Many people who love sports have the experience of experiencing significant knee pain and discomfort after excessive exercise, but in fact the pain is hardly confined to one part of the body, but is more common in the “front of the knee”, or what we call “anterior knee pain”. This is what we call “anterior knee pain”. Anterior knee pain is the most common area of chronic knee pain. It usually manifests as soreness and weakness when walking up and down stairs, pain when standing up after squatting, popping and interlocking pressure in front of the knee, accompanied by different degrees of knee swelling and atrophy of the thigh muscles. The painful swelling is closely related to activity and usually worsens with activity and is relieved or partially relieved by rest, and in some cases is also related to weather changes. Some patients have a significant history of knee sprains or collision injuries, or strenuous activity, or a history of prolonged long-distance walking, mountain climbing, and travel. However, some do not have an obvious cause or predisposing factor. Some of the onset is related to the occupation in which they are employed. Female patients also have a relationship with changes in the endocrine system. This chronic knee pain is easily diagnosed and treated as rheumatoid arthritis, traumatic arthritis or age-related osteoarthritis, but the treatment is unsatisfactory or even ineffective. As one of the more prevalent knee disorders, there are 10 common causes of anterior knee pain. Identifying these causes will help us avoid injury as much as possible and find the best way to relieve symptoms. ① Patellofemoral articular cartilage injury This is the most common form of injury. The patellofemoral joint surface of the human body is subjected to a strong load during exercise, especially when the knee is flexed, the patellofemoral joint can be under pressure up to 3 to 5 times its body weight. Long-term repeated sports stimulation, as well as some minor acute trauma, accumulate over time, resulting in chronic damage to the articular cartilage in this area. In addition to the manifestation of anterior knee pain, there are usually deep sensitive pressure points under the patella, grinding the patella and pushing the patella to trigger or aggravate the pain. For treatment, conservative treatment can be started by braking and resting or reducing activities, local massage and hot compresses, and taking Chinese medicine to activate blood circulation and remove blood stasis. Physical therapy, such as microwave and infrared rays, can also be used. In the daily activities, we should avoid climbing, squatting and other forms of sports that stimulate the joint. Meniscus injury The meniscus has the function of distributing pressure, absorbing shock and stabilizing the joint. It is susceptible to injury during twisting movements of the knee joint, and its pain is characterized as being confined to the medial and lateral joint spaces of the knee joint, usually in the middle or anterior part of the space. There may be a history of joint popping or interlocking joints, and the pressure pain is sensitive and limited. A physical examination combined with MRI can mostly clarify the diagnosis and the exact nature of the injury. If the symptoms are severe, the meniscus injury usually requires prompt surgical treatment, including arthroscopic meniscal suturing, shaping, partial or even total resection. Synovial crease syndrome is a relic of incomplete resorption of the synovial layer of the joint cavity during development, which usually does not cause symptoms, but can cause pain after injury, compression, or strain and fibrosis. In the early stage of treatment, conservative treatment is possible, with appropriate braking and rest, knee protection, avoiding strenuous activities, taking anti-inflammatory and analgesic drugs, or local closure and water injection treatment. For patients with severe symptoms and ineffective conservative treatment, synovial lesions can be removed surgically, and arthroscopic surgery is currently the most popular choice. Most of the intra-articular free bodies are fine pieces of cartilage that have been ground and wrapped in the joint cavity and gradually grown. It is characterized by interlocking, rattling and pain in the knee joint, or restriction of joint extension and flexion, and sometimes the patient can feel a small hard object moving in the knee joint. Treatment requires arthroscopic removal of the free body and management of the corresponding intra-articular lesion. Bursitis
The bursa is an accessory structure that exists where soft tissues such as tendons and ligaments pass adjacent to or through the bony prominence and serves to relieve stress and reduce friction. There are mainly prepatellar bursa, subpatellar tendon bursa, suprapatellar bursa, femoral epicondyle bursa and goose foot tendon bursa around the knee joint, etc. When excessive movement, excessive friction or extrusion, contusion, can cause bursitis, mainly pain in the corresponding part of the bursa, local swelling, slightly high skin temperature, accompanied by pressure pain, certain activities or posture can cause or aggravate the symptoms. Treatment is generally conservative, with proper rest and avoidance of excessive activity, local application of topical ointment, taking anti-inflammatory and analgesic drugs, and local closure treatment. In recent years, dispersive extracorporeal shock wave therapy has also been widely used, and has achieved good results. For those who are not effective in conservative treatment, surgery can be chosen to remove the diseased bursa. (6) Ligament injury Ligaments are the static structures that maintain the stability of the knee joint.
