Dr. Scott Gudeman, OrthoIndy sports medicine specialist explains why your knee hurts and “clicks.”
Knee pain and clicking can occur for many different reasons. Some of the factors include acute injury, overuse from physical activity or work activity, mechanical problems, and weak or tight musculature. When a patient comes to see me in clinic for knee problems and/or pain we will address all of the above factors. Patients will have an x ray and I will complete an exam. From that exam and x ray information, I will decide if I need to order further testing such as an MRI to better evaluate the structures in the knee. Depending on the final diagnosis, I may recommend surgery to repair or remove damaged structures in the knee or suggest non-surgical options including a home exercise program, formal physical therapy, cryotherapy (cold treatment), bracing and/or activity modification.
It is important, however, to remember that sometimes joints (including the knee) produce non-painful clicking that is not problematic for the individual. In those situations, no treatment is indicated.
The cause of pain and clicking in your knee can mean damage to either of the menisci. This injury can happen to people of all ages and activity levels. The menisci are composed of cartilage and sit between the tibia (shin bone) and Femur (thigh bone). This cartilage helps create stability in the joint and helps with shock absorption. The menisci can be torn from an acute, mild or severe injury and surgery can be indicated. Surgery involves sewing the meniscus or removing the portion that is damaged. I decide during the arthroscopy which type of treatment is indicated depending on the type of damage to the meniscus. Initial recovery from a meniscal surgery, where the meniscus is the only structure repaired, is typically less than one month. However, return to more vigorous activity may be longer, especially return to sports.
Patellofemoral Syndrome (PFS)
Patellofemoral syndrome (PFS) occurs when someone is experiencing knee pain and clicking. Pain and clicking sensations from PFS can stem from many different problems within the lower extremity. Muscle weakness, decrease muscle flexibility, patellar malalignment (knee cap maltracking), and/or incorrect form during work or physical activity can cause PFS. Typically one or a few of these factors combined will cause inflammation and then therefore pain in the knee and sometimes a clicking sensation. This can happen to all ages and to people at all activity levels. In order to determine if you have PFS, an evaluation including a thorough history, exam and possible testing will be done. Treatment typically does not include surgical intervention, but includes regular rehabilitation and activity modification.
The cause of knee pain can be ligament damage to one or many of the following ligaments: ACL (anterior cruciate ligament), MCL (medial collateral ligament), PCL (posterior cruciate ligament) or LCL (lateral collateral ligament). Usually injuries to these structures occur during an acute incident with different mechanisms of injury. For example, the ACL is typically torn when a person lands and twists with their foot planted. Some other factors such as genetics and gender have been researched as well in determining the likelihood of an ACL tear. The PCL is typically damaged when the shin bone is struck with a hard force like onto a dashboard in car accident or a basketball player falling to the ground on their knee with their foot flexed. An MCL or LCL injury typically occurs when a person is hit on either side of the knee with their foot planted or changes directions quickly.
If you are active and have an ACL tear, ACL reconstruction is indicated. An ACL is a very important ligament in the stability of the knee and it does not repair itself. ACL reconstructions have a recovery time of six to nine months, though functional progression, for example an athlete, will begin around four to six months.
The MCL and LCL will typically repair on their own, but it will take time and consistent/dedicated rehabilitation, therefore I usually do not recommend surgery for this injury. Recovery to full activity is completely dependent on the severity of the tear and the commitment to rehabilitation and activity modification during the healing process. Recovery time ranges from one month – six months. Lastly, the PCL is a ligament that also supports stability in the knee and when damaged is typically not treated by surgery. However, there are circumstances when the injury does not respond to conservative treatment and surgery is recommended to repair the damaged PCL. Recovery to full activity or work duties is completely dependent on the severity of the tear and the commitment to rehabilitation and activity modification during healing as well as post-operative outcomes. Recovery time ranges from one month – six months.
Ultimately, there are many reasons that someone might experience knee pain and/or clicking. It is important to track the progress and/or decline of your signs and symptoms leading up to you first appointment with an orthopedic knee specialist. Sharing this information clearly during your visit will help the physician gather a more accurate diagnosis and defined treatment plan. The following are a list of questions to review before you see a physician regarding your knee pain issues.
What to think about before your visit
1. What are your specific complaints?
2. Did you have an incident that caused your knee to start bothering you?
3. Do you have any previous injuries to your lower extremities before?
4. How long have you had your signs and symptoms symptoms?
5. What makes it better, what makes it worse?
6. Where is the pain or clicking located in your knee?
7. Have you done anything to make it better i.e. anti-inflammatories, activity modification, weight loss, ice?
8. What do you hope to get out of this visit?
To schedule an appointment with Dr. Gudeman call 317.884.5161. or learn more about knee pain at OrthoIndy.
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