Knee: Bones and Structure – Overview

Anatomy: Which bones form the knee?

The knee joint is formed by three bones: the femoral condyles (joint rollers of the thigh bone), the tibial plateau (upper end of the shinbone) and the patella (kneecap). These structures are covered by articular cartilage and guided by the capsular ligament apparatus, menisci and muscles. Beneath the cartilage lies the subchondral bone, which absorbs peak loads. The bone membrane (periosteum) is very sensitive - irritation is often very painful.

• Femur: two joint rollers (medial/lateral), attachment points for cruciate ligaments and collateral ligaments
• Tibia: Tibial plateau with inner/outer articular surface, eminentia intercondylaris (cruciate ligament anchoring), tuberositas tibiae (patellar tendon insertion)
• Patella: sesamoid bone in the quadriceps tendon; slides in the groove (trochlea) of the femur
• Bone tissue: compact cortex on the outside, cancellous trabecular structure on the inside; subchondral plate directly under the cartilage

The bones are closely interconnected with the soft tissues: menisci distribute loads, cruciate and collateral ligaments stabilize, and the patella optimizes the power lever of the quadriceps. Bone disorders therefore always influence the overall functioning of the knee.

Common causes of knee bone pain

• Trauma: fall, torsion, impact – from bone bruises to fractures
• Overload: Stress reaction/stress fracture during running and jumping sports or rapid increase in training
• Misalignments: Varus/Valgus increase the load on certain areas (e.g. medial tibial plateau)
• Circulatory disorder: subchondral osteonecrosis (SONK), post-traumatic circulatory problems
• Bone marrow edema syndrome: painful increase in fluid in the bone as a sign of irritation or stress
• Degeneration: Cartilage wear with subchondral bone changes
• Inflammation/infection: rare, but urgently in need of clarification (bacterial, rheumatological)
• Metabolism/medication: Osteoporosis, long-term cortisone therapy

Typical complaints and warning signs

• Stress-dependent pain, localized pressure pain over bony prominences
• Swelling, overheating, possibly bruising
• Snapping/blockage in free bone/cartilage parts
• Feeling of instability after trauma
• Pain at rest or at night (possible with edema/inflammation)
• Acute misalignment or shortening (suspected fracture)

When should I seek medical advice?

• Acute accident with immediate severe pain or audible/tactile cracking
• Inability to bear weight, significant misalignment, open injury
• Severe swelling with rapid increase
• Fever, chills, general feeling of illness
• Numbness, blueness or coldness in the lower leg/foot
• Persistent pain > 2–3 weeks despite rest

Diagnostics in our orthopedic practice (Hamburg)

The aim is a precise, radiation- and resource-saving clarification that identifies the cause of the symptoms and guides further action. We start with anamnesis and examination and use imaging specifically. If necessary, we coordinate further diagnostics with partners in Hamburg.

Not every complaint requires an MRI immediately. The selection depends on the findings, age, previous illnesses and symptoms. We explain the options transparently and together.

Conservative therapy – our standard first

For most bone and structural problems in the knee, conservative, functional treatment is the first priority. The aim is to reduce pain, calm inflammation, protect the bone and gradually build resilience.

• Acute measures: cooling, elevation, compression (individually), relative rest
• Relief: forearm crutches, partial weight-bearing as determined; temporary splints/orthosis
• Drug pain therapy: needs-based and time-limited (e.g. NSAIDs), topical preparations; Be aware of stomach/kidney risks
• Physiotherapy: maintaining mobility, pain relief, coordination and muscle building (quadriceps/hip/torso)
• Gait school & everyday adaptation: stairs, workplace, sport change
• Aids: Taping, insoles or axis correction aids in case of incorrect loading
• Bone marrow edema: relief phase, load control, gradual reconstruction; Bone-specific medications only after strict indication testing
• Osteoporosis management: clarification and therapy in cooperation (nutrition, vitamin D/calcium, medication options if necessary)
• Lifestyle: Weight management, quitting smoking (promotes bone healing), sleep/stress management

The duration and intensity of the measures depend on the diagnosis and healing progress. Regular follow-up checks help to increase or, if necessary, slow down the load in a timely manner.

