Inner Knee Pain

Understanding the Knee

The knee is a complex joint in the human body that connects the femur (thigh bone) to the tibia (shin bone). The fibula and the patella are the other bones that make up the knee.

The knee has 2 crescent-shaped pads of cartilage (an elastic material that absorbs shocks) called the lateral meniscus and the medial meniscus. The knee is held together by a tendon and four ligaments. These are:

• Quadriceps tendon
• Medial collateral ligament
• Lateral collateral ligament 
• Anterior cruciate ligament
• Posterior cruciate ligament 

 The hamstrings and the quadriceps are the two groups of muscles that support the knee.

What causes knee pain?

Knee pain is one of the most common types of affliction in humans. Generally, people over 60 develop knee pain but it may also occur in younger people.

Knee can happen due to a number of reasons including:

Injury

Sportsperson and people who are physically active are at a high risk of injuring their knee. Playing sports, exercising or running puts a lot of strain on the knee joint and that leads to injury. An accident or trauma to the knee may also cause injury. The most common types of knee injury are:

Medial meniscus injury

There are two meniscus cartilages (which provide a cushion between the femur and the tibia) in each knee. This cartilage can tear if the knee is rotated or put under pressure. There are four types of meniscus tears:

• Bucket handle: This is a full-thickness tear of the inner portion of the medial meniscus. This tear is usually difficult to treat.
• Flap: This tear usually consists of a displaced fragment of the cartilage, which looks like a flap.
• Radial: This is a type of tear that happens in the avascular zone, which has no blood supply. As a result, these tears can’t heal by themselves and have to be fixed surgically.
• Complex: Complex tears are a combination of the aforementioned tear patterns.

Symptoms of a Medial meniscus injury include:

• Sharp pain in the knee
• Locking knees
• Imbalance
• Inability to put pressure on the affected leg

 Treatment

Meniscal injuries are treated depending on the location and the extent of the tear. If the outer portion of the meniscus is damaged, there is a good chance that it will heal on its own, provided the tear is small. To quicken your recover, you can

• Limit physical activities: Like exercising, walking
• Apply Ice: This helps in reducing the swelling.
• Compress your knee: You can use an elastic bandage or a brace. This is done to control the swelling.
• Elevate the knee: Keeping the knee on a pillow or a cushion while lying down or sitting helps with the recovery process.

However, surgery may be required if the tear is in the inner two-thirds of the meniscus. There are 3 types of surgeries to repair the meniscus

Arthroscopic surgery: In this procedure, the surgeon will insert an arthroscope (a small camera) to get an idea of the tear. He will then put small devices (which are absorbed by the body over time) along with the tear and stitch it up.

Arthroscopic partial meniscectomy: In this procedure, a piece of the torn meniscus is removed and then reattached.

Arthroscopic total meniscectomy: This is done when the tear is complex. In this procedure, the whole meniscus is removed. Patients who undergo this surgery have a significantly increased risk of developing arthritis.

Medial collateral ligament injury

The MCL connects the tibia and femur. When the MCL is damaged, it means it has either been overstretched or torn. This generally happens when a lot of force is applied to the knee. MCL injuries, which are common in sportspersons, are divided into 3 grades, depending on the severity.

Grade 1: This is the least severe and means the ligament has been only pulled and not torn. These injuries take a few days to heal.

Grade 2: This means that the MCL has been partly torn. This injury takes up to 1 month to heal.

Grade 3: This is the most severe and means that the MCL has been completely torn off. These tears take up to 2 months or more to completely heal.

If you’ve damaged your MCL, you may feel

• Stiffness in the knee
• Swelling
• A popping sound at the time of the injury
• Severe pain

 Treatment

After sustaining the injury, you should:

• Put ice on the knee to reduce swelling
• Use crutches to walk
• Compress the knee with a brace
• Not move

If you’ve suffered a Grade 1 or 2 injury, there is no need for surgery as the MCL will repair itself. However, you can opt for other treatments including:

Physical therapy: This is done to strengthen the knee and improve mobility

Wearing a protective knee brace: This will keep your knee from sustaining further damage as it heals itself.

Limiting physical activity: You should get plenty to rest to help the MCL heal.

If you’ve suffered a Grade 3 tear then you will require surgery. The surgeon may use the arthroscopy procedure. If the tear is towards the side, the surgeon will reattach using large stitches, a metal screw, a suture anchor or bone stapes. If the tear is in the middle then the surgeon will stitch the MCL together.

Osteoarthritis

Osteoarthritis is a common type of arthritis that develops when the cartilage that cushions the ends of two bones wears down with age. A person with osteoarthritis generally experiences pain in the knee while walking up and down the stairs as the joints in the knee grind together. People suffering from OA should see a doctor as soon as possible as the condition gets worse with time.

Rheumatoid arthritis

 Rheumatoid arthritis is an autoimmune disease that causes inflammation to the joints of the body. People with Rheumatoid arthritis experience severe inner knee pain, especially in the mornings. After a while, the inflammation may lead to bone erosion and joint deformity. Although there is no treatment, rheumatoid arthritis can be controlled by anti-rheumatic drugs.

