Knee

• Knee pain non-traumatic:

  • Bursitis (most commonly prepatellar)
  • Degenerative meniscal tear
  • Baker's cyst
  • Patellar tendonitis
  • Iliotibial band syndrome - lateral knee pain in runners
  • Infection
  • Malignancy
  • Arthritis - OA, RA, seronegative arthopathies, gout and pseudogout
  • Referred pain from hip, ankles and spine
• Knee pain traumatic:

  • ACL injury
  • PCL injury
  • Meniscal injury or degenerative tear
  • Medical collateral ligament injury
  • Lateral collateral ligament injury
  • Fracture
  • Patellar dislocation
  • Quadriceps or patellar tendon rupture
• The Ottawa knee rules state that a patient with acute knee injury requires a knee x-ray if any of the following are present to look for fracture:

  •Age 55 years or older

  •Patella tenderness (with no tenderness elsewhere)

  •Tenderness of the head of the fibula

  •Can’t flex the knee to 90 degrees

  •Can’t weight bear (can’t take 4 steps – limping steps count)
• Depending on local arrangements, refer to an accident and emergency department, fracture clinic or acute knee clinic if:

  A significant soft tissue injury is suspected in a person with acute knee pain following trauma, due to:

  •A sensation of a 'pop' or 'snap'

  •Effusion, with rapid or gradual onset of swelling

  •Inability to complete the activity

  •Instability

  •Locking

  •Giving way

  •Difficulty weight bearing
• Swelling of knee post injury:

  • Swelling/effusion that develops rapidly within a few hours – most likely haemarthrosis
  • Swelling/effusion that develops more slowly or the following day more likely traumatic synovitis (inflammation of synovial membrane)