Patellofemoral syndrome is characterized by pain in the anterior region of the knee, around the small kneecap bone, the patella. It is one of the most common causes of knee pain among young athletes, especially in sports that involve a lot of running or jumping. It can have a gradual onset, for example due to muscle imbalance in the thigh region, or result from a single incident, whether in response to a sudden increase in training intensity with overuse of the thigh muscles, or a traumatic event that causes, for example, misalignment of the kneecap.

Symptoms

Pain in the front of the knee, around the kneecap area. The pain may be more intense when running, climbing up and down stairs, or even when sitting and squatting, i.e., all activities that involve bending the knee.

Risk Factors

Sports that involve running and jumping, with repeated impact on the kneecap region when the legs hit the ground, such as runners and marathon runners, cyclists, basketball players, among others; anatomical misalignment of the patella in relation to the femur (thigh bone); muscle weakness of the thigh with reduced flexibility and joint stability of the knee; inadequate or excessive training; previous knee injuries; being overweight; women with an incidence about 2x higher than men; adults and young adolescents.

Protective Factors

Appropriate sports footwear and posture; Muscle strengthening of the thigh; Good general physical condition, including maintaining a healthy weight; Avoiding intense training and repetitive exercises.

Treatment

Rest is recommended, avoiding activities that involve running, jumping, or deep knee bending, or when this is difficult, periods of low and high-intensity exercise can be alternated. The application of ice to the painful area of the knee is recommended, and oral analgesic medication may be necessary if the pain is severe. There is also an indication to use a knee brace to support the patella, which can be worn during daily activity, when walking, or to provide more support during physical exercise (there are various models, depending on individual goals and circumstances). In parallel, a strengthening plan for the leg muscles (focusing on the Vastus Medialis Obliquus muscle) should be started, and/or correction of the kneecap misalignment, which in severe cases, may require surgery.

Iliotibial band syndrome is a common type of injury caused by damage to the iliotibial band, which is located on the outside of the upper leg (thigh) and extends from the hip to below the knee, and which is responsible for hip extension, abduction, and rotation movements and is involved in the stability and movement of the outside of the knee. It develops due to overuse, such as in exercises involving knee flexion and extension movements like running, cycling, or squats, or due to anatomical factors.

Symptoms

Pain, stinging, and irritation on the outside of the thigh, just above the knee, with a feeling of weakness or instability in the affected knee; intense pain during physical activities that involve bending and straightening the knee, especially if done repetitively.

Risk Factors

Practice of exercises and sports that involve repeated knee movements such as running, cycling, and squats; sudden increase in training intensity or duration; climbing up and down stairs or remaining seated for long periods with knees bent; biomechanical misalignment, such as poor posture, or muscle weakness in the hip and leg; anatomical factors, such as bowlegs or differences in leg length, an anatomically “tight” iliotibial band, leg length asymmetry, flat feet, bowlegs; knee arthritis; use of inadequate or worn-out footwear; previous history of iliotibial band syndrome.

Protective Factors

Properly warming up and stretching before physical activity; gradually increasing exercise intensity and duration; proper sports footwear and posture; strengthening the thigh, leg, and hip muscles, especially knee stabilizer muscles; good general physical condition, including maintaining a healthy weight; avoiding intense training and repetitive exercises, taking regular breaks during prolonged activities.

Treatment

Rest – avoid physical activity that causes symptoms, such as running, cycling, or other activities that promote movement of the thigh and knee for some time until pain and irritation disappear; use of support devices/orthotics to relieve pressure on the iliotibial band; applying ice to the outside of the knee to better manage pain; use of analgesic medication for pain if the pain is exceptionally intense; stretching and strengthening exercises for the hip, thigh, and leg muscles, especially the abductor muscles; physical therapy to reduce the risk of recurrence, especially if you intend to continue the sport in question in the long term.

Knee osteoarthritis is a degenerative condition characterized by the progressive loss of joint cartilage, leading to symptoms such as pain and limited movement.

Symptoms

They develop gradually over time; Pain, especially when walking, climbing stairs, and performing physical activities; Stiffness in the morning or after periods of inactivity; Edema (swelling), which may occur due to inflammation.

Risk Factors

Knee osteoarthritis is more common in older people; Excess weight increases the load on the knee joint; Trauma or injuries can predispose one to osteoarthritis; Hereditary predisposition.

Protective Factors

Low-impact exercises strengthen the muscles around the knee; Maintaining a healthy weight reduces pressure on the joint; Physiotherapy for muscle strengthening and improvement of range of motion.

Treatment

Specific exercises to strengthen muscles and improve joint function.  Intra-articular injections with hyaluronic acid or Platelet-Rich Plasma; Analgesics and anti-inflammatories for pain and inflammation control may be necessary. In advanced cases, surgery may be considered.

Pes anserine tendinitis is a painful condition that involves inflammation of the tendons located in the inner region of the knee, where they converge in a shape resembling a goose's foot.

