Medial Knee Pain

Written By: Chloe Wilson, BSc(Hons) Physiotherapy
Reviewed by: KPE Medical Review Board

Find out about the common causes of medial knee pain and how to treat them

Medial knee pain is pain that occurs on the inner side of the knee and can be due to a number of problems.

There are a number of structures on the medial side of the knee and problems in any one or more of these can cause pain.

Symptoms of inner knee pain may come on gradually over time or may develop suddenly after a knee injury. There may be a general inner side of knee pain, movement may be restricted or there may be a sharp pain.

It is very common to get medial knee pain, because muscle weakness and/or tightness, which is very common, can subtly change the way the knee moves.

What Causes Medial Knee Pain?

There are a number of possible causes of medial knee pain and we are going to look at the common symptoms and treatment options for each:

1. MCL Tear

Medial knee pain is often the result of an MCL tear

An MCL tear is the most common cause of medial knee pain in people under the age of 50. With an MCL tear, there is damage to some or all of the fibres of the medial collateral ligament on the inner side of the knee.

MCL tears are a common injury in sports, usually from either a force through the outer side of the knee or twisting the knee while the foot is fixed to the ground e.g. with cleats.

Typical symptoms of an MCL tear include

  • Medial Knee Pain: particularly when bending the knee, walking, going up and down stairs or playing sports
  • Swelling: bruising and tenderness over the injured ligament
  • Knee Instability: the knee may feel like it is going to give way, particularly with twisting movements
  • Knee Stiffness: knee movement may be limited

There are three grades of MCL tear, depending on how severely you have damaged the ligament and treatment usually involves a combination of PRICE, knee brace, exercises and physical therapy.

Find Out More: MCL Tear - Causes, Symptoms & Treatment

2. Medial Meniscus Tear

A cartilage tear is a common cause of medial knee pain.

Another common cause of medial knee pain is a tear in the cartilage lining on the inner side of the knee joint, known as the meniscus.

Symptoms of a meniscus tear may develop:

  • Suddenly: usually from awkward twisting or a force through the knee or
  • Gradually: over a period of weeks or month due to wear and tear in the knee

Typical features of a medial meniscus tear include medial knee pain, swelling, locking, instability and difficulty straightening the leg. Symptoms typically get worse with walking, running, squatting and on stairs, especially going up.

Treatment for medial knee pain from an MCL tear usually consists of rest, ice, compression, elevation, strengthening and stretching exercises and physical therapy. If the ligament tears completely, then surgery may be necessary to repair the damage.

Find Out More: Meniscus Tears - Causes, Symptoms & Treatment

3. Pes Anserine Bursitis

Pes Anserine Bursitis is one of the less common causes of medial knee pain

Inflammation of the pes anserine bursa, a small fluid-filled sac the reduces friction, can also cause inner knee pain.

In most cases or pes anserine bursitis, there is a gradual onset of medial knee pain, approximately 2-3 inches below the knee joint, swelling, stiffness, weakness and sleep may be affected. 

Inner knee pain from pes anserine bursitis usually gets worse with resisted knee flexion and exercise, as well as when climbing stairs. It most commonly affects overweight middle aged women or runners and swimmers.

Treatment usually involves a combination of rest, ice, stretching and strengthening exercises to reduce the medial knee pain and regain stability at the knee. In some cases, your doctor may advise corticosteroid injections or even surgery. 

Find Out More: Pes Anserine Bursitis - Causes, Symptoms & Treatment

4. Knee Arthritis

Osteoarthritis most commonly affects the inner side of the knee joint causing medial knee pain.

Wear and tear in the cartilage lining the medial side of the joint from arthritis is the most common cause of medial knee pain in the over 50's.

Arthritis is more prevalent in the inner side of the knee, rather than the outer side due to the angles at the hip, knee and ankle. Symptoms typically develop gradually and include morning stiffness, inner knee pain, swelling, clicking/grinding and knee stiffness. Medial knee pain from arthritis tends to be worse after prolonged rest and in cold weather.

