Knee locking refers to when the leg gets stuck in one position, unable to bend or straighten. Most cases fall into one of two categories.
There is true locking caused by a mechanical block where something gets stuck inside the joint, preventing movement. It most commonly occurs as you move the knee into full extension, i.e. towards being fully straight. Secondly, there is pseudo locking, caused by severe pain which temporarily limits movement in any direction. True locking is quite rare.
Here, we will look at the common causes of knee locking and the different treatment options.
The knee joint is designed to bend up and down (flexion and extension) and rotate slightly. If something gets caught inside the joint, it blocks the movement and the leg gets stuck. It feels like the knee is totally blocked, unable to move at all. It often takes a few minutes of gently moving the knee, or as patients often say “waggling it about”, or sometimes professional intervention is needed to get the fragment to move out of the way, before can move the leg again. This is known as true locking, when something is physically stopping the joint from moving.
True knee locking may or may not be accompanied by pain, depending on the cause. It is usually extension that is limited in this type of knee locking, preventing you from being able to fully extend your leg. True locking is usually caused by one of two things:
The meniscus is a thick piece of cartilage which lines the knee joint to provide cushioning and allow smooth movement. If it gets torn, the loose fragment may get stuck in the joint stopping it from being able to move. The most common type of meniscus tear that causes locking is known as a bucket-handle tear. This is where part of the cartilage gets torn, but remains partially attached producing a moveable flap. As the knee moves around, if the flap is large enough it can get wedged in the wrong position, blocking the joint and causing knee locking.
A meniscus tear can be caused by an injury, usually from a twisting movement or from gradual wear and tear on the joint. You can find out more in the meniscus tear section.
Another thing that can block the joint and cause knee locking is where a small fragment of bone breaks off from the knee joint and floats around. As with a meniscus tear, if it moves into the wrong place, it can get wedged in place and cause the joint to lock in a specific position.
In some cases if pain is severe enough, it can prevent the knee from being able to move properly. This happens when the body’s protective mechanisms kick in, limiting the movement as the body tries to prevent any damage being done. It usually does this by causing the muscles to spasm, holding the leg still. This is known as pseudo locking. The difference with true locking is that there is nothing stuck inside the joint, and whilst the knee may at first appear to be stuck, it usually unlocks quickly. It is often more of a “catching” sensation which inhibits movement but quickly disappears. Pseudo locking can limit both flexion and extension, bending and straightening the knee, whereas true locking is usually a block to extension only.
The most common causes of pseudo locking at the knee include:
Swelling: Excess fluid in the joint capsule can limit the movement due to increased tension, preventing full flexion and extension.
Inflammation: inflammation of the structures in and around the knee can also limit movement. The most common causes of this are rheumatoid arthritis and gout.
Patellar Maltracking: a problem with the movement of the kneecap in the groove on the front of the knee can cause pseudo locking. It is usually very painful.
Plica Syndrome: Irritation of the medial plica, a fold in the synovial tissue lining the joint can cause pseudo locking
Knee Injury: Damage to any of the structures in the knee that is bad enough to illicit severe pain can induce muscle spasm which may feel like a locked knee e.g. ligament sprain
In cases of true knee locking, you will almost certainly need surgery to remove the fragment of cartilage or bone, otherwise the problem is likely to continue and may get worse. An orthopedic surgeon will in most cases carry out an arthroscopy, keyhole surgery, where the fragment is removed and any associated damage repaired. It is a simple operation with a quick recovery time.
With pseudo knee locking, it is the underlying cause of the pain that needs treating. Assessment by your doctor or physical therapist should be able identify what is causing the restricted movement. Initial treatment may involve painkillers, anti-inflammatories and ice to help get the pain and any inflammation under control. Longer term treatment may include exercises to build up the strength and stability of the knee.
Knee locking is one of the more rare knee symptoms. If you have other symptoms and would like some help working out what is wrong, visit the diagnosis section.