(65) 64712744|info@boneclinic.com.sg

About Knee

How is the knee designed, and what is its function?

The knee is a joint that has three compartments. This joint has an inner (medial) and an outer (lateral) compartment. The kneecap (patella) joins the femur to form a third compartment called the patellofemoral joint. The thigh bone (femur) meets the large shinbone (tibia) forming the main knee joint.

The knee joint is surrounded by a joint capsule with ligaments strapping the inside and outside of the joint (collateral ligaments) as well as crossing within the joint (cruciate ligaments). These ligaments provide stability and strength to the knee joint.

The meniscus is a thickened cartilage pad between the two joints formed by the femur and tibia. The meniscus acts as a smooth surface for motion and absorbs the load of the body above the knee when standing. The knee joint is surrounded by fluid-filled sacs called bursae, which serve as gliding surfaces that reduce friction of the tendons. Below the kneecap, there is a large tendon (patellar tendon) which attaches to the front of the tibia bone. There are large blood vessels passing through the area behind the knee (referred to as the popliteal space). The large muscles of the thigh move the knee. In the front of the thigh, the quadriceps muscles extend the knee joint. In the back of the thigh, the hamstring muscles flex the knee. The knee also rotates slightly under guidance of specific muscles of the thigh.

The knee functions to allow movement of the leg and is critical to normal walking. The knee flexes normally to a maximum of 135 degrees and extends to 0 degrees. The bursae, or fluid-filled sacs, serve as gliding surfaces for the tendons to reduce the force of friction as these tendons move. The knee is a weight-bearing joint. Each meniscus serves to evenly load the surface during weight-bearing and also aids in disbursing joint fluid for joint lubrication.

What injuries can cause knee pain, and what other symptoms may accompany knee pain? How is knee pain diagnosed?

Injury can affect any of the ligaments, bursae, or tendons surrounding the knee joint. Injury can also affect the ligaments, cartilage, menisci (plural for meniscus), and bones forming the joint. The complexity of the design of the knee joint and the fact that it is an active weight-bearing joint are factors in making the knee one of the most commonly injured joints.

Ligament injury

Trauma can cause injury to the ligaments on the inner portion of the knee (medial collateral ligament), the outer portion of the knee (lateral collateral ligament), or within the knee (cruciate ligaments). Injuries to these areas are noticed as immediate pain but are sometimes difficult to localize. Usually, a collateral ligament injury is felt on the inner or outer portions of the knee. A collateral ligament injury is often associated with local tenderness over the area of the ligament involved. A cruciate ligament injury is felt deep within the knee. It is sometimes noticed with a “popping” sensation with the initial trauma. A ligament injury to the knee is usually painful at rest and may be swollen and warm. The pain is usually worsened by bending the knee, putting weight on the knee, or walking. The severity of the injury can vary from mild (minor stretching or tearing of the ligament fibers, such as a low grade sprain) to severe (complete tear of the ligament fibers). Patients can have more than one area injured in a single traumatic event.

Ligament injuries are initially treated with ice packs, immobilization, rest, and elevation. It is generally recommended to avoid bearing weight on the injured joint, and crutches may be required for walking. Some patients are placed in splints or braces to immobilize the joint to decrease pain and promote healing. Arthroscopic or open surgery may be necessary to repair severe injuries.

Surgical repair of ligaments can involve suturing alone, grafting, and synthetic graft repair. These procedures can be done by either open knee surgery or arthroscopic surgery (described in the section below). The decision to perform various types of surgery depends on the level of damage to the ligaments and the activity expectations of the patient. Many repairs can now be done arthroscopically. However, certain severe injuries will require an open surgical repair. Reconstruction procedures for cruciate ligaments are increasingly successful with current surgical techniques.

Meniscus tears

The meniscus can be torn with the shearing forces of rotation that are applied to the knee during sharp, rapid motions. This is especially common in sports requiring reaction body movements. There is a higher incidence with aging and degeneration of the underlying cartilage. More than one tear can be present in an individual meniscus. The patient with a meniscal tear may have a rapid onset of a popping sensation with a certain activity or movement of the knee. Occasionally, it is associated with swelling and warmth in the knee. It is often associated with locking or an unstable sensation in the knee joint. The doctor can perform certain maneuvers while examining the knee which might provide further clues to the presence of a meniscal tear.

Routine X-rays, while they do not reveal a meniscal tear, can be used to exclude other problems of the knee joint. The meniscal tear can be diagnosed in one of three ways: arthroscopy, arthrography, or an MRI.

