Two Cases of Physical Therapy Focusing on the Meniscotibial Ligament and Its Associated Fat Pad for Medial Knee Pain in Knee Osteoarthritis

Medial knee pain in knee osteoarthritis cannot always be explained solely by static structural abnormalities such as meniscal tears or osteophyte formation. Increasing attention has therefore been directed toward the dynamic behavior of peri-meniscal structures as potential contributors to symptom generation. This report describes two cases of knee osteoarthritis in which medial knee pain was localized near the tibial attachment of the medial meniscus (MM) despite minimal restriction of the knee range of motion and negative meniscal provocation tests. Dynamic ultrasonography revealed restricted MM displacement during tibial rotation in both cases, suggesting impaired adaptability of the meniscotibial ligament (MTL) and its underlying fat pad. Physical therapy focused on reducing tension in the MTL and facilitating physiological MM motion resulted in immediate and sustained pain reduction, accompanied by improvement in meniscal mobility on ultrasonographic assessment. These findings suggest that dynamic ultrasonographic evaluation combined with targeted physical therapy may represent a useful clinical approach for the assessment and management of medial knee pain in patients with knee osteoarthritis.