Treatment | Knee pain on the front

Treatment

Therapy for pain in the knee joint area depends on the underlying cause. If the disease can be treated conservatively (non-surgically), pain-inhibiting drugs in tablet form (e.g. diclofenac, ibuprofen) or as an ointment (Voltaren, contains the active ingredient diclofenac) help in the acute phase. Cooling the knee often helps with injuries, while in other diseases such as osteoarthritis, warmth is usually perceived as more pleasant.Depending on the disease, temporary complete or partial immobilization or support of the knee joint in the form of an orthosis may be necessary.

Indications include injuries to the ligamentous apparatus or the menisci. However, in most cases of disease or injury, the knee should not be spared for too long, so that it should be reexercised quickly – if necessary under physiotherapeutic guidance. Shoe insoles and bandages can also be helpful, as can crutches.

In addition to physiotherapy, physical therapy is also used in conservative treatment. Among other things, it works with ultrasound as well as alternating and direct current. This results in improved blood circulation, inhibition of inflammatory processes and the relaxation of tense muscle areas.

Invasive therapy methods for knee damage include knee arthroscopy and surgery. Arthroscopy often serves diagnostic purposes in the first instance, but it also allows the performance of procedures such as cartilage smoothing or the removal of certain structures. Open surgery is used, for example, to replace ligaments, correct bone malpositions or to insert an artificial knee joint.

For the knee joint there are a number of different bandages that can be used depending on the type of complaint or injury. For anterior knee pain, bandages that fix the kneecap in a special way are often helpful. If only the kneecap is problematic, a patella bandage may also be sufficient. If the pain is muscular or caused by ligament structures, a larger bandage should be chosen.

Diagnosis

Pain in the knee joint area can have numerous causes. Accordingly, a doctor – usually an orthopedic surgeon – should be consulted in the case of persistent pain to get to the bottom of the cause. The diagnosis always begins with an interview with the patient (anamnesis).

Important questions in the case of knee pain are, for example, where exactly it is located, when it first appeared, whether it is permanent or only present in certain situations, whether it only occurs under stress or also at rest, whether the pain radiates, whether there has been a trauma in the patient’s history, whether the patient is active in sports and if so, what sports he or she does, what kind of profession the patient practises, whether the patient feels a feeling of instability and what has been tried therapeutically so far, for example, taking pain-relieving medication. Next comes the physical examination. Here the doctor should first just inspect, i.e. look at the knee.

Attention should be paid to malpositioning, redness, knee swelling and bruising as well as the gait pattern. The examination follows. The examination should be started carefully and if possible not directly at the most painful point, as this can severely limit the patient’s willingness to cooperate.

There are numerous tests for the knee examination, which are named by their own names and can differentiate more precisely where the problem lies. At the beginning, the range of motion should always be carried out according to the neutral-zero method in order to find out whether or not there is a movement restriction. Then more specific tests such as Steinmann 1, Steinmann 2, Apley and Payr can be performed if damage to the meniscus is suspected, or front and back drawer if damage to the cruciate ligament is suspected.

After completion of the anamnesis and the clinical examination, the examiner already has a suspicion in many cases and can adjust the further procedure to this suspicion. Depending on the suspected cause, the following examinations may follow: A blood sample to find out whether it could be an inflammatory process, the taking of an x-ray to assess the bony structures, a sectional image examination (usually magnetic resonance imaging = MRI of the knee joint) for a precise assessment of soft tissue, ligaments and menisci in the area of the knee joint. In a broader sense, minimally invasive diagnostic procedures include knee joint puncture in the event of effusion formation and arthroscopy, both of which can provide more precise information about the cause of pain.

In arthroscopy, in addition to the inspection of the knee joint, it is also possible to intervene in the same procedure if necessary. Diagnosis is thus established from the patient’s medical history and clinical examination, through imaging procedures, to minimally invasive surgery.For each patient, it must be considered individually which examinations are useful and which are avoidable. The medical history and clinical examination, however, should be given to each patient without exception.