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31st December 2019

KNEE PAIN LOCATION CHART

B y M r. S a m R a j a r a t n a m F R C S ( Tr. & O r t h o ) ( / a b o u t - s a m - r a j a r a t n a m / )

Knee pain can vary in degree from being something which is a minor irritation or which causes
slight concern to being a major problem impacting on your mobility and way of life.

Technically the knee is a synovial hinge joint, meaning that it is supplied with synovial fluid to
lubricate movement and nourish the joint, and also moves forward and backwards like a hinge.
However, apart from being the largest hinge joint in the body, it is also unusual in that it has a
degree of rotational
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movement.
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The knee is a complex structure consisting of bone, cartilage, muscle, tendon, ligament, synovial
fluid and nerves. Knee pain could be the result of a problem with any one of these components,
or a combination of several.

You may be experiencing knee pain and want to know the possible causes. The diagram, below, is
a handy guide to the possible reasons for your pain.

PAIN AT THE FRONT ABOVE THE KNEE

This is the location of the quadriceps tendon which attaches the four large muscles of the front
of the thigh to the knee cap.

POSSIBLE CAUSES OF PAIN

QUADRICEPS TENDONITIS – THIS IS CAUSED BY THE IRRITATION, STRAIN OR INJURY TO
THE QUADRICEPS TENDON.
PATELLOFEMORAL ARTHRITIS
This affects the underside of the kneecap (patella) and the trochlear groove in the femur in
which it moves. When the articular cartilage covering the surfaces of the bone wears away and
becomes inflamed the bones come into contact with each other resulting in pain.

PLICA SYNDROME
A plica is the fold in the thin synovial membrane that lines the knee joint. There were four of
these folds in the knee joint originally, but they often become absorbed during foetal
development. About 50% of the population is thought to have the remains of the embryonic
plicae. When a plica becomes inflamed (https://www.thechelseakneeclinic.com/knee-
arthroscopy/), perhaps because of repetitive knee movement, trauma or twisting, it causes pain
and weakness in the knee.

LATERAL PATELLAR FACET OVERLOAD SYNDROME

This refers to dull aching pain underneath, around the sides or below kneecap. It is caused by
increased pressure on the lateral facet of the patella. The reason for this is improper tracking
(https://www.thechelseakneeclinic.com/patello-femoral-joint/), poor alignment or dislocation of
the
Thekneecap.

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Chelsea The
Kneecondition
Clinic is often apparent during repetitive exercise such as climbing stairs.
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SYNOVITIS
The knee is a synovial hinge joint, and as such the joint is lined with a synovial membrane. If this
membrane becomes inflamed it is called synovitis. It is caused by overuse or trauma and results
in repeated bleeds into the joint. If not treated early or correctly the synovial membrane
becomes thickened with more blood vessels and becomes swollen and painful. It is also
associated with arthritis and gout.

PAIN AT THE KNEE ITSELF

This includes pain at the front and within the knee.

POSSIBLE CAUSES OF PAIN

ANTERIOR CRUCIATE LIGAMENT (ACL)
The ACL runs through the knee, gives it stability and controls back and forward movement.
Damage occurs due to twisting, over extension or sudden force through the knee. It is the most
common form of sports injury (https://www.thechelseakneeclinic.com/blog/acl-surgery-ruptured-
torn-acl-symptoms-surgery-recovery/). Symptoms include pain, possible “popping” sound,
swelling and instability.

PATELLOFEMORAL PAIN SYNDROME

This is a general term used for a dull pain in the vicinity of the kneecap and front of the knee.
Sometimes known as runner’s knee. Various causes including overuse or misalignment of the
kneecap.

PATELLA CHONDROMALACIA
A grating feeling and pain at the junction of the thigh and kneecap may be patella
chondromalacia. It is caused by the softening and deterioration of the cartilage on the underside
of the kneecap or a loose flap of cartilage.

PATELLOFEMORAL ARTHRITIS
The
The kneecap
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this does
not happen, the cartilage on the two surfaces may wear away and the bones come into contact
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with each other causing pain due to arthritis.

PARTIALLY DISLOCATED PATELLA

Twisting or trauma could cause the kneecap to move
(https://www.thechelseakneeclinic.com/patello-femoral-joint/) out of the groove in the thigh
bone. This produces severe pain and swelling at the front of the knee.

PATELLA TENDONITIS
This is caused by over-stretching or putting extra stress on the patellar tendon at the front of the
knee. It produces a burning sensation just below the kneecap.

OSGOOD-SCHLATTER DISEASE
Most common in children or adolescents. This is inflammation of a growth plate just below the
knee where the patellar tendon attaches to the shinbone. It produces swelling and a feeling of
tenderness and tightness.

SINDING-LARSEN-JOHANSSON SYNDROME
This tends to affect active adolescents. It is an inflammation of a growth plate under the
attachment of the patella tendon to the kneecap. The symptoms include pain near the bottom of
the kneecap accompanied by swelling and tenderness around the kneecap.

