Knee History

Groups of Knee Pain

Acute knee pain with history of trauma or overuse Atraumatic knee pain with effusion Atraumatic knee pain without effusion Referred pain Location based

History

• Mechanism
  • Trauma vs atraumatic sudden vs insidious
• Pain
  • Location and character
    • Any neuropathic qualities?
  • Pattern
    • Inflammatory arthropathy – morning stiffness, rest pain, relief on movement
    • Mechanical – pain on weightbearing, worse later in day
  • Severity – although limited clinical utility
• Swelling – immediate vs delayed?
• Locking, giving way, instability – internal derangement
• Snapping - consider ITB, pes anserine tendons

• Constitutional symptoms – fever, night sweats, weight loss, rash
• Back pain?
• Other joint involvement

• Previous injuries and treatments
• Medical history – any systemic or rheumatological disease?
• Occupation and hobbies/sports
• Training history

• Possible differential based on history of trauma
  • Flexion, rotation, compression: meniscus
  • Valgus force: MCL
  • Sudden deceleration or change in direction with planted/fixed foot: ACL
  • Landing on flexed knee or MVA with posterior force to tibia: PCL
  • Force to anteromedial extended knee or external rotation and hyperextension: posterolateral corner injury
  • Swelling in knee with occasional locking and clicking: meniscus or loose body
  • Pain on prolonged knee flexion, during squats, up and down stairs: PFS
  • Anterior knee pain jumping and on full flexion: patellar tendinitis, PFS

Differential Diagnoses

Anterior, focal or vague

• Patellofemoral Pain Syndrome
• Knee Osteoarthritis
• Patellar Tendinopathy
• Plica Syndrome
• Quadriceps Tendinopathy
• Patellar Instability
• Hoffa's Fat Pad Inflammation
• Prepatellar Bursitis and Infrapatellar Bursitis
• Osgood-Schlatter Disease
• Sinding-Larsen-Johansson Disease
• Referred hip pain
• Avascular necrosis
• Patellar Stress Fractures
• Anterior cruciate ligament tear
• Osteochondral defect
• Posterior cruciate ligament tear
• Tibiofemoral dislocation
• Parameniscal cyst

Medial

• Knee Osteoarthritis
• Medial collateral ligament tear
• Medial meniscal tear
• Medial meniscal cyst
• Bakers cyst
• Medial Plica Syndrome
• Pes anserine bursitis/tendinopathy
• Inflammatory arthritis
• Osteochondral lesion medial femoral condyle (lateral aspect of medial epicondyle most common)
• Saphenous Nerve Entrapment
• Medial friction syndrome
• Medial collateral ligament bursitis
• Osteonecrosis
• Semimembranosus-Tibial Collateral Ligament Bursitis
• Pigmented Villonodular Synovitis
• Synovial Chondromatosis
• Referred Pain - Hip Joint, Lumbosacral spine pathology
• Neoplasm - soft tissue, intraosseous

Lateral

• Lateral meniscus tear
• Posterolateral corner injury
• Patellar dislocation or subluxation
• Lateral collateral ligament tear
• Iliotibial Band Syndrome
• Osteoarthritis exacerbation
• Osteochondral lesion lateral femoral condyle
• Popliteus Tendinopathy
• Biceps Femoris Tendinoapthy
• Semimembranosus Tendinopathy/bursitis
• Fibula head fracture
• Proximal Tibiofibular Joint Instability
• Snapping Biceps Femoris and Popliteus Tendons
• Peroneal Nerve Compression/Neuritis

Posterior

• Baker's or popliteal cyst
• Popliteus Tendinopathy
• Popliteal artery aneurysm
• Popliteal artery entrapment
• Posterior capsule tear
• Posterior cruciate ligament tear
• Tibiofemoral dislocation

Effusion present without trauma

• Osteochondral injury
• Osteoarthritis exacerbation
• Rheumatological disease (gout, RA, psoriatic arthritis)
• Septic arthritis