Tendinopathy
Tendinopathy affects the patella tendon. In this condition there is microscopic failure of tendon fibers with an inadequate healing response. It is common in repetitive sports. Tendinopathy can be insertional (where the tendon is connected to the patella at the top ("jumper's knee") or the tibia, or non-insertional when it affects just the tendon. This condition often improves with specialist physiotherapy exercises.
Impingement
Hoffa's fat pad protects the front of the knee and fills the space between the patella tendon and thigh bone (femur). It can get pinched between the bones causing pain at the front of the knee. This is called impingement. The inside knee lining (synovium) can also cause impingement in other parts of the knee. In the early stages anti-inflammatory measures can help as well as physiotherapy. Other options are steroid injections and arthroscopy (keyhole surgery).
Ilio-tibial band friction syndrome
The ilio-tibial band is a strong tendon like structure running from the pelvis to below the knee. It is a stabiliser of the knee when standing on one leg. With overuse (running, cycling) it can rub over the bone prominence on the outside of the knee causing pain. Anti-inflammatory measures and stretching of the ilio-tibial band with physiotherapy can help initially. A steroid injection is an option but is best avoided.
Patello-femoral overload syndrome
Patello-femoral overload syndrome
The patella moves up and down with knee movement (tracking) and is contained by a groove at the front of the thigh bone (femur). Abnormal tracking can cause overload and pain. Possible causes include a shallow groove (trochlea dysplasia), rotational deformity of the top of the femur, angular deformity of the knee, tightness of the ilio-tibial band and weak quadriceps muscle strength. It is important to identify the cause and focus treatment on the cause. In the majority of cases physiotherapy exercises can improve the situation but this is a condition which is difficult to cure completely.
Plica syndrome
The inside knee lining (synovium) has several natural folds. Sometimes the folds can get injured acutely or with overuse. The fold then thickens and rubs over bones causing pain. In the early stages anti-inflammatory measures can help. Other options are steroid injections and arthroscopy (keyhole surgery).
Baker's or popliteal cyst
A Baker's cyst is a common finding in chronically inflamed knee joints, usually related to arthritis. Treatment should be aimed at the arthritis, simply draining the cyst will lead to a recurrence. Rarely a swelling at the back of the knee is caused by a popliteal cyst, a fluid filled cavity related to the tendons. Surgical removal can be considered when it is large and pressing on other tissues.
Osgood-Schlatter disease
Osgood-Schlatter disease is a condition affecting the bone prominence where the patella tendon is attached to the shin bone (apophysitis of the tibial tubercle). There is inflammation and pain and a prominent lump can form. It affects children from the age of 8 upwards and stops when growth is complete. However, the lump remains and can cause pain in adulthood as well. Rest and anti-inflammatory measures can help. In rare circumstances splinting the knee straight helps.
Other conditions