Knee Injuries
Anterior Cruciate Ligament (ACL) Sprain
An ACL injury is the most serious ligament injury in the knee. It can be caused by a direct blow to the knee or a non-contact injury from a twisting mechanism on a planted foot, or a faulty landing from a jump. Signs and symptoms of an ACL sprain or tear are “experiencing a pop” followed by immediate disability. Those injured may complain that it feels like the knee is “coming apart”. Tears produce rapid swelling at the joint line. Treatment includes rest, crutches, ice, compression, elevation, and immediate referral to a physician.
Bursitis
A bursa is a sac filled with fluid. It is located between a bone and a tendon or muscle. Its function is to allow the tendon to slide smoothly over the bone. In the knee, this condition can be acute, chronic, or recurrent. The cause can be constant kneeling or overuse of the patella tendon. The signs and symptoms of bursitis are localized swelling and discomfort. Rest and an anti-inflammatory medication can usually relieve bursitis.
Chondromalacia Patella
Caused by the deterioration of the articular cartilage on the back of the patella. With this condition the individual may experience pain in the anterior aspect of the knee while walking, running, ascending and descending stairs, or squatting.
Lateral Collateral Ligament (LCL) sprain or tear
This injury occurs when a stress is applied to the medial (inside) aspect of the knee, and is very common in skiing. The signs and symptoms of this injury are pain and tenderness over the LCL, swelling, effusion, and possible joint laxity (looseness). There are three grades to this injury, namely grades I, II, and III. In grade I the symptoms are less severe. With a grade II injury the pain and other symptoms are more severe. In a grade III injury, the pain is intense initially, and then becomes a dull ache. In any injury, medical treatment is necessary and a physician should determine a diagnosis.
Medial Collateral Ligament (MCL) sprain or tear
An injury to the inside ligament of the knee, the MCL, is a result of a direct blow from the lateral (outside) side of the knee or a severe outward twist. The severity of the injury can be classified as a grade I, II, or III.
Grade I - The joint is stable with little or no joint effusion (swelling), some minor stiffness, and the athlete usually has full range of motion. This injury should be treated with rest, ice, compression, and elevation. Seek medical treatment from a physician.
Grade II - The joint exhibits slight instability, slight swelling, moderate to sever joint stiffness with the inability to fully extend the knee, decreased passive range of motion, and pain along the medial aspect of the knee. Treatment consists of rest, ice, compression, and elevation. Crutches may be used for ambulation, and seek treatment by a physician.
Grade III - A complete tear of the ligament exhibits a loss of medial stability, minimal to moderate swelling, immediate pain followed by a dull ache, and decreased range of motion secondary to joint effusion. Treatment is rest, ice, compression, elevation, and referral to a physician.
Meniscal Lesions or Tears
The menisci are two oval fibrocartilages that act as shock absorbers and widen the space between the bones of the leg. The medical meniscus is located on the inside of the knee, and the lateral is on the outside. They also provide lubrication and help stabilize the knee. Acute meniscal tears result from rotation and flexion of the knee, impinging the menisci between the joint. Classic symptoms of meniscal tears involve “locking” of or “clicking” in the knee joint noticed especially with climbing stairs; pain and/or crepitus along the joint line which is usually accompanied with swelling; and the “giving way” during walking.
Patella Injuries
The patella is a sesamoid bone located in the patellar tendon that improves the mechanical function of the quadriceps when extending the knee, dissipates the forces received from the extensor mechanism, and protects the anterior portion of the knee. There are a few exceptions to this rule, but generally injury to the patellofemoral joint are the result of overuse, a congenital malalignment, or structural insufficiency.
Patellar Fracture
Can be caused by direct or indirect trauma. The fracture causes hemorrhage and joint effusion, resulting in generalized swelling.
Patellar Maltracking
People suffering from patellar tracking conditions describe gradual onset with symptoms related to increased activity. This condition is based on a number of individual variables, each with its own influence on the extensor mechanism. Many of theses condition are congenital. A good physical therapist can help tremendously in correcting dysfunctions.
Patellar Subluxation/Dislocation
Laxity (or looseness) of the medial patellar restraints that are acute, chronic, or congenital can result in an increased lateral glide of the patella, which predisposed the individual to subluxations, and/or dislocations of the patella. A true dislocation of the patella causes it to shift laterally and lock out of place, producing an obvious deformity and spasm of the quad muscles as it guards the injury. Both acute patellar dislocations and chronic subluxations will exhibit swelling within 24 hours after the onset of the injury.
Patellar Tendon Rupture
A sudden powerful contraction of the quads with the weight of the body applied to the affected knee can cause a rupture. With this injury, the patella moves upward toward the thigh and the defect can be palpated. The individual will not be able to extend the knee. There is considerable swelling with significant pain initially that decreases and may not feel that serious. This injury usually requires surgical repair.
Patellar Tendonitis
The most common site of pain with this type of injury is at the inferior pole of the patella, although it may be described as pain up into the quads or down below the patella. Pain is the primary complaint with this type of injury.
Posterior Cruciate Ligament (PCL) Sprain
The PCL is at risk when the knee is flexed to 90 degrees and falling with full weight on the front of a bent knee or a hard blow to a bent knee. Signs and symptoms of this injury include a “pop” in the back of the knee, tenderness and swelling in the back of the knee. Treatment is rest, crutches, ice, elevation, compression, and referral to a physician.