Pes anserine bursitis

Bursae are tiny, jelly-like sacs found throughout the body. Bursae, which contain fluid, act as cushions between bones and soft tissues. Pes anserine bursitis is the term given to the inflammation of the bursa present between the tibia and the tendons of the hamstring at the inside of the knee. This happens when the bursa produces too much fluid and irritates the other parts of the knee.

It is common in athletes, who use wrong training techniques. People who have osteoarthritis are also at risk of developing this condition. Pes anserine bursitis is generally treated by correcting training techniques. If it does not become better you can:

• Apply ice: Applying ice at regular intervals helps with this condition
• Take anti-inflammatory medication: These medicines work by reducing inflammation and reducing pain.
• Get shots: Doctors inject a solution of anesthetic and steroid into the bursa to provide immediate relief.

Medial plica irritation

The medial plica of the knee is a thin fold of the joint lining over the inner portion of the knee. Overuse of this joint (such as repeatedly flexing the knee) can cause the medial plica to thicken and this results in it getting stuck between bones.

Physical therapy including Hamstring stretching, Quadriceps strengthening is generally used to treat this condition. However, if that doesn’t work, you may have to undergo a surgery called arthroscopic resection. The surgeon will insert a small camera and other instruments through several incisions to adjust the plica’s position.

Patellar tendinitis

Tendinitis is the term given when tendons get irritated and inflamed. Patellar tendinitis happens when the tendons connecting the patella (kneecap) to the tibia gets damaged. It is most common in runners, skiers, cyclists, and those involved in jumping sports as the patella tendon is used for jumping.

Patellar tendinitis can be treated by physical therapy techniques including:

Iontophoresis: In this therapy, corticosteroid drugs (that relieve swelling and inflammation) are spread on your skin using a low electrical charge.

Stretching: Stretching is a good way to reduce muscle spasm and lengthen the muscle-tendon unit.

Strengthening exercises: As weak muscles add to the strain on the patellar tendon, strengthening exercises of the legs are helpful.

Patellar tendon strap: This strap helps relieve pain by distributing pressure away from the patellar tendon.

Gout

Gout is a painful condition that affects the joints of the body. Gouts generally occur when the body has high levels of uric acid. The acid forms sharp crystal in the joints that are very painful. When the knee is affected by gout, walking or standing becomes painful.  Although there is no cure for gout, it can be managed by diet control, certain medications and lifestyle changes.

If you have gout, it is important to:

• Stop or reduce the consumption of alcohol
• Reduce weight
• Stop consuming foods with high-purine content such as seafood, shellfish and red meat.

Pseudogout (Calcium Pyrophosphate deposition)

Pseudogout aka false gout is another painful form of arthritis that mostly affects the knee. Unlike gout, pseudogout happens due to the formation of crystallized calcium pyrophosphate in the joints. This condition is characterized by sudden painful swelling of the joints.  You are at the risk of developing this condition if you have had kidney failure or a thyroid condition. It usually affects people over the age of 60.  There is again no cure for pseudogout, although there are treatments to manage pain and improve joint function.

Septic arthritis

Septic arthritis happens when the joint is inflamed due to an infection. This is a painful condition that is characterized by redness and heat. This condition generally affects the knees. Septic arthritis usually affects infants and elderly people. People with this condition require immediate medical care as the infection spreads quickly and severely damages bones and cartilages.

Although Septic arthritis can be caused by a range of microbes, Staphylococcus aureus (a type of bacteria) is usually responsible. Treatments include joint drainage and antibiotics.

Risk Factors

Although knee pain can happen to anybody at any time, there are certain factors that increase the risk of developing knee pain. These are:

• Being Obese: If a person is obese, he/she is likely to develop knee pain as the added weight puts pressure on the knees. Obesity can also put a person at risk of developing osteoarthritis as the cartilage wears down faster in overweight people.
• If the knee was previously injured: The chances of a person developing knee pain significantly increases if he/she has already suffered a knee injury.
• Being an athlete or a sportsperson: People who play sports regularly or professionally are at the risk of sustaining different injuries. People who play basketball (which involves a lot of jumping) have the highest risk of developing knee injuries.
• Having weak muscles: Muscle weakness can lead to knee problems as strong muscles help protect your joints.

Prevention

Knee pain is something that cannot be always prevented. However, there are certain measures you can take. These are:

Maintaining a healthy weight: Keeping your BMI (Body Mass Index) under control will help you prevent, not only knee pain but also a lot of other conditions.

Utilizing proper training techniques: If you are a sportsperson or an athlete, doing the right training exercises will reduce the risk of injuries.

Exercise: Too much rest results in the weakening of muscles, which in turn leads to knee problems. So it is important that you workout or jog at least 3 times a week.

Wearing the right shoes: Wearing the right kind of shoes can help you prevent knee pain especially if you jog, hike, trek or play sports.

Maintain the right posture: Slouching while walking or standing is one of the causes that lead to knee pain. This is because, when you slouch, the body is off center and the muscles have to work harder to keep you in balance. As a result, the muscles tire leading to strain in your joints.

TL;DR?

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