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Outer Knee Pain

About Outer Knee Pain

It is estimated that one in four adults suffer from knee pain that often restricts their mobility and also reduces their quality of life.(1) Pain on the outer (lateral) part of the knee can happen due to an injury. Outer knee pain may also happen as a result of inflammation in the band of tough fibrous tissue that is located down the outer side of the thigh and attaches to the front part of the shin bone (tibia). Pain in the outer part of the knee can also be a sign of arthritis.

Lateral knee pain is a common occurrence in distance runners. However, any type of injury that causes twisting of the knee or trauma that pushes the knee out away from the other leg can also cause outer knee pain.

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It is possible to treat lateral knee pain, but the exact treatment depends on the severity and cause of your symptoms. The majority of the time, nonsurgical and conservative treatment is all that is required to get relief from outer knee pain. However, in some extreme cases, surgery might be needed. As with any treatment, the time required to recover from an injury to the outer knee depends on the severity of the injury.

Causes of Outer Knee Pain

Here are some of the most common causes of outer knee pain and how you can get relief from such type of pain:

  1. Lateral Meniscus Tear

    The menisci are two hard and rubbery pieces of cartilage that are located between the thigh bone (femur) and the shin bone (tibia). The medial meniscus is located on the inner side of the knee, while the lateral meniscus sits on the outer side of the knee.(2, 3)

    It is possible to experience a tear in the lateral meniscus if a sudden twisting motion takes place when the foot is planted on the ground but the body turns to the side. Athletes who are known to make a sudden change in direction, such as those who play tennis, soccer, football, and basketball, are especially prone to such type of injury. A meniscus tear can also happen in children.(4)

    Experiencing a torn lateral meniscus might not become immediately apparent. A torn lateral meniscus might develop slowly over a period of time as the cartilage becomes less and less resilient as you age. Such types of tears usually happen without any apparent injury, but they can cause immense pain. Some of the other symptoms of a meniscus tear include feeling a locking sensation when you try to straighten your leg, pain when squatting, and inflammation of the knee.

    Most meniscus tears do not heal on their own. Small tears can be managed with rest, ice, and bracing of the knee. Physical therapy and steroid injections can also help. More severe tears need surgery.

  2. Iliotibial Band Syndrome

    The iliotibial band is a touch, thick strip of connective tissue that runs from the outer side of the hip all the way down to the shin bone. Studies have shown that iliotibial band syndrome (ITBS) is a common occurrence in males rather than females, and it also tends to affect runners. Athletes who indulge in constant, repetitive motions, such as climbing, jumping and cycling, are at a higher risk of developing iliotibial band syndrome.(5, 6, 7)

    The repetitive straightening and bending of the knee under a lot of pressure or extreme circumstances can cause the iliotibial band to tighten and become swollen. The iliotibial band may also start to irritate the nearby tissues, and pain is usually felt on the outer part of the knee. However, you can also feel pain higher up in the outer thigh.(8, 9)

    Illiotibial band syndrome can be treated with rest and ensuring that you make a slow return to your daily activities once you start feeling better. Exercises to enhance the flexibility of the iliotibial band and also strengthen the knee can be helpful.

  3. Lateral Collateral Ligament Injury

    There are four major ligaments in the knee, out of which the lateral collateral ligament (LCL) is one of the most important ones. This ligament connects the outer side of your femur and tibia, and it is also responsible for stabilizing the outer part of the knee. Getting injured on the LCL, usually through a sprain, or a blow to the inner part of the knee, can cause the LCL to get stretched beyond its normal limits. This can cause a partial or complete tearing of the ligament.(10, 11, 12)

    Symptoms of an LCL injury can include swelling, stiffness, and soreness, and pain in the outer part of the knee.

    Minor tears or sprains of a ligament might not need any surgical intervention. Bracing and resting the knee can be enough to heal the ligament. However, you will need surgery to repair a complete tear of the LCL.

  4. Osteoarthritis

    Osteoarthritis is one of the most common types of arthritis that affects over 32 million adults in the United States alone.(13) Osteoarthritis commonly happens as part of the natural aging process. This is because as you age, the cartilage that provides cushioning to the ends of the bones in the knee joint starts to wear thin and eventually causes the bones of the knee to rub against one another. Stiffness, pain, and eventual loss of joint movement tend to follow.(14, 15)

    Some people experience more significant wearing down of the cartilage, especially in the outer part of the knee joint, which causes lateral-sided knee pain.(16) Your doctor will come up with a long-term treatment plan for osteoarthritis.

  5. Fracture of the Lateral Tibial Plateau

    The tibial plateau can be found on top of the shin bone at the knee. A break that occurs on the lateral or outer part of the tibial plateau can cause excruciating knee pain. Even a fracture of the lateral tibial plateau, which is usually caused by a vehicle accident or taking a bad fall, can have a direct impact on the outer part of the knee.(17, 18)

    In case of a break, if the bones remain aligned, there might not be any need for surgical intervention to treat the injury. However, if the bones are not in alignment, you may require surgery to put back the affected bones in their proper position. They are then secured with screws or plates to prevent them from moving.(19, 20)

  6. Knee Contusion

    A knee contusion is a medical term used to describe a bruised knee. A soft tissue contusion is typically limited to the muscle and skin tissue, but if the injury goes deep enough to cause damage or hurt to the bone, it is known as a bone contusion.(21, 22)

    If the bruising occurs on the outer part of the knee, you can experience lateral knee pain that can last for a couple of hours or even a few days, depending on the severity of the injury. Typically, ice, rest, and keeping the knee elevated are enough to alleviate the symptoms while allowing the lateral knee bruise to heal.

