Conditions · Carrollwood · Tampa Bay
Knee Pain
What the words on your knee report mean, what they do and do not tell you, and an examination that takes the knee, the hip and the foot together.
A radiology report is written for other doctors, not for you. So when yours says chondromalacia, meniscal tear, or joint effusion, the words land without a translator, and the internet fills the silence badly. This page is the translator. Dr. Bobby Koser, DC, chiropractic physician, examines the knee, the hip and the foot in the same visit, because the knee sits between the other two and the examination has to account for all three, and reading your report with the person it belongs to is part of that examination. Bring yours.
Knee Pain Overview
What the words on your report mean
The knee is a hinge with a kneecap riding in a groove at the front of the thigh bone, two crescent-shaped cushions of cartilage sitting between the thigh bone and the shin bone, a smooth cartilage lining on the bone ends, and ligaments and tendons holding the whole arrangement in line. Nearly every word on a knee report names one of those parts and describes how it looked. Here is what the common ones are saying.
Patellofemoral pain
Patellofemoral pain means pain behind or around the kneecap. The term is an address, not a cause: patella is the kneecap, femoral is the thigh bone it sits against. Notes and referrals usually attach the situations it shows up in, such as stairs, squatting, kneeling, or a long stretch of sitting. It is a clinical description made by examination rather than something a scan announces, which is why the same knee can collect this label and a separate imaging label in the same week.
Also written as: anterior knee pain, patellofemoral pain syndrome, PFPS, patellofemoral syndrome, retropatellar pain, peripatellar pain, runner’s knee.
Chondromalacia, and the cartilage words
Chondromalacia patellae describes how the cartilage on the underside of the kneecap looked: softened or roughened rather than smooth. Radiologists and surgeons also write cartilage defect or chondral defect, which names a spot where that smooth lining is thinner or interrupted, and they sometimes attach a grade to describe how deep into the layer the change goes. These are descriptions of an appearance. Whether the appearance explains what you feel is a separate question, and it is the one the examination answers.
Also written as: chondromalacia patella, patellar chondromalacia, chondral defect, cartilage defect, cartilage thinning, chondral fissuring, articular cartilage loss.
Meniscus tear
Each knee has two menisci, crescent-shaped wedges of cartilage that sit between the thigh bone and the shin bone and spread load across the joint. A meniscus tear on a report means the scan described a split or fray in one of those wedges. Reports usually add which side it is on, medial for the inner meniscus and lateral for the outer, and what shape the split takes: horizontal, radial, oblique, complex, bucket-handle, or a root tear at the point where the meniscus anchors to bone. Some reports describe meniscal destruction, which is the phrase used when the damage is more extensive than a single line.
Reports and referral letters also sort tears with the words degenerative and traumatic. Those are report words. A scan alone does not settle which one yours is. That question belongs to your examination and to your own history, and it can matter a great deal if your knee was hurt in a crash, a fall, or a game.
Also written as: meniscal tear, torn meniscus, torn cartilage, meniscal damage, meniscal destruction, bucket-handle tear, root tear, meniscal extrusion, parameniscal cyst.
Osteoarthritis, and the grades on your X-ray
Osteoarthritis on a knee report names a set of changes described together: the space between the bones looking narrower on X-ray, osteophytes, which are bony outgrowths at the edges of the joint, changes in the cartilage lining, and changes in the bone underneath it. On MRI a report may list a bone marrow lesion, which is a change in the bone just under the joint surface that shows up bright on the scan.
On X-ray, radiologists commonly attach a grade from 0 to 4 using the Kellgren-Lawrence scale, which counts how many of those changes are visible and how much the space between the bones has narrowed. Some reports print a word rather than a number for the same idea. A grade describes a picture taken at one moment. It is not a score for how much your knee hurts, and it does not set what you are able to do. It is one more piece of information for the examination to line up against what your knee actually does under load.
Also written as: knee OA, gonarthrosis, degenerative joint disease, DJD, tricompartmental osteoarthritis, medial compartment osteoarthritis, joint space narrowing, osteophytes, spurring, subchondral changes, Kellgren-Lawrence grade.
Iliotibial band syndrome
The iliotibial band is a thick strap of connective tissue running down the outside of the thigh, from the hip to a point just below the knee on the outer side of the shin. Iliotibial band syndrome is the name given to pain at the outer knee where that band passes the end of the thigh bone. Like patellofemoral pain, it is a clinical description arrived at by examination rather than a line on a scan, and it is one of the reasons the hip is examined when the outside of the knee is what hurts.