Arthroscopy is a surgical technique by which a small diameter video camera is inserted through tiny incisions on the sides of the knee for the purposes of examining and repairing internal knee joint problems. Tiny instruments can be used during arthroscopy to repair the torn meniscus.

Arthrography is a radiology technique whereby a contrast liquid is directly injected into the knee joint and internal structures of the knee joint thereby become visible on X-ray film.

An MRI scan is another radiology technique whereby magnetic fields and a computer combine to produce two- or three-dimensional images of the internal structures of the body. It does not use X-rays and can give accurate information about the internal structures of the knee when considering a surgical intervention. Meniscal tears are often visible using an MRI scanner. MRI scans have largely replaced arthrography in diagnosing meniscal tears of the knee. Meniscal tears are generally repaired arthroscopically.

Tendinitis

Tendinitis of the knee occurs in the front of the knee below the kneecap at the patellar tendon (patellar tendinitis) or in the back of the knee at the popliteal tendon (popliteal tendinitis). Tendinitis is an inflammation of the tendon, which is often produced by a strain event, such as jumping. Patellar tendinitis, therefore, also has the name “jumper’s knee.” Tendinitis is diagnosed based on the presence of pain and tenderness localized to the tendon. It is treated with a combination of ice packs, immobilization with a knee brace as needed, rest, and anti-inflammatory medications. Gradually, exercise programs can rehabilitate the tissues in and around the involved tendon. Anti-inflammatory injections, which can be given for tendinitis elsewhere, are generally avoided in patellar tendinitis because there are reports of risk of tendon rupture as a result of corticosteroids in this area. In severe cases, surgery can be required. A rupture of the tendon below or above the kneecap can occur. When it does, there may be bleeding within the knee joint and extreme pain with any knee movement. Surgical repair of the ruptured tendon is often necessary.

Fractures

With severe knee trauma, such as motor vehicle accidents and impact traumas, bone breakage (fracture) of any of the three bones of the knee can occur. Bone fractures within the knee joint can be serious and can require surgical repair as well as immobilization with casting or other supports.

What are diseases and conditions that can cause knee pain, and what is the treatment for knee pain?

Pain can occur in the knee from diseases or conditions that involve the knee joint, the soft tissues and bones surrounding the knee, or the nerves that supply sensation to the knee area. In fact, the knee joint is the most commonly involved joint in rheumatic diseases, immune diseases that affect various tissues of the body including the joints to cause arthritis.

Arthritis is inflammation within a joint. The causes of knee joint inflammation range from noninflammatory types of arthritis such as osteoarthritis, which is a degeneration of the cartilage of the knee, to inflammatory types of arthritis (such as rheumatoid arthritis or gout). Treatment of the arthritis is directed according to the nature of the specific type of arthritis. Many people suffer from arthritis; the pain and discomfort can be so limiting that some patients may require a total knee joint replacement. Knee replacement surgery often allows the patient to regain much of their mobility.

Swelling of the knee joint from arthritis can lead to a localized collection of fluid accumulating in a cyst behind the knee. This is referred to as a Baker cyst and is a common cause of pain at the back of the knee.

Infections of the bone or joint can rarely be a serious cause of knee pain and have associated signs of infection including fever, extreme heat, warmth of the joint, chills of the body, and may be associated with puncture wounds in the area around the knee. These infections are often diagnosed by aspirating joint fluid accumulations with a needle (joint aspiration) and examining the fluid microscopically and with microbial culture techniques. Treatment is done with antibiotics.

Tumors involving the joint are extremely rare (for example, synovial sarcomas, and giant cell tumors). They can cause ambulatory problems with local pain. Treatment usually involves surgery; a few individuals may require amputation of the knee and lower leg. Treatments and surgery depend on the tumor type.

The collateral ligament on the inside of the knee joint can become calcified and is referred to as Pellegrini-Stieda syndrome. With this condition, the knee can become inflamed and can be treated conservatively with ice packs, immobilization, and rest. Infrequently, it requires a local injection of corticosteroids.

Chondromalacia refers to a softening of the cartilage under the kneecap (patella). It is a common cause of deep knee pain and stiffness in younger women and can be associated with pain and stiffness after prolonged sitting and climbing stairs or hills. While treatment with anti-inflammatory medications, ice packs, and rest can help, long-term relief is best achieved by strengthening exercises for the quadriceps muscles of the front of the thigh.

