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Introduction

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I retired because I had a knee injury, my cartilage was wearing out, it was painful and I couldn’t put in the four hours of practice each day that I needed to.

Guy Forget, former French professional tennis player

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Although acute knee injuries and anterior knee pain are very common presentations in sports medicine practice, patients presenting with lateral, medial, or posterior knee pain can also provide challenges to the practitioner.

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Lateral knee pain

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Pain about the lateral knee (Fig. 34.1) is a frequent problem, especially among distance runners and cyclists. The most common cause of lateral knee pain is iliotibial band friction syndrome (ITBFS) which is an overuse injury. Training errors and biomechanical abnormalities can precipitate ITBFS. Patellofemoral syndrome (Chapter 33) may also present as lateral knee pain. In the older active person, degeneration of the lateral meniscus or lateral compartment osteoarthritis should be considered.

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Figure 34.1

Lateral aspect of the knee

(a) Surface anatomy

Graphic Jump Location
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The biceps femoris tendon may cause pain as it passes posterolaterally to the knee and inserts into the head of the fibula; this occurs in sprinters and footballers. Injuries of the superior tibiofibular joint may cause lateral knee pain. Lateral knee pain may be referred from the lumbar spine. The causes and differential diagnoses of lateral knee pain are shown in Table 34.1.

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Table Graphic Jump Location
Table 34.1

Causes of lateral knee pain

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Clinical approach

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As with acute knee injuries (Chapter 32) history and physical examination are the key to an accurate diagnosis.

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History
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A history of overuse suggest ITBFS or biceps femoris tendinopathy. If there is a history of excessive downhill running or running on an uneven surface, ITBFS may be implicated. If the pain occurs with sprinting or kicking activities, biceps femoris tendinopathy is more likely. Lateral knee pain following knee or ankle injury may indicate the superior tibiofibular joint or lateral meniscus as the site of injury.

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The pain associated with biceps femoris tendinopathy flares up on initial activity and then starts to settle with warming up; ...

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