Also written as: IT band syndrome, ITBS, iliotibial band friction syndrome, lateral knee pain, runner’s knee. That last name is used for kneecap pain as well, so it is worth asking which one the person in front of you means.
Patellar tendinopathy
The patellar tendon connects the bottom of the kneecap to the top of the shin bone. Patellar tendinopathy is the name for pain and tissue change in that tendon, felt at the front of the knee just below the kneecap and usually described with jumping, landing, and pushing off. Imaging reports describe thickening of the tendon, or a change in its signal on MRI or its echo pattern on ultrasound.
Also written as: jumper’s knee, patellar tendonitis, patellar tendinitis, patellar tendinosis, infrapatellar tendinopathy, proximal patellar tendinopathy. Quadriceps tendinopathy names the tendon just above the kneecap instead.
Baker’s cyst, and effusion
A Baker’s cyst is a fluid-filled pocket at the back of the knee, in the hollow behind the joint. Reports also call it a popliteal cyst, after the name of that hollow. An effusion is fluid inside the joint itself, which is what most people mean when they say a swollen knee, and reports describe how much of it the radiologist saw and where it collected.
Both words describe fluid. Neither one says where the fluid came from, which is why they usually appear alongside other findings on a report rather than instead of them. One thing to act on: if a cyst behind the knee turns painful, or swelling or pain runs down your calf, go to the emergency department. A clot in a leg vein can look the same from the outside, and that is an emergency.
Also written as: popliteal cyst, synovial cyst, joint effusion, suprapatellar effusion, knee joint fluid, water on the knee, synovitis.
A finding is not a diagnosis
Here is something worth knowing before you read your report again. In a review that pooled 63 studies and 5,397 knees, the MRI findings used to describe knee osteoarthritis, cartilage defects, meniscus tears, bone marrow lesions and bone spurs, turned up in adults who had no knee symptoms and no knee injury: depending on which finding, in 4% to 14% of adults under 40, and in 19% to 43% of adults 40 and older.1 That cuts in both directions, and both matter. A finding on your report is not automatically the cause of your pain, and your pain is not less real because the same words appear on other people’s reports. In that review, the estimates moved with how the MRI scans were done, with physical activity, with whether osteoarthritis was already visible on X-ray, and with the risk of bias in the studies pooled, so those figures are pooled estimates rather than fixed rates. And every knee in it was an uninjured knee, which is why nothing in that number describes a knee after a crash, a fall, or a sports injury.
The same two-sided picture shows up in the meniscus. In a Framingham, Massachusetts study, MRI scans of the right knee in 991 adults ages 50 to 90, recruited without regard to whether they had knee trouble, showed a meniscus tear or more extensive meniscal damage in 19% of women ages 50 to 59 and in 56% of men ages 70 to 90, and 61% of the people whose scan showed a tear had had no knee pain, aching or stiffness in the previous month. Tears were just as common in the knees that did hurt: among people who also had osteoarthritis on X-ray, a meniscus tear showed up in 63% of those with knee pain on most days and in 60% of those without it.2 A tear on your report is not automatically the reason your knee hurts, and your knee is not hurting less because the same word appears on a report belonging to someone who feels fine. In that study the scans covered one knee per person and everyone was 50 or older. What those figures describe is that age group and nothing beyond it.
So a report can be accurate and still not be the answer to your question. Whether a finding explains your symptoms depends on where it sits, what it sits next to, and whether that matches what you actually feel and what your knee does under load. The report is the starting point. The examination connects it to you.
1. Culvenor AG, et al. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med. 2019;53(20):1268-1278. PubMed
2. Englund M, et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008;359(11):1108-1115. PubMed
Symptoms, and the warning signs we screen for
Knee pain usually arrives with a pattern attached, and the pattern is worth bringing with you. Pain behind or around the kneecap is most often described with stairs, squatting, kneeling, and after a long stretch of sitting. Pain at the outer knee tends to show up at a predictable distance into a run or a walk. Pain at the front just below the kneecap shows up with jumping and landing. A knee that swells hours after activity is telling the examination something different from a knee that swelled within minutes of an injury. Catching, clicking, locking, and a knee that gives way each send the examination somewhere specific.
