knee non-traumatic injuries

• Inability of tissue to keep up with the demand placed upon them 

  Could be an overuse injury – increase load placed on the tissues which affects tissue capacity & repair 
• Patellofemoral pain sysndrome: ususally nociceptive pain 

  Most common knee problem : 22% prevalence in general population  

  Can be difficult to treat: 1/3 still have pain a year after starting treatment 

  Injuries PFPS is generally defined by pain around the patellofemoral joint articulation, when there is an absence of a confirmed pathology 

  it is a diagnosis of exclusion 
• pfps:

  Risk factors: 

  Reduced gluteal strength  

  Reduced quads strength  

  2:1 Female:male ratio  

  Altered knee position on movement  

  Altered foot posture  
• pfps:

  Typical features: 

  Retropatella pain  

  Mechanical nature  

  Squatting, stairs, prolonged sitting  

  Eccentric > concentric loading  

   

  Objective findings: Pain reproduced with…  

  Palpation around patella 

  Compression of patella 

  Resisted mid range extension  

  Demo of aggravating movements 
• pfps:

  Proposed mechanism: 

  Suboptimal strength/biomechanics  

  Reduced contact between patella and femur in the trochlea groove  

  Increased pressure  

  Pressure on the underlying subchondral bone causes pain 
• Patella tendinopathy: 

  1. Pain localised to the inferior pole of the patella  

  2) Load related pain with increased demand on knee extensors – especially ‘energy store and release’  

   

  Key differences to PFJP:  

  Males > females  

  Typically aggravated by jumping sports  

  Pattern of pain: ‘ warm up pain’ and worse the day after loading  
• Patella tendinopathy diagnosis  

  Primarily based on defining features:  

  Pain localised to inferior pole of patella  

  2) Aggravated by energy store and release activities  

   

  Some studies include:  

  Pain on single leg decline squat 

  2) Tendinosis on ultrasound  

   

  Other key distinguish features:  

  1. ‘warm up phenomenon’  

  2) Rare to have pain at rest  

  3) Dose-dependent pain  
• Iliotibial band syndrome (ITBS): 

  Causes: 

  Friction of the ITB flicking over lateral femoral condyle  

  Compression of the underlying fat  

  True bursitis 

   

  Symptoms 

  Sharp or burning pain  

  Onset with prolonged activity  

  May radiate up or down limb 

   

  Nil consistently proven to be related / causative of symptoms but …  

  High running mileage with inadequate rest  

  Weak proximal muscles - especially glutes  

  • Tight ITB 

   

  Treatment: 

  Rest --> stretch ITB --> muscle strengthening --> running technique coaching --> surgery 

   
• Osteoarthritis: 

  Diagnosis can be made without imaging :  

  • Age > 45 and  

  • Activity related joint pain and  

  • No early morning stiffness (EMS) or EMS < 30 minutes 

   

  If patient has history of trauma, prolonged EMS, rapid worsening of symptoms or a hot swollen joint → consider other causes 

   
• OA:

  Common objective findings:  

  - TibFem joint line tenderness (plus painful patella compression if affects both joints) 

  Pain on passive range of movement as well as active and weightbearing movements  

  • If moderate/advanced OA may have visible joint deformity  

   

  In practice:  

  • Advice and education  

  • Exercise  

  • Considering onward referrals if needed:  

   

  ➢ Orthopaedics  

  ➢ Dietician  

  ➢ Foot health  

  ➢ OT 
•  

  Bursitis: 

  Pre-patella bursitis  

  AKA: beat knee, carpet layer's knee, housemaid's knee, rug cutter's knee