ISSUE BASED TREATMENT OF KNEE PAIN IN THE YOUNG POPULATION FOR EARLY BACK TO WORK AND SPORTS

KNEE PAIN IN YOUNG


 Many young people complain of knee pain without a history of any trauma.

 Broadly classified into three groups

1. Patellofemoral pain Syndrome  

2. Enthesitis around the knee  

3. Knee involvement due to an arthritic affection

1. Patellofemoral Pain Syndrome (PFPS) –

Symptoms – Young individuals (female > male) complaining of unexplained knee pain while knee loading activities like climbing or descending stairs, squatting or getting up from prolonged sitting (Theater sign), and buckling or sense of giving way of the knee.

Probable causes – Though the definite cause is not known, it may happen in muscle imbalance and hypermobility, patellar dysplasia, abnormal patellar tracking, trauma to the patella, foot malalignment, and training shoe worn. Females are involved more than males.




Pathology –  Different theories have been advocated – Structural changes in the patellofemoral joint, increased intraosseous pressure due to impaired venous flow, altered pain processing pathways and psychosocial factors.

Signs –  Tenderness around patella, pressure on patella causes pain (Grind test), tests to rule out probable causes of PFPS mostly hip muscle imbalances, tightness of lower limb muscles and ligament laxity

Investigations – X-ray and MRI as needed

Prevention – Modifiable risk factors should be identified. Lower limb specific strengthening and stretching exercises, correctible knee and patellofemoral orthoses

Treatment –

There is emerging evidence that patellofemoral pain is not self-limiting.

Non-operative management involves most part of the treatment. Customized physical therapy regime involving hip and knee exercises, home-based or institutional depending on the patients motivation and involvement. Physiotherapy involves stretching and strengthening of muscles involved. Sometimes Orthoses (Knee braces, patella taps) can help. Most of the cases are not self-limiting as shown in recent studies.

Key Treatment Options

  • Exercises to improve strength and function of the hip and thigh muscles
  • Taping of the kneecap to reduce knee pain
  • Foot Orthotics if there is too much pronation (Foot roll)

2. Enthesitis around Knee

These are a group of diseases around the knee seen in younger persons with inflammation of structures. They are varied conditions

a. Osgood-Schlatter Disease – It is seen as painful swelling of the front of the upper tibia usually seen in adolescents due to the growth plate traction. It is bilateral in 30% of cases and more prevalent in boys.  It is seen during the rapid growth phase typically in athletes. X-ray is done for diagnosis. Activity modification, immobilization, anti-inflammatory drugs, and rehabilitation are the mainstay of treatment and it also decreases with time. It is usually a self-limiting disorder without sequelae. Conditioning and training programs and limit of repetition

b. Bursitis – There are many fluid-filled spaces to decrease the friction seen around the knee. There are almost 13 such spaces 4 on the front, 4 on the outer aspect, and 5 on the inner aspect, which get inflamed to cause painful bursitis. They are seen in young persons. The majority of the decrease with anti-inflammatory drugs, rest, ice gel application, and immobilization.

c. Iliotibial band syndrome – Pain on the outer aspect of knee at the insertion of the thigh band Iliotibial band. Runners and cyclists are predisposed to a female preponderance because of weak hip abduction. NSAIDs and physical therapy for stretching and myofascial restrictions and band release. Recovery should be done gradually and surgery for refractory cases may be needed.

d. Recurrent Dislocation of Patella – Pain, and instability due to repeated dislocation of the patella is common in adolescent girls due to inherent weakness of stabilizers of the patella bone. Repeated dislocation causes joint damage and failure to walk in a normal gait. Such patients need medical attention. Few patients may benefit from patella stabilizing orthoses for the knee. But old cases and multiple dislocators benefit from stabilizing surgeries, which can have soft tissue or bony component.

3. Knee arthritis in the young

a. Osteoarthritis – Common degenerative arthritis is seen in older patients. But sometimes due to secondary causes like infection and trauma, it can be seen in young persons. Young osteoarthritic patients after evaluation for the cause of joint damage can benefit from medications, orthobiologics like prp (platelet-rich plasma), BMAC (Bone Marrow Aspirate Cytology), Cartilage transfer and Deformity correction surgery.

b. Inflammatory Arthritis – Wide range of inflammatory arthritis like Rheumatoid arthritis, Psoriatic arthritis, or Ankylosing spondylitis needs regular medications and blood tests to keep the disease under control. Joint surgery needed when there is pain and deformity of the joints involved.

If you are young and suffer from knee joint pain then you must visit to our highly skilled Doctors at Top Bone and Joint Clinic.

To find out what is an appropriate treatment option for you and also for a second opinion, contact the team. Our Doctors will suggest you best treatment option for your knee pain. Call us today at 9337431976, 06743567913. 

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