The knee is also where other places get felt. A hip problem can be felt at the knee, and in children and adolescents it is often felt at the knee and nowhere else. What your foot does under load is part of the knee picture too, which is why footwear, foot structure and gait get looked at in the same visit.
Common, and examined here
- Pain behind or around the kneecap on stairs, squatting, or after sitting
- Pain at the outer knee that arrives at the same point into a run or walk
- Pain at the front of the knee just below the kneecap with jumping or landing
- A knee that swells after activity, or fullness behind the knee
- Clicking, catching, or a knee that feels unreliable on uneven ground
- Knee pain alongside hip, foot, or low back trouble
- An X-ray grade or an MRI report you have never had explained to you
Emergency, not an appointment
- A hot, swollen knee with fever
- A knee that will not bear weight after an injury
- New swelling or pain in the calf, and more urgently with chest pain or shortness of breath
A hot swollen joint with fever can mean infection inside the joint. A knee that will not take your weight after an injury needs imaging before anything else happens. New calf swelling or calf pain can mean a clot in a leg vein, and with chest pain or shortness of breath it can mean that clot has moved to the lung. Go to the emergency department now. Screening for these is part of the examination here.
How we approach a knee
The examination comes first: your history, the knee taken through its range, the kneecap and the tendons around it checked directly, the ligaments and the meniscus tested, strength and load tolerance measured, and the hip and the foot examined in the same visit. Bring any X-ray, MRI, or report you have. Reading it with you rather than at you is part of the visit. That visit is the Pain Source Exam.
When conservative care fits, it is built from what the examination found rather than from what the report said. That means a chiropractic adjustment where the examination finds restricted motion in the knee, the hip, the ankle or the foot, hands-on muscle work around the knee and up the thigh, dry needling for trigger points (tight, painful knots in a muscle) or myofascial pain (pain from the muscle and its covering tissue) in those muscles, and a loading program, meaning specific movement prescribed at a dose you can actually complete and reviewed at the next visit. Care is monitored, and the plan changes if you do not.
Because the foot is examined alongside the knee, how you load your feet is part of the conversation. If the examination points there, Dr. Koser prescribes custom orthotics made from a weight-bearing laser scan of your own feet, and the fee and terms for that visit are published on that page.
Some knees are examined here and then sent elsewhere.
- A knee that locks, catches hard, or will not fully straighten: orthopedic opinion and imaging before any trial of care.
- A knee that gives way, or that tests unstable: orthopedic opinion, with the ligaments assessed before the knee is loaded.
- A knee that will not take weight after an injury, or a suspected fracture: imaging first, the same day.
- A hot, swollen knee with fever: emergency department, not an appointment.
- A child or adolescent with a limp and knee, thigh, or hip pain: pediatric orthopedics the same day, because a hip problem at that age is often felt at the knee.
- Findings that belong in front of an orthopedic surgeon, or a knee that is not progressing under a monitored plan.
Surgery decisions belong with surgeons, and making sure you are in the right room is part of the job here. When we refer you, your records go with you. More than one joint involved? Our joint pain page has that version and the prices. Hurt in a car accident? Florida law gives you 14 days from the crash to begin care and keep your no-fault medical benefits. If that window is open, start at our auto accident page and we will get you examined.
What the research shows
Three questions tend to follow a knee report. Does moving it help? What does dry needling do? Do I need surgery for this tear? Here is what the published research says about each. Several of the studies below are randomized trials, meaning studies where chance decides which treatment each person gets so the groups can be compared fairly.
On movement, start with the knee osteoarthritis trials, and with the limit their reviewers put on them. In a 2024 Cochrane review of 139 trials and 12,468 people with knee osteoarthritis, the reviewers rated the certainty of the evidence low to moderate, and said that measured against the thresholds they used for a minimal important difference, the size of the benefit was of uncertain clinical importance. What they found inside that limit is that land-based exercise, meaning exercise done on land rather than in water, probably improved pain and physical function in the short term, by roughly 9 to 13 points on a 100-point scale depending on what it was compared with.3 In that review the outcomes were short-term, measured right after the programs ended, most trials sat at unclear or high risk of bias, and participants knew which group they were in, which the reviewers noted may have contributed to the improvements reported. In that review there was also no difference in effect between the types of exercise studied, and no relationship between how much people improved and how many sessions they were prescribed.