Invasive/surgical options – when do they make sense?

Surgical procedures are considered when conservative measures are not sufficient or when structural stability/anatomy needs to be restored. The decision is made individually, risk-consciously and after information.

• Fractures with misalignment/instability: Osteosynthesis (screws/plates, if necessary wire cerclage on the patella) to restore the step and axis
• Tibial plateau and femoral condyle fractures: anatomical reconstruction of the articular plateau, early functional follow-up treatment
• Free joint bodies or osteochondral fragments: arthroscopic removal/refixation
• Subchondral lesions/threatening circulatory disorders: in selected cases, relieving drilling (core decompression) in specialized centers
• Severe axial misalignment with overloading of the subchondral bone: axial correction (e.g. corrective osteotomy) as a joint-preserving option
• Endoprosthetics: only for advanced osteoarthritis with comprehensive consideration - not primarily for isolated bone irritations

Before each procedure, the benefits, risks, alternatives and the expected rehabilitation plan are discussed. We avoid hasty surgery without a clear indication.

Healing process and rehabilitation

• Bone bruise: often 2-6 weeks until significant improvement
• Stress reaction/stress fracture: usually 6–12 weeks, depending on location and load control
• Fractures: 8-16+ weeks to bony consolidation; individual differences
• Phase-oriented: pain control → mobility → strength/coordination → return to work/sport
• Thrombosis prophylaxis: in case of immobilization according to medical assessment
• Return-to-Activity: gradual, objectified through clinical tests and, if necessary, imaging

Healing is rarely linear. Short-term fluctuations are normal. Early overload can prolong the process. Structured support increases the chance of a stable, resilient bone status.

Prevention: protect bones, control stress

• Strength & Coordination: Quadriceps, hip abductors, calves; neuromuscular training
• Axis and landing technique: knee over foot, avoid knock-knees/bow-legs, practice soft landing
• Training control: gradual increase (e.g. 10% rule), sufficient regeneration
• Suitable footwear and, if necessary, insoles for axle problems
• Nutrition: adequate protein, vitamin D and calcium; Pay attention to sunlight exposure
• Fall prevention: balance training, living environment safety, check visual aids
• Sports alternatives in states of irritation: cycle ergometer, aqua jogging

Special situations

• Children/Adolescents: Growth plates (epiphyses) must be protected; special fracture types
• Elderly/people with osteoporosis: lower impact loads can cause fractures; Fall prevention is key
• Athletes: increased risk of stress fractures when changing volume/intensity, pay attention to energy availability
• After fracture/surgery: metal removal only if there are complaints/medical necessity

Subtopics and in-depth pages

For specific information on individual clinical pictures, please refer to our detailed pages. There you will find symptoms, diagnostics, therapy and rehabilitation information in detail.

• Tibial plateau fracture – staged reconstruction and follow-up treatment
• Femoral condyle fracture – articular surface injuries to the thigh
• Patellar fracture – injuries to the kneecap
• Bone marrow edema - causes, course, conservative options
• Trauma/Acute Injuries – Initial Responses and Priorities
• Joint, cartilage, synovia - connections with the subchondral bone
• Muscles, tendons, ligaments – stability and load distribution
• Meniscus – shock absorber between bone surfaces
• Cruciate ligaments and instability – stress on bones and cartilage
• Patella / patellofemoral system – sliding mechanics and retropatellar pain

Glossary: ​​Important terms explained simply

• Subchondral: located directly under the articular cartilage
• Bone marrow edema: excess fluid in the bone as a sign of irritation/stress
• Osteonecrosis (SONK): circulatory disorder with loss of bone tissue
• Osteosynthesis: surgical stabilization of fractures (plates, screws, wires)
• Adjustment osteotomy: Axis correction through targeted bone cutting
• Stress fracture: Fracture caused by repeated overload without acute trauma