Knee Conditions

The knee is a large body joint with many components. The complexity of the joint, along with it bearing most of person’s bodyweight, makes it vulnerable to a variety of injuries.

The knee is made up of the lower end of the femur (thighbone) which rotates on the upper end of the tibia or shinbone. The knee cap 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. An important structure called the meniscus is a wedge of soft cartilage between the femur and tibia that serves to cushion the knee and helps it absorb shock during motion.

Ligament injuries

Many people, including athletes, experience injuries to their knee ligaments. Ligaments hold bone-to-bone alignment and position. Of the four major ligaments found in the knee, the ACL (anterior cruciate ligament) and the MCL (medial collateral ligament) are most often injured. Injury to these internal ligaments may require reconstructive surgery.

ACL injuries

Rapid changes of direction, slowing down when running, and landing from a jump may cause tears in the ACL. Twisting the knee is a common cause of an overstretched or torn

ACL ligament of the knee. Athletes who participate in skiing, basketball, gymnastics and athletes who wear cleats, such as football players, are susceptible to ACL injuries. Symptoms of a torn ACL include knee pain, swelling, stiffness, and bruising. The knee feels unstable and walking is painful . The feeling of instability results from the bones in the knee joint sliding too far due to ligament damage.

Treatment of Torn ACLs

A tear to the ACL is difficult to heal because blood supply to the ligament is poor. If the tear is small, the knee may be relatively stable and surgery may not be necessary. Exercises to strengthen the muscles that support the knee can help compensate for the lack of ligament stability.

Being able to function adequately in daily activities is often possible with a torn ACL. However, for those individuals who are involved in sports that require pivoting and sharp turning movements a torn ACL may not provide the needed knee stability to perform their chosen sport or activity. If knee instability is present, often surgery is considered. If surgery is chosen, it is usually performed several weeks after the injury occurs to allow the inflammation to subside. The ACL is usually removed and reconstructed by grafting on a segment of a large tendon or ligament.

Crutches are the usual requirement for a couple of weeks following an ACL reconstruction surgery. Full recovery varies from person to person and may take several months. High-impact activities must be avoided to allow the knee to sufficiently recover. Low-impact activities such as water aerobics help strengthen the muscles that support the knee joint (to take some load off the ligaments) without straining the joint. Normal activities can be resumed before high-impact activities.

MCL injuries

The medial collateral ligament is on the inside of the knee joint and spans the distance from the end of the thigh bone(femur) to the top of the shin bone ( tibia). The medial collateral ligament acts to resist widening of the inside of the joint, and prevents the knee from opening up.

MCL injuries are usually caused by a blow to outside of the knee causing it to buckle and the inside of the knee to widen too far. This stretching of the MCL makes it susceptible to tears and injuries. MCL types of injuries often occur in contact sports, such as football or soccer. A medial collateral ligament injury can occur as an isolated injury or may be part of a complex injury to the knee. A complex injury usually involves injury to the ACL and the meniscus (kneecap) along with the medial collateral ligament injury.

MCL injuries are graded on a scale of I to III. Symptoms are proportionally related to the grade of the injury.
  • Grade I MCL Tear Is an incomplete tear of the MCL. The tendon is intact and the symptoms are usually minimal. Individuals usually complain of pain with pressure on the MCL, and may be able to return to their sport very quickly. Most athletes miss 1-2 weeks of play.
  • Grade II MCL Tear

Grade II injuries are also incomplete tears of the MCL. Individuals may complain of instability when attempting to cut or pivot. The pain and swelling is more significant, and usually a period of 3-4 weeks of rest is necessary.

  • Grade III MCL Tear

A grade III injury is a complete tear of the MCL. Individuals have significant pain and swelling, and often have difficulty bending the knee. Instability, or giving out, is a common finding with grade III MCL tears. A knee brace or a knee immobilizer is usually needed for comfort, and healing may take 6 weeks or longer.

Treatment of MCL injuries.

Grade I sprains of the MCL usually resolve within a few weeks. Treatments consists of:

  • Anti-inflammatory medications
  • Icing the injury
  • Refraining from activity

Most individuals with a grade I MCL tear will be able to return to their sports activities within 1-2 weeks following their injury.

Grade II MCL Tears

When a grade II MCL sprain occurs, a hinged brace to support the knee is a common early treatment. Individuals with a grade II injury often return to sports within 3-4 weeks after their injury and can do so if they do not experience pain over the MCL.

Grade III MCL Tears

Individuals usually wear a knee immobilizer and are non weight-bearing (using crutches) for the first week to 10 days following a Grade III injury. It is best that an individual work on maintaining knee mobility by removing the immobilizer and bending the knee several times a day. After the first week or, you can wear a hinged knee brace and can work to increase your range of motion in the knee. More weight can be applied to the knee as pain allows.

When you can flex the knee around 100 degrees, riding a stationary bicycle is a good exercise. Crutches can be discontinued when you are able to walk without limping. When you have regained 60% of their quadriceps strength (compared to the opposite side), jogging may begin. Agility drills can be introduced when one has regained 80% of his or her strength. Rehab from a grade III MCL tear can take 3-4 months.

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