knee injuries

Many knee injuries are due to overuse, problems with alignment, sports or physical activities, and failure to warm up and stretch before exercise. But they can also result from trauma, such as a car accident, a fall or a direct blow to your knee.

Most ACL injuries are sports-related. They frequently occur during activities such as football, basketball, soccer and skiing, when you slow down suddenly or cut or pivot with your foot firmly planted — movements that twist or overextend your knee. ACL tears rarely result from contact with other players, but they can develop when you land awkwardly from a jump or fall. If an ACL tear has occured you will probably of heard a pop and swelling will occur within 2 hours. Pain may be less than expected after the initial incident.

PCL tears, on the other hand, aren't usually associated with sports. Because the PCL is a strong ligament located deep inside your knee, tears most often result from traumatic injuries, such as those you might receive in a car accident. And because a violent impact is needed to damage the PCL, you're almost certain to injure other ligaments at the same time.

Bursitis. Sometimes called housemaid's knee or carpet layer's knee, prepatellar bursitis often occurs after an activity that requires you to kneel for long periods — scrubbing floors, gardening, or installing tile or carpet, for example. It can also result from an infection or as one of the signs of arthritis or gout.

Dislocated kneecap. Kneecap (patellar) dislocations can occur in contact sports and in activities that require you to change direction while running, such as tennis, racquetball and volleyball. If your knees tend to turn inward or your kneecaps are higher than normal, you may be more prone to this injury.

Iliotibial band syndrome

This is a common cause of lateral knee pain in runners. Competitive runners are especially susceptible, but amateurs aren't exempt. You're more likely to develop iliotibial band syndrome if you have biomechanical problems such as unequal leg length or weak hip abductors, the muscles responsible for sideways leg motion. Exercising on concrete surfaces or uneven ground, increasing the intensity or duration of your exercise too quickly, wearing worn or ill-fitting shoes, and excessive uphill or downhill running also can contribute to iliotibial band syndrome.

Osgood-Schlatter disease

This condition can develop in athletic young people during the years when their bones are growing rapidly — usually ages 10 to 15 for boys and 8 to 13 for girls. Osgood-Schlatter disease results from repeated tugging of the patellar tendon on a growth plate at the top of the tibia. This is most likely to occur during activities that involve running, jumping and bending, when the pull of the quadriceps muscle puts tension on the patellar tendon. In time, the tendon may begin to pull away from the tibia, resulting in a small bump you can see. In severe cases, the tendon may come away from the tibia completely.

