Knee Injuries

Introduction

The knee is a joint that can take a lot of abuse. Unfortunately, many of us push our knees as young adults through sports. Others want to continue to be active in sports throughout life. Both are excellent goals for overall health, and there are things you can do to prevent injury, but in some instances sports conditions may aggravate or begin issues with the knee.

Most sports injuries of the knee, of course, begin with pain. The injury can be a sudden injury like a fall or accident, or it may be the result of long-term use of the knee in athletics. Morover, many patients have knee injuries as young adults - wherein they may get by for many years, only to find in middle age that they are candidates for minimally invasive knee surgery, partial knee replacement, or even total knee replacements.

Your situation, of course, will be unique - so reach out to our top Vikram Hospital Knee Surgeons and Specialists to discuss your knee condition and options for minimally invasive, partial, or total knee replacements due to sports injuries. To find the best sports medicine doctor or surgeon for you, your first step is an initial consultation. All patients are unique, so finding the best sports medicine surgeon for your specific needs (knee or otherwise) is a process that is different for each patient.

When is Knee Surgery recommended?

Knee injuries are perhaps the most common injuries assessed by the Vikram Hospital Specialists/Surgeons. Any athlete subjects his or her knee joints to more stress than the average person. Whether or not the actual sport involves heavy knee impact, athletes who train with running, jumping, and weight lifting are constantly dependent upon the knee joints to provide stability and strength. In sports that involve heavy running or tight turns, the knees are at risk for injury. Ligament and cartilage tears are very common in football, basketball, swimming, wrestling, skiing, and soccer, and the team vikram has years of experience treating knee-related problems.

Three common knee injuries include Ligament Tears, Meniscus Tears, and Arthritis.

  • Ligament – The medial collateral ligament (MCL), posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) are commonly torn. The ACL is commonly torn when changing directions quickly, stopping suddenly, or landing from a jump. The MCL may be torn when forced impact occurs on the outside of the knee, and the PCL is often torn after experiencing a blow to the front of the knee.

  • Meniscus – The medial meniscus, rubbery cartilage connected to the knee ligaments, is often torn along with the ligaments of the knee or independently. Meniscus tears are common following tackles or sharp twisting, cutting, or pivoting moves.

  • Arthritis – Athletes who’ve suffered previous knee injury may develop post-traumatic arthritis, a condition where the cartilage of the knee slowly degenerates and causes pain and stiffness. Rheumatoid arthritis and Osteoarthritis are two other forms

Signs of a knee injury may include:

  • Popping noise

  • Knee “giving out”

  • Knee weakness or instability

  • Stiffness in the knee

  • Swelling

  • Pain

What are the causes?

Knee pain can be caused by:

  • Anterior knee pain

  • Arthritis -- including rheumatoid arthritis, osteoarthritis, and gout

  • Baker's cyst -- a fluid-filled swelling behind the knee that may occur with swelling (inflammation) from other causes, like arthritis

  • Bursitis -- inflammation from repeated pressure on the knee, such as kneeling for long periods of time, overuse, or injury

  • Connective tissue disorders such as lupus

  • Dislocation of the kneecap

  • Iliotibial band syndrome -- a hip disorder from injury to the thick band that runs from your hip to the outside of your knee

  • Infection in the joint

  • Knee injuries -- an anterior cruciate ligament injury or medial collateral ligament injury may cause bleeding into your knee, which makes the pain worse

  • Osgood-Schlatter disease

  • Tendinitis -- a pain in the front of your knee that gets worse when going up and down stairs or inclines

  • Torn cartilage (a meniscus tear) -- pain felt on the inside or outside of the knee joint

  • Torn ligament (ACL tear) -- leads to pain and instability of the knee

  • Strain or sprain -- minor injuries to the ligaments caused by sudden or unnatural twisting

Less common conditions that can lead to knee pain include bone tumors.

How is Knee Injuries diagnosed?

The initial evaluation by the physician or health-care provider will begin with a medical history. Whether the evaluation is occurring immediately after the injury or weeks later, the physician may ask about the mechanism of injury to help isolate what structures in the knee might be damaged. Is the injury due to a direct blow that might suggest a fracture or contusion (bruise)? Was it a twisting injury that causes a cartilage or meniscus tear? Was there an injury associated with a planted foot to place stress and potentially tear a ligament?

Further questions will address other symptoms. Was swelling present, and if so, did it occur right away or was it delayed by hours? Did the injury prevent weight-bearing or walking? Does going up or down steps cause pain? Is there associated hip or ankle pain?

Physical examination of the knee begins with inspection, in which the physician will look at the bones and make certain they are where they belong. With fractures of the kneecap or patellar tendon injuries, the kneecap can slide high out of position. Also, patellar dislocations, where the kneecap slides to the outside or lateral part of the knee, are easily evident on inspection. Looking at how the knee is held is also important. If the knee is held slightly flexed, it can be a clue that there is fluid in the joint space, since joint space is maximal at 15 degrees of flexion.

Palpation (feeling) is the next part of the exam, and knowing the anatomy, the physician can feel where any pain might exist and correlate that to the underlying structures like ligaments or muscle-insertion points. Palpation over the joint line, the space between the bones in the front part of the knee, can uncover fluid or tenderness associated with a meniscus injury. This is also the part of the exam when the ligaments are stressed to make certain that they are intact. Sometimes, the physician will also exert stress on the uninjured knee to see how loose or tight the normal ligaments are as a comparison. Finally, the blood supply and nerve supply to the leg and foot will be assessed.

