The knee is one of the largest and most complex joints in the body. The knee joins the thigh bone (femur) to the shin bone (tibia). The smaller bone that runs alongside the tibia (fibula) and the kneecap (patella) are the other bones that make the knee joint.

Tendons connect the knee bones to the leg muscles that move the knee joint. Ligaments join the knee bones and provide stability to the knee:

The anterior cruciate ligament prevents the femur from sliding backward on the tibia (or the tibia sliding forward on the femur).
The posterior cruciate ligament prevents the femur from sliding forward on the tibia (or the tibia from sliding backward on the femur).
The medial and lateral collateral ligaments prevent the femur from sliding side to side.

Two C-shaped pieces of cartilage called the medial and lateral menisci act as shock absorbers between the femur and tibia.
Numerous bursae, or fluid-filled sacs, help the knee move smoothly.

Your knee joints serve a vital role holding up your bodyweight and are put through even more pressure when you walk, run or jump. Knee pain is very common, both from sport injuries and the wear and tear of day-to-day life.

Knee pain can come from injuries including sprains, swollen or torn ligaments (anterior cruciate ligament or ACL), meniscus or cartilage tears and runner’s knee.

Sports injuries tend to affect one knee at a time. Pain in both knees is more common with arthritis, osteoarthritis, gout or pseudogout, usually later in life.

Conditions that cause knee pain

Tendonitis. This is an overuse injury causing swelling of the tendons, the bands of tissue that connect your bones and muscles. This is sometimes called ‘jumper’s knee’ as it is common in sports involving jumping, such as basketball.
Bone chips. Sometimes, a knee injury can break off fragments from the bone or cartilage. These pieces can get stuck in the joint, causing it to freeze up. You may also have pain and swelling.
Housemaid’s knee or bursitis is caused by kneeling for long periods of time or repetitive knee movements. Fluid builds up in the bursa, the sac of fluid that cushions the knee joints. Swelling behind the knee is called a ‘Baker’s cyst’ and may be caused by injuries or arthritis.
Bleeding in the knee joint. This injury is also called haemarthrosis and affectsblood vessels around the knee ligaments causing the knee to feel warm, stiff, bruised and swollen. This may require hospital treatment in serious cases.
Iliotibial band syndrome. This is an overuse injury to the iliotibial band of tissue that runs from the hip to the shin past the knee.
Medial plica syndrome. This overuse injury affects the plica, a fold of tissue in the knee joint.
Osgood- Schlatter Disease. This overuse condition is common in teenagers playing sport and causes swelling and tenderness over the bony bump just below the knee.
Partially dislocated kneecap (or patellar subluxation). This is usually due to a physical condition with the legs rather than a sports injury. The kneecap slides out of position and causes pain and swelling.

Treatment for knee pain

Treatment will depend on the type and severity of the injury. Many knee injuries will get better on their own, or can be treated at home. Avoid putting weight on the injured knee as much as possible. Raise the leg with cushions and use an ice pack or bag of frozen veg wrapped in a towel held to the knee. Painkillers such asibuprofen can help with pain and swelling.

You may need to see your GP or seek medical advice if:

No weight can be put on the injured knee
There’s severe pain when no weight is put on the knee
The knee locks, clicks painfully or gives way
The knee looks deformed
There’s fever, redness or a feeling of heat around the knee, or there’s extensive swelling
The calf beneath the injured knee is painful, swollen, numb or tingling
Pain is still there after three days of home care treatment

A doctor will carry out a physical examination of the injured knee and may arrange some extra tests, including blood tests, an X-ray or MRI scan.

Treatment may involve physiotherapy, painkillers and sometimes an arthroscopy – a form of keyhole surgery that is used to look inside a joint and repair any damage that has occurred.

When will my knee pain feel better?

Recovery from knee pain will depend on the type and severity of the injury.

If recovery prevents you doing high impact sport such as running, try a low impact one like swimming.

