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Knee Injuries

The knee joint allows you to run, walk and play sport. Awkward movements, falls and collisions, sudden twists, excessive force or overuse can result in a range of injuries to the knee joint and the structures supporting it. Common knee injuries include ligament, tendon and cartilage tears, and patello-femoral pain syndrome.

Prompt medical attention for any knee injury increases the chances of a full recovery. Treatment options include physiotherapy, arthroscopic surgery and open surgery.

The structure of the knee

The knee is a hinge joint, situated between the thigh bone (femur) and shin bones (tibia and fibula). Contraction of the muscles on the front of the thigh (quadriceps) straightens the leg, while contraction of the muscles on the back of the thigh (the hamstrings) allows the leg to bend at the knee. The end of the femur rests in the shallow cup of the tibia, cushioned by a thick layer of cartilage.

At the front of the knee joint, the kneecap or patella sits in a groove at the lower end of the femur. The joint is further bolstered on each side by additional cartilages, which sit in between the knee joint. The bones are held in place by tough bands of connective tissue called ligaments. The entire joint is enclosed inside a tough capsule lined with a membrane and filled with lubricating synovial fluid. Extra capsules of fluid, known as bursae, offer extra cushioning.

Ligament sprains

The knee joint is held together by tough bands of connective tissue called ligaments. Sudden twists or excessive force on the knee joint, commonly caused by repeated jumping or coming to a rapid halt while running, can stretch ligaments beyond their capacity. Torn ligaments can bleed into the knee and typically cause swelling, pain and joint laxity. The anterior cruciate ligament (ACL) situated in the centre of the joint is the knee ligament commonly injured. A ruptured ACL does not heal by itself and may require reconstructive surgery.

Tendon tears

The muscles are anchored to the joints with tendons. Overstretched tendons can tear and bleed, but these injuries tend to heal by themselves without the need for surgery.

Cartilage tears

The knee joint is bolstered on both sides by additional strips of cartilage, called ‘menisci’ or semilunar cartilages. One of the most common knee injuries is a torn or split meniscus. Severe impact or twisting, especially during weight bearing exercise, can tear this cartilage. Tears of the meniscus can also occur in older people due to wear and tear. Symptoms include swelling, pain and the inability to straighten the leg. The damaged cartilage can be surgically trimmed or even removed without causing any joint instability.

Patello-femoral pain syndrome

Patello-femoral pain syndrome is characterised by pain felt behind the kneecap. Squatting, walking up and down hills or stairs, or sitting still for extended periods of time can exacerbate the pain. The usual cause is abnormal movement of the kneecap as the knee is bent and straightened. This can lead to wear and tear of the cartilage on the back of the kneecap. Imbalances in muscle strength, tight muscles and structural abnormalities of the lower limb can contribute to the problem. The pain usually comes on gradually over time.

First aid for knee injuries in the first 48 to 72 hours

Suggestions for first aid treatment of an injured knee include:

  • Stop your activity immediately. Don’t ‘work through’ the pain.
  • Rest the joint at first.
  • Reduce pain, swelling and internal bleeding with icepacks, applied for 15 minutes every couple of hours.
  • Bandage the knee firmly and extend the wrapping down the lower leg.
  • Elevate the injured leg.
  • Don’t apply heat to the joint.
  • Avoid alcohol, as this encourages bleeding and swelling.
  • Don’t massage the joint, as this encourages bleeding and swelling.

Professional help

Mild knee injuries may heal by themselves, but all injuries should be checked and diagnosed by a doctor or physiotherapist. Persistent knee pain needs professional help. Prompt medical attention for any knee injury increases the chances of a full recovery. Treatment options include:

  • Aspiration – if the knee joint is grossly swollen, the doctor may release the pressure by drawing off some of the fluid with a fine needle.
  • Physiotherapy – including ultrasound and electrical muscle stimulation treatment, kneecap taping, exercises for increased mobility and strength, and associated rehabilitation techniques.
  • Arthroscopic surgery – or ‘keyhole’ surgery, where the knee operation is performed by inserting slender instruments through small incisions (cuts). Cartilage tears are often treated with arthroscopic surgery.
  • Open surgery – required when the injuries are more severe and the entire joint needs to be laid open for repair.