How To Diagnose Outer Knee Pain?

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If the pain in your outer knee continues to persist even after three to four days, you should see a doctor about the pain. Your doctor will carry out a physical examination and ask you questions about the location and type of pain, including how sharp or severe the pain is. They will also enquire about when the pain began and what activity you were doing when your symptoms started.

The physical examination typically involves extending and flexing your knee while moving it gently from side to side. While doing this, your doctor will check to see if there is any swelling, areas of soreness or any looseness in any of the ligaments of the knee.

Your doctor may also prescribe certain diagnostic tests, including one or more of the following:

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Based on your symptoms, the physical exam, and the imaging tests, your doctor will be able to diagnose the cause of your knee injury or condition and then propose a treatment plan.

Conclusion

For mild to moderate lateral knee injuries, plenty of rest and nonsurgical measures are all that are necessary to allow the knee to heal. However, in cases of meniscus tears, ligament tears, and advanced arthritis symptoms, you may require surgery.

Knee injuries can affect children, athletes, older adults, and almost everyone else. An orthopedic surgeon specializing in knee injuries can help diagnose and treat your injury.

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References:

  1. Nguyen, U.S.D., Zhang, Y., Zhu, Y., Niu, J., Zhang, B. and Felson, D.T., 2011. Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data. Annals of internal medicine, 155(11), pp.725-732.
  2. Atay, Ö.A., Doral, M.N., Leblebicioğlu, G., Tetik, O. and Aydıngöz, Ü., 2003. Management of discoid lateral meniscus tears: observations in 34 knees. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 19(4), pp.346-352.
  3. Feucht, M.J., Bigdon, S., Bode, G., Salzmann, G.M., Dovi-Akue, D., Südkamp, N.P. and Niemeyer, P., 2015. Associated tears of the lateral meniscus in anterior cruciate ligament injuries: risk factors for different tear patterns. Journal of orthopaedic surgery and research, 10(1), pp.1-8.
  4. Bellisari, G., Samora, W. and Klingele, K., 2011. Meniscus tears in children. Sports medicine and arthroscopy review, 19(1), pp.50-55.
  5. Mellinger, S. and Neurohr, G.A., 2019. Evidence based treatment options for common knee injuries in runners. Annals of translational medicine, 7(Suppl 7).
  6. Strauss, E.J., Kim, S., Calcei, J.G. and Park, D., 2011. Iliotibial band syndrome: evaluation and management. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 19(12), pp.728-736.
  7. Fredericson, M. and Wolf, C., 2005. Iliotibial band syndrome in runners. Sports Medicine, 35(5), pp.451-459.
  8. Fairclough, J., Hayashi, K., Toumi, H., Lyons, K., Bydder, G., Phillips, N., Best, T.M. and Benjamin, M., 2007. Is iliotibial band syndrome really a friction syndrome?. Journal of Science and Medicine in Sport, 10(2), pp.74-76.
  9. Barber, F.A. and Sutker, A.N., 1992. Iliotibial band syndrome. Sports Medicine, 14(2), pp.144-148.
  10. Grawe, B., Schroeder, A.J., Kakazu, R. and Messer, M.S., 2018. Lateral collateral ligament injury about the knee: anatomy, evaluation, and management. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 26(6), pp.e120-e127.
  11. Krukhaug, Y., Mølster, A., Rodt, A. and Strand, T., 1998. Lateral ligament injuries of the knee. Knee Surgery, Sports Traumatology, Arthroscopy, 6(1), pp.21-25.
  12. Hewett, T.E., Myer, G.D. and Ford, K.R., 2001. Prevention of anterior cruciate ligament injuries. Current women’s health reports, 1(3), pp.218-224.
  13. 2022. [online] Available at: <https://www.cdc.gov/arthritis/basics/osteoarthritis.htm> [Accessed 24 June 2022].
  14. Felson, D.T., 2006. Osteoarthritis of the knee. New England Journal of Medicine, 354(8), pp.841-848.
  15. Sharma, L., 2021. Osteoarthritis of the knee. New England Journal of Medicine, 384(1), pp.51-59.
  16. Creamer, P., Lethbridge-Cejku, M. and Hochberg, M.C., 1998. Where does it hurt? Pain localization in osteoarthritis of the knee. Osteoarthritis and Cartilage, 6(5), pp.318-323.
  17. Weigel, D.P. and Marsh, J.L., 2002. High-energy fractures of the tibial plateau: knee function after longer follow-up. JBJS, 84(9), pp.1541-1551.
  18. Weiss, N.G., Parvizi, J., Trousdale, R.T., Bryce, R.D. and Lewallen, D.G., 2003. Total knee arthroplasty in patients with a prior fracture of the tibial plateau. JBJS, 85(2), pp.218-221.
  19. Gaston, P., Will, E.M. and Keating, J.F., 2005. Recovery of knee function following fracture of the tibial plateau. The Journal of Bone and Joint Surgery. British volume, 87(9), pp.1233-1236.
  20. Stannard, J.P., Lopez, R. and Volgas, D., 2010. Soft tissue injury of the knee after tibial plateau fractures. The journal of knee surgery, 23(04), pp.187-192.
  21. Sanders, T.G., Medynski, M.A., Feller, J.F. and Lawhorn, K.W., 2000. Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury. Radiographics, 20(suppl_1), pp.S135-S151.
  22. Mandalia, V., Fogg, A.J.B., Chari, R., Murray, J., Beale, A. and Henson, J.H.L., 2005. Bone bruising of the knee. Clinical radiology, 60(6), pp.627-636.
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