Knee pain is a common complaint that affects people of all ages and activity levels, often limiting movement and daily function. When this discomfort is specifically felt along the inner side of the joint, it is medically referred to as medial knee pain. The term “medial” describes the location closest to the midline of the body, meaning the pain is centered on the side of the knee facing the opposite leg. This location is frequently reported because the inner knee houses several structures that bear significant load and are vulnerable to injury or degenerative changes.
Identifying the Medial Knee
The medial knee is a complex structure defined by the tissues and ligaments that provide stability and cushion the joint. The main static stabilizer is the Medial Collateral Ligament (MCL), a broad band of tissue that connects the femur (thigh bone) to the tibia (shin bone).
Nestled between the bones is the medial meniscus, a C-shaped piece of fibrocartilage that acts as a shock absorber and helps distribute force across the joint surface. The medial joint line, where the femur and tibia meet, is a common site for pain originating from the meniscus or articular cartilage. Slightly below the joint line is the pes anserine bursa, a small fluid-filled sac that cushions the tendons of three hamstring muscles—the sartorius, gracilis, and semitendinosus—as they attach to the tibia.
Top Causes of Medial Knee Pain
Injury to the Medial Collateral Ligament (MCL) is a frequent cause of acute inner knee pain. It typically results from a direct blow to the outside of the knee that forces the joint inward, stretching or tearing the ligament. This causes immediate, sharp pain and tenderness directly over the MCL. Pain from an MCL sprain often worsens when the knee is stressed sideways or fully straightened.
A Medial Meniscus Tear often occurs during activities involving sudden twisting or pivoting of the knee while the foot is planted. A tear can cause a sharp, catching, or locking sensation within the joint, particularly when squatting or twisting. Degenerative tears are common in older adults due to wear and tear, causing a dull, persistent ache that may be accompanied by swelling.
Osteoarthritis (OA) of the medial compartment is a degenerative condition where the smooth articular cartilage covering the ends of the bones wears down. This cartilage loss leads to bones rubbing against each other, causing a deep, aching pain. The pain typically worsens with activity and progresses over time. It is often most noticeable when bearing weight, such as climbing stairs, and may be accompanied by stiffness after periods of rest.
Pes Anserine Bursitis involves inflammation of the bursa located on the inner side of the tibia, approximately two inches below the joint line. This condition manifests as a burning or aching pain localized to this specific area. It can be exacerbated by repetitive activities like running or climbing stairs. It is often associated with overuse, tight hamstring muscles, or underlying knee conditions.
Diagnosis and Initial Self-Care
A diagnosis for medial knee pain begins with a detailed patient history regarding the onset of pain, specific symptoms, and recent injuries. This is followed by a physical examination, which includes maneuvers like the valgus stress test to assess MCL stability and specific movements to check for meniscal involvement. Imaging studies confirm the diagnosis or rule out other issues. X-rays visualize bone changes, such as those seen in osteoarthritis, while Magnetic Resonance Imaging (MRI) is the preferred method for viewing soft tissue structures like the MCL, menisci, and cartilage.
While awaiting a medical consultation, immediate self-care measures can help manage pain and prevent further irritation. Following the R.I.C.E. protocol is recommended:
- Rest from aggravating activities.
- Ice for 15-20 minutes several times a day to reduce swelling.
- Compression using a bandage.
- Elevation of the leg.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can also manage pain and inflammation. Activities should be modified to reduce stress on the knee, such as avoiding prolonged standing or using crutches if weight-bearing is painful.
Professional Treatment Options
Once a specific diagnosis is confirmed, professional treatment focuses on restoring function and alleviating pain, tailored to the underlying cause. Physical therapy is a primary intervention for many causes of medial knee pain. It aims to strengthen the muscles surrounding the joint, particularly the quadriceps and hamstrings, to improve stability. A therapist designs a customized exercise program to improve range of motion and correct movement patterns.
Injections
For inflammation-related conditions like bursitis or arthritis flares, injections may deliver medication directly to the affected area. Corticosteroid injections provide temporary relief by reducing inflammation and pain within the joint or bursa. Viscosupplementation, another type of injection, uses hyaluronic acid to supplement the joint’s natural lubricating fluid, which can benefit certain cases of osteoarthritis.
Surgical Options
Surgical interventions are reserved for cases that do not respond to non-operative measures or for specific structural damage. Arthroscopic surgery, a minimally invasive procedure, may repair or trim a torn meniscus or remove loose fragments of cartilage. For severe osteoarthritis with extensive cartilage damage, a partial knee replacement (replacing only the damaged medial compartment) or a total knee replacement may be necessary to restore joint function.