Knee Pain Cure

The patella is the moveable bone on the front of the femur. The patella is wrapped inside a large tendon that secures the large quadriceps to the lower leg bone. This complex is called the quadriceps mechanism. There are two separate tendons, the patellar tendon below the patella, and the quadriceps tendon on top of the patella. This mechanism allows you to straighten your knee. The patella acts as a fulcrum to increase the action of the quadriceps muscle. The underside of the patella is covered with smooth and slippery articular cartilage which expedites the patella sliding over a groove of the femur or thigh bone. This whole complex is referred to as the patello-femoral mechanism. 

Numerous problems can develop with this complex. First, deterioration can occur in the cartilage under the patella. This can result from the aging process and generalized wear and tear. Arthritis can set in here as well. One source of knee pain is the way the patella glides through the patello-femoral groove as the knee extends. Muscle imbalances, or weakness in some part of the muscle, can cause the patella to be pulled out of line, resulting in pressure on the articular cartilage and consequent damage.

Imbalances can result from the shape of the bones of the knee. For instance, the patellar-femoral groove is too shallow. This can cause the patella to actually slip out of the groove, causing a dislocation. This condition is painful and results in damage to the underlying cartilage, resulting in a circumstance called chondromalcia. Pain varies, but generally going down stairs or sitting for long periods can precipitate pain. The knee may feel out of joint, but this is not because of instability so much as a response to pain.

These conditions may result in the knee emitting a grinding or crunching sound when the knees are bent deeply or when going up and down steep inclines. There might also be popping and clicking if there is significant deterioration. The underside of the patella and femoral groove do not slide smoothly. Swelling can result from heavy use and become stiff, generally because of fluid accumulating in the knee joint. This water on the knee can also result from other structural problems in the knee.

X-rays can determine if the patellar-femoral alignment is proper. After deterioration, arthritis may be visible. At times, symptoms may lead to misdiagnosis, since other structural problems can create clicking, swelling, and pain. Arthroscopy is sometimes needed to determine specific etiology.

As with other problems of the knee and joints, initial treatment target reducing the swelling. The R.I.C.E. (Rest, Ice, Compression, and Elevation) plus anti-inflammatories represent the first step. Second, a physical therapist will work to correct deficiencies with flexibility, strength, alignment, and muscle balance.

If non-operative procedures are not successful then arthroscopy can be useful to determine the degree of cartilage damage under the patella, and the degree of abnormal tracking. Roughness in cartilage can be smoothed through shaving of the patella. If the problem is poor tracking along the patellar-femoral groove, a procedure is done to shift the patella back to a more normal position by cut or releasing the outside (lateral) ligaments. The ligaments eventually heal with scar tissue that fills in the gap caused by the procedure.

If the misalignment is so bad that dislocation are chronic, the previous procedure may be expanded to include the lateral release of ligaments, the tendons on the inside edge of the knee (the medial side), may have to be tightened. Additionally, the patellar tendon that attaches the patella to the tibia (lower leg bone) may have to have its attachment point moved, which would serve to change the direction of the patella though the patellar-femoral groove.

Simple shaving of the patella or lateral release can be done normally on an outpatient basis. Rehab should commence almost immediately. Surgeries requiring cutting of the bone require several nights in the hospital a longer healing time since the bone must heal before strain can be applied to the knee.