For pain behind or around the kneecap, the trials are fewer and the reviewers rated them lower. A Cochrane review of 31 trials and 1,690 people with patellofemoral pain, meaning pain behind or around the kneecap, reported that exercise therapy may reduce pain and improve function compared with no treatment, and that adding hip exercises to knee exercises may reduce pain more than knee exercises alone. The reviewers rated the evidence behind every one of those findings very low quality, because of flaws in how the trials were designed and how few people were in them, and said there is not enough evidence to determine which form of exercise is best.4 In that review the authors also stated that it is unknown whether the result would apply to everyone with patellofemoral pain. The hip half of that finding is one of the reasons the hip is examined when the front of the knee is what hurts.
On dry needling, which is used here for trigger points or myofascial pain, start with what was not shown. A systematic review of 10 randomized trials of trigger-point dry needling for knee pain, 6 of them in patellofemoral pain, 2 in knee osteoarthritis and 2 in pain after knee surgery, found no significant effect at mid-term or long-term follow-up, and the effect it did find was not shown in the knee osteoarthritis studies or in the post-surgical studies. What that review found was a short-term reduction in pain and in related disability against the comparison groups, with the effect concentrated in the patellofemoral pain studies. The reviewers graded the overall evidence low to moderate, and noted that differences between the studies and imprecision in the results were what lowered that grade.5 In those trials needling was studied alone and also as an addition to other treatment, so the review does not isolate it as a standalone treatment.
The last question is surgery, and the first thing to say is which knees the two studies below do not cover. They do not cover a knee that locks or is mechanically blocked, a knee that will not bear weight, or an acute tear from an injury. Those go for an orthopedic opinion rather than a trial of care, and they are on the referral list above for that reason.
A meta-analysis of 7 randomized trials in 805 middle-aged patients whose meniscus tears the trials classified as degenerative, with little or no osteoarthritis alongside, found that arthroscopic surgery, done through small incisions with a camera, to trim the tear produced no clinically important advantage over nonoperative care or a sham procedure, meaning a placebo operation used for comparison. A short-term difference in function did favor surgery, but it fell below the threshold the reviewers used for a minimally important difference, and long-term function and pain at both time points showed no significant difference. The reviewers called this moderate evidence and recommended a trial of nonoperative management as the first-line treatment for that group.6 In that review, degenerative was the trials’ own inclusion criterion, and so was the little-or-no-osteoarthritis part of the description. Neither phrase attaches to your knee until an examination and your history put it there.
Where a tear and osteoarthritis appear on the same report, one trial ran the comparison head to head. In a trial of 351 people age 45 and older who had both a meniscus tear and osteoarthritis on imaging, inside the range the trial set for entry, 30% of those assigned to physical therapy alone had gone on to surgery within 6 months. Counting everyone in the group they were assigned to, knee function improved by an average of 18.5 points on a 100-point scale in the physical therapy arm and 20.9 points in the surgery arm, a difference the trial reported as not statistically significant, and the 12-month results looked like the 6-month results.7 Everyone in that trial received active care: the comparison arm followed a standardized physical therapy program, and the surgical arm had surgery plus physical therapy afterward. Not statistically significant is not the same as equal, either. The 95% confidence interval around that difference, the range of statistical uncertainty around a comparison between two groups and not a number about any one person, ran from -1.8 to 6.5 points, which does not rule out an advantage for surgery. The switches to surgery happened at the discretion of the patient and the surgeon together.
All of these are group results in populations the trials defined, not a prediction for your knee. Finding out where you actually stand is what the examination is for.
3. Lawford BJ, et al. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2024;12(12):CD004376. PubMed
4. van der Heijden RA, et al. Exercise for treating patellofemoral pain syndrome. Cochrane Database Syst Rev. 2015;1(1):CD010387. PubMed
5. Rahou-El-Bachiri Y, et al. Effects of trigger point dry needling for the management of knee pain syndromes: a systematic review and meta-analysis. J Clin Med. 2020;9(7):2044. PubMed
6. Khan M, et al. Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis. CMAJ. 2014;186(14):1057-1064. PubMed
7. Katz JN, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. 2013;368(18):1675-1684. PubMed
Common questions about knee pain
Why does my knee hurt on stairs and after sitting?
