Knee Crepitus: Causes and Treatment Options

Knee cartilage wear with crepitus?

Hello, I recently suffered a ligament strain while playing basketball.
Initially, I couldn't bend my right leg fully, and there was a small popping sound.
Since I had no issues with daily activities, I continued to play.
The next day, my range of motion worsened, and the popping sound increased to two pops.
I also experienced discomfort when going up and down stairs.
I visited a traditional Chinese medicine practitioner for acupuncture and massage of the tendons and muscles, but there was no improvement.
A few days later, I noticed swelling in my knee.
I returned for more acupuncture and applied medicinal ointments.
After about two weeks, the swelling subsided, and I thought I was better, so I played again.
Immediately after playing, my knee felt tight, and I had weakness going up and down stairs.

I went to the orthopedic department of a hospital for an X-ray, which revealed cartilage softening.
I was prescribed medication and ointments.
At this point, the popping sound in my knee had become a noticeable creaking noise, more severe in my right knee than in my left.
I had weekly follow-ups, and it took about three weeks for the swelling to reduce.
I received hyaluronic acid injections, which were said to improve lubrication.
During the follow-up visits at the hospital, I experienced pain upon waking or when changing positions after being still for a while.
Later, I consulted an orthopedic clinic due to recurrent swelling.
I had fluid drained and continued medication.
About a month later, I received PRP injections, and my knee pain subsided.
After two injections, I could play basketball without experiencing swelling again, but the creaking noise when bending my knee persisted.
The doctor mentioned that the tendons above my thigh were too tight, which was causing the issue.
I received an injection, likely a relaxant, with the first one covered by insurance.
After that, it still felt very stiff, so I opted for two additional self-paid injections costing six thousand each, which softened the knee somewhat, but the noise remained unchanged.
This has been quite troubling.

Is this equivalent to wearing down the cartilage with each bend? Currently, I can bend and play basketball without pain.
I often kneel on the bed and lie back to stretch, and after stretching, the noise improves immediately.
When lying on my side with the painful leg bent in the opposite direction, there is no sound, and it feels smooth.
However, bending towards the painful leg produces a loud sound similar to cracking finger joints.
When I lift my leg to straighten it, there is still some noise, but it's much less.
After a few minutes, the condition returns to the same.
The improvement only lasts for a few minutes after stretching, and repeating the stretches multiple times a day yields similar results.

I am no longer seeking medical treatment.
I wear a knee brace while playing, and I don't experience pain without it, but I am still concerned about the noise.
I can also feel friction when bending my knee.
I would like to know if there are any other methods for treatment.
Currently, I can squat normally, but I still feel a bit weak when standing up and hesitate to exert myself too much or too quickly for fear of re-injury.
However, I have improved significantly compared to the initial phase when I couldn't stand up without support.
Thank you for taking the time to respond.

Mr. Zhao, 30~39 year old female. Ask Date: 2014/12/04

Dr. Shi Guozheng reply Orthopedics

Your treatment has been proactive and has shown improvement, but the body's recovery takes a certain amount of time.
Typically, injured tissues require more than six weeks to gradually heal, and in more severe cases, it may take up to three months.
The treatment you have received has been sufficient; now you just need to gradually return to normal activities.
Occasionally, you may hear sounds during joint movements, but if there is no pain associated with it, you do not need to be concerned.

Reply Date: 2014/12/04

More Info

Knee crepitus, often described as a crackling or popping sound during movement, can be a common occurrence, especially following injuries or conditions affecting the knee joint. In your case, it seems to have developed after a ligament strain while playing basketball, and despite some improvement in pain and mobility, the crepitus persists. Understanding the causes and treatment options for knee crepitus is essential for managing your condition effectively.

Causes of Knee Crepitus
1. Cartilage Damage: The most common cause of knee crepitus is damage to the cartilage, which can occur due to injuries, wear and tear, or conditions like osteoarthritis. In your case, the initial diagnosis of cartilage softening suggests that the cartilage may not be providing adequate cushioning, leading to the sounds you hear during movement.

2. Tendon and Ligament Issues: Tightness in the tendons or ligaments around the knee can also contribute to crepitus. As you mentioned, your doctor noted that the tendons above your knee are very tight, which can cause friction and result in the popping sounds when you bend or straighten your knee.

3. Synovial Fluid Changes: The knee joint is lubricated by synovial fluid, which can become less effective due to inflammation or injury. This can lead to increased friction and the characteristic sounds during movement.

4. Joint Effusion: The accumulation of fluid in the knee joint (often referred to as "water on the knee") can also contribute to crepitus. You mentioned experiencing swelling and fluid accumulation, which can exacerbate the noise and discomfort.

Treatment Options
1. Physical Therapy: Since you have already engaged in physical therapy, continuing with targeted exercises to strengthen the muscles around the knee and improve flexibility is crucial. Focus on stretching the quadriceps, hamstrings, and calf muscles to alleviate tightness. Strengthening exercises for the hip and thigh muscles can also help stabilize the knee joint.

2. Knee Bracing: Wearing a knee brace during activities, especially sports, can provide additional support and stability. However, if the brace causes discomfort or a feeling of pressure, it may be worth discussing alternative options with your healthcare provider.

3. Injections: You mentioned receiving hyaluronic acid injections, which can help lubricate the joint. Additionally, PRP (Platelet-Rich Plasma) therapy has shown promise in promoting healing and reducing inflammation. If you continue to experience issues, discussing further injection options with your orthopedic specialist may be beneficial.

4. Activity Modification: While you have returned to playing basketball, it’s essential to listen to your body. Avoid high-impact activities that may exacerbate your symptoms. Incorporating low-impact exercises, such as swimming or cycling, can help maintain fitness without putting excessive strain on your knee.

5. Weight Management: If applicable, maintaining a healthy weight can reduce the stress on your knee joints, potentially alleviating some of the crepitus and discomfort.

6. Surgical Options: If conservative treatments fail and the crepitus is accompanied by significant pain or functional limitations, surgical options may be considered. Procedures such as arthroscopy can help clean out damaged cartilage or repair any underlying issues.

Conclusion
While knee crepitus can be concerning, it is often manageable with the right approach. Continuing to work with your healthcare team, including orthopedic specialists and physical therapists, will be essential in developing a comprehensive treatment plan tailored to your needs. Regular follow-ups will help monitor your progress and adjust your treatment as necessary. Remember, it’s crucial to prioritize your knee health and avoid activities that may lead to further injury. If the crepitus persists or worsens, seeking further evaluation may be warranted to rule out any significant underlying issues.

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