Knee Pain

Understanding the Knee

The knee is a key and complex joint essential for movement. It:

Supports walking, standing, climbing, and exercise
Consists of three bones: femur, tibia, and patella
Contains cartilage and menisci (medial and lateral) — these cushion the bones, facilitate smooth movement, and provide stability
Is stabilized by four ligaments: ACL, PCL, MCL, and LCL

Common Causes of Knee Pain

1. Knee Osteoarthritis

Wear-and-tear of cartilage with age; most common in older adults

2. Ligament Injuries

Damage to ACL, PCL, MCL, or LCL; often from twisting, falls, or sports-related injuries

3. Meniscal Injuries

Tears in shock-absorbing cartilage, often due to lifting, twisting, or squatting movements

4. Inflammatory Arthritis

Conditions like rheumatoid arthritis or psoriatic arthritis; immune-mediated, causing joint swelling, stiffness (especially in the morning), and long-term damage

5. Other Causes

Infections, gout, referred pain, patellofemoral syndrome, or bursitis.

How Is Knee Pain Evaluated?

Your doctor will:

Take a detailed history (onset, timing, triggers)
Examine the knee clinically
Order X-rays or MRI if needed
Request blood tests if inflammatory arthritis is suspected

This helps determine whether pain stems from wear-and-tear (OA), injury, or inflammation. Since osteoarthritis is the most common cause, it’s the main focus here.

(Left) In this X-ray of a normal knee, the space between the bones indicates healthy cartilage (arrows). (Right) This X-ray of an arthritic knee shows severe loss of joint space.

Knee Osteoarthritis (OA)

What is Knee OA

Breakdown of cartilage in the knee joint
Caused by aging, prolonged standing/walking, weak muscles, previous injury, or excess weight
Damaged cartilage cannot grow back – without care, pain and stiffness will worsen

Goals of Treatment

Reduce pain
Prevent further joint damage

Daily Care & Prevention Tips

Avoid prolonged standing/walking — for every 10 minutes of activity, take a 5-minute rest
Minimize stair use
Avoid low chairs and squatting
When in pain: apply ice packs (15 minutes) or use pain-relief gels/creams

Pain Relief Options

Tablets:

Paracetamol, Panadeine, short courses of NSAIDs (under medical advice)

Injections:

Steroid – temporary relief for 3–6 months
PRP (Platelet-Rich Plasma) – may help stimulate cartilage or slow degeneration; more effective in mild-to-moderate cases, less so in advanced OA
Gel injections (Hyaluronic acid) – provide cushioning; typically used after weight loss and exercise eff

Supplements:

Glucosamine: may offer symptom relief in mild-to-moderate osteoarthritis; no evidence it causes cartilage growth
Fish Oil (Omega3): May help reduce inflammation and support general health, though not a direct cure.Emphasized that these supplements are complementary—not replacements for prescribed treatments like exercise, weight control, and medication.

Strengthening & Weight Control

Exercises: 2–3 times daily; guided by a physiotherapist or clinic video
Weight loss: achieved primarily through diet. High-impact exercises may worsen knee OA. Prefer low-impact options like swimming, cycling, or using a cross-trainer, combined with strength training using proper techniques

Review: Regular clinical reviews are essential to assess for progression and ensure patient is following proper treatment plan.

Other Types of Arthritis

If knee pain is due to rheumatoid or psoriatic arthritis:

The immune system attacks the joint, causing swelling and morning stiffness (lasting >30 minutes)
Managed with DMARDs (Disease-Modifying Anti-Rheumatic Drugs) to prevent joint damage

When to Consider Surgery

Surgery may be considered if Pain severely limits daily activities Inability to get out of bed, go to the washroom.

Considered only for severe cases after optimal non-surgical care;Arthroscopy is not recommended for uncomplicated OA

⚠️ All surgeries carry risk. Delay until absolutely necessary.

Rheumatology