Symptoms

Sharp pain, especially around the knee, in the area where the tendons meet; Edema (swelling) may occur due to inflammation; Tenderness to palpation of the affected region.

Risk Factors

Repetitive movements, such as running or frequently rotating the knee; Excessive internal rotation of the foot while walking or running; Obesity increases the load on the knee tendons.

Protective Factors

Proper footwear, especially for those prone to overpronation; Exercises to strengthen the muscles around the knee; avoiding excessive high-impact physical activity.

Treatment

Initially, rest and ice may be necessary to control inflammation; Specific exercises to strengthen the muscles and improve biomechanics; Analgesic and anti-inflammatory medication for pain relief may be necessary; Correction of the underlying cause: Modification of activities or techniques, if necessary.

A meniscus tear is an injury that affects these structures which act as “shock absorbers” and “stabilizers” for the knee.

Symptoms

Sharp pain may occur during physical activity or specific movements; Edema (swelling) due to the inflammation resulting from the injury; A feeling of locking may occur, totally or partially preventing knee movement.

Types of Meniscus Injuries: Bucket-handle tear – A tear that extends across the width of the meniscus; Radial tear – A tear that starts from the center of the meniscus towards the outer edge.

Risk Factors

More common in older people due to natural wear and tear; Sports involving rotations and sudden changes of direction; Sudden impact injuries to the knee.

Protective Factors

Quadriceps and hamstring strengthening exercises; Correct execution of movements and physical activities; Avoidance of high-impact activities, especially if there is a predisposition.

Treatment

R.I.C.E.: Rest, Ice, Compression, and Elevation for initial symptom control; Specific exercises for strengthening and improving range of motion; In more severe cases, surgical repair or removal of the meniscus may be considered.

A Baker's cyst is an abnormal formation of synovial fluid behind the knee, forming a visible or palpable bulge.

Symptoms

Swelling/protrusion behind the knee, visible or palpable; Pain or discomfort may occur, especially when bending the knee. Stiffness/sensation of tightness in the affected area.

Risk Factors

Previous trauma or injuries may predispose to the cyst; Arthritis or other conditions affecting the knee joint; More common in older people.

Protective Factors

Addressing joint problems that may contribute to the formation of the cyst; Exercises to strengthen the muscles around the knee; Avoiding activities that place excessive pressure on the knee.

Treatment

Initially, relative rest and ice may be necessary to reduce inflammation; Aspiration drainage to relieve fluid accumulation; Addressing underlying joint conditions; In rare cases, surgery may be required to remove the cyst.

A knee sprain occurs when the ligaments that stabilize the knee joint are stretched or torn due to sudden movements.

Symptoms

Acute pain may occur during the initial trauma. Edema (swelling) may occur due to the inflammatory response, as well as instability, with a feeling of weakness or inability to bear weight. Sprains can be graded as: Grade I – Mild stretching of the ligaments; Grade II – Partial tearing of the ligaments; Grade III – Complete tearing of the ligaments.

Risk Factors

Contact sports or those involving rapid changes of direction; Weak muscles around the knee can increase the risk; Previous injuries can predispose to sprains.

Protective Factors

Exercises to strengthen the quadriceps and hamstrings; Correct execution of movements and physical activities; Use of protective equipment in high-risk sports.

Treatment

R.I.C.E.: Rest, Ice, Compression, and Elevation for initial symptom control. Exercises for muscle strengthening, stretching, and stability improvement; In severe cases, immobilization using a splint or brace may be necessary; In cases of severe tears or associated injuries, surgery may be indicated.

An anterior cruciate ligament (ACL) tear is a significant injury involving the rupture of a central ligament in the knee joint, which is crucial for knee stability and often results from sudden movements or trauma.

Symptoms

A popping sound or sensation may be heard or felt at the time of injury; rapid edema (swelling) due to an inflammatory response; instability, a feeling of weakness, or lack of support when bearing weight.

Risk Factors

Sports involving changes in direction and contact, such as football or basketball; knee anatomy, as some individuals may have a genetic predisposition; more common in young people and women.

Protective Factors

Balance and stability training; strengthening the muscles around the knee; instruction on correct movements / proper technique during physical activities; use of protective equipment in high-risk sports.

Treatment

R.I.C.E.: Rest, Ice, Compression, and Elevation for initial symptom control; exercises for strengthening, rehabilitation, and improved stability; surgical reconstruction of the ACL is recommended, especially for active individuals; post-surgical rehabilitation is important for a gradual return to physical activities.

A collateral ligament rupture, whether medial (MCL) or lateral (LCL), is an injury that affects the stability of the knee joint.

Symptoms

Usually, sharp pain occurs during the initial trauma; Edema (swelling) may occur due to inflammation in the affected area; A feeling of instability or lack of control in the knee joint.

Medial Collateral Ligament (MCL): Isolated Rupture: Usually resulting from external forces that push the knee inward.

Lateral Collateral Ligament (LCL): Isolated Rupture: The result of external forces that push the knee outward.

