Knee Pain

Knee pain is one of the most common musculoskeletal complaints, affecting people of all ages and activity levels. It can arise from a wide variety of causes — ranging from acute injuries and sports-related conditions to chronic degenerative disease — and can significantly impact mobility, daily activities, and quality of life. Accurate diagnosis is the cornerstone of effective treatment, as many conditions share similar symptoms but require very different management approaches.

Anatomy of the Knee

The knee is the largest and one of the most complex joints in the body. It is formed by three bones — the femur (thigh bone), tibia (shin bone), and patella (kneecap) — and is stabilised by four major ligaments: the ACL, PCL, MCL, and LCL. The two C-shaped menisci act as shock absorbers, and a smooth layer of articular cartilage covers the joint surfaces to allow frictionless movement. The bursa, tendons, and muscles surrounding the knee all contribute to its function and stability.

Common Causes of Knee Pain

Osteoarthritis
Osteoarthritis is the most common cause of knee pain in adults over 45. It involves the gradual breakdown of articular cartilage, leading to bone-on-bone contact, pain, stiffness, swelling, and progressive loss of function. Symptoms typically worsen with activity and improve with rest.

ACL Injury
A tear of the anterior cruciate ligament is a common sports injury, typically occurring during pivoting, twisting, or sudden deceleration. It causes immediate swelling, pain, and a feeling of instability.

Meniscus Tear
Tears of the meniscal cartilage are frequent in both younger athletes and older individuals with degenerative change. Symptoms include pain along the joint line, swelling, clicking, and difficulty fully bending or straightening the knee.

Patellofemoral Pain Syndrome
Pain arising from the patellofemoral joint (between the kneecap and femur) is common in younger active individuals and runners. It causes pain at the front of the knee, typically worsening with stairs, squatting, or prolonged sitting.

Patellar Tendinopathy (Jumper's Knee)
Degeneration of the patellar tendon from repetitive loading, causing pain below the kneecap. It is common in jumping sports such as basketball and volleyball.

Iliotibial Band (ITB) Syndrome
A common overuse injury in runners, causing pain on the outer side of the knee due to friction of the iliotibial band over the lateral femoral condyle.

Bursitis
Inflammation of the bursae (fluid-filled sacs) around the knee can cause localised pain and swelling. Prepatellar bursitis (at the front of the kneecap) and pes anserine bursitis (on the inner side below the joint) are the most common forms.

Ligament Sprains
Injuries to the MCL (medial collateral ligament) are common following valgus stress to the knee and cause pain and swelling along the inner side of the joint. Most MCL injuries heal with non-surgical management.

Osteochondral Defects
Damage to the articular cartilage and underlying bone within the knee joint, which can cause pain, swelling, and mechanical symptoms. These lesions may require arthroscopic assessment and treatment.

Loose Bodies
Fragments of bone or cartilage floating within the knee joint can cause intermittent locking, catching, and pain.

Symptoms to Watch For

• Pain with weight-bearing, stairs, or prolonged walking
• Swelling and warmth around the joint
• Morning stiffness or stiffness after rest
• A clicking, catching, or locking sensation
• A feeling of the knee giving way
• Reduced range of movement
• Deformity or malalignment of the leg

Diagnosis

A thorough clinical assessment is essential. This includes a detailed history of the onset, location, and character of pain along with aggravating and relieving factors, followed by a systematic physical examination of the knee assessing alignment, swelling, range of motion, ligament stability, and meniscal signs.

Investigations may include:

• X-rays: Evaluate bony changes, joint space narrowing, and alignment
• MRI: Provides detailed images of soft tissues including ligaments, menisci, cartilage, and tendons
• Ultrasound: Useful for assessing tendons and bursae
• CT scan: Used for complex bony pathology and surgical planning
• Blood tests: When inflammatory or infective causes are suspected

Treatment Options

Non-Surgical Management

• Activity modification and relative rest during the acute phase
• Physiotherapy — targeted strengthening and rehabilitation programmes are the cornerstone of treatment for most knee conditions
• Weight management to reduce load across the joint
• Analgesic and anti-inflammatory medications
• Bracing and supportive devices
• Corticosteroid or hyaluronic acid injections for arthritis-related pain
• Biologic therapies (PRP, BMAC) for joint preservation in selected patients

Surgical Management

Surgery is considered when the underlying cause has been clearly identified and non-surgical treatment has not provided adequate relief, or when the structural problem requires repair or reconstruction. Minimally invasive arthroscopic techniques are used wherever possible.

• ACL Reconstruction — for ACL tears with instability
• Meniscus Repair or Trimming — for symptomatic meniscal tears
• High Tibial Osteotomy (HTO) — to realign the knee and preserve the joint in younger patients with focal arthritis
• PRP & BMAC — biologic therapies for joint preservation
• Knee Replacement — for end-stage arthritis unresponsive to non-surgical care

Why Choose Dr. Raja Nadar for Knee Pain?

Dr. Raja Nadar has specialised fellowship training in knee arthroscopy and joint replacement, with clinical experience managing the full spectrum of knee conditions — from acute sports injuries and cartilage problems to advanced arthritis requiring joint replacement. His training at leading institutions and his academic work in orthopaedic surgery underpin a patient-centred approach focused on accurate diagnosis, evidence-based treatment, and optimising long-term function.