EpistemisPain in the femorotibial joint line
Specialty: Musculoskeletal.
Why it occurs
- Degenerative or traumatic tear of the medial or lateral meniscus
- Medial or lateral femoro-tibial osteoarthritis (wear and tear of the joint compartment)
- Sprain or strain of the medial or lateral collateral ligament of the knee
- Osteochondral injury of the tibial plateau or femoral condyle (osteochondritis dissecans)
- Meniscal or parameniscal cyst that exerts local pressure
- Meniscal extrusion associated with severe joint degeneration
Initial workup
Specific clinical maneuvers (McMurray Test, Appley Test, Thessaly Test) | Magnetic resonance imaging of the knee (gold standard for classifying meniscal tears and evaluating the femoro-tibial cartilage) | Weight-bearing knee x-ray (AP, lateral and axial of patella).
red flags
Intense pain in the joint interline associated with inability to flex or extend the knee (flexion lock), rapid onset of blood effusion after rotational trauma and persistent painful clicking sensation with passive movement (indicates complex meniscal tear or free osteochondral detachment).
Standard management
- Ibuprofen — 400 mg every 8 hours orally for initial control of mechanical pain and periarticular inflammation
- Chondroitin sulfate — 800 mg daily orally
- Intra-articular infiltration of high molecular weight hyaluronic acid — indicated if femoro-tibial osteoarthritis coexists
- Tramadol (50 mg orally in case of limiting refractory pain).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 4