Creaky knees: Is there a reason for concern? A qualitative study of the perspectives of people with knee crepitus

Key Points

1. People with knee crepitus do not consider it to be a major concern.
2. However, beliefs about crepitus may affect exercise behavior and physical activity levels.

BACKGROUND & OBJECTIVE

Crepitus means audible or palpable sensations of grating, cracking, or popping around a moving joint. Some patients believe crepitus is associated with degeneration of the joint and are afraid that crepitus‐producing movement can cause further damage (1). This results in a decrease in activity levels and modification of movements to avoid crepitus and prevent further joint degeneration (1). Furthermore, people seeking advice regarding their crepitus expect their healthcare professional to have a strong evidence‐based understanding on the management of crepitus‐producing knees.

This study investigated beliefs about crepitus in people with knee crepitus, how those beliefs affect exercise and physical activity levels, and how those beliefs were shaped by interactions with health care professionals.

Some patients believe crepitus is associated with degeneration of the joint and are afraid that crepitus‐producing movement can cause further damage.

Clinicians should educate their clients, provide reassurance about the benefits of exercise, and help clients find the types of exercise that will be most beneficial for them personally.

METHODS

The authors interviewed 24 people with knee crepitus. 16 were female and 8 were male, and the age range was 21-69. The people spoke in focus groups and individual interviews about their experience with crepitus, whether it was associated with pain, what they thought it meant, how it affected their exercise and movement behavior, and what they had been told by health care professionals.

The transcripts were analyzed to identify thematic patterns using an inductive approach based on grounded theory.

RESULTS

The authors identified the following patterns in the responses:

• About half of the participants had crepitus but no pain. Others had both crepitus and pain, but only some found that the presence of crepitus had any connection to the timing or severity of pain or stiffness. This connection was more common in people with knee osteoarthritis (OA).

• Some participants were worried when they first heard the crepitus, and others were not. As time passed, people tended to become less worried. In general, people were far more concerned with pain and function than crepitus and believed that crepitus was not anything to worry about in isolation from pain.

• All participants believed that exercise was healthy for knees provided that it was the right type. Therefore, most remained physically active, but many were modifying their movement to avoid the crepitus and associated pain.

• Many people were curious about the meaning of the crepitus, but none had contacted a health professional about it. Of those who had mentioned it to a health care professional, some had been assured that it was not something to worry about. Many participants would appreciate learning more about what exercises to do and what crepitus means.

• The authors concluded that crepitus did not appear to be a major cause of concern for people who experience it, but that healthcare professionals should provide people with explanations about what it means, because misconceptions may be negatively affecting exercise behaviors.

LIMITATIONS

The participants in the study were relatively physically active and educated about the benefits of exercise for knee health. It is possible that beliefs about crepitus would be different in less active populations.

CLINICAL IMPLICATIONS

Knee osteoarthritis (OA) is a common chronic and progressive disease (2). Signs and symptoms of OA include pain, stiffness, crepitus, and reduced joint mobility (3). Crepitus may be an early warning sign of knee OA (4), however it can be present in healthy tissue, and therefore the significance of crepitus without other symptoms is unknown.

There is research indicating that people associate crepitus with knee degeneration and this perception may decrease activity levels (5). This is a concern because of the general health benefits of exercise and specific benefits of exercise for knee OA.

This study sought to determine what beliefs people with knee crepitus have about crepitus, how those beliefs have been shaped by interactions with healthcare professionals, and how they affect exercise and other physical behaviors.

It found that people are curious but not very concerned about crepitus, and far more concerned with pain and function. Clinicians should educate their clients about the meaning of crepitus, provide reassurance about the benefits of exercise and physical activity, and help clients find the types of exercise and physical activity that will be most beneficial for them personally.

+STUDY REFERENCE

Drum E, Kovats A, Jones M, Dennis S, Naylor J, Mills K, Thom J (2023) Creaky knees: Is there a reason for concern? A qualitative study of the perspectives of people with knee crepitus. Musculoskeletal Care, 1–11.

SUPPORTING REFERENCE

1. Robertson, C. J., Hurley, M., & Jones, F. (2017). People's beliefs about the meaning of crepitus in patellofemoral pain and the impact of these beliefs on their behaviour: A qualitative study. Musculoskelet Sci Pract, 28, 59–64.
2. Cui, A., Li, H., Wang, D., Zhong, J., Chen, Y., & Lu, H. (2020). Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinical Medicine, 29–30, 100587.
3. RACGP. (2018). The royal Australian college of general practitioners guideline for the management of knee and hip osteoarthritis.
4. Crema, M. D., Guermazi, A., Sayre, E. C., Roemer, F. W., Wong, H., Thorne, A., Singer, J., Esdaile, J. M., Marra, M. D., Kopec, J. A., Nicolaou, S., & Cibere, J. (2011). The association of magnetic resonance imaging (MRI)-detected structural pathology of the knee with crepitus in a population-based cohort with knee pain: The MoDEKO study. Osteoarthritis and Cartilage, 19(12), 1429–1432.
5. Lo, G. H., Strayhorn, M. T., Driban, J. B., Price, L. L., Eaton, C. B., & McAlindon, T. E. (2018). Subjective crepitus as a risk factor for incident symptomatic knee osteoarthritis: Data from the osteoarthritis initiative. Arthritis Care & Research, 70(1), 53–60.