Diagnostic Approach to Medial Knee Pain

Causes of Medial Knee Pain

The American College of Radiology recommends considering arthrosis, medial meniscal tears, medial collateral ligament (MCL) injuries, and referred pain from the hip or lumbar spine as potential causes of medial knee pain 1, 2
Osteoarthritis is the most common cause of chronic knee pain, particularly in the medial compartment 1, 2
The American College of Radiology suggests that bone marrow lesions (BMLs) are associated with knee pain in osteoarthritis, particularly in the medial compartment 2
Fracture of the medial tibial plateau or medial femoral condyle can cause medial knee pain, and may not be visible on initial radiographs 2

The American College of Radiology recommends initial radiographs, including anteroposterior and lateral views, as well as a tangential patellar view 1, 4
Magnetic resonance imaging (MRI) without contrast is recommended if radiographs are normal or show only an effusion, and pain persists despite adequate conservative treatment 1, 2, 4
MRI with contrast is recommended for synovitis, Hoffa's disease, deep infrapatellar bursitis, patellofemoral friction syndrome, adhesive capsulitis, and pigmented villonodular synovitis 2
Ultrasound is useful for confirming effusion, guiding aspiration, evaluating medial plica, popliteal cysts, and masses 2, 4

The American College of Radiology suggests that hip and lumbar spine pathology should be considered if knee radiographs are normal, and recommends radiographs of the hip and lumbar spine if clinically suspected 1, 3

The American College of Radiology recommends not ordering MRI without recent radiographs (within the past year), as approximately 20% of patients receive MRI without prior radiographs 5
It is essential to document laterality using specific right/left codes rather than "unspecified" 5