Prevention suggestions

You can help to prevent injuries if you:

  • Warm up joints and muscles by gently going through the motions of your sport or activity and stretching muscles.
  • Wear appropriate footwear.
  • Avoid sudden jarring motions.
  • Try to turn on the balls of your feet when you’re changing direction, rather than twisting through your knees.
  • Cool down after exercise by performing light, easy and sustained stretches
  • Build up an exercise program slowly over time.

Knee Injuries

There are many different structures inside and outside your knee. These include ligaments, which connect your bones together, articular cartilage, which covers the end of your shin bone and thigh bone in your knee joint, and a crescent-shaped disc called a meniscus. This is made from cartilage and acts as a shock absorber and helps to stabilise your knee. Injury to your knee may damage any one of these structures.

Knee ligament injuries

Your knee ligaments help to keep your knee stable.

The medial collateral and lateral collateral ligaments are found on either side of your knee joint, and act to limit the amount it can move from side to side. You can sprain or tear your medial collateral ligament if you twist your leg while it’s straightened, for example, when being tackled in rugby. Your lateral collateral ligament isn’t usually damaged on its own, but you may need to have it repaired if you have damaged other ligaments.

Your anterior cruciate ligament and posterior cruciate ligament form a cross (cruciate) inside your knee. They help to keep your knee stable when the joint is moving backwards and forwards. Anterior cruciate ligament injuries are one of the most serious types of knee injury.

If you have injured your medial collateral or lateral collateral ligaments, your doctor may grade your injury according to how severe the damage is.

  • Grade 1 is a stretch of the ligament without tearing.
  • Grade 2 is a partial tear of the ligament.
  • Grade 3 is a complete tear of the ligament.

Other soft tissue injuries

Apart from ligaments there are other soft tissues around your knee that can be injured. Soft tissue means any tissue in your body that isn’t bone.

You may tear the meniscus in your knee. You can damage it if you play a sport that involves twisting your upper leg while your foot is planted on the floor. As you get older, your meniscus may become slightly thinner or have micro tears (degenerates). This makes it more likely to tear after a very minor injury.

If you use your knee a lot, for example if you run, you can irritate or tear the tendon that connects your kneecap (patella) to your thigh muscle. This tendon is called the patella tendon and the condition is patella tendonitis.

Symptoms of knee injuries

You may feel or hear a popping or snapping sensation at the time of the injury. You may also find that you can’t stand properly on the affected leg, or put your full weight on it.

The symptoms for most ligament injuries will be similar, no matter which one has been damaged. These may include:

  • pain
  • swelling
  • instability – you may feel like your knee is giving way

You may feel a tearing sensation and severe pain if you injure the meniscus in your knee. Pain may develop towards the inside, outside or back of your knee joint (depending on which menisus you injured) and you may see some swelling.

If you have any of these symptoms, visit your GP or physiotherapist for advice.

Causes of knee injuries

You may injure your knee if:

  • an impact moves your knee beyond its usual range of movement, for example if you have a fall or land awkwardly
  • you play a sport that combines running, jumping and stopping with quick changes of direction, such as football
  • you have a condition such as arthritis or gout, which can affect your joints, or are very overweight, which can put pressure on your knees
  • your knees hit the dashboard in a car accident – posterior cruciate ligament damage is sometimes called the ‘dashboard injury’ as this is often how it occurs
  • you wear footwear that doesn’t match the shape of your feet or have poor training methods or flexibility, which can lead to overuse injuries of your knee

Diagnosis of knee injuries

Your doctor or physiotherapist will ask about your symptoms and examine you. This may include feeling for fluid in your knee joint by pressing gently around your kneecap. He or she will also ask you to describe how your injury happened, where your pain is and what type of pain it is.

Your doctor or physiotherapist may ask you to walk, sit or lie down so he or she can test for injury to your knee ligaments or soft tissues. He or she will bend and flex your knee and move your leg into different positions. Your physiotherapist may also ask you to step, squat or hop.

Your doctor may refer you for other tests in a hospital or clinic. These may include an MRI or ultrasound scan, and occasionally an X-ray. These tests can help to diagnose more complicated or severe injuries.

Treatment of knee injuries

There are different types of treatment that your doctor or physiotherapist may suggest, depending on the type and severity of the damage to your knee. It’s important to be patient when recovering from a knee injury. Your injury may take time to fully repair itself, so you may not be able to do all the things you are used to doing for some time.

Self help

You should follow the PRICE procedure to manage any type of soft tissue injury to your knee. PRICE stands for the following.

