Knee pain, also called gonalgia, affects 25% of women and 22% of men. Osteoarthritis, stress fracture, more serious illness… List of possible causes of knee pain, pain relief advice and tests to be carried out.
To have knee pain is frequent. According to High Authority of Healthknee pain or “knee pain” concern nearly 25% of women And 22% of men and can be very disabling in everyday life. Gonalgia can occur at the following a shock or trauma to the knee (car accident, during a sporting activity, etc.) or outside of any trauma (osteoarthritis is a common cause over 40).
What is the definition of gonalgia?
This term designates the pain felt in one or both knees. “Each of the elements that make up this joint can cause this pain: the ligaments, tendons, meniscus… “says Dr. Laurent Grange, rheumatologist and President of theAflar (French Association for the Fight against Rheumatism). The knee is a major joint of the body, because it ensures the junction between the thigh and the leg. The knee joint, body pivotallows a good distribution of the weight of the body and plays a major role in bending of the leg. The knee joint represents the assembly made up of the lower end of the femur, the upper end of the tibia and the patella located in front.
What are the symptoms associated with knee pain?
“The symptoms are essentially of two types: pain and stiffness. The pain can be of a mechanical schedule, that is to say which calms down at rest and worsens with movement, or of an inflammatory schedule. describes Pr Francis Berenbaum, head of the rheumatology department at Saint-Antoine Hospital (Paris). In this case, pain wakes up at night. The knee is then often swollen, hot and sometimes red. stiffness causes a difficulty in flexion and extension thus hindering walking. Gonalgia can affect only one knee, the right or the left. Or both: doctors then speak of bilateral gonalgia.
Meaning: what causes knee pain?
Knee pain can have different causes. It is quite common, the knee being a load-bearing joint. “Knee pain can be of traumatic origin or not, articular, tendon, ligament Or meniscal“ explains Professor Berenbaum. Here are the possible meanings of knee pain:
► One knee fracture : it occurs most often following an accident
► One stress fracture especially in athletes, or people providing intense and repetitive efforts, or overtrained (long walks, multiple jumps, etc.).
► A knee sprain corresponds to an attack of the ligaments allowing the stability of the knee joint and follows a traumatism, caused most of the time during the practice of a sport, such as for example the basketball, rugby, football, and skiing which are responsible for a third of knee sprains.
► Ligament ruptures (more severe when the cruciate ligaments are affected). “The menisci, cartilage pads, make the knee joint more stable. Their elasticity and shape allow the stresses to be better distributed. They absorb the shocks of the knee joint”, explains Professor Berenbaum. Before adding: “They can crack following acute trauma and cause pain and joint effusion. In this case an arthroscopic gesture is sometimes proposed for a suture or a resection. You should know that the fact of surgically removing part of the meniscus entails a risk of developing osteoarthritis in one out of two people in the 10 years following the operation.
► Inflammatory arthritis (rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, etc.) may affect the knees. In these cases, the swollen knee and are accompanied by pain of inflammatory schedule. Bursitis of the knee (or pre–patellar bursitis) is a inflammation of the bursa in front of the patella. This then becomes painful and swollen. This condition is sometimes seen in people who work on their knees (eg tiler).
► One reflex pain syndrome or Complex regional pain syndrome corresponds to a set of symptoms sometimes occurring after surgery or trauma: pain, joint stiffness, circulatory disorders with red and thinned skin, bone decalcification), etc.
► One osteonecrosis aseptic femoral condyles is bone death with destruction of part of the bone at the ends of the femur (condyle), of non-infectious origin. It often occurs in the elderly.
► One Osgood–Schlatter disease is also called “anterior tibial growth epiphysitis”. It is a growth defect with inflammation and fragmentation of an area of growth in the anterior tibial tuberosity (small bony bump at the front of the tibia). This pathology affects especially the boy between 10 and 15 years old
► One frequent wearing of high heels and one lack of flexibility are also mentioned to explain knee pain.
What tests to do when your knee hurts?
In order to determine the cause of knee pain and the most appropriate action to take, after the clinical examination of the patient, the doctor may need to request an imaging examination. In this case, the first examination to be carried out is an X-ray (carried out standing). The radio makes it possible to view, for example signs of osteoarthritis, calcifications, a fracture, or even other bone damage, effusion, abnormal bone alignment. Often, this imaging examination is sufficient; magnetic resonance imaging (MRI) is rarely needed. In June 2022, the Haute Autorité de Santé updated its recommendations concerning the performance of examinations in the event of knee pain to avoid overloading the MRI platforms.
