Dear doctor, I woke up with severe pain on the inside of my knee about three weeks ago. What could I have done?
24 April 2018
Q: I’m in my 40's and never had problems with my knee. I woke up about three weeks ago with severe pain on the inside of my knee and have been unable to walk or sleep with comfort and cannot straighten my knee. I don't understand as I haven’t injured my knee. What could I have done?
A: Over 50% of people who tear their cartilage over the age of 40 do not recall any injury to their knee. They search their mind for an answer without success. Even if there is an injury, it is often minor... 'I felt a twinge in my knee as I got out of the car but did not think anything of it... Now I am really struggling.'
The pain is most commonly localised to the inside of the knee. You can often point to the spot - we call it the 'pointing sign'. Eg 'It is very painful to straighten my knee, twisting on my knee is agonising, it keeps me awake in bed and I am walking with a limp.'
You may have sprained the ligaments on the inside of the knee, which will get better. If the symptoms continue beyond two to three weeks, it is highly likely you have torn the cartilage. The cartilage has little blood supply so does not heal itself. You naturally protect your knee, it feels easier, but you still cannot trust it and return to exercise. Physiotherapy can help with sprains, but if it has not worked within two to four weeks, it is time to seek help.
An experienced surgeon should be able to tell from examination, what is wrong. A scan and an X-ray will confirm the diagnosis and whether you have any associated osteoarthritis. Like the tread on a car tyre, knees wear. An arthroscopy (keyhole surgery) will remove a torn cartilage, resolve the pain, even if there is mild arthritis. If the arthritis is more severe (and there often has been problems in the knee before) the surgeon will discuss this with you because arthroscopy may be unsuccessful and you could eventually need a knee replacement.
Find out more about Mr Lee Taylor, Consultant Orthopaedic Surgeon practising at Spire Portsmouth Hospital.
The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.