Knee Injuries…

 

Types and Causes of Knee Injuries

While direct blows to the knee will occur, the knee is more susceptible to twisting or stretching injuries, taking the joint through a greater range of motion than it can tolerate.

If the knee is stressed from a specific direction, then the ligament trying to hold it in place against that force can tear. Ligament stretching or tears are called sprains. These sprains are graded as first, second, or third degree based upon how much damage has occurred. Grade-one sprains stretch the ligament but don’t tear the fibers; grade-two sprains partially tear the fibers, but the ligament remains intact; and grade-three tears completely disrupt the ligament.

Twisting injuries to the knee put stress on the cartilage or meniscus and can pinch it between the tibial surface and the edges of the femoral condyle, causing tears.

Injuries of the muscles and tendons surrounding the knee are caused by acute hyperflexion or hyperextension of the knee or by overuse. These injuries are called strains. Strains are graded similarly to sprains, with first-degree strains stretching muscle or tendon fibers but not tearing them, second-degree strains partially tearing the muscle tendon unit, and third-degree strains completely tearing it.

There can be inflammation of the bursas (known as bursitis) of the knee that can occur because of direct blows or chronic use and abuse.

Acute knee injuries fall into two groups; those where there is almost immediate swelling in the joint associated with the inability to bend the knee and bear weight, and those in which there is discomfort and perhaps localized pain to one side of the knee, but with minimal swelling and minimal effects on walking.

Acute knee injuries can cause pain and swelling with difficulty bending the knee and weight-bearing. If the swelling occurs immediately, it may suggest a ligament tear or fracture. If the swelling arises over a period of many hours, meniscal or cartilage injuries may be the cause. However, injuries to the knee may involve more than one structure and the symptoms may not present classically.

Longer-term symptoms that point to knee problems will include pain and swelling in addition to other complaints. Inflammation in the joint may be caused by even minor activity. Swelling may be intermittent, brought on by activity, and may gradually resolve as the inflammation decreases.

Pain, too, may come and go and may not occur right away with activity but might be delayed as the inflammation develops. Pain can also be felt with specific activities. Pain while climbing stairs is a symptom of meniscus injury, where the cartilage is being pinched in the joint as it narrows with bending. Pain with walking down stairs suggests patellar pain, where the kneecap is being forced onto the femur.

Giving way, or a feeling of instability of the knee, or, popping or grinding in the knee is associated with cartilage or meniscus tears. “Locking” is the term used when the knee joint refuses to completely straighten, and this is almost always due to torn cartilage. In this situation, the torn piece of cartilage folds upon itself and doesn’t allow the knee to extend.

Knee Injury Treatment

Almost all knee injuries will need more than one visit to the doctor. If no operation is indicated, then RICE (rest, ice, compression, and elevation) with some strengthening exercises and perhaps physical therapy will be needed. Sometimes the decision for surgery is delayed to see if the RICE and physical therapy will be effective. Each injury is unique, and treatment decisions depend on what the expectation for function will be. As an example, a torn ACL (anterior cruciate ligament) would usually require surgery in a young athlete or a construction worker, but the ACL may be allowed to heal with physical therapy in an 80-year-old who is not very mobile.

Muscle Tendon Injuries, MCL and LCL Injuries, ACL Injuries, and Meniscus Tears

Muscle Tendon Injuries

Almost all of these strains are treated with ice, elevation, and rest. Sometimes compression with an Ace wrap or knee sleeve is recommended, and crutches may be used for a short time to assist with walking. Ibuprofen(Advil) can be used as an anti-inflammatory medication.

The mechanism of injury is either hyperextension, in which the hamstring muscles can be stretched or torn, or hyperflexion, in which the quadriceps muscle is injured. Uncommonly, with a hyperflexion injury, the patellar or quadriceps tendon can be damaged and rupture. This injury is characterized by the inability to extend the knee and a defect that can be felt either above or below the patella. Surgery is required to repair this injury.

Except for elite athletes, tears of the hamstring muscle are treated conservatively without an operation, allowing time, exercise, and perhaps physical therapy to return the muscle to normal function.

MCL and LCL Injuries

These ligaments can be stretched or torn when the foot is planted and a sideways force is directed to the knee. This can cause significant pain and difficulty walking as the body tries to protect the knee, but there is usually little swelling within the knee. The treatment for this injury may include a knee immobilizer, a removable Velcro splint that keeps the knee straight and keeps the knee stable. RICE (rest, ice, compression, and elevation) are the mainstays of treatment.