► If x-rays show typical signs of osteoarthritisMRI is generally not indicated because it will not modify the management of the patient.
► In the event of an atypical clinical course, if the X-rays are not sufficient to explain the origin of the pain or if they highlight a problem other than osteoarthritis, MRI or other imaging examinations such as an ultrasound or CT scan may be indicated.
► After a trauma : If the X-rays show a fractureA surgical opinion is necessary. In the absence of a fracture, MRI may be useful in some cases if damage to the menisci or ligaments is suspected
“In all cases, repeat imaging in the event of a new episode of gonalgia in a patient whose pathology is known and who has the usual symptoms is not recommended“ esteem authority.
When to consult?
It’s necessary urgent consultation, after a knee injury, when the pain is very intense and you can no longer stand or walk. Apart from knee trauma, if you feel very intense pain, not relieved by rest, rapidly getting worse, which keep you awake, and whether these are associated with knee swelling or fever.
What are the treatments to relieve knee pain?
They depend on the cause and severity:
► The mild pain of the knee can be relieved easily thanks to restthe application of pocket of cold on the painful area and taking a non-steroidal anti-inflammatory drug (NSAID) either topically (cream, gel) or orally or an analgesic (e.g. paracetamol).
► “Osteoarthritis-related knee pain can be treated by a combination of care that may include: weight loss, physical activity, muscle strengthening, physiotherapy, Spa treatment, knee brace and/or orthopedic insoles, application of a slow-acting NSAID or capsaicin-based or anti-osteoarthritis NSAID AASAL gel (chondroitin, glucosamine, sofa or avocado unsaponifiables for example), cortisone or hyaluronic acid injections (viscosupplementation) “, says Dr. Grange.
► corticosteroid injections in the event of an inflammatory flare-up and/or hyaluronic acid are sometimes offered.
► If this is insufficient, a surgical intervention to replace all or part of the knee with a prosthesis may be considered. In 90% of cases, it permanently puts an end to the pain.
► In case of fracture or rupture of ligamentsthe patient can be referred to a orthopedic surgeon to discuss a surgical operation followed by a period of rehabilitation or management by immobilization such as plaster.
Shoes: no more than 3 cm in heel.
Why does osteoarthritis hurt the knee?
Osteoarthritis of the knee, caused by deterioration of the cartilage of the knee joint, causes disabling manifestations, such as pain and inability to perform certain physical activities sports or everyday life. For example patellofemoral osteoarthritis (between the femur and the patella) leads to difficulty descending stairs. Mechanical pain is the main manifestation of knee osteoarthritis. They worsen with exertion and subside with rest and interfere with extension and flexion of the knee. Also appear stiffness and limitation of movements, episodes of bend of the kneelameness and sometimes knee deformity hit. Knee osteoarthritis can occur in young people (in case of a history of meniscal or ligament trauma) in obese patients and increases with age. Thus, the aging of the population partly explains the appearance of more and more cases of people with osteoarthritis of the knee.
Lifestyle rules can help reduce the risk of onset of gonalgia:
► Losing weight : the extra pounds weigh on the joint: 1kg lost means 4kg less pressure on each knee!
► Practice a physical activity : it has the advantage of helping you maintain good joint mobility. 2 to 3 times a week, for 30 minutes, practice yoga, swimming, tai chi, water aerobics or walking. Do you like to run? The practice of running is not prohibited but to avoid hurting yourself, warm up before the session to prepare the joint, prefer loose ground such as earth, grass or a stadium rather than asphalt and have at a podiatrist custom-made insoles that will absorb shocks. Finally, wearing a knee brace, by locking the joint, limits amplitude and reduces pain.
► Alternate your footwear : if high heels draw a pretty leg, avoid wearing them every day and opt for shoes with a heel no higher than 3 cm.
Thank you to Pr Francis Berenbaum, head of the rheumatology department at Saint-Antoine Hospital (Paris) and Dr Laurent Grange, rheumatologist and President of Aflar (French Anti-Rheumatic Association).
Source: Knee pain: which imaging test to perform? Press release, June 27, 2022.