Knee Pain
Injuries affecting the knee joint can cause considerable disability and time off sport. They are most common in sports that incur twisting and sudden changes in direction and speed. When the patient presents with a history of an acute injury to the knee there are several factors which will indicate the structures injured and the severity of the injury: The mechanism of injury – contact, non-contact, foot fixed or free, flexed or extended, valgus or varus force. The amount of pain and disability at the time – able to play on or not. The time to onset of swelling and its location. Symptoms and degree of disability since the injury. For chronic injuries the history is important for changes in training volume, training surface or footwear. Recent growth spurts in children can be very important. Many knee injuries are due to overuse, problems with alignment, sports or physical activities, and failure to warm up and stretch before exercise. But they can also result from trauma, such as a car accident, a fall or a direct blow to your knee. Finding, the exact location of a patient's pain (when possible) and correlating it to potential abnormalities or specific anatomic structures is an essential part of the physical exam. Joint line pain - Can be indicative of a tear of the lining of the joint (the capsule), a meniscus tear, or may indicate abnormalities with the bone or cartilage at the joint line (chondromalacia, arthritis, osteochondritis dissecans, etc). Anterior knee pain - Pain at the inferior pole of the patella is usually indicative of patellar tendonitis. Pain at the quadriceps insertion on the proximal patella may indicate a partial quadriceps tendon tear, quadriceps tendonitis, or the residual of a previous injury or surgery. Pain over the anterior aspect of the knee with deep knee flexion is usually found in patients with patellofemoral dysfunction. In these patients, they may have pain from plical irritation, patellofemoral syndrome, chondromalacia (needs MRI confirmation), or other anterior joint pathology. Medial knee pain - This can usually indicate a medial collateral ligament sprain. It is very localised to the ligament with little swelling. Tibial tuberosity pain - Tenderness at the tibial tuberosity is primarily due to Osgood-Schlatter's syndrome, or its residual, or deep infrapatellar bursitis. Tenderness in either of these two locations usually goes hand in hand with tight hamstrings. Lateral knee pain - This can indicate a problem with the iliotibial band. It may be due to a lateral collateral ligamnet sprain.	Click here to find out about KNEE ANATOMY The knee functions to allow movement of the leg and is critical to normal walking. The knee flexes normally to a maximum of 135 degrees and extends to 0 degrees. The alignment of the joint is of great importance as forces need to be absorbed effectively. Factors affecting alignment of the knee include, bony abnormalities, muscles imbalance, soft tissue length and foot position. Figure 3b shows what to expect from someone who has PFS. The lower limb is in excessive lateral pelvic translation, internal femoral rotation, external tibial rotation and foot pronation. Giving a bow legged posture with the knee cap facing inwards. These changes can generate abnormal forces in the tissues of the knee, which could trigger Anterior knee pain (AKP). The rotation could be expressed as a torsional load on the patella tendon or altered patella tracking. The increased abduction of the knee changes the angle of pull from the quadriceps, altering patella tracking as it passes through the trochlear groove. Or causes the ITB to ‘bowstring’across the lateral aspect of the knee joint. There is an intimate relationship between lower limb alignment and AKP because of the chronic overuse nature of the conditions, which cause AKP. When alignment problems are present it also means the proprioception of the joint has changed and needs re-training. This will allow correct movements patterns to be completed when getting back into sport. It may be this loss of proprioception that led to the injury, especially if a previous lower limb injury was not treated effectively. Knee pain is likely to effect movements such as squatting, up-hill, down-hill, full flexion, full extension. It is important to take note of which movements are the most aggravating as this will also help to diferentiate between conditions. For example pain going down hill may siggest patellofemoral syndrome as where going up hill may suggest quadriceps tendonitis.
Plica Syndrome This condition can be hard to diagnose at first. It is usually considered when PFS rehabilitation has failed. An inflamed plica may cause variable sharp pain located on the anterior medial aspect below the patella. If thickened it can be palpated. It is painful on full flexion and can cause a popping or snapping sound. The only differences found between PFS and plica syndrome is the medial glide of the patella may aggravate the condition in the plica.	Fat pad Impingement This condition it caused by a direct blow or repetitive micro trauma from repeated hyperextension (swimming, fast bowling). The knee will appear puffy below the knee cap. It will be aggravated by prolonged standing, downhill running, descending stairs. The athlete may not be able to fully extend the knee without pain and discomfort. to be completed
Cruciate Ligament Injury Most ACL injuries are sports-related. They frequently occur during activities such as football, basketball, soccer and skiing, when you slow down suddenly or cut or pivot with your foot firmly planted — movements that twist or overextend your knee. ACL tears rarely result from contact with other players, but they can develop when you land awkwardly from a jump or fall. If an ACL tear has occured you will probably of heard a pop and swelling will occur within 2 hours. Pain may be less than expected after the initial incident. PCL tears, on the other hand, aren't usually associated with sports. Because the PCL is a strong ligament located deep inside your knee, tears most often result from traumatic injuries, such as those you might receive in a car accident. And because a violent impact is needed to damage the PCL, you're almost certain to injure other ligaments at the same time.	Collateral Ligament Injury You're most likely to tear your collateral ligaments in sports that require quick stops and turns, such as soccer, basketball and skiing, or in contact sports when repeated blows to the inside or outside of your knee can cause the opposing ligament to stretch or tear. Collateral ligaments can also be damaged by repeated stress, which causes them to lose their elasticity, much like an overstretched rubber band. There can be little swelling with collateral ligament strains and tend to be very localised.
Meniscus Injury A meniscus tear can result from aggressive pivoting or sudden turns — any activity that twists or rotates your knee. Occasionally, you can tear your meniscus while lifting something heavy. Older adults sometimes tear their meniscus during repetitive movements, such as kneeling or squatting, but more often it tears because it has degenerated over time. Meniscus injuries may develop swelling 24 hours after the injury occurred.	Bursitis. Sometimes called housemaid's knee or carpet layer's knee, prepatellar bursitis often occurs after an activity that requires you to kneel for long periods — scrubbing floors, gardening, or installing tile or carpet, for example. It can also result from an infection or as one of the signs of arthritis or gout. Dislocated kneecap. Kneecap (patellar) dislocations can occur in contact sports and in activities that require you to change direction while running, such as tennis, racquetball and volleyball. If your knees tend to turn inward or your kneecaps are higher than normal, you may be more prone to this injury.
Iliotibial band syndrome This is a common cause of lateral knee pain in runners. Competitive runners are especially susceptible, but amateurs aren't exempt. You're more likely to develop iliotibial band syndrome if you have biomechanical problems such as unequal leg length or weak hip abductors, the muscles responsible for sideways leg motion. Exercising on concrete surfaces or uneven ground, increasing the intensity or duration of your exercise too quickly, wearing worn or ill-fitting shoes, and excessive uphill or downhill running also can contribute to iliotibial band syndrome.	Osgood-Schlatter disease This condition can develop in athletic young people during the years when their bones are growing rapidly — usually ages 10 to 15 for boys and 8 to 13 for girls. Osgood-Schlatter disease results from repeated tugging of the patellar tendon on a growth plate at the top of the tibia. This is most likely to occur during activities that involve running, jumping and bending, when the pull of the quadriceps muscle puts tension on the patellar tendon. In time, the tendon may begin to pull away from the tibia, resulting in a small bump you can see. In severe cases, the tendon may come away from the tibia completely.