Preventing knee pain

Knee pain cannot always be avoided, but good precautions include stretching, warming up and cooling down around a workout or playing sport. Having the right equipment, such as trainers designed for running and kneepads for jobs involving kneeling can help.

Stop exercising if you feel pain in your knee.

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What is Synvisc?

The joints of people with osteoarthritis or other degenerative joint diseases are different in several ways from those of healthy people. They contain less synovial fluid (the oily liquid which lubricates joints), and that fluid is thinner and therefore less able to lubricate nicely.

Synvisc is Visco-Supplementation entails the supplementation of the defective matrix of the joint with material of high viscosity and elasticity, namely Sodium Hyaluronate. When injected into the joint, it provides protection, lubrication, shock absorption and restoration of the viscosity of synovial fluid.

By supplementing the patient’s natural lubricants, Synvisc injection may reduce pain and stiffness in the treated joints for easier, more comfortable movement. A number of studies in Canada and Europe have shown the beneficial effects of Visco-supplementation in the management of osteroarthritis.

What is Sodium Hyaluronate?

Sodium Hyaluronate is an important component of synovial fluid and provides it with its lubricating properties. It also acts as a shock absorber during movement such as walking down the staircase.

Sodium Hyaluronate is injected intra-articularly into the synovial cavity of a joint.

What makes me a good candidate for Synvisc?

Synvisc is particularly useful for patients in relatively early stages of osteoarthritis, where physical damage has not progressed very far. It can also be used as an alternative or supplement to therapy with non-steroidal anti-inflammatory drugs (NSAID’s) or analgesics, the medications most often prescribed for arthritis patients.

If you are unable to tolerate or you do not wish to take NSAID’s , Synvisc may be an appropriate therapy. If you have recently been diagnosed as having osteoarthritis, Synvisc may be appropriate if your doctor has decided that your current therapy needs to changed or enhanced.

How is Synvisc injection administered?

Synvisc injection is given to the knee. More than one joint may be treated at the same time.

More injections may be given in chronic conditions. It is available only through a healthcare professional. Dr. Kevin Yip specialises in joint injection.

How long will the benefits of Synvisc last?

This form of treatment appears to be effective in more than 75% of patients after one course, and in 84% of cases after the second course of therapy. The effectiveness of therapy was evaluated by assessment of patient activity, and decreased use of concomitant therapy. Majority of patients experience clinical benefits lasting from 6 to 12 months. The clinical outcomes also depend on the severity of symptoms. Those with more severe condition would benefit from additional injections.

What are the advantages of Synvisc?

Sodium Hyaluronate (Hyaluronic Acid) is the natural substance of the joint. It is injected to the joint space and works only locally within the joint, thus there have been no reported systemic reactions related to the treatment. This is different from those medication such as pain-killer known as Nonsteroidal anti-inflammatory drugs (NSAIDs) which can cause gastro-intestinal bleeding or ulcer.

Recent studies also shown that Synvisc decreased the use of concomitant therapy such as pain-killer or analgesics. Synvisc injection is effective in relieving the symptoms of osteoarthritis, and may also slow down the progression of the diseases.

Visco-Supplementation is one of the recommended choice for Osteoarthritis treatment according to the American College of Rheumatology Subcommittee on Osteoarthritis Guidelines of the Knee year 2000.

Is Synvisc injection painful?

Naturally, as with all injections, there may be a mild and short-lasting discomfort during the actual procedure., but aside from this it is virtually painless.

Often your doctor may use a topical anaesthetic to reduce the discomfort. If there is considerable inflammation around the joint, the doctor may remove some of the excess fluid (exudate) prior to an injection of Sodium Hyaluronate. Visco-Supplement injection is only administered when joint swelling disappeared.

What precautions should I take after Synvisc?

You should rest and avoid strenuous weight-bearing activities for 1-2 days after an injection.

Patient Education about Knee Pain