Knee pain syndromes

Question 1

Iliotibial band syndrome

Answer 1

Iliotibial band syndrome——most common cause of lateral knee pain in runners.
Iliotibial band syndrome is a common cause of lateral knee pain in runners, occurring in around 1 in 10 people who run regularly.

Features
tenderness 2-3cm above the lateral joint line
The pain may radiate proximally or distally. In less severe cases, the pain begins after a reproducible time or distance and subsides quickly upon cessation of activities

Management
activity modification and iliotibial band stretches
if not improving then physiotherapy referral
Corticosteroid injections are recommended for patients with severe pain or swelling and as a means to progress the rehabilitation

Question 2

Patellofemoral pain syndrome

Answer 2

Patellofemoral pain syndrome is one of the most common disorders of the knee, accounting for 25% of knee injuries seen in a sports medicine clinic.

The causes of patellofemoral problems are multifactorial, including abnormal patellofemoral joint mechanics, lower kinetic chain alterations, and overuse.

Patients typically note the insidious onset of an ill-defined ache localised to the anterior knee behind the patella.
aggravated with activities that increase patellofemoral compressive forces, such as ascending and descending hills or stairs, running, squatting
Increase The greater the Q angle, the greater the patellar tendency to move laterally. (It is a measure of patellar tendency to move laterally when the quadriceps muscles are contracted)

RICE+NSAIDS, then look at what caused it
training modif, quads strengthening

Question 3

Osglood schlatter disease

Answer 3

Osgood-Schlatter disease (tibial apophysitis) is a type of osteochondrosis characterised by inflammation at the tibial tuberosity. It is a traction apophysitis thought to be caused by repeated avulsion of the apophysis into which the patellar tendon is inserted

Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle

Pain on tibial tuberosity

Management is supportive
may go on to require surgical treatment. Surgery should not be performed until after the patient reaches skeletal maturity
cx–Bony overgrowth of the tibial tubercle or persistence of a bony ossicle into adulthood may be a purely cosmetic problem or may cause pain and functional limitation

Question 4

Chondromalacia patellae

Answer 4

Anterior pain.

In this condition there is softening of the patellar articular cartilage. It occurs in a subset of patients who present with anterior knee pain.
Softening of the cartilage of the patella
Common in teenage girls
Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting

Usually responds to physiotherapy

MRI

Question 5

Osteochondritis dissecans

Answer 5

Pain after exercise
Intermittent swelling and locking

Patients typically present with a subacute onset of:
Knee pain and swelling, typically after exercise=== stair-climbing or running up- or downhill
Knee catching, locking and/or giving way: more constant and severe symptoms are associated with the presence of loose bodies
Feeling a painful ‘clunk’ when flexing or extending the knee - indicating the involvement of the lateral femoral condyle
Joint effusion
Tenderness on palpation of the articular cartilage of the medial femoral condyle, when the knee is flexed

X-ray (anteroposterior, lateral and tunnel views) - may show the subchondral crescent sign or loose bodies
MRI - used to evaluate cartilage, visualise loose bodies, stage and assess the stability of the lesion
Clinical signs may be subtle in the early stages hence there should be a low threshold for imaging and/or orthopaedic opinion.

NSAID and rest
consider arthroscopy if fail conservative mx