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Knee pain is among the most frequent reasons for seeing an orthopaedic doctor at any age. Where the pain sits helps identify it. Front of the knee: patellofemoral pain, patellar tendinopathy and, in teenagers, Osgood-Schlatter disease. Inner or outer joint line: meniscus tears, collateral ligament sprains and osteoarthritis. Outer side in runners: iliotibial band syndrome. Back of the knee: a Baker's cyst, which usually reflects a problem inside the joint.

How it began matters as much. A twist with a pop and rapid swelling suggests a ligament or meniscus injury. Gradual onset with activity suggests overuse or arthritis. Most knee pain is treated successfully with strengthening and load management. Keyhole surgery is valuable for a locked knee or an unstable ligament injury, but it does not help degenerative meniscus tears in arthritic knees any more than physiotherapy does.

Symptoms

• Pain around or behind the kneecap on stairs, squatting or after sitting for a long time
• Swelling within hours of an injury, or gradual swelling that comes and goes
• Locking, where the knee gets stuck and will not straighten
• Giving way on twisting or stepping down
• Sharp pain on the joint line when twisting
• A tender bump below the kneecap in an active teenager
• Fullness or tightness behind the knee
• Stiffness and aching after rest in older adults

Causes and risk factors

Injuries include tears of the ACL, other ligaments and the meniscus, kneecap dislocation and fractures. Overuse conditions include patellofemoral pain (linked to weak hip and thigh muscles and sudden training increases), patellar tendinopathy in jumping sports, iliotibial band syndrome and bursitis from kneeling. Degenerative causes are osteoarthritis and degenerative meniscus tears, which are often present on MRI in middle age without being the source of pain. Gout, pseudogout, rheumatoid arthritis and infection cause a swollen, warm knee. Pain can also be referred from the hip, which is particularly important in children and teenagers.

How it is diagnosed

• History and examination: Mechanism, swelling timing, locking or giving way, then tests of the ligaments, menisci, kneecap tracking and the hip.
• X-rays: Weight-bearing views for arthritis; after injury, used according to the Ottawa knee rules to exclude fracture.
• MRI: For suspected ligament or meniscus tears, cartilage injury or unexplained persistent pain. Findings must be matched to symptoms.
• Ultrasound: Shows tendon disease, bursitis and Baker's cysts.
• Joint aspiration: Distinguishes blood, crystals, inflammation and infection in a swollen knee.
• Blood tests: Inflammatory and uric acid tests when arthritis is suspected.

Treatment options

• Early injury care: Relative rest, ice, compression and elevation for a few days, then early movement.
• Strengthening and movement retraining: Quadriceps, hip and calf work is the main treatment for patellofemoral pain, tendinopathy, early arthritis and most meniscus problems.
• Activity modification: Reduce, do not stop: adjust running volume, hills, deep squats and kneeling while symptoms settle.
• Taping, bracing and insoles: Short-term aids for kneecap pain or single-compartment arthritis.
• Medication and injections: Anti-inflammatories for flares; steroid injection for an inflamed arthritic knee. Evidence for PRP and hyaluronic acid is mixed.
• Arthroscopic surgery: Meniscus repair or partial removal for a locked knee or a repairable tear in a younger patient; removal of loose bodies.
• Ligament reconstruction: ACL or other ligament reconstruction for an unstable knee.
• Osteotomy or knee replacement: For established arthritis that no longer responds to non-surgical care.

When it is urgent

Seek emergency care locally if you cannot bear weight or the knee is deformed after an injury, the knee is locked, the knee is hot, red and swollen with fever, the foot is cold or numb, or the calf is swollen and painful. A child or teenager with a limp and knee pain but a normal knee should have the hip examined the same day.

Travelling to Türkiye for treatment

For long-standing or unexplained knee pain, a consultation with MRI and a clear plan can be done in 2 to 3 days. Planned operations such as arthroscopy, ACL reconstruction, osteotomy or knee replacement are suitable for a trip, with stays ranging from about 5 days to 2 weeks. Recovery after every one of them is driven by physiotherapy at home. Acute injuries should first be assessed where they happen, and overuse problems need weeks of exercise, not a procedure.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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