BURSITIS
The bursae are thin, fluid-filled, sacs at the points of contact between bone and soft tissue. If one
of these sacs at the front of the knee becomes inflamed it causes swelling on the knee,
tenderness and a dull ache.

OSTEOARTHRITIS
Osteoarthritis (https://www.thechelseakneeclinic.com/blog/osteoarthritis-of-the-knee/) is a
painful condition which commonly affects the knee joint. At first the symptoms may be mild, but
eventually surgery may be needed. The articular (also called hyaline) cartilage within the joint
breaks down and no longer cushions the bones. Also the synovial fluid no longer lubricates and
nourishes the cartilage. The result is pain and stiffness which increases over time.
BONE TUMOURS
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Bone tumours form when the bone cells (osteoblasts, osteocytes and osteoclasts) divide
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abnormally in an uncontrolled way forming a lump of tissue. Most bone tumours are benign, but
can weaken the bone and make it vulnerable to other problems. However, some are malignant
and spread cancerous cells to other parts of the body (metastasis). Symptoms include
continuous pain in the bones, local swelling and inflammation.

INFLAMMATORY JOINT DISEASE

Inflammatory joint disease or inflammatory arthritis is an overarching term for a number of
diseases, including different forms of arthritis, which are all characterised by inflammation of the
joints and often other tissues too. Many of these diseases are autoimmune disease in which the
body’s immune system turns against itself and damages its own tissues. Symptoms include
swelling, pain, stiffness and reduced joint function.

LATERAL PAIN (OUTER SIDE OF THE KNEE)

This area is the least liable to give rise to problems, but if pain does occur
(https://www.thechelseakneeclinic.com/blog/pain-on-outside-of-knee/) it may be due to one of
the following conditions.

POSSIBLE CAUSES OF PAIN

HAMSTRING TENDINITIS
This is an inflammation of the tendon which attaches one of the muscles of the hamstring, the
biceps femoris, to the back of the knee.

ILIOTIBIAL BAND SYNDROME

Inflammation and irritation of the thick fibrous iliotibial band which runs from the pelvis to the
tibia on the outside of the leg. Usually pain is felt on the outside of the leg, but may transfer to
the outer side of the hip.

LATERAL COLLATERAL LIGAMENT DAMAGE

Trauma, sprain or tear of the ligament on the outer side of the knee. Possibly accompanied by
pressure on the peroneal nerve problem and damage to the posterolateral corner of the knee.
LATERAL MENISCUS
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Knee Clinic
The menisci are crescent-shaped bands of cartilage which act as shock absorbers for the knee.
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The lateral meniscus can tear, rip or split in many ways. Symptoms are a sudden pain followed by
swelling and difficulty in walking (https://www.thechelseakneeclinic.com/knee-arthroscopy/).

CYST FORMING PRESSURE ON THE MENISCUS

If there is a tear within the meniscus cartilage, synovial fluid can collect and causes pressure on
the meniscus. It can be caused by over-rotation of the knee or by trauma. A lump may be visible
at the location of the cyst and pain or a burning sensation may result.

OSTEOARTHRITIS
The compartment on the outer side of the knee, the lateral femorotibial compartment, contains
articular cartilage. If this cartilage starts to wear down and degenerate, extra fluid may be
produced and bony osteophytes form. The symptoms include pain, reduced mobility and
instability (https://www.thechelseakneeclinic.com/knee-replacement-surgery/).

DISLOCATION OF THE SUPERIOR TIBIOFIBULAR JOINT AND POSSIBLE ACCOMPANYING

PERONEAL NERVE DAMAGE
The superior (or proximal) tibiofibular joint is located just below the knee. It is where the outer
side of the fibula is joined to the inner side of the tibia. Its purpose is to allow and limit twisting of
the leg and facilitate weight transfer between your foot and your body. A fall can trigger partial
dislocation causing pain and instability. If the peroneal nerve, which is located at the joint, is
damaged it can cause a feeling of pins and needles and numbness at the outer side of the knee.

TIBIAL PLATEAU FRACTURE

A tibial plateau fracture is a complex injury because it is a fracture at the top end of the shinbone
(proximal end of the tibia). It affects the knee by involving the cartilage on the floor of the joint
where the knee joint meets the tibia. The fracture can also affect surrounding tissue nerves and
blood vessels. The fracture is usually caused by a high or low energy trauma. Symptoms include
pain and swelling, possibly accompanied by pins and needles or numbness.

POSTEROLATERAL CORNER INJURY (PLC)

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The PLC is theKnee
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below the knee on the outside of the leg at the top of the tibia andMENU
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fibula to
the bottom of the femur. The PLC is a juncture for a number of ligaments and tendons. They
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work to avoid over extension and give the knee stability. Injury to this area is a common result of
trauma caused by sporting accidents. Trauma to the PLC often includes damage to the posterior
cruciate ligament and could also affect the common peroneal nerve.

MEDIAL PAIN (INNER SIDE OF THE KNEE)

The causes of pain on the medial side of the knee are going to be similar in many cases to that on
the lateral side.