That pattern points the examination toward the kneecap. Patellofemoral pain means pain behind or around the kneecap, and stairs, squatting, kneeling and long stretches of sitting are the situations people most often describe it in. The pattern narrows the field without settling it, because pain at the front of the knee also comes from the tendon below the kneecap and from the fat pad behind that tendon, a cushion of fatty tissue that can be tender in its own right. Testing the kneecap, the tendons, the hip and the foot in one visit is how those get sorted.
My MRI says meniscus tear. Does that mean surgery?
That decision belongs with a surgeon, and a line on a report does not make it. A knee that locks, will not straighten, gives way, or will not take your weight goes for an orthopedic opinion promptly. Outside of that group, a meta-analysis of 7 randomized trials in 805 middle-aged patients whose tears the trials classified as degenerative, with little or no osteoarthritis alongside, found that arthroscopic surgery, done through small incisions with a camera, to trim the tear produced no clinically important advantage over nonoperative care or a sham procedure, meaning a placebo operation, and the reviewers, calling this moderate evidence, recommended a trial of nonoperative management as first-line treatment for that group. Whether your knee is in that group is a question for an examination and your history, not for the scan alone.
Is the finding on my knee MRI the reason I hurt?
Not automatically, and it matters in both directions. In a review that pooled 63 studies and 5,397 knees, cartilage defects, meniscus tears, changes in the bone just under the joint surface and bone spurs turned up in adults who had no knee symptoms and no knee injury, in 4% to 14% of adults under 40 and in 19% to 43% of adults 40 and older, depending on which finding. Every knee in that review was an uninjured knee, so it says nothing about a knee after a crash or a fall. And your pain is not less real because the same words appear on other people’s reports. Whether the finding explains you is what the examination works out.
My X-ray came back with an osteoarthritis grade. What does the grade mean?
On X-ray, radiologists commonly grade knee osteoarthritis from 0 to 4 on the Kellgren-Lawrence scale, counting the changes they can see: narrowing of the space between the bones, bony outgrowths at the joint edges called osteophytes, and changes in the bone near the joint surface. The grade describes the picture at one moment. It is not a score for your pain, and it does not set what you are able to do. What it does is give the examination one more piece of information to line up against what your knee actually does under load.
Do you use dry needling for knee pain?
Dry needling is used here for trigger points, meaning tight, painful knots in a muscle, and myofascial pain, meaning pain from the muscle and its covering tissue, which around a knee means the muscles above and around the joint. On the research: a systematic review of 10 randomized trials of trigger-point dry needling for knee pain found no significant effect at mid-term or long-term follow-up. It did find a short-term reduction in pain and in related disability, concentrated in the patellofemoral pain trials and not shown in the knee osteoarthritis trials or the trials of pain after knee surgery, and the reviewers graded that evidence low to moderate. It is one tool inside an examination-led plan, and whether it belongs in yours is decided at the visit.
Why would you examine my hip and my foot when it is my knee that hurts?
Because the knee sits between them and the examination has to account for all three. A hip problem can be felt at the knee, and in children and adolescents it is often felt at the knee and nowhere else, which is why a limping child with knee pain is examined at the hip the same day. On the exercise side, a Cochrane review of 31 trials in patellofemoral pain reported that adding hip exercises to knee exercises may reduce pain more than knee exercises alone, on evidence the reviewers rated very low quality. And how you load your feet is part of the knee picture, which is why footwear, foot structure and gait get looked at in the same visit.
You examined my feet. When do orthotics come into it?
If the examination points to your foot structure, Dr. Koser prescribes custom orthotics made from a weight-bearing laser scan of your own feet. That starts with its own evaluation and scan visit, which includes your fitting when the devices arrive. The device itself is quoted to you in writing, and nothing is ordered until you approve the price. The fee for that visit, the terms that come with it, and how orthotics are billed when a third-party payor is involved are all published on our custom orthotics page.
When is knee pain an emergency?
A hot, swollen knee with fever, a knee that will not take your weight after an injury, and new swelling or pain in the calf, which is more urgent still with chest pain or shortness of breath. Those are emergency department visits now, not appointments.
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This page is general health information and is not medical advice for any individual. The studies summarized describe groups, not any one person’s outcome, and whether any finding on your imaging explains your symptoms can only be determined by examination. Talk to Dr. Bobby Koser, DC, about your own situation, and seek emergency care immediately for the warning signs listed above.
Bring the knee, the report, and the shoes.
A complete examination with Dr. Bobby Koser, DC, the knee, hip and foot looked at together, and your findings explained the same day.