The knee joint is a large complex joint consisting of the femur (thigh), tibia (shin), patellar (kneecap) and fibula bones.
It is the largest joint in the human body. The knee is a modified hinge joint, which permits flexion and extension as well as slight internal and external rotation. The knee is vulnerable to injury and to the development of osteoarthritis.
Common knee injuries/conditions include:
- Anterior cruciate ligament (ACL)
- Meniscal tears
- Medial collateral ligament (MCL)
- Patella tendinopathy
- Osteoarthritis (OA)
Anterior Cruciate Ligament (ACL)
The ACL connects from the anterior (front) of the shin bone to the thigh bone and is an important structure in the knee, resisting the shin bone moving forward on the thigh bone and rotational forces. It is an injury commonly seen in athletes especially those involved in sports that involve twisting, jumping and changes of direction such as football. Both contact and non-contact injuries can occur. Characteristics of an ACL injury are an audible ‘pop’ or ‘crack’ at the time of injury, extreme pain and immediate swelling in most cases immediately. The knee will feel unstable and restricted movement, especially an inability to fully straighten the knee. Once the injury has settled, walking (even running) in straight lines without pain may be possible but any twisting or turning when weight-bearing may see the knee give way and collapse with pain. In addition to the ACL injury occurring, damage to the meniscus and/or MCL may also occur at the same time and in unfortunate circumstances all three at the same time.
There are 2 menisci (cartilage) attached to the leg bone (tibia), medial and lateral – sometimes may be thought of or referred to as knee ‘cartilage’. Their purpose is to absorb forces through the knee especially when weight-bearing, in addition to nourishing the knee joint. Tears to the cartilage can occur via traumatic events or degenerative changes. Traumatic tears commonly occur during sporting activities that involve weight-bearing and twisting on the knee such as seen in football or tennis. Degenerative tears generally occur later in life in the fourth or fifth decade. Clinically, the knee may ‘lock’ resulting in a person ‘shaking’ or moving the knee to try and unlock the knee. Symptoms may also include popping sounds with residual pain and knee joint tenderness. Activities such as deep squatting and kneeling will be poorly tolerated with this injury.
Medial collateral ligament (MCL)
The MCL passes from the medially part of the thigh bone to the medial aspect of the shin bone and is a knee stabiliser resisting forces from the lateral aspect of the knee causing the knee to move into valgus (falls inwards). The MCL also resists lateral rotation of the shin bone on the thigh bone and restraining the shin bone moving forward on the thigh bone. Depending on the severity of the MCL injury will depend on symptoms. MCL grade I injuries will have some mild pain on the medial aspect of the knee when a lateral force is applied but no knee instability. MCL grade II injuries moderate pain and swelling is present with some knee instability. Grade III MCL injuries are complete ruptures of the ligament with severe pain, swelling and knee giving way inwards.
Primarily a condition of relatively young (15 – 30 years old) athletes, who participate in sports that involve regular loading of the patella (kneecap) tendon such as football, tennis and athletic jumping events. Pain can occur instantly once the tendon is loaded and usually stops once the load is removed. Clinically, pain is localised to the front of the kneecap were the tendon attaches to the shin bone. Pain may increase in severity with prolonged sitting, squatting and stairs although these symptoms can a feature of another pathology called patellofemoral pain. The condition patellofemoral pain syndrome is usually pain in the front of the kneecap and similar to patellar tendinopathy pain increases with compression forces on the kneecap such as up and down stairs, prolonged sitting with knees bent, kneeling and squatting.
Osteoarthritis (OA) is a common condition most likely found in joints in the body that weight bear such as the knees, although OA can affect any joint in the body. OA occurs when the smooth surfaces of opposing bones that allow movement become thinner and rougher, therefore, the joint does not move as smoothly as before and can cause pain. Naturally our bodies try to repair the surfaces but may not be able to repair the surfaces sufficiently and potentially produce extra bone that can formed on the edge of the joint to try and distribute joint loads, called osteophytes. Characteristics of knee OA will be pain, in most cases along the medial joint line, reduced knee movement and joint stiffness, grating or crackling sounds and reduced mobility. Additionally, degenerative meniscal tears will be present.
Really there is no bad time to see a professional if you have pain. Whether it be a doctor or a physiotherapist, both will conduct a thorough assessment to rule out anything serious and come up with a diagnosis where treatment can be applied. Here at Joints and Points, we offer private physiotherapy and talking therapy services and a free 20 minute consultation, for those who are struggling with physical or mental health related issues. We do not operate on a waiting list and aim to see you withing 48 hours.
If you need help or advice, our physiotherapists and sports therapist’s at J&P are here to help get you back to health. Contact us to book an appointment, or find out more.
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