  • Protection. Protect your injury from further harm.
  • Rest. Rest the injury for the first two to three days, then reintroduce movement so you don’t lose too much muscle strength.
  • Ice. Apply a cold compress such as ice or a bag of frozen peas wrapped in a towel to help reduce swelling and bruising. Do this for 15 to 20 minutes every two to three hours. Don’t apply ice directly to your skin as it can damage your skin.
  • Compression. Compress the joint by bandaging it to support the injury and help decrease swelling. Don’t leave this on while you sleep.
  • Elevation. Elevate your knee by resting it above the level of your heart and keeping it supported.

There are certain things you should not do in the first three days after your injury so you don’t damage your knee further. These can be remembered as HARM.

  • Heat. This includes having a hot bath or using a heat pack.
  • Alcohol. Drinking alcohol can increase bleeding and swelling in the affected area.
  • Running or other forms of exercise.
  • Massaging the injured knee. This can cause more swelling or bleeding.

If you’re having difficulty bearing weight on your knee, you may need to use crutches or wear a brace to make sure that you keep weight off the affected knee.

Medicines

You can buy over-the-counter painkillers such as paracetamol to treat mild and moderate pain. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and ketoprofen can help to reduce inflammation and swelling, as well as relieve pain. NSAIDs are available as gels, creams and sprays that you can put directly onto your skin and gently massage in, as well as tablets or capsules that you take by mouth.

Your doctor may prescribe stronger painkillers if your pain is severe. Always read the patient information that comes with your medicine and if you have questions, ask your pharmacist or doctor for advice.

Physiotherapy

If your injury is more severe or complex, your doctor may refer you to a physiotherapist (a health professional who specialises in movement and mobility). You can also choose to see a physiotherapist privately. He or she will develop a programme of rehabilitation exercises to gradually strengthen your knee and stretch your muscles. These exercises will vary depending on the type of injury you have and how severe it is. Your physiotherapist may also use various techniques to help speed up the healing of your knee.

Braces or strapping to support your knee are occasionally used during rehabilitation, usually when an injury has been severe.

Surgery

For some types of knee injury, our doctor or physiotherapist may recommend that you have surgery to repair the injury to your knee – especially if other forms of treatment haven’t worked. Your doctor will refer you to an orthopaedic surgeon for assessment.

The surgeon is more likely to suggest surgery if you have one of the following injuries.

  • You have torn your anterior cruciate ligament and you do a lot of sport or have also torn the meniscus or your medial collateral ligament. Anterior cruciate ligament reconstruction involves taking a piece of tendon (usually from your hamstring) to replace the damaged ligament.
  • Your knee remains painful or locks after an injury to your meniscus.

Rarely, surgery may involve opening up your knee joint to repair it, or you may be able to have a type of keyhole surgery called knee arthroscopy to access the damaged area of your knee.

Prevention of knee injuries

There are some precautions you can take to try to reduce the risk of damaging your knee ligaments.

  • Exercise regularly to maintain a good level of fitness. This will mean your muscles are stronger and better able to support your joints, including your knees. If you haven’t been active for a while, start gently and gradually increase the intensity.
  • Spend five to 10 minutes warming up before exercise to increase blood flow to your muscles and reduce the chance of an injury. Many sports professionals advise stretching your muscles after warming up and again after cooling down; however, the benefit of stretching before or after exercise to prevent soft tissue injuries is unproven.
  • Wear correct footwear. There are many different models of trainers available, but the best is one that matches the shape of your feet. If you’re not sure, it’s a good idea to go to a specialist sports shop and ask for advice.

To Check on Your Knee, Call us at +65 6471 2744 (24 Hours) / info@boneclinic.com.sg

 

Getting Back Into Sports After Anterior Cruciate Ligament Injuries

Anterior Cruciate Ligament (ACL) injuries are some of the most dreaded injuries among sports professionals and even amateurs. They are usually season-ending and often entail surgery and a prolonged period of rehabilitation. So what exactly are ACL injuries, the causes and treatment options?

What is an ACL?

An ACL connects the thigh bone (femur) with the shin bone (tibia). An ACL stabilises the knee for cutting, twisting, jumping and pivoting activities. This ligament is located in the centre of the knee joint and prevents abnormal rotation of the femur on the tibia.

ACL injuries are common in a wide variety of sports especially where twisting and pivoting are involved such as basketball, netball and football. It affects both men and women and is in fact eight times more common in women than men.

Without an ACL most people have trouble with twisting and