Sometimes X-rays of the knee are required to make certain there are no broken bones, but often with stress or overuse injuries where no direct blow has occurred, plain X-rays may not be needed and imaging of the knee may wait until a later date, where an MRI might be considered.

What are the treatment options for Knee Injuries?

  • 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.

  • With the technology available, many knee injuries that require surgery can be treated surgically with an arthroscope, in which a camera is used and small punctures are made in the knee to insert instruments. Patients usually begin their post-op rehabilitation within days of the surgery.

  • If there is no rush to operate, then opportunity exists to strengthen the quadriceps and hamstring muscles beforehand. When a joint like the knee is injured, the muscles around it start to weaken almost immediately. This is also true after the surgery, which can also be considered a further injury. Strong muscles in the pre-operative state allow the potential for easier post-operative therapy.

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, but chronic 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.

Fractures, Bursa Inflammation, and Patellar Injuries

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.

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.

What are the risk factors for Knee Injuries?

A number of factors can increase your risk of having knee problems, including:

  • Age. Certain types of knee problems are more common in young people — Osgood-Schlatter disease and patellar tendinitis, for example. Others, such as osteoarthritis, gout and pseudogout, tend to affect older adults.

  • Sex. Teenage girls are more likely than are boys to experience an ACL tear or a dislocated kneecap. Boys, on the other hand, are at greater risk of Osgood-Schlatter disease and patellar tendinitis than girls are.

  • Excess weight. Being overweight or obese increases stress on your knee joints, even during ordinary activities such as walking or going up and down stairs. It also puts you at increased risk of osteoarthritis by accelerating the breakdown of joint cartilage.

  • Mechanical problems. Certain structural abnormalities, such as having one leg shorter than the other, misaligned knees and even flat feet, can make you more prone to knee problems.

  • Lack of muscle flexibility or strength. A lack of strength and flexibility are among the leading causes of knee injuries. Tight or weak muscles offer less support for your knee because they don't absorb enough of the stress exerted on the joint.

  • Certain sports. Some sports put greater stress on your knees than do others. Alpine skiing with its sharp twists and turns and potential for falls, basketball's jumps and pivots, and the repeated pounding your knees take when you run or jog all increase your risk of knee injury.

  • Previous injury. Having a previous knee injury makes it more likely that you'll injure your knee again.

Can Knee Injuries be prevented?

Accidents happen, and while many knee injuries occur during recreational activities or sports, more happen at work and at home.

Strong muscles stabilize joints. With the knee, having strong and flexible quadriceps and hamstring muscles can prevent minor stresses to the knee from causing significant injury.

Proper footwear can also minimize the risk for knee injury. Wearing shoes that are appropriate for the activity can lessen the risk of twisting and other forces that can stress the knee.

How fast can you recover?

Conservative Treatment Options

This type of recovery includes rehabilitation therapy, which involves range of motion and strength exercises to help restore the knee to full function. These exercises include bending and strengthening the knee while sitting or riding a stationary bike. This type of exercise strengthens the muscles surrounding the knee, particularly the hamstrings. The surgeon may have you perform different exercises in order to help regain strength to the ligament.

Surgical Options

If the ligament is a complete tear or the patient is physically active, then the surgeon may suggest a complete reconstruction of the ligament in order to prevent further damage and stabilize the knee. Arthroscopic surgery may be performed. Surgery may involve reconstruction of the damaged ligament using a strip of tendon from the patient's knee (patellar tendon) or hamstring muscle. A cadaver graft or allograft can also be used. The surgeon may determine to secure the new ligament with an implantable fixation device. A physical therapy program will usually follow the surgery in order to strengthen the muscles and restore full joint mobility.

After Discharge?

Rehabilitation

Rehabilitation is often used to help surgical and nonsurgical knee injury patients recover and get back to their lives. A treatment program focused on muscle strengthening is a common choice. Rehabilitation may include range-of-motion, strength, and flexibility exercises, concentration on strengthening quadriceps muscles for added support, and temporary use of crutches or a brace for stability.

For arthritis therapy, integrating lower impact training activities may help relieve some of the symptoms. For example, substitute swimming instead of running on some days. Your physical therapist will work with you to alleviate your specific symptoms and introduce exercises to help increase strength and range of motion. Regular use of heat or ice, bandaging during certain activities, and massage or topical ointments may offer relief as well.

At Vikram Hospital, we help athletes with knee injuries recover with the best techniques modern medicine has to offer. If you or your child sustains a knee injury, contact us today for an appointment with an experienced sports injury specialist.

What are the results of the surgery?

To be provided by the doctor.

What are the complications?

Not all knee pain is serious. But some knee injuries and medical conditions, such as osteoarthritis, can lead to increasing pain, joint damage and even disability if left untreated. And having a knee injury — even a minor one — makes it more likely that you'll have similar injuries in the future.

Cost of Surgery?

The cost of surgery for Knee Injuries depends on many factors. They include the cost of being in the hospital for several days. Unexpected events that result in an extended hospital stay will also increase the overall cost.

Costs also vary depending on the type of insurance coverage you have. Many insurance companies cover the cost of the surgery, the hospital stay, and the instruments to straighten the spine. You may owe a co-payment or you may be billed the balance of what your insurance does not cover.

Be sure to contact your insurance provider prior to surgery to discuss the extent of your coverage. Discuss with your surgeon, as well as the hospital billing department to make sure you understand all the costs involved.
 

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