Painful knee clicking: causes and solutions explained

Written by: Mr Graeme Nicholas Fernandez
Published:
Edited by: Emma McLeod

Mr Graeme Nicholas Fernandez, one of the UK’s most experienced orthopaedic surgeons, provides you with a list of conditions that could be causing painful knee clicking and the treatment available for these conditions. He also clarifies how you can receive help during the coronavirus crisis.

An x-ray scan of two knees

Is clicking of the knee normal?

No, painful clicking of the knee is not normal and warrants medical attention.

 

What conditions can cause painful clicking?

  • Damage to the meniscus (e.g. a torn meniscus) from a sporting injury or simply squatting down
  • A spontaneous degenerative meniscal tear
  • Loose bodies (pieces of cartilage or bone) in the knee. As well as painful clicking, they can cause the knee to jam momentarily – this is known as locking
  • Damage to the joint’s surface (e.g. osteochondritis dissecans)
  • Arthritis of the knee
  • Inflammation of the surrounding soft tissues (ligaments, tendons and bursa)
  • Pain from the hip – pain from hip arthritis can sometimes be felt in the knee

 

When should someone see a doctor/specialist for painful knee clicking?

This depends on the severity of the pain:

  • Clicking but no pain: This can be safely ignored for around six weeks. If there is no improvement, consulting a physiotherapist might be helpful.
  • Mild pain: This pain should be addressed by a physiotherapist.
  • Severe pain: This warrants seeing a doctor within a few weeks. If your mobility is very restricted go to see your doctor as soon as you can.

 

Diagnosis

The diagnosis is made by assessing the patient clinically and possibly with x-rays and an MRI (magnetic resonance imaging) scan. Most patients will need to see a physiotherapist first, as well as trying rest and anti-inflammatory medication. If symptoms are severe, an appointment with an orthopaedic surgeon should be arranged.

 

How is the painful knee clicking treated?

Treatment depends on the diagnosis:

 

Damage to the meniscus and meniscal tears

This may require keyhole surgery to repair or trim the damaged meniscus, providing there is no significant arthritis in the joint. If the pain is mild it is worth waiting a few months as the pain may settle without surgery.

 

Loose bodies (pieces of cartilage or bone)

These almost always require removal as they can cause significant damage to the joints. This is usually done via keyhole surgery.

 

Osteochondritis dissecans

This may require keyhole surgery to trim or stabilise the loose fragment, or it may need removing.

 

Arthritis of the knee

This is treated initially with activity modification

  • The patient is advised to stop activities that make it worse
  • Weight loss if appropriate
  • Physiotherapy
  • Anti-inflammatory medication
  • Non-weight bearing exercises (e.g. cycling, swimming, rowing) to help strengthen muscles and stabilise the knee

 

Injections of steroids into the knee may give short-medium term relief. A small proportion of patients benefit from viscosupplementation injection into the knee.

 

An off-loading knee brace may be helpful if just one side of the knee is worn.

 

Surgery is reserved for severe symptoms.

 

Younger patients with joint deformity may be offered an osteotomy to correct the deformity. This can delay joint replacement for many years. Joint replacement of one, two or all three compartments of the knee is very effective at reducing pain and improving function. It is possible to play golf and tennis and some patients return to skiing. Recovery from surgery is long with benefits continuing over 18 months. Complying with physiotherapy instructions is very important. It should be born in mind that four out of five patients are very happy with their knee replacement but one out of five is not.

 

During the current COVID-19 pandemic joint replacement has been halted as the mortality rate is higher if the patient develops COVID-19 in the first six weeks after surgery. Joint replacements currently are reserved for patients with the most severe pain and who are struggling to walk but are otherwise fit. As the pandemic passes, surgery will again be offered to all patients.

 

Inflammation of the surrounding soft tissues (ligaments, tendons and bursa)

Bursitis and tendonitis rarely need surgery. They usually respond to rest, anti-inflammatories, application of ice pack, anti-inflammatory gel and physiotherapy. Occasionally, steroid injections may be indicated.

 

Pain from the hip

Certain hip conditions cause pain only in the knee, such as osteoarthritis of the hip. A diagnostic injection into the hip will usually relieve the knee pain in the short term. Hip replacement may subsequently be needed

 

What habits should people with painful knee clicking avoid

Any activity that makes it worse should be avoided. It’s especially important to avoid applying high loads to the knee e.g. by running on hard surfaces or carrying heavy weights.

 

How to see an orthopaedic surgeon during the COVID-19 crisis

Some surgeons are offering video consultations. Face-face consultations for non-urgent patients are currently not being performed but will be resumed probably within a month or two

 

You can request a consultation with an orthopaedic surgeon through a general practitioner, or if you wish to be seen privately, contact your chosen consultant’s secretary. If you have health insurance, contact them directly, or contact your private hospital to request an appointment.

 

Mr Fernandez is one of the most experienced orthopaedic surgeons in the UK. Click here to learn how he can help you and to arrange an online or face-to-face consultation.

Mr Graeme Nicholas Fernandez

By Mr Graeme Nicholas Fernandez
Orthopaedic surgery

With more than 27 years at consultant level, Mr Graeme Nicholas Fernandez is one of the UK's most experienced orthopaedic surgeons. Working across BMI The Winterbourne Hospital, Circle Reading Hospital, and BMI The Harbour Hospital, Poole. Mr Fernandez's special interest is in shoulder surgery but he also has considerable experience in partial and total knee replacement, hip replacement, and carpal tunnel surgery. He is committed to achieving the best possible outcomes in surgery with the latest minimally-invasive techniques and surgical guidance systems, and is the recipient of four clinical excellence awards.

Mr Fernandez qualified from the University of London in 1976 and pursued specialist training in Exeter, Bath, Portsmouth, Southampton and Alton. He passed the Orthopaedic Specialty Exam FRCS Orth in Edinburgh in 1989 - one of the first in the country - and was appointed Consultant Orthopaedic and Trauma Surgeon at Dorset County Hospital in 1993. In his capacity as Clinical Director, he spent six years overseeing the growth of the department into a centre of Orthopaedic excellence. In 2012 he founded the Dorset Orthopaedic Clinic and the Dorset Shockwave Clinic, bringing together a team of experienced specialists to provide high-quality care to patients using the latest proven treatments.

Mr Fernandez has widely published in leading orthopaedic journals and has presented at conferences in San Francisco and Basel. He also offers talks at the Dorset Orthopaedic Clinic to GPs interested in keeping up to date with modern techniques in orthopaedic surgery.

Mr Fernandez treats degenerative conditions such as arthritis as well as acute trauma and sports injuries. He has a special expertise in performing arthroscopy of the knee without a tourniquet which results in a lighter anaesthetic, faster recovery and less postoperative pain. Patients who play racquet sports or work in construction and suffer from carpal tunnel syndrome will be operated on endoscopically, as this results in reduced post-operative pain and scar sensitivity. Finally, Mr Fernandez has special interest in patient-specific instrumentation for knee replacements, which results in a more accurate fit and a shorter time in the operating room. If, on occasion, a patient's case is complex and requires care beyond his area of expertise, Mr Fernandez has a wide network of experienced colleagues to whom he can refer.


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