The Diagnosis and Treatment of Knee Problems
Injuries and disorders of the knee represent one of the more common problems seen by the orthopedic surgeon. Inadequate and painful knee function can be very disabling and severely alter one’s daily activities. Knee disorders may be severe enough to prevent walking, or may prohibit fine control necessary for work or sports activities. The specialists at AOKC utilize the most advanced techniques to get you back on your feet, including state of the art arthroscopic techniques.
How Do the Knees Work?
The knees provide stability for the body and allow legs to bend and straighten. Both flexibility and stability are needed for standing and for motions like walking, running, crouching, and jumping. Several kinds of supporting and moving parts, including bones, cartilage, muscles, ligaments, and tendons help the knees to do their job. Any of these parts can be involved in pain or dysfunction.
What Causes Knee Problems?
There are two general kinds of knee problems: mechanical and inflammatory.
Mechanical Knee Problems: Some knee problems result from injury, such as a direct blow or sudden movements that strain the knee beyond its normal range of movement. Other problems, such as osteoarthritis, result from wear and tear.
Inflammatory Knee Problems: Inflammation that occurs in certain rheumatic diseases, such asrheumatoid arthritis and systemic lupus erythematosus, can damage the knee.
More information on some common knee injuries:
Meniscus Injuries :
The meniscus is easily injured by the force of rotating the knee while bearing weight. A partial or total tear may occur when a person quickly twists or rotates the upper leg while the foot stays still. If the tear is tiny, the meniscus stays connected to the front and back of the knee; if the tear is large, the meniscus may be left hanging by a thread of cartilage. Serious depends on location and extent of the tear.
Symptoms: Mild to severe pain at point of injury, especially when leg is straightened. Swelling is likely, and knee may click, lock, or feel weak.
Treatment : Most patients will benefit from a muscle-strengthening physical therapy regimen. For more extensive tears, arthroscopic or open surgery may be required. The meniscus may be repaired or removed and replaced with an allograft.
ACL & PCL: The Anterior Cruciate Ligament (ACL) is most often stretched or torn (or both) by a sudden twisting motion. The Posterior Cruciate Ligament (PCL) is most often injured in direct impact, such as a car accident or football tackle.
Symptoms: Injury to a cruciate ligament may not cause pain. Popping and buckling are common. An MRI will accurately detect a complete tear, but arthroscopy may be the only reliable means of detecting a partial one.
Treatment : For an incomplete tear, patients will benefit from bracing and physical therapy. For a complete tear, especially in athletes and active people, surgery is recommended, with reconstruction using allografts or autografts.
MCL & LCL: The Medial Collateral Ligament is more often injured than the Lateral Collateral Ligament. The cause is most often a blow to the outer side of the knee that stretches and tears the ligament on the inner side of the knee. Such blows occur frequently in contact sports.
Symptoms: When a collateral ligament is injured, a pop and sideways buckle may occur. Pain and swelling are common.
Treatment: Most sprains will heal with Physical Therapy, and bracing and ice packs will help. Severely sprained or torn ligaments require surgical repair.
Tendon Injuries and Disorders:
Tendonitis and Ruptured Tendons: These injuries may be caused by inflammation or tear. Overuse contributes to inflammation. Also, trying to break a fall may cause the quadriceps muscles to contract and tear the quadriceps tendon above the patella (kneecap) or the patellar tendon below the patella. Tendonitis of the patellar tendon is sometimes called Jumper’s Knee because in sports that require jumping, the muscle contraction and force hitting the ground after a jump strain the tendon. After repeated stress, the tendon may become inflamed or tear.
Symptoms: Repeated tenderness at the point where the patellar tendon meets the bone. Pain may be present, as well as difficulty bending, extending, and lifting the leg.
Treatment: Rest, Ice, Compression, Elevation. Anti-inflammatory medicines also help. For complete tears, surgery is required to reattach the ends of the tendon. For partial tears, only a cast may be applied without surgery. Physical Therapy restores strength.
Osgood -Schlatter Disease: Caused by repetitive stress or tension on part of the growth area of the upper tibia (the apophysis). May also be associated with an injury in which the tendon is stretched so much that it tears away from the tibia and takes a fragment of the bone with it. Commonly occurs in younger people.
Symptoms: Pain just below the knee that worsens with activity and is relieved by rest. A bony bump below the kneecap may occur.
Treatment: Rest, Ice, Compression, Elevation. Limitation in vigorous sports may be advised and bracing or use of knee pads may be recommended.
Iliotibial Band Syndrome: This is usually an overuse syndrome which causes inflammation, although it may be caused by direct injury to the knee.
Symptoms : Aching or burning at the sides of the knee during activity. Pain may also localize at the side of the knee or radiate up the side of the thigh. The patient may feel a snap when bending the knee and there is usually no swelling.
Treatment : Rest, Ice, Compression, Elevation. In rare cases where the syndrome does not resolve, surgery is necessary to split the tendon so it isn’t stretched so tightly over the bone.
Arthritis of the knee is most often osteoarthritis. In this disease, the cartilage in the joint gradually wears away. In rheumatoid arthritis, the joint becomes inflamed and cartilage may be destroyed. Arthritis affects joints as well as supporting structures such as muscles, tendons, and ligaments.
Osteoarthritis may be caused by excess stress on the joint from deformity, repeated injury or irritation, excess weight, or heredity. Rheumatoid arthritis often affects people at an earlier age than Osteoarthritis.
Symptoms: Pain, swelling, and decrease in range of motion are common complaints. Other common symptoms are morning stiffness, joint locking, and stiffening.
Treatment : Osteoarthritis is most often treated with pain-reducing medications, such as nonsteroidal anti-inflammatory drugs. Losing weight may also help. Rheumatoid arthritis may require physical therapy and stronger medications. Joint replacement is also an option. Recently, new technological advances have been made in treating all forms of arthritis with magnetic resonance imaging.