Risk Factors

Injuries caused by lateral or frontal impacts. Contact sports or rapid changes in direction.

Protective Factors

Balance training and muscle strengthening contribute to stability.

Correct execution of movements and physical activities; Use of protective equipment in high-risk sports.

Treatment

R.I.C.E.: Rest, Ice, Compression, and Elevation for initial symptom control; Specific exercises for rehabilitation and strengthening; Temporary immobilization using splints or orthoses in severe cases; Surgical intervention may be considered in cases of more severe injuries or persistent instability.

This syndrome is characterized by inflammation of the growth plate due to excessive traction of the patellar tendon on the anterior tibial tuberosity, usually occurring during the rapid growth spurt in adolescence.

Symptoms

Pain in the tibia, especially below the kneecap, which worsens with physical activity; Edema (swelling) and local hyperemia (redness) may also be present in the affected area; Sensitivity to touch in this region.

Risk Factors

More common during the growth spurt. Intense physical activities and sports involving frequent jumping and running; More prevalent in adolescent males.

Protective Factors

Proper warm-up before physical activities; Moderation in activities, avoiding overtraining and impact; Strengthening exercises for the quadriceps and other muscles around the knee.

Treatment

Relative rest with a temporary reduction in physical activity; Ice and anti-inflammatory drugs to reduce inflammation; Specific rehabilitation exercises for strengthening and flexibility; Use of a support knee brace.

Chondromalacia refers to the process of softening, wear, or degeneration of the cartilage on the posterior surface of the patella/kneecap, generally associated with changes in the knee joint.

Symptoms

Pain in the patella/kneecap, especially when going up or down stairs, or when sitting for prolonged periods. Clicking or crepitus are sounds that may occur during knee movement; mild edema (swelling) may occur due to joint irritation.

Grades of Chondromalacia: Grade I: Mild softening of the cartilage; Grade II: Superficial cartilage lesions; Grade III: More extensive cartilage lesions; Grade IV: Exposure of the underlying bone.

Risk Factors

Previous injuries may predispose one to chondromalacia; Joint instability; Poor patellar alignment.

Protective Factors

Strengthening exercises for the quadriceps and other muscles around the knee; Weight control, with a consequent reduction in pressure on the joint; Proper technique during physical activities, avoiding harmful movements.

Treatment

Specific rehabilitation exercises for strengthening and improving biomechanics; Anti-inflammatory medications to control pain and inflammation may be necessary; Intra-articular injections with Platelet-Rich Plasma or Hyaluronic Acid for temporary pain relief; In severe cases, surgical repair or removal of the cartilage may be considered.

Knee deformities, such as varus, valgus, and recurvatum, refer to changes in the normal angulation of the joint.

Genu varum (bow-leggedness): Characterized by excessive outward angulation, resulting in a larger gap between the knees when the ankles are together.

• Causes: Bone misalignment can be due to genetic factors, injuries, or muscle imbalances.
• Complications: Can lead to cartilage degeneration and osteoarthritis.
• Treatment: Exercises to strengthen muscles and improve posture; orthotics or insoles to correct alignment and reduce pressure on affected areas; in severe cases, surgical correction may be considered.

Genu valgum (knock-knees): Characterized by excessive inward angulation, resulting in a smaller gap between the knees when the ankles are together.

• Causes: Bone misalignment can be due to genetic factors, injuries, or muscle imbalances.
• Complications: Additional stress on the lateral structures of the knee, potentially leading to injury.
• Treatment: Exercises to strengthen muscles and improve posture; orthotics or insoles to correct alignment and reduce pressure on affected areas; in severe cases, surgical correction may be considered.

Recurvatum: Characterized by excessive backward curvature, extending beyond the normal range.

• Causes: Muscle weakness or joint misalignment can result from injuries or neuromuscular conditions.
• Complications: Excessive pressure on the anterior part of the knee, which can lead to injury and discomfort.
• Treatment: Exercises to strengthen muscles and improve balance; orthotics or insoles to correct alignment and reduce pressure on affected areas; in severe cases, surgical correction may be considered.

Knee instability refers to a lack of adequate support in the joint, resulting in excessive movements that go beyond what is normal.

Types of Instability: Mechanical – Related to injuries of the ligaments, cartilage, or other structures that affect physical stability, such as the anterior cruciate ligament or meniscus; Functional – Associated with muscle imbalances or weakness, causing a feeling of instability.

Symptoms

Sensation that the knee may give way; Recurrent pain, especially during physical activities; Edema (swelling) resulting from associated injuries.

Risk Factors

Individuals with a history of ligament injuries; High-impact sports activities, especially those involving rapid changes of direction.

Protective Factors

Strengthening exercises for the quadriceps, hamstrings, and other muscles around the knee; Balance and stability training contribute to improved motor control; Use of orthoses.

Treatment

Specific exercises for strengthening, balance, and motor control; In severe cases, ligament repair or reconstruction may be considered; Post-surgical rehabilitation is important for a gradual return to activities.