Overview

 

About The Knee

The bones of the knee, the femur and the tibia, meet to form a hinge joint. The joint is protected in front by the patella (kneecap).

The knee joint is cushioned by articular cartilage that covers the ends of the tibia and femur, as well as the underside of the patella. The lateral meniscus and medial meniscus are pads of cartilage that further cushion the joint, acting as shock absorbers between the bones

Common Knee Injury

Acute injuries -

A sudden force that twists the knee or moves it beyond its normal boundaries can cause major damage to the knee. Common areas that are injured are.


Most acute injuries, including breaks in the bones, accumulation of joint fluid due to severe knee strain, infection, arthritis, or bleeding, or a severe torn cartilage or ligament rupture cause severe pain and swelling. However, more subtle injuries, such as partially torn cartilage or tendon, and ligament sprains cause less swelling, pain, and minimal functional loss. Overuse or excessive use of the knee, particularly when the muscles are "out of shape," can cause painful knee caps, arthritis flares, bursitis, or a knee strain and effusion.


Patellar tracking disorder -

Patellar tracking disorder is a condition in which the kneecap (patella) shifts out of place as the leg bends or straightens. In most cases, the kneecap shifts too far toward the outside of the leg, although in a few people it shifts toward the inside. The kneecap can shift or rotate off track if the groove is too shallow or if the cartilage is damaged. Ligaments, tendons, or muscles that are too loose or too tight may also lead to a misaligned kneecap.


Excessive use and Overuse -

Repetitive soft-tissue trauma and imbalanced knee muscles can result in tendonitis, bursitis, patellofemoral pain syndrome and iliotibial band friction syndrome.


Wear and tear -

Arthritis is a common cause of knee pain. Parts of the knees are vulnerable to wear and tear. One such area is the knee cartilage. The purpose of cartilage is to stop bones rubbing together and allow a smooth motion in the joints.


Patellar Tendon Strain -

The patellar tendon is a very strong tendon which extends for a short distance below the knee cap (patellar). It is used whenever the knee bends under load e.g. jumping, squatting, kicking etc. The most common injury is an over use injury by overwork although a sudden injury can occur if the knee is blocked whilst traveling from the bent to straight leg position e.g. if you catch the ground whilst running or kicking.


Knee-cap Dislocation -

Knee-cap dislocation occurs when the knee-cap slips or has been pulled out sideways under the influence of the contracting quadriceps muscle group. Usually the knee-cap returns to it's correct position and a certain amount of swelling and discomfort is apparent.


Patello-Femoral Syndrome (PFS) -

The patella, commonly referred to as the "knee cap", and its tendon transmit power from the quadriceps to the lower leg. Normally, as the knee bends, the patella slides smoothly along a groove in the thigh bone. However, under certain conditions the patella may experience forces which push it against the sides of the groove, causing pain. Additionally, inflammation and roughening of the smooth underside of the patella may occur. Collectively, this process is referred to as patello-femoral syndrome (PFS).


Medial Collateral ligament strain -

This ligament protects the inner-side of the knee and can be injured by a twisting strain on the knee such as can occur in a tackle or if your foot slips whilst running. It is also possible to suffer from an overuse injury to this ligament. If the collateral ligament is completely torn or torn in such a way that ligament fibers cannot heal, you may need surgery. Repair may bring good results, with a return to good knee stability. After satisfactory rehabilitation, many people resume their previous levels of activity.


Lateral Collateral ligament strain -
The lateral collateral ligament (LCL) connects the thighbone to the other bone in the lower portion of your leg (fibula) and stabilizes the outer side. Similar to the medial ligament, the lateral ligament can be damaged by a twisting action on the knee and sometimes both ligaments are damaged at the same time.

Meniscus Tears

The most common injury to the young athletic knee is a tear of the medial meniscus. There are two menisci within each knee and they function to distribute stress during weight-bearing activities. By distributing stress evenly, menisci can limit articular cartilage surface damage which is the beginning of arthritic degeneration. Menisci also function to help stabilize the knee and to increase the smooth motion of the knee joints.

Posterior Cruciate Ligament (PCL) injuries -

The posterior cruciate ligament, or PCL, is not injured as frequently as the ACL. PCL sprains usually occur because the ligament was pulled or stretched too far, a blow to the front of the knee, or a simple misstep. PCL injuries disrupt knee joint stability because the shinbone can sag backwards. The ends of the thighbone and shinbone rub directly against each other, causing wear and tear to the thin, smooth articular cartilage. This abrasion may lead to arthritis in the knee.

Causes

Meniscal tears most often occur posteriorly in the knee. The tears occur as the knee is in a flexed weight-bearing position and then the knee is twisted. This creates a shear force on the meniscus, causing it to tear. Unfortunately, meniscal tears usually do not heal themselves once they have reached a substantial length (1 cm). When meniscal tears of this length or greater occur, mechanical problems and pains are caused, bringing the injured athlete to a physician’s office.

Meniscal tears often occur in association with other injuries to the knee. Perhaps the most common of these is an anterior cruciate ligament (ACL) tear. Interestingly, meniscal tears that occur in association with an ACL disruption occur on the lateral side more commonly than on the medial side while isolated and degenerative meniscal tears occur more commonly on the medial side.

Symptoms

Treatment

Meniscal tears occur in all age groups. Care of meniscal tears is dependent not only on the age of the patient, but also the size, length, and quality of the tear. As an athlete ages, the meniscus becomes less vascular and therefore less able to heal and/or be repaired. For this reason, degenerative meniscal tears usually occur in individuals aged 35 and over and they are commonly treated by surgical excision of the tear.

Non-operative

Many meniscal tears are small and will not become symptomatic. Tears that are big enough to cause symptoms can be treated non-operatively especially in older individuals. A course of activity modification followed by therapy and a gradual return to sports is successful in approximately 50% of these individuals. The tear itself does not heal but rather is ‘ground-down’ to a point where it is no longer symptomatic. When this does occur, a patient feels better within three weeks and is able to return to normal activities by six weeks.

This form of treatment is not recommended in young, healthy individuals as this age group has a greater potential to worsen their tear by walking or playing on it. Further, younger individuals can often have their tear repaired surgically. This possibility decreases the longer surgical intervention is delayed.

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