Acute Knee Pain

Aka: Acute Knee Pain, Knee Pain, Anterior Knee Pain

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II. Precautions: Pitfalls

  1. Consider referred pain (including Neuropathy or radiculopathy)
    1. Referred Hip Pain in children (e.g. SCFE, Legg-Calve-Perthes Disease)
    2. Lumbar Radiculopathy
    3. Sacroiliitis
    4. Proximal Musculoskeletal Injury (e.g. non-displaced Hip Fracture may present with Knee Pain)
  2. Consider malignancy
    1. Osteosarcoma
    2. Chondrosarcoma
    3. Ewing Sarcoma

III. Causes: Fractures and dislocations

  1. Knee Dislocation (Tibial Femoral Dislocation) or Knee Subluxation
  2. Tibial Plateau Fracture
  3. Patella Fracture
  4. Patella Dislocation
  5. Proximal Fibula Fracture

IV. Causes: Adult Knee Pain by frequency

  1. Most common causes of Acute Knee Pain
    1. Knee Osteoarthritis (most common)
    2. Meniscus Injury
    3. Collateral Ligament Tear of Knee
    4. Anterior Cruciate Ligament Rupture (ACL Rupture)
    5. Posterior Cruciate Ligament Rupture (PCL Rupture)
    6. Acute Gouty Arthritis
    7. Fracture (see above)
  2. Uncommon but important causes of Acute Knee Pain
    1. See Rheumatologic Conditions affecting the Knee
    2. Septic Arthritis (most critical to rule-out)
    3. Rheumatoid Arthritis
    4. Pseudogout
    5. Lyme Disease
    6. Parvovirus B19

V. Causes: Pain by location

  1. Anterior Knee Pain
    1. Patellar Subluxation or instability
    2. Osgood Schlatter or Tibial Apophysitis (adolescents)
    3. Sinding-Larsen-Johansson Syndrome or Distal Patellar Apophysitis (adolescents)
    4. Jumper's Knee
    5. Patellofemoral Syndrome
    6. Chondromalacia Patellae
    7. Prepatellar Bursitis
    8. Patellofemoral Osteoarthritis
    9. Hoffa Disease
      1. Infrapatella fat pad tenderness
    10. Osteochondritis Dissecans
    11. Patella Stress Fracture
  2. Posterior Knee Pain
    1. Baker's Cyst
    2. Posterior Cruciate Ligament Tear
    3. Tear of posterior aspect of meniscus
  3. Medial Knee Pain
    1. Medial Collateral Ligament Tear
    2. Medial Meniscus Tear
    3. Pes Anserine Bursitis
    4. Plica Syndrome
    5. Slipped Capital Femoral Epiphysis (referred pain from hip in adolescents)
  4. Lateral Knee Pain
    1. Knee Lateral Collateral Ligament Tear
    2. Lateral Meniscus Tear
    3. Iliotibial Band Syndrome
  5. Diffuse, atraumatic Knee Pain
    1. See Monoarthritis or Polyarthritis
    2. Osteoarthritis (especially over age 50 years old)
    3. Septic Joint
    4. Acute Gouty Arthritis
    5. Rheumatoid Arthritis

VI. Causes: Pain by age

  1. See Knee Injury Acute History for injury related causes
  2. Children
    1. Osteochondritis Dissecans
    2. Osgood Schlatter
    3. Jumper's Knee
    4. Patellar Subluxation
  3. Young Adults
    1. Patellofemoral Syndrome
    2. Plica Syndrome
    3. Pes Anserine Bursitis
    4. Rheumatoid Arthritis
    5. Reiter's Syndrome
    6. Septic knee
  4. Older Adults
    1. Knee Osteoarthritis
    2. Gout
    3. Pseudogout
    4. Baker's Cyst

VII. Evaluation

  1. See Knee Injury Acute History
  2. See Knee Examination

VIII. Imaging: Xray indications

  1. See Ottawa Knee Rules
  2. Evaluate for Fracture or Osteoarthritis

IX. References

  1. Spangler and Tollefson (2014) in Herbert 14(6): 9-11
  2. Bunt (2018) Am Fam Physician 98(9): 576-85 [PubMed]
  3. Calmbach (2003) Am Fam Physician 68(5):917-22 [PubMed]
  4. Jackson (2003) Ann Intern Med 139:575-88 [PubMed]

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