Knee Pain

IT Band Syndrome

Iliotibial band syndrome (aka Iliotibial Band Friction Syndrome) describes an irritation of the tissues near the distal attachment of the iliotibial band. This overuse syndrome is particularly common in runners and cyclists.

ITB syndrome is common in populations exposed to repetitive knee flexion and extension while in a single leg stance. The problem is particularly prevalent in runners, where it compromises almost ¼ of all lower extremity injuries.

Ultimately, ITB syndrome affects up to 12% of all runners. The condition is also frequently seen in cycling, weight lifting, skiing, soccer, basketball, field hockey, and competitive rowing. 

Meniscus Tear/ Injury

A common sports injury

The knee menisci are shock-absorbent, fibrocartilage discs which conform to the femoral and tibial intraarticular contours (in the joint space). 

The outside 1/3 edge of a meniscus (near its joint capsule attachment) is vascularized and innervated for pain and proprioception. The remainder of the meniscus is avascular and lacks nerve supply.

Not surprisingly, healing potential diminishes in the less vascular inner region. 

Meniscal tears may be classified as “traumatic” or “degenerative”.

Meniscal injuries may occur at any age. In children and adolescents, the menisci are durable and rubbery so most injuries are “traumatic” as a result of a forceful rotational injury. 

As we age the meniscus grows weaker and “degenerative” tears become more likely, often resulting from simple or unrecognized insults.  “Degenerative” tears are more common.

The medial meniscus is damaged more commonly than the lateral meniscus with acute tears often involving the middle and posterior regions

Patellar Tendinitis

Patellar tendinopathy results from micro-tearing or degeneration of the proximal attachment of the patellar tendon from its origin on the inferior pole of the patella. The damage most characteristically involves the proximal, posterior  medial fibers of the tendon.

The condition has been named “jumper’s knee” since excessive loading of the knee extensor mechanism during high frequency repetitive jumping is considered the primary risk factor for this condition. 

Pain is usually experienced upon landing!

Patellar tendinopathy is common, affecting up to 20% of skeletally mature athletes with a prevalence as high as 50% in sports which require repetitive forceful jumping and landing like volleyball and basketball. 

Patellofemoral Pain/ Chondromalacia Patella Syndrome

Any factor that alters normal patellofemoral mechanics is a risk factor for chondromalacia patellae.

This includes lateral tracking disorders, tightness in the lateral knee capsule, weakness of the vastus medialis or quadriceps, pes planus, hip abductor weakness, joint overloads/overuse, trauma, patellar hypermobility, and muscle imbalance, particularly quadriceps or iliotibial band hypertonicity and vasus medialis or quadriceps weakness.

Weakness in the quadriceps or hamstring muscles increases one’s risk of developing patellofemoral pain three to five fold.

Weakness in the hip abductors is common in patients with knee pain and is a significant contributor to patellofemoral pain. 

Retropatellar (behind the knee cap) cartilage breakdown is the hallmark feature of chondromalacia.

Biomechanical tracking stressors are compounded through activities of daily living, causing irritation and eventually wear to the patellofemoral cartilage. 

Pes-Anserine Bursitis

Pes Anserine Bursitis (also known as pes anserinus or anserine bursitis) is a painful irritation of the pes anserine bursa of the medial knee.

Due to the blended anatomy of the medial knee, it is often difficult to pinpoint and diagnose the pes anserine bursa as the source of the patient’s symptoms.

The disorder should be considered in any patient with pain inferior to the medial joint line of the knee.

The prevalence of pes anserine bursitis is higher among distance runners, breaststroke swimmers (kick) and athletes participating in sports that require cutting or rapid side-to-side movement including: football, baseball, soccer, and racquet sports.

Functional risk factors for the development of pes anserine bursitis include hamstring tightness, lack of knee extension, and improper or rapid changes in training. 

Knee Sprain- Collateral Ligament Tear (MCL/ACL) in Prince William County

Knee stability is derived primarily from the four major ligaments: the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). 

Ligament injuries are traditionally classified as Grade I (stretch with no macroscopic fiber disruption), Grade II (partial fiber disruption), or Grade III (rupture).

Significant knee trauma is capable of producing a multi-ligament injury. In fact, a Grade III MCL sprain results in concomitant ACL disruption in more than ¾ of cases.

A combined injury of the MCL, ACL and meniscus are termed an “unhappy triad” or “blown knee”. 

The typical presentation of collateral ligament sprain includes pain on the medial or lateral aspect of the knee following acute trauma, i.e. sporting event or vehicular accident.

Patients will often report hearing a “pop” with subsequent pain.

Complaints may include diminished range of motion from pain and swelling, or a feeling of “weakness” or instability. “Clicking” is possible, particularly with concomitant damage to a meniscus.