Bursitis of the knee commonly occurs on the inside of the knee (anserine bursitis) and the front of the kneecap (patellar bursitis, or “housemaid’s knee”). Bursitis is generally treated with ice packs, immobilization, and anti-inflammatory medications such as ibuprofen (Advil, Motrin) or aspirin and may require local injections of corticosteroids (cortisone medication) as well as exercise therapy to develop the musculature of the front of the thigh.

STOP YOUR KNEE PAIN TODAY! CALL +65 6471 2744 or Email to info@boneclinic.com.sg for Appointment

Pain Free Knee, Is it Possible?

One would have some experiences with knee problems at some point in life regardless of your activity level. Do we really have to live with this pain in the knee? No. Knee pain in a common problem that affects people of all ages. It occurs due to a few different reasons and causes.

Knee Injuries

– Anterior Cruciate Ligament (ACL) tear, Medial & Lateral Collateral Ligament (MCL and LCL) Tear, Meniscal Tear and/or Cartilage Tear are injuries that could result in knee pain. Most of these injuries happen as a result of a shearing or twisting action on tke knee causing laxity and presence of loose bodies or knee movement limitations. People with ACL tears tend to present with higher risk of having knee osteoarthritis where the cartilages are worn off.

– There are two C-shape meniscus in the knee joint that acts as shock absorbers between the thigh and shin bone and as stabilizers of the knee. Meniscus tear comes about when there is sudden twisting and compression of the knee or there is repetitive stress to the knee and this injury can occur together with an ACL tear, and increase the chances of arthritis changes in the knee joint. Medications will be given by your doctor to reduce any inflammatory reactions and physiotherapy is usually the treatment for any such tears. However, is cases where it is imminent to remove or repair the meniscus, surgical interventions such as meniscus repair will be done arthroscopically.

Patellar Tendinitis

A common overuse injury, commonly termed “jumper’s knee” as it occurs mostly in people who don’t jump due to the following reasons:

– Malaligment of knee cap, thigh bone & shin bone

– Rapid weight gain resulting in excessive strain on the tendon.

– Muscle imbalance-tightness of Quadriceps (muscle on front of thigh), tightness of hamstrings (muscle on front of thigh), tightness of hamstring (muscle on back of thigh) and / or weakness of VMO muscle (one of the four muscles of the quadriceps).

In some cases, your doctor may prescribe medications to reduce the inflammation & pain or administer other techniques like ESWT (Extracorporeal Shock Wave Therapy), PRP (Platelet Rich Plasma treatment) to help promote healing in the tendon.

Knee Degeneration

– Osteoarthritis (OA) is one of the most common degenerative problems of the knee and it can affect people of all ages. It occurs due to the wear and tear of the cartilages in the knee joint and is therefore dependent on the amount of impact that the knee takes on with activities, Customised insules can also help elleviate any pain that occurs because of changes in joint allignment thus reduces the impact on the worn our portion of the knee.

– Proper physiotherapy treatments and use of customized insoles greatly reduces the need to have any surgical interventions especially if administered early.

– In certain cases, cartilage degeneration could have occured for a long time, and without proper management this condition canbe debilitating with loss of ROM.

– Rheumatoid arthritis( (RA) is the other type of arthritis that can affect any joint in your body as it is an autoimmune condition. It is a chronic problem that has to be managed by medications, rest and physiotherapy.

Knee Malalignment Problems

– Illiotibial band syndrome occurs when the band on the outer part of your thigh bone becomes too tight and rubs against the outer knee.

– Patellofemoral pain (PFP) syndrome is the pain one experiences in the knee cap due to malaligment of the knee cap and is also experienced in people with OA knee. In most cases, PFP can be resolved with a pair of customized insoles, mobilisation techniques, taping techniques and proper strengthening & stretching exercises.

– Hip & foot allignment problems can also cause knee pain due to changes in loading on the knee. Prople with flat feet or high arch problem may also experience knee pain. In some cases, the lowering of foot arch may be caused by massive weight gain and weight loss programs as precribed. In most cases, a good pair of customized insole and joint mobilisation helps to resolve the whole issue. Stretching & stengthening exercises prescrived by your physiotherapist is beneficial to prevent any recurrence.

As in any other injuries, always consult a doctor or a physiotherapist to find out the root cause of your problem and receive the appropriate treatment forit.

Stop Your Knee Pain Today! Call +65 6471 2744 for Appointment