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Three causes of pain on the inner side of the knee

Knee pain may have many causes requiring surgeryPain on the inner side of the knee may have a number of causes. The three commonest conditions that I diagnose are one (or a combination) of the following:

  1. Osteoarthritis
  2. Meniscal tear
  3. Chondromalacia patella..

Osteoarthritis of the right knee; Waterfall Hospital


Osteoarthritis is a degenerative condition of the knee. In layman’s terms it can be thought of as “wear and tear” in the knee joint.The knee consists of three areas or compartments, the medial or inner compartment, the lateral or outer compartment, and the patellofemoral joint (the area under the patella or knee cap). Arthritis in the knee affects one or more of these areas in the knee. The most encountered situation is the development of arthritis in the medial or inner compartment. As the condition progresses there is a gradual narrowing of the joint space on the inner aspect of the knee due to cartilage thinning and a deformity can result which can give the legs a bow-legged appearance. Swelling is often present with arthritis. If the arthritis progresses and becomes unresponsive to non-operative interventions, a total knee replacement may eventually be required.

Arthroscopic picture of a vertical meniscus tear; Waterfall Hospital

Meniscal Tear

The meniscus is a C-shaped cartilage structure in the knee which acts as a “shock absorber”. There are two such structures in the knee, a medial meniscus on the inner side and a lateral meniscus on the outer side. The meniscus can be torn through injury to the knee, but not uncommonly it can also be injured after even minor trauma if the meniscal tissue is weak. Patients complain of pain along the inner side of the knee and there may be associated symptoms such as swelling, clicking and locking. Arthroscopy is often required to treat a meniscus tear.


Chondromalacia patella is usually treated by a muscle strengthening program

Chondromalacia Patella

Chondromalacia patella is an extremely common cause of knee pain. It typically affects younger women but can occur in men and in other age groups as well. The pain is typically located in the front of the knee and is worse when using the stairs or sitting for long periods of time. Patients usually develop a crunching sensation in the knee. Chondromalacia patella literally means softening of the cartilage of the patella and the crunching or crepitus is because of progressive roughness and fissuring of this cartilage. Due to the nerves supplying the knee, the pain from chondromalacia patella can often refer to the inner side of the knee and occasionally causes difficulties in diagnosing the condition. Fortunately surgery is uncommonly needed to treat this condition and strengthening treatment with a physiotherapist or biokineticist is usually all that is needed.

What should do if I have pain on the inner side of the knee?

The above conditions may all present in a similar way, but the treatment for each is usually very different, and ranges from conservative measures such as starting a rehabilitation or strengthening programme, to having major surgery like a total knee replacement. In some instances obtaining an accurate diagnosis may be difficult initially and I would recommend that you see an experienced knee surgeon for a thorough assessment. I see and treat many patients with each of these conditions at Waterfall Hospital in Waterfall/Midrand and at Morningside Clinic in Sandton.

Yours in good health,

Dr Warren Matthee

MB BCh (Wits), MRCS (England), MMed (Ortho Surg), FC Orth (SA)

Orthopaedic Surgeon

(011) 304 6784

About the author…

I am an orthopaedic surgeon with a special interest in sports injuries and minimally invasive (arthroscopic) surgery of the knee and shoulder. I treat patients at Waterfall Hospital in Waterfall/Midrand and Morningside Mediclinic in Sandton. Besides these, I also treat patients from other areas as well, including Rosebank, Sunninghill and Fourways.

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