Knee Pain Inner Side – Causes and Treatment

What is Medial Knee Pain?

Medial knee pain, also referred to as inner knee pain, describes discomfort occurring on the inner (medial) side of the knee joint. The knee is one of the largest and most heavily loaded joints in the human body. The inner side contains several key structures, including the medial meniscus, the medial collateral ligament (MCL), the pes anserinus (the attachment point of three muscles), as well as cartilage and bone surfaces. Damage or inflammation in any of these structures can lead to pain on the inside of the knee.

Causes

There are many potential causes of inner knee pain. The most common include:

• Medial meniscus tear: The medial meniscus acts as a shock absorber. Tears can occur due to twisting injuries or age-related degeneration.
• Medial collateral ligament (MCL) injury: A sprain or tear of the MCL causes pain and instability on the inner side of the knee.
• Knee osteoarthritis (gonarthrosis): Degenerative wear of the cartilage, most commonly affecting the medial compartment, leads to chronic pain.
• Pes anserine bursitis: Inflammation of the bursa on the inner side of the knee, often associated with obesity, diabetes, or arthritis.
• Medial plica syndrome: Irritation of a fold of synovial tissue inside the knee joint.
• Osteonecrosis of the knee: Bone tissue death in the medial area of the knee joint.
• Overuse injuries: Common in runners, cyclists, and athletes who place repetitive stress on the knee.

Symptoms

Depending on the underlying cause, symptoms may include:

• Tenderness or pressure pain along the inner knee
• Swelling or joint effusion
• Pain when climbing stairs, squatting, or getting up
• Stiffness after periods of rest
• A feeling of instability or the knee giving way
• Reduced range of motion
• Clicking or locking sensations (especially with meniscus damage)

Diagnosis

Diagnosis is based on a combination of clinical examination and imaging:

• Medical history: Assessment of symptoms, injury mechanism, and previous conditions.
• Physical examination: Specific tests such as the McMurray test (meniscus), valgus stress test (MCL), and palpation of the inner knee.
• X-ray: Used to assess bone changes and joint space narrowing.
• MRI (Magnetic Resonance Imaging): The gold standard for visualizing meniscus, ligament, and cartilage damage.
• Ultrasound: Useful for evaluating bursitis and soft tissue changes.

Treatment

Conservative Treatment

In many cases, non-surgical treatment is recommended first:

• Rest and activity modification: Reducing load-bearing activities during the acute phase.
• Ice therapy: Applying ice packs to reduce inflammation and swelling.
• Physiotherapy: Targeted strengthening of the muscles surrounding the knee, stretching, and stability exercises.
• Pain medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac to relieve pain.
• Braces and orthotics: Supportive devices to offload the medial knee compartment.
• Corticosteroid injections: For significant inflammation, such as in bursitis.

Surgical Treatment

If conservative measures are insufficient, surgical intervention may be considered:

• Arthroscopy: Minimally invasive joint surgery to treat meniscus tears or cartilage defects.
• Ligament reconstruction: For complete MCL ruptures.
• Knee replacement: For advanced osteoarthritis as a last resort.

When to See a Doctor

The following warning signs require prompt medical evaluation:

• Significant swelling or joint effusion following an injury
• Sudden locking of the knee joint
• Persistent pain lasting more than two weeks
• Instability or the feeling that the knee gives way
• Redness and warmth (possible infection or gout)

References

1. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS): Knee Problems. Available at: www.niams.nih.gov
2. Logerstedt DS et al. - Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions. Journal of Orthopaedic and Sports Physical Therapy, 2010.
3. Braunwald E. et al. (eds.): Harrison's Principles of Internal Medicine, 21st Edition, McGraw-Hill, 2022.