shook says. This is a structure in the knee providing cushioning that tends to suffer wear and
tear over your life. He often sees young, active patients who have suddenly gotten a meniscal
tear in a sporting event, and older patients who develop a more chronic tear in a worn meniscus.
Osgood-Schlatter disease: Typically affecting obese, active adolescent boys, this condition is
caused by tendons attached to the upper shin bone in the knee. During certain movements, the
tendons pull away from the bone, triggering knee pain.

Bursitis: Several fluid-filled structures in your knee called bursas help provide more cushioning
in the joint. Certain activities, such as kneeling on the floor, can cause a bursa to become
irritated, a condition called bursitis.

Tendinitis: Tendons are strong tissues that anchor muscles to bones, and they can become torn
or inflamed, a condition called tendinitis.

Ligament injuries: Ligaments are another kind of tissue that helps hold the knee together. You
have ligaments that connect bones in the knee along the inside and outside edges (the collateral
ligaments), and two that criss-cross within the knee (the cruciate ligaments). These ligaments can
become over-stretched or torn, often during sporting or athletic activities. Depending on the
ligament, this may cause varying degrees of knee pain, and your knee may become wobbly after
the ligament injury.

Chondromalacia patellae: In this condition, cartilage under the kneecap weakens and breaks
down. It can be caused by overuse of the knee, injuries to the joint, or having a kneecap that's not
properly in line. The damage to the cartilage can be mild or severe.

Patellofemoral pain syndrome: Also called "runner's knee," this is a common cause of knee
pain. It can be caused by overdoing physical activities, tissues around your knee that are too tight
or too weak, and misalignment of your kneecap.

Knee dislocation: Another condition that can cause knee pain is when your kneecap becomes
dislocated. Instead of resting in its normal location in a notch at the bottom of your thigh bone, it
moves to the side — typically toward the outside edge of your knee. This often occurs when a
person is bearing the full body weight on one foot and