A clicky knee?

A common query and worry from patients is the occurrance of clicking in the knee.

There can be three explantions for this:

The first is when tendons and ligaments flick over a bony prominence they sometimes produce a clicking sensation.  This is completely normal and should cause no discomfort.

The second is due to the location of the patella (knee cap).  The patella is held in place by a shallow groove on the femur (thigh bone) and also the muscles of the thigh (the quadriceps).  If the muscle contraction on one side is stronger then the other the patella can articulate in a different part of the femur bone creating a click. This can cause pain and overtime creates wearing of the wrong part of the patella. 

The third reason is the more serious which is because of breakdown of cartilage.  There are two main areas of cartilage in the knee.  There is cartilage around all articulating surfaces of the knee, which is shown in blue on the picture below and the menisci of the knee, also shown on the picture below.

The menisci have several functions in the knee.  They act as shock absorbers and aid in health of the joint by helping with the nutrition and lubrication of the joint.

Menisci have no nerves so when they are damaged strictly speaking there is no pain.  In reality there is likely to be pain as other structures such as muscles, ligaments or the capsule may well be involved.  Unfortunately they also have poor blood supply so when the menisci are damaged and torn the healing rate is poor. 

When you come to the clinic with knee pain we often ask if there is any swelling, locking, clicking or giving way. Yes to more then one of these questions can strongly suggest to us you may have developed a tear in part of your menisci.

Tears can occur normally through an injury involving some flexion and rotation of the knee.  It maybe gradual or traumatic.

There are two types of tear depending on how they develop: a bucket handle tear and a radial tear.

Some meniscal tears settle with conservative treatment and are helped with strengthening the knee afterwards.  Depending on the severity, others however do not settle and need to be assessed by a surgeon.