The anterior and posterior cruciate ligaments and the medial and lateral collateral ligaments are the main ones. The anterior cruciate ligament injury mostly causes pain in the front of the knee; the posterior cruciate ligament injury mostly causes pain at the femoral attachment site, that is, the posterior side, and sometimes also shows pain in the front of the knee. MRI examination can clarify the diagnosis and the extent of the injury. Early treatment requires braking, pressure bandaging and aspiration of blood in the joint. Surgical reconstruction of the ligament can be considered in the late stage of joint instability. In recent years, arthroscopic cruciate ligament reconstruction techniques have developed rapidly, and patients have a good prognosis. For diagnosed anterior and posterior cruciate ligament injuries, early surgical treatment is strongly recommended to protect the joint function and avoid aggravating the damage to the articular cartilage as well as the meniscus. Lateral collateral ligament injuries are painful in the area between the medial and lateral femoral condyles to the slightly distal end of the medial and lateral tibial plateau, and can have local swelling, skin bruising, and pressure pain, with a positive lateral stress test. Treatment is early braking with bracing or cast protection. It is supplemented with ice and swelling reduction, etc., and timely and active functional exercises in the later stage. If there is obvious lateral instability, surgery should be performed to restore ligament tension and joint function. (7) Patellofemoral joint instability
The patella is the largest seed bone in the body and is the fulcrum of the knee extension device, which can significantly enhance the knee extension strength. The obvious manifestation of patellofemoral joint instability is patellar dislocation. Patients tend to have a history of trauma, as evidenced by a history of significant outward patellar dislocation at the time of knee trauma, which can occur repeatedly. On examination, the peripatellar rim is painful, and the provocation test and fear test can be positive. x-rays can show the outward deviation of the patella. Early treatment can be protected by plaster for 4-6 weeks. Repeated dislocations, i.e. habitual dislocations, should be treated by surgical reconstruction of the knee extension device. (8) Tibial tuberosity epiphysitis
It is a result of ischemic changes in the tibial tuberosity epiphysis as a result of long-term injury and distraction stress. It is characterized by pain during jumping or strenuous activities, or in severe cases, when walking. On examination, the tibial tuberosity may be swollen, red and hot, with significant pressure pain and a positive resistance test, and on X-ray, the tibial tuberosity may be separated, fragmented or hyperdense. Treatment.
Adequate rest, avoiding strenuous activities such as running and jumping, and applying topical medication and heat to the area. EMS treatment can have significant effects. Tumors Knee tumors include bone tumors and soft tissue tumors. The former commonly includes bone cyst, osteosarcoma, osteochondroma, osteomegaloblastoma, etc. The latter includes hemangioma, tendon sheath cyst, meniscal cyst, pigmented villous nodular synovitis, etc. The clinical manifestations are local pain, localized masses, and localized occupying images on imaging. The main treatment is early surgery and some other necessary treatment. Vascular nerve bundle entrapment is a symptom caused by the compression of small vascular nerve bundles by scars or fibrous strips or other lesions. It is mostly seen above the patella and may have a history of local contusion, mainly manifesting as local pain. The painful area is not precisely localized during the examination, and the painful symptoms can be triggered or aggravated by touch or pressure. For treatment, physical therapy, including massage, can be used first, and EMS treatment has excellent results. In severe cases, hydroacupuncture can be used to release the pain, and if the effect is not obvious, surgery can be considered.