ACL Injuries

If the foot is planted and there is force applied from the front or back to the knee, then the cruciate ligaments can be damaged. Swelling in the knee occurs within minutes, and attempts at walking are difficult. The definitive diagnosis is difficult in the emergency department because the swelling and pain make it hard to test if the ligament is loose. Long-term treatment may require surgery and significant physical therapy to return good function of the knee joint. Recovery from these injuries is measured in months, not weeks.

Meniscus Tears

The cartilage of the knee can be acutely injured or can gradually tear. Acutely, the injury is of a twisting nature; the cartilage that is attached to and lays flat on the tibia is pinched between the femoral condyle and the tibial plateau. Pain and swelling occur gradually over many hours (as opposed to an ACL tear which swells much more quickly). Sometimes the injury seems trivial and no care is sought, butchronic pain develops over time. There may be intermittent swelling, pain with walking uphill or climbing steps, or giving way of the knee that results in near falls. History and physical examination often can make the diagnosis and MRI may be used to confirm it.

Bursa Inflammation

Housemaid’s knee (prepatellar bursitis) is due to repetitive kneeling and crawling on the knees. The bursa or space between the skin and kneecap becomes inflamed and fills with fluid. It is a localized injury and does not involve the knee itself. Treatment includes padding the knee and using ibuprofen as an anti-inflammatory medication. This injury is commonly seen in carpet installers and roofers.

Patellar Injuries

The kneecap sits within the tendon of the quadriceps muscle, in front of the femur, just above the knee joint. It is held in place by the muscles of the knee.

The patella can dislocate laterally (toward the outside of the knee). This occurs more commonly in women because of anatomic differences in the angle aligning the femur and tibia. Fortunately, the dislocation is easily returned to the normal position by straightening out the knee, usually resulting in the kneecap popping into place. Physical therapy for muscle strengthening may be needed to prevent recurrent dislocations.

Patello-femoral syndrome occurs when the underside of the patella becomes inflamed if irritation develops as it rides its path with each flexion and extension of the knee, and it does not track smoothly. This inflammation can cause localized pain, especially with walking down stairs and with running. Treatment includes ice, anti-inflammatory medication, and exercises to balance the quadriceps muscle. More severe cases may require arthroscopic surgery to remove some of the inflamed cartilage and realign parts of the quadriceps muscle.

Fractures

Fractures of the bones of knee are relatively common. The patella, or kneecap, may fracture due to a fall directly onto it or in car accidents, when the knee is driven into the dashboard. If the bone is pulled apart, surgery will be required for repair, but if the bone is in good position, a knee immobilizer and watchful waiting may be all that is required.

The head of the fibula on the lateral side of the knee joint can be fractured either by a direct blow or as part of an injury to the shin or ankle. This bone usually heals with little intervention, but fractures of this bone can have a major complication. The peroneal nerve wraps around the bone and can be damaged by the fracture. This will cause a foot drop, so do not be surprised if the physician examines your foot when you complain of knee problems.

With jumping injuries, the surface of the tibia can be damaged, resulting in a fracture to the tibial plateau. Since this is where the femoral condyle sits to move the knee joint, it is important that it heals in the best position possible. For that reason, after plain X-rays reveal this fracture, a CT scan is done to make certain that there is no displacement of the bones. Occasionally, this type of fracture requires surgery for repair.

Fractures of the femur require significant force, but in people with osteoporosis, less force is needed to cause a fracture of this large bone. In people with knee replacements who fall, there is a potential weakness at the site of the knee replacement above the femoral condyle, and this can be a site of fracture. The decision to operate or treat by immobilization with a cast will be made by the orthopedist.

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10 thoughts on “Knee Injuries…

  1. Thanks for sharing superb informations. Your web-site is very cool. I am impressed by the details that you have on this blog. It reveals how nicely you perceive this subject. Bookmarked this website page, will come back for extra articles.

  2. Your blog is very helpful. I am happy to find this post very useful for me, as it contains lot of information. I always prefer to read the quality content and this thing I found in you post. Thanks for sharing.

    • Thanks :)i´m trying to do my best to post useful info and to find good exercises 🙂 i have to admitt that your positive feedbacks and nice comments are very encouraging and they motivate me more ! have a nice day and hope to hear from you again soon!