POSSIBLE CAUSES OF PAIN

IRRITATION OF MEDIAL PLICA
A plica is a fold in the thin synovial membrane that lines the knee joint. There are usually four in
each knee, at the embryonic stage, and help to bend the joints easily. About 50% of the
population loose their plicae by absorption at the foetal stage. If a plica becomes inflamed
because of injury or overuse it can cause pain, swelling or locking of the knee joint
(https://www.thechelseakneeclinic.com/knee-arthroscopy/).

MEDIAL MENISCUS TEAR OR LOOSE CARTILAGE

If the meniscus on the inner side of the knee becomes torn
(https://www.thechelseakneeclinic.com/knee-arthroscopy/) or a small piece of cartilage becomes
detached or loose it will cause pain, swelling and mobility problems (see lateral meniscus tear).

OSTEOARTHRITIS
If the cartilage of the medial femorotibial compartment begins to wear down and degenerate,
the production of extra synovial fluid and formation of bony osteophytes cause pain, reduced
mobility and instability (https://www.thechelseakneeclinic.com/knee-replacement-surgery/).

MEDIAL COLLATERAL LIGAMENT DAMAGE

The
The medial
Chelseacollateral ligament is one of the four ligaments which aid stability of the knee
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is the most common knee ligament injury. Damage to the ligament
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joint. It
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(https://www.thechelseakneeclinic.com/ligament-reconstruction/) could be in the form of a

stretch, partial or complete tear, usually caused by an outward (valgus) force on the joint in a
lateral direction. Symptoms include pain, stiffness and possibly bruising.

OSTEOCHONDRAL DEFECT
An osteochondral defect is damage and loss of some articular cartilage which affects the
underlying bone. Symptoms include pain when putting weight onto the joint, swelling and
instability. Causes can include trauma, repetitive strain or loss of blood supply.

AVASCULAR NECROSIS
Avascular necrosis is the death of bone tissue due to a lack of blood supply. The result is collapse
of the bone. The causes include high alcohol intake or long-term use of high-dose steroid
medications. Pain can be progressive, perhaps at first only when weight is put on the knee, but
eventually the pain can be continuous.

PAIN AT THE BACK OF THE KNEE

Pain in this location is often due to problems with muscles, tendons or ligaments. Other possible
reasons for pain at the back of the knee (https://www.thechelseakneeclinic.com/blog/back-of-
knee-pain/) may be associated with synovial fluid or blood vessels.

POSSIBLE CAUSES OF PAIN

HAMSTRING TENDONITIS
The hamstring is one of three muscles at the back of the leg between the hip and the knee. The
hamstring tendon connects the hamstring to the knee. If the tendon becomes inflamed because
of overuse a sharp pain is felt at the back of the knee.

HAMSTRING TEAR OR PULL

Overloading the hamstring muscle can cause it to strain, partially tear or tear. Often caused by
strenuous exercise. A sharp pain is felt at the back of the thigh.
POPLITEUS
The Chelsea MUSCLE INJURY
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The popliteus muscle is a thin triangular muscle located in the depression at the back of the knee
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joint, called the popliteal fossa. Exercise or trauma may cause injury to the popliteus muscle. If
the muscle is injured you may feel tenderness when rotating your leg inwards.

CRAMP
The well known, sudden, pain of cramp can occur in any of the muscles at the rear of the leg. The
muscle involuntarily contracts and becomes tight and painful. Cramp can be caused by muscle
fatigue, strain or dehydration, but some causes are not known. Cramp is generally harmless, but
might point to an underlying problem such as restricted blood supply.

POSTERIOR CRUCIATE LIGAMENT INJURY

The posterior cruciate ligament is one of the four major ligaments of the knee. It lies within the
knee and has attachments at medial condyle of the femur and posterior intercondylar area of the
tibia. When injuries occur to this ligament (https://www.thechelseakneeclinic.com/ligament-
reconstruction/) it is usually when the knee is bent. Injuries range from a partial tear to a
complete tear accompanied by other ligament damage. Pain is sometimes accompanied by
swelling and instability of the joint.

BAKER’S CYST
A Baker’s cyst is an excessive accumulation of synovial fluid in an inflamed bursa of the popliteal
fossa. Bursae are fluid filled structures between skin and tendon or tendon and bone which
reduce friction between the adjacent moving parts. The increased synovial fluid is caused by
arthritis or trauma, and the swelling is seen behind the knee causing a feeling of tightness.

MENISCUS TEAR OR LOOSE CARTILAGE

Stiffness and pain at the back of the knee may be due to a torn posterior horn of one of the
menisci (https://www.thechelseakneeclinic.com/knee-arthroscopy/)(see medial and lateral
meniscus tear). This type of damage is often due to athletic activity and the pain may not be
evident until some time later.
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Pain on the Outside of the Knee (https://www.thechelseakneeclinic.com/blog/pain-on-outside-
of-knee/)

31st December 2019

Knee Pain Location Chart

(https://www.thechelseakneeclinic.com/blog/knee-pain-location-chart/)