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The two main symptoms which come to my mind are:

1. Pain that is either increasing day-to-day or which makes it hard/impossible to put weight on the knee, and

2. Swelling or stiffness that is increasing day-to-day or which consistently recurs after any strenuous activity.

Discussion:

Pain: 

​This is the body’s primary self-defense mechanism and should always be taken seriously.  If you can’t comfortably put weight on your knee it might be a sign of bone injury (fracture or bone bruise) or significant soft tissue injury—like damage to ligaments or cartilage.  “Fighting through” pain is never a good idea.  By that, I mean one should never try to exercise pain away, or force oneself to walk on a painful knee.  Severe pain that is accompanied by significant swelling should always be protected with limited weight-bearing (crutches or wheelchair) and should be evaluated by a health care provider ASAP.  Pain that is less than severe, i.e. “nagging” rather than disabling, can be managed appropriately on a less-than-emergent basis.

Swelling/stiffness: 

​This often appears initially as discomfort in the back of the knee and/or calf and a feeling that one cannot either straighten the knee fully or cannot flex/bend the knee fully (often most noticeable when comparing to the opposite knee).  This is a sign that there is increased fluid production occurring in the knee in response to a mechanical or inflammatory irritant within the knee. 

​If the irritant is mechanical (like a torn meniscus cartilage or damage to the articular cartilage) there will be attendant production of microscopic wear debris particles.  The joint lining has specialized cells which respond to these particles by pouring water and enzymes into the knee—in an effort to dissolve these particles.  The greater the amount of debris being generated, the greater the water/enzyme response.  This reciprocal reaction is obvious if the fluid/stiffness resolves with rest (less debris generation) and then resumes with increased activity/exercise (more debris generation).

​Examples of inflammatory irritants include metabolic processes such as gout or pseudogout, rheumatoid arthritis and related diseases, and infections such as Lyme disease and other bacterial infections.

​Infections are, of course, always an emergency—and should be diagnosed and treated as rapidly as possible for a number of reasons.  A hallmark of infection is that it is relentless in its progression—and does not improve with rest.

​Mechanical irritation should also be addressed with relative alacrity because early intervention may slow or eliminate the onset of arthritis—which, if left untreated, also gains a “life of its own” and become relentless in its progression.