  3. I am 57 years old. 2 months ago I noticed an inability to kneel,squat or bend my knee. Since I have left sided deficite from a stroke I have counted on my right knee to bear most of my weight. I allergic to Aspirin,Tylenol and al NSAIDs. I find if I aon my feet the pain is horrible, within 30 minutes my right knee is swollen and warm to the touch/ I have used Ice and heat therapy along with a topical counter irritant, nothing relieves the pain, Should I bend the knee the pain is excruciating. I cannot raise my self from a a sitting position, such as the toilet or low seat. This has been leading to intolerable pain. The pain is not\w traveling up my thigh. and radiates into the hip. a sligh fever may accompany the swelling/ My knee looks deformed/ I have not had an injury to the knee and never had knee problems. Even lifting my leg to step up is terrible I am a active person waling everywhere. If I bend my knees while lying down, I cannot straighten it out, Hyper extention is impossible, I must keep a pi;;oe under my knee at all times/ I do have slight hip arthritis and bulging low back disc L-4 thru S-1 due to a fall/ This knee pain is puzzling as no injury to the knee itself preceded it I have never had gout nor do I eat in a way that could cause gout/

    • Hello, i am really sorry for what happened to you. Having a stroke makes getting back to normal more difficult but not impossible.
      Well,i read a bit about recovery from stroke and here is something that might intrest you with regards to muscle, joint and nervious system .
      Moving around and doing normal daily tasks such as dressing and feeding may be harder after a stroke.

      Muscles on one side of the body may be weaker or may not move at all. This may involve only part of the arm or leg, or the whole side of the body.

      Muscles on the weak side of the body may be very tight.
      Different joints in the body may become hard to move. The shoulder and other joints may dislocate.
      I also read that pain may occure after having a stroke from changes to the brain itself. With regards to pain killers since you are alergic to most of them i would advice you to talk to your health care provider and they will know what kind of medicine to give you. Pain killers also helo very much with the muscle spasm ( About one in five stroke survivors suffers from painful muscle spasms, which result when weakened muscles contract abnormally. Someone with muscle spasticity may have a tight fist, an abnormally bent arm, a stiff knee, or a pointed foot. Not only are these spasms extremely painful but they can interfere with walking or performing routine tasks. Left untreated, muscle spasticity may deform a stroke survivor’s limbs, restrict his ability to move, and lead to pressure sores.)

      It is important to :
      -Keep all of the muscles as strong as possible and stay as physically active as possible, even if you cannot walk
      -Manage muscle spasms or tightness with stretching exercises and braces that fit around the ankle, elbow, shoulder, and other joints

      Also,for the beginning you could go and have some sessions of electrotherapy ( ultrasound , magneto- therapy, massage – they are anti-inflammatory )
      Having a stroke and not being able to use properly both your legs put a lot of stress on the good leg, because now the good leg has to do the work of both of them and that causes pain and tiredness . Try some streching exercises , try to find these kind f therapy ,massage ( you can ddo it yourself at home and maybe try some creams to help) .
      Also try to rest and not force yourself to much becasuse you might get to a stress fracture ….
      You can try also hidrotherapy ….
      Her si a link with muscle spastisity after a stroke ,treatment… and i will try to find some simple streching exercises for you and post them of the blog…
      I will also leave you my e-mail : bea_betty27@hotmail.com

      Hope to hear again from you and hope you will get better soon!
      Have a nice day 🙂

  4. I am 33 years male and had a displaced tibia plateau fracture back in may 2014,it took me a long time to get over this,starting to hear a grinding noise in my knee and sounds to be getting worse,I have no pain what so ever my knee always looks A little bit bigger than the other side was looking to go back to football this year would it be possible or wise if you could give me some information it would be great thanks.mark

    • Hello Mark. Well my advice to you is to wait a bit more with regards to football and get an appoinment with a pshysio ,get an x-ray ,make sure injure its completly healed. Did you see a pshysio after your accident or done recovery ?? maybe your leg was not completly healed ,probably you overused it …after this kind of injuries if u had surgery there are some complications that can develope such as : knee stiffness, ankylosis, deep infection, post-traumatic arthritis, malunion and nonunion. im sorry for the late answer , have been really busy, didnt check my blog in a long time. hope you receive my answer and please keep me posted. If you didnt do it yet , get an appoinment with a pshysio to make sure the fracture its completly healed and that you have non of the complications i mentioned above.
      Bea

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