J Korean Rheum Assoc.  2007 Sep;14(3):185-195. 10.4078/jkra.2007.14.3.185.

Differential Diagnosis of Knee Pain Commonly Encountered in Clinical Practice

• Kwon SK
• Chang CB

• KMID: 2202166
• DOI: http://doi.org/10.4078/jkra.2007.14.3.185

Abstract

The knee is a complex structure and far from being the simple hinge joint of popular belief. Knee pain would not be properly understood unless one is familiar with the anatomy and understands the role of the various structures. For patient consultation or for selecting a treatment option, it is crucial to find the central cause of symptoms and functional disabilities of the patient based on a detailed history, a focused examination and, when indicated, the selective use of appropriate imaging and laboratory studies. The history taking should be comprehensive and include the demographic characteristics, past medical history, comprehending the associated trauma, pain characteristics and quality of life. Basic physical examination should include inspection of walking pattern and the knee, evaluation of joint effusion, range of motion and the location of tenderness, and precise assessment of joint stability. Although many advanced diagnostic tools are available, plain radiographs are frequently utilized as a primary tool to evaluate conditions of the knee joint for practical and economic reasons. A weight-bearing anteroposterior radiographs should be taken for appropriate evaluation of the condition of the tibiofemoral joint, and weight-bearing radiographs in semi-flexed position is valuable to evaluate the joint space more precisely. To evaluate the patellofemoral joint, axial and lateral views should be included in the routine radiographs. In practice, physicians need to be cautious not to easily reach the conclusion that the symptoms of the knee joint can be attributed to only a few clinical findings in consulting the patients with knee pain.

Keyword

Knee pain; Differential diagnosis

MeSH Terms

Diagnosis, Differential*
Humans
Joints
Knee Joint
Knee*
Patellofemoral Joint
Physical Examination
Quality of Life
Range of Motion, Articular
Walking
Weight-Bearing

Figure

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  Fig. 1. Standing anteroposterior radiograph in extension (A) and standing 45o flexion posteroanterior radiograph (B) of a 69-year-old female who suffered from left knee pain. The radiograph in A indicates mild joint space narrowing (arrow), while the radiograph in B indicates almost obliteration of the joint space (arrow).

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  Fig. 2. Standing whole-length lower leg anteroposterior radiograph for evaluation of the limb alignment. In the radiograph, the lines connecting the center of the femoral head and the talus passed through the medial side of both knee joints, indicating significant varus alignment of the lower leg.

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  Fig. 3. A 21-year old man with posterlateral corner injury of the left knee. The photograph shows hyperextension of the left knee.

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  Fig. 4. Standing anteroposterior radiographs of a 62-year-old female who suffered from right knee pain. (A) A radiograph taken at her first visit to our institution shows only minimal osteoarthritic change of the knee joint. (B) A radiograph taken 8 months after her first visit shows a large osteonecrotic lesion in the medial femoral condyle (white arrow). (C) An intraoperative photograph shows osteonecrotic lesion involved the medial femoral condyle (black arrow).

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