Diagnosing and Treating Inner Side Knee Pain

Inner knee pain, also called medial knee pain, is common in walkers, runners, and sportspeople. Symptoms can occur gradually or suddenly and may present with or without injury. What causes inner-side knee pain, and how do we determine the correct diagnosis?

Symptoms of inner knee pain

Generally, people point to the inner side of their knees across from the kneecap. Medial knee pain usually occurs during or after running or sports.

Depending on the cause of medial knee pain, other symptoms that may be present include:

swelling in the knee

an inability to bend or flex your knee

a feeling of instability or giving way

the knee locking or getting stuck in one position

Common causes of Inner knee pain

Medial Meniscal tear

Menisci are the shock absorbers of the knee joint. You can rip your meniscus during an injury, such as a twist during a sport. You can also tear your meniscus as you get older due to degeneration. Generally, a tear of the inner or medial meniscus causes medial knee pain at the joint line. A tear is often associated with knee swelling and restricted movement. In more severe cases, giving way or locking of the knee may occur.

Osteoarthritis

X-ray revealing medial knee arthritis as a cause of inner knee pain

Osteoarthritis is characterised by erosion of the cartilage lining the joint surface. Over time, due to past trauma or other factors such as obesity, the cartilage wears away completely, producing inflammation and swelling in the joint. The medial compartment is often affected. Usually, people with osteoarthritis report generalised inner knee pain with puffiness or swelling. Sometimes, knee movement is restricted, and walking for long distances can be difficult.

In general, treatment for knee arthritis typically includes exercise therapy, weight loss, medications, and injections.

Patellofemoral pain syndrome

Pain from this condition arises from the patellofemoral joint between the kneecap and the distal thigh (femur). Ususally, pain is triggered by excess pressure in the kneecap joint arising from mal-tracking and excessive sport or running. Generally, pain can occur at the front of the knee. However, in many cases, pain is located one or two fingers from the kneecap.

Ususally, patellofemoral pain resolves with physiotherapy aimed at modifying lower-leg and pelvic biomechanics.

Pes Anserine bursitis

The tendons of the inner thigh muscles move across the medial joint and attach to the top of the lower leg bone (tibia). At the attachment, a sac of fluid called the bursa becomes swollen and inflamed from too much sport. It is common to develop tendon inflammation in association with other conditions, such as osteoarthritis or a meniscal tear. Often, people report inner knee pain just below the medial joint line. In addition, the tendon is tender to palpation and painful with hamstring activation.

In general, treatment is similar to that for patellofemoral pain.

Medial Collateral ligament (MCL) sprain

The MCL is a large ligament from the femur that attaches to the tibia. It helps to stabilise the knee. Often, injury to the MCL occurs during a twisting injury. Most commonly, the ligament is injured at the top attachment to the femur, although damage at the middle or lower part can also occur. Generally, people report pain above the medial joint line. Typically, there is restricted knee movement with localised swelling of the inner knee. Sometimes other structures are damaged, such as the ACL or PCL, so it is essential to see a physician to obtain a definitive diagnosis.

Sometimes, injury to the MCL can cause calcification, leading to pain in the knee and restricted movement. We call this condition Pellegrini-Stieda syndrome.

Osteochondritis Dissecans Knee

Osteochondritis Dissecans affects the cartilage and bone in teenagers and young adults. It involves the blood supply to the cartilage, leading to cartilage separation and a loose body. The condition can cause pain, clicking, locking, and giving way. Early diagnosis is key to improving outcomes.

Less Common Causes of Inner Knee Pain

Medial plica,
Fat pad impingement,
Referred pain from the hip or spine.

Diagnosis of Inner Knee Pain

Obtaining a precise diagnosis can be challenging, as knee pain can often result from multiple causes.

It would help if you saw a specialist doctor who would ask questions about your problem. For example, during a clinical examination, your doctor will assess various structures of the knee, including tender areas, how well the knee moves, and how stable the ligaments are. Also, your doctor may examine other sites above and below the knee, such as your foot biomechanics, gait, and pelvic control.

Generally, we perform investigations based on clinical assessment. For example, weight-bearing X-rays can demonstrate evidence of arthritis in the knee joint and assess knee alignment. MRI, which uses magnetic fields to generate images, will show surface cartilage damage, a meniscal tear, or tendon inflammation. Sometimes, we use imaging modalities such as ultrasound or CT to confirm a structural problem.

When to See a Doctor

Although not all cases of medial knee pain are severe. In some cases, you need to see a doctor for assessment. You should consider seeing a doctor if:

You have experienced trauma to your knee

Pain is limiting your ability to move around properly

The knee locks or gives way

Inner knee pain lasts for more than a few weeks

Final Word from Sportdoctorlondon about Inner Knee Pain

Inner knee pain can be complex and often related to multiple underlying causes. You should see a specialist physician to obtain an accurate diagnosis and an appropriate management plan early.