Lewis Gale Physicians November 01, 2017

Learn about top knee injuries and their treatment.

The knee is an intricate joint that is prone to injury. In fact, an injury to the knee is one of the top reasons that people visit an orthopedist. More than 10 million knee injuries are reported every year, and most are related to fractures, dislocation, sprains, and torn ligaments. Fortunately, there are several injury prevention strategies and treatment options available.

Knee Anatomy

The knee is the largest joint in the body, and is made up of four main components: bones, cartilage, ligaments, and tendons.

Common Knee Injuries

Your knee is made up of several important structures, any of which can be injured. The most common knee injuries include fractures around the knee, dislocation of the patella (kneecap), and sprains and tears of soft tissue structures like ligaments, tendons or menisci. In many cases, injuries involve more than one structure in the knee. Pain and swelling are the most common signs of knee injury. In addition, your knee may catch, lock, or become unstable— the feeling that your knee is giving way.

Fractures

The most common broken bone around the knee is the patella, also known as the kneecap. The patella is the bone at the front of the knee. The femur and tibia, where they meet to form the knee joint, also can be fractured. Most fractures are caused by a sharp blow or excessive force on the kneecap from injuries such as falls and motor vehicle collisions.

If the patellar fracture is not displaced, your doctor may place the knee in a cast or brace, which will be worn for up to six weeks. If fracture is more severe you may need surgery. Once healing has occurred after casting or surgery, you may wear a knee brace, do physical therapy, and may need to use a cane or crutches to help with walking. Your doctor may recommend medication to help with pain.

Dislocations

A dislocation occurs when the bones of the knee are forced out of place. A dislocation of the tibia and femur is very rare and usually occurs only with high energy injuries such as motor vehicle collisions.

Patellar dislocation is much more common and can occur with trauma or occasionally with no traumatic event in certain individuals. Treatment of a patellar dislocation includes nonsurgical manipulation of the patella to put it back in place if it doesn’t correct itself, immobilization in a cast or brace, medications to help control pain, and physical therapy. In some cases, surgery may be required to repair damage caused by the dislocation. Surgery may also be an option for a patient who is prone to recurrent dislocations.

Sometimes dislocations are caused by an abnormality in the structure of a knee. More commonly, a traumatic event is the cause. Examples include a direct blow to the knee during an athletic event, fall or collision

or a sudden twisting motions, sometimes experienced in certain high-impact sports.

Anterior Cruciate Ligament (ACL) Injuries

Ligaments are strong connective tissues that connect one bone to another. The ACL is one of two important ligaments in the center of the knee that connect the thigh bone (femur) to the shin bone (tibia). Along with the posterior cruciate ligament (PCL), the ACL helps provide stability for knee by preventing the thigh bone from sliding forward and backward on the shin bone.

ACL injuries may occur with a direct blow to the knee during an athletic event, fall or accident, but they often occur without direct impact such as when a player forcefully plants his or her foot during a high-speed, high-impact stop and change of direction, or during a routine jump-stop that an athlete may do dozens of times in a game.

Posterior Cruciate Ligament (PCL) Injuries

Posterior Cruciate Ligament (PCL injuries are much less common than ACL injuries. The PCL is usually torn with a blow to the front of the knee while it is in a bent position, most often i during a motor vehicle collision or during high –impact sports. PCL injuries are often treated without surgery depending on their severity, but surgery may be considered to reconstruct the torn ligament if

  • The injury to the ligament causes instability, especially in athletes.
  • The injury affects more than one ligament in the knee.
  • Other treatment methods fail.

Meniscal Tears

The meniscus is a C-shaped piece of soft tissue that acts as a shock-absorbing structure or cushion in the knee. There are two menisci in each knee, a medial one on the inside, and a lateral one on the outside. Tears in the meniscus most often occur in athletes as a result of twisting, cutting, pivoting, or being tackled. Meniscal tears also may occur as a result of arthritis or aging, also know as degenerative tears. Treatment of a meniscal tear depends on the severity of the tear, the age and activity level of the patient, and the symptoms the tear may be causing.

Symptoms of a meniscal tear are:

  • A popping sound at the time of the injury.
  • Pain and swelling in the knee.
  • Tightness in the knee.
  • Locking catching, or giving way of the knee.
  • Tenderness of the joint.

Tendon Tears

A tendon attaches muscle to bone and when torn may result in weakness or loss of function of the involved muscle. The quadriceps and patellar tendons may be stretched or torn. Tears of these tendons are most common among middle-aged people who play running or jumping sports. Falls, direct force to the front of the knee, and landing awkwardly from a jump are common causes of tendon injuries. Surgically reattaching or reconstructing the tendon will help improve weakness and function. Incomplete tears of the quadriceps or patellar tendons are sometimes managed without surgery using a brace or cast as well as physical therapy.

Treatment Options for Knee Injuries

Talk with your doctor about the best treatment plan for you. The type of treatment your doctor recommends will depend on several factors, including the severity of your injury, your age, general health, and activity level. Recovery time will depend on the severity of your injury. Treatment may include:

Supportive Care

The knee will need time to heal. Supportive care may include the R.I.C.E method

  • Rest—Activities may need to be restricted at first. Normal activities will gradually resume as the injury heals.
  • Ice—Ice therapy may help relieve swelling. You may be advised to use heat as you begin to return to normal activities.
  • Compression—Compression bandages provide gentle pressure to the area, helping with pain and reducing swelling.
  • Elevation—Keeping the knee elevated helps prevent or reduce swelling of the knee
  • A brace to immobilize the knee and a cane, walker or crutches to keep extra weight off of the leg may be recommended.
  • Over-the-counter or prescription anti-inflammatory medication may be used to reduce pain.

Physical Therapy

A physical therapist will assess the knee and recommend an exercise program that will assist recovery by stretching and strengthening the muscles.

Surgery

Surgery may be recommended to fully restore function to your leg. In some cases surgery is done arthroscopically using small instruments and incisions. Some injuries require open surgery with a larger incision that provides your surgeon with a more direct view and easier access to the injured structures.

Prevention

To help reduce knee injuries:

  • Weight-bearing exercises that strengthen both the quadriceps and the hamstrings.
  • Maintain proper technique when exercising or playing sports.
  • Wear appropriate footwear, padding, and safety equipment for your sport and playing surface.
  • Ask your doctor whether a knee brace would be beneficial for your particular sport and position.

Sources:

American Academy of Orthopaedic Surgeons: www.aaos.org

If you believe that you may have an knee injury, Dr. Robyn Hakanson can review your symptoms, diagnose, and prescribe a treatment plan. To schedule an appointment, call the office at (540) 772-3530 or click the button to schedule an appointment online.

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