There are three classification stages of arthritis, mild, moderate and severe based on how badly the joint is affected. Knee arthritis treatment will depend on the severity of the symptoms but typically includes exercises, medication, heat/ice, acupuncture, injections and knee braces.

Find Out More: Knee Arthritis - Causes, Symptoms & Treatment

5. Medial Plica Syndrome

Medial Plica Syndrome causes inner knee pain. Find out about the common causes, symptoms and treatment of medial knee pain

One of the more unusual causes of medial knee pain is inflammation of a fold in the synovial membrane (plica) on the inner side of the knee. 

With medial plica syndrome there tends to be anterior and medial knee pain and tenderness, and some people notice an audible clicking sound when they move their knee. 

Inner knee pain due to inflamed plica usually gets worse with repetitive knee movements, squatting, on stairs and when getting up after you've been sitting or lying down for a while.

A combination of knee exercises, anti-inflammatory medication, rest and ice is usually sufficient to reduce the medial knee pain and inflammation, but in severe cases, surgery may be necessary to remove the injured plica. 

Find Out More: Plica Syndrome - Causes, Symptoms & Treatment

What Is Causing My Inner Knee Pain?

Let's have a look at the common symptoms associated with medial knee pain and what they typically indicate:

Pain On Inside Of Knee No Swelling: If there is no swelling with your medial knee pain, it is likely only a minor injury such as a small cartilage tear or a grade 1 sprain of the MCL.

Inner Knee Pain Running: Knee pain medial side during or after running is most typically caused by a cartilage tear or Runners Knee.

Inner Knee Pain When Straightening Leg: Pes Anserine Bursitis is the main culprit here as the bursa can easily get squashed when straightening the knee.

Medial Knee Pain With Flexion: Most medial knee pain gets worse with knee flexion, especially when weight bearing through the leg. If it's worse when standing, it may indicate an MCL tear or meniscus tear. If it happens when you are sitting or bending the knee, it may be pes anserine bursitis or plica syndrome.

Anterior Medial Knee Pain: If your inner knee pain is coming round to the front of the knee, it may actually be a problem with the knee cap or Runners Knee rather than one of the structures on the inner knee.

Medial Knee Pain When Sitting Cross Legged: Pain in the inner side of knee when sitting cross legged is most likely due to a meniscus tear as this position places extra stress on the cartilage.

Medial Knee Pain After Sitting or Lying: Inner knee pain that is at its worse when you first move the knee after sitting or lying down for a while tends to be due to knee arthritis. The pain usually eases once you are up and about. In younger patients, it is more likely to be due to Plica Syndrome.

Why Is Medial Knee Pain So Common?

It is very common to get pain on the medial side of the knee, because muscle weakness and/or tightness, which is very common, can subtly change the way the knee moves.

This causes more force to go through the inner side of the joint, rather than distributing weight evenly through the whole joint, which results in damage to the inner side of the knee and therefore results in medial knee pain. For example, it is much more common to get osteoarthritis on the inner side of the knee than the outer side.

Want to Know More?

Just because there is inner knee pain, doesn’t necessarily mean the problem is on the inner side of the joint. Pain can refer from different places such as the knee cap or even the lower back.

If your inside knee pain doesn’t sound quite like any of these problems, visit the Common Causes of Knee Pain section to find out about the most common knee problems.

Alternatively, if would like some guidance with working out what is causing your problem, visit the knee pain diagnosis chart for help.

Remember, you should always see a doctor with any new onset of pain. To find out more about these common causes of medial knee pain, choose from the links above.

Page Last Updated: 10/12/21
Next Review Due: 10/12/23


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References

1. Journal of Orthopedics. Medial collateral ligament injuries. August 2017

2. The Surgery Journal. Synovial Plica Syndrome of the Knee: A Commonly Overlooked Cause of Anterior Knee Pain. February 2017

3. Arthritis Research & Therapy Journal. Functional electrical stimulation of gluteus medius reduces the medial joint reaction force of the knee during level walking. November 2016

4. Muscles, Ligaments and Tendons Journal. Meniscus tear surgery and meniscus replacement. May 2016