From the Guidelines
The patient, a 22-year-old male basketball player with left knee pain, should follow a personalized exercise therapy program, focusing on knee-targeted exercises with possible hip exercises, and avoid sports activities for at least 6 weeks, as this approach has been shown to be effective in managing patellofemoral pain 1. The X-ray shows no acute fracture, maintained joint spacing, and possible prepatellar soft tissue swelling, but no joint effusion, suggesting a soft tissue injury rather than a bone fracture. The RICE protocol (Rest, Ice, Compression, Elevation) can be used to reduce inflammation and promote healing, but it should be complemented with a more comprehensive approach that includes exercise therapy and education. Key features to consider in the treatment plan include levels of pain, fear of movement, expectations, self-efficacy, and perceived patellofemoral joint resilience, as well as objective evaluations of hip and knee strength, movement patterns, and tissue tolerance to load 1. Over-the-counter NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) can help manage pain and inflammation, but their use should be limited to the initial phase of treatment. The patient should gradually reintroduce activities after the 6-week period, starting with gentle range-of-motion exercises before returning to more strenuous activities, and should be educated on the concept of pain not correlating with tissue damage, and the importance of autonomy and reduced fear in the recovery process 1. If pain persists beyond this period or worsens during treatment, further evaluation may be necessary, including reassessment of the treatment plan and consideration of adjunctive therapies such as prefabricated foot orthoses, taping, and manual therapy 1.
From the Research
Diagnosis and Treatment of Knee Pain
- The patient's complaint of left knee pain, particularly in the context of playing basketball, could be related to various conditions such as osteoarthritis (OA), patellofemoral pain, or meniscal tears, as discussed in 2.
- The x-ray findings indicating no evidence of a joint effusion, possibility of prepatellar soft tissue swelling, and intact bones with well-maintained joint spacing suggest that the patient may not have an acute fracture.
- The patient's age and physical activity level, as well as the presence of anterior knee pain, could suggest patellofemoral pain, which has a lifetime prevalence of approximately 25% and is commonly seen in people younger than 40 years who are physically active 2.
Management of Knee Pain
- The recommended first-line management for knee pain, depending on the underlying condition, includes exercise therapy, weight loss (if overweight), education, and self-management programs 2.
- For patellofemoral pain, hip and knee strengthening exercises in combination with foot orthoses or patellar taping are recommended, with no indication for surgery 2.
- The RICE protocol (rest, ice, compression, and elevation) is often advised for managing swelling and pain, as seen in the patient's treatment plan, and has been studied in the context of postoperative swelling management 3.
Meniscal Tears and Treatment
- Meniscal tears can occur due to acute trauma or as a degenerative condition, and their diagnosis can be assisted by clinical tests such as the McMurray test and joint line tenderness 2.
- The treatment of meniscal tears can include conservative management with exercise therapy for 4-6 weeks, or surgical intervention such as meniscus repair or partial meniscectomy, depending on the tear's characteristics and the patient's condition 2, 4, 5, 6.
- Meniscal repair is considered superior to partial meniscectomy, with better functional outcomes and less severe degenerative changes over time, and is now recommended for all repairable tears, especially in young and physically active patients 4, 5, 6.