The knee is the largest joint in the body and one of the most commonly injured. A complex joint with many components, it is vulnerable to a wide range of injuries. Some of those can be treated without surgery, while others require surgery to correct. The surgeons at Summit Orthopedic Specialists are skilled at diagnosing and treating a wide range of knee injuries to get our patients back to their sport or activity as quickly as possible.
The knee is made up of the lower end of the thighbone (femur), which rotates on the upper end of the shinbone (tibia), and the kneecap (patella), which slides in a groove on the end of the femur.
The knee also contains large ligaments, which help control motion by connecting bones and by bracing the joint against abnormal types of motion. Another important structure, the meniscus, is a wedge of soft cartilage between the femur and tibia that serves to cushion the knee and help it absorb shock during motion.
Depending on the location and severity of the injury, symptoms of a knee injury may vary. Symptoms that often coincide with knee pain include:
ADOLESCENT ANTERIOR KNEE PAIN
Chronic pain in the front and center of the knee is common among active, healthy young people, especially girls. It is usually not caused by any particular abnormality and does not mean that the knee will be damaged by continuing activities. The true cause of anterior knee pain is not always clear, but may involve different factors such as imbalance of the thigh muscles, poor flexibility and overdoing sports or activities. Pain usually begins gradually and may include popping sounds in the knee, pain at night, and pain during activities that repeatedly bend the knee. Ice, rest and simple exercises are often helpful for teens with pain behind the kneecap.
ANTERIOR CRUCIATE LIGAMENT INJURY
An ACL injury typically occurs when changing direction rapidly, slowing down when running, and landing from a jump. It is a common injury in twisting and pivoting sports, such as skiing and basketball. The pain of an ACL tear usually subsides with physical therapy and bracing, but surgical repair is usually recommended for individuals who want a full return to their sport. Arthroscopic ACL reconstruction is the most common ligament surgery in the knee, followed by physical therapy to rehabilitate the knee.
MEDIA COLLATERAL LIGAMENT INJURY
This is the most common knee ligament injury. The MCL ligament runs along the inner side of the knee. It may be injured from a twisting injury or from contact sports, such as football or soccer, where blows to the outside of the knee can occur. MCL tears do not usually require surgery. Treatment typically includes rest, anti-inflammatory medications, bracing and physical therapy.
POSTERIOR CRUCIATE LIGAMENT INJURY
The PCL is often injured when an athlete receives a blow to the front of the knee on the playing field. It is less common than an ACL tear. However, because the PCL crosses the ACL, the two may sometimes be injured together. Surgical reconstruction may be needed to help stabilize the knee.
EXERTIONAL COMPARTMENT SYNDROME
Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. The pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells. It is typically caused by athletic exertion, especially sports with repetitive motions like running, cycling and swimming. Exertional compartment syndrome causes pain or cramping during exercise, which subsides when activity stops. Physical therapy, orthotics and anti-inflammatory medication may help. Cross-training with low impact activities or switching to a different surface during exercise (concrete vs. running track) may relieve pain. Surgery may be necessary if conservative measures don’t work.
KNEE TENDON BURSITIS
Knee bursitis, an inflammation of a bursa, usually develops as a result of overuse or constant friction and stress on a bursa. A bursa is a small fluid-filled sac that reduces friction and cushions pressure points between your bones and the tendons and muscles near your joints. Knee bursitis most commonly occurs over the kneecap or on the inner side of your knee. Treatment often includes rest, icing, anti-inflammatory medication and/or a steroid injection.
MENISCAL TEARS/TORN CARTILAGE
When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus. The meniscus is a tough rubbery cartilage between the femur and tibia that serves as a shock absorber. Meniscal tears are among the most common knee injuries. Athletes who play contact sports are at higher risk for meniscal tears. Whether or not the tear requires arthroscopic surgical treatment depends upon the type of tear, its size, and location.
This is an overuse injury that occurs in the knee area of growing adolescents. It is caused by inflammation of the tendon below the kneecap (patellar tendon) where it attaches to the shinbone (tibia). Young athletes who participate in certain sports that involve running, jumping and swift changes in direction, such as soccer, gymnastics and distance running, are most at risk for the disease. It usually only occurs in one knee, but sometimes develops in both. The discomfort can last from weeks to month and may recur until the child has stopped growing. Treatment is aimed at reducing knee pain and swelling and may include anti-inflammatory medication and wrapping the knee.
PATELLAR TENDINITIS (JUMPER’S KNEE)
Patellar Tendinitis is an inflammation of the tendon that connects the kneecap (patella) to the shinbone. Patellar tendinitis is most common in athletes whose sport involves frequent jumping, such as basketball and volleyball. Treatment involves physical therapy to strengthen and stretch the muscles around the knee, rest, icing and anti-inflammatories. A patellar strap may help take the pressure off the tendon while it is healing.
PATELLOFEMORAL PAIN SYNDROME (RUNNER’S KNEE)
This is a common ailment among runners, but can also strike any athlete who performs a lot of movements that involve knee bending, like walking, cycling and jumping. It usually causes aching pain around the kneecap. Many factors can contribute to patellofemoral pain, including overuse, misalignment of the kneecap, direct trauma to the knee, flat feet, and weak or tight thigh muscles. Treatment usually involves rest, icing, compression, elevation, anti-inflammatory medications, stretching and strengthening exercises, and/or orthotics. When needed, surgical treatments include arthroscopy to remove damaged kneecap cartilage or realignment of the kneecap.
QUADRICEPS TENDON TEAR
Quadriceps tendon tears can be either partial or complete tears. A tear often occurs in running and jumping sports, such as basketball. When the quadriceps tendon tears, there is often a tearing or popping sensation, usually followed by pain and swelling. Other symptoms include an indentation at the top of the kneecap, bruising, tenderness, a sagging or drooping kneecap, and difficulty walking or straightening the knee. Most small, partial tears respond well to nonsurgical treatment, which may include mobilization and physical therapy. Complete tears require surgical repair to reattach the torn tendon to the top of the kneecap.
Shin splints typically develop after vigorous physical activity, especially if you are just starting a fitness program. The most common symptom is pain along the inner edge of the shinbone (tibia). Pain can occur both during and after exercise and you may experience mild swelling and soreness around the area. The injury responds to non-surgical treatment that includes rest from the activity that causes the pain, anti-inflammatory medications and ice. People who have flat feet or recurrent problems with shin splints may benefit from orthotics.
The kneecap (patella) connects the muscles in the front of the thigh to the shinbone (tibia). Normally, the kneecap fits nicely into a v-shaped notch (femoral groove) at one end of the femur to accommodate the kneecap when we move. But if the groove is too shallow or you sustain a blow to the kneecap, it can pop out of place. If the kneecap has been completely dislocated, your doctor will push the kneecap back in place. Arthroscopic surgery may be needed to repaid damage to the area. If the kneecap is only partially dislocated, nonsurgical treatments may be successful.
6620 Coyle Avenue, Suite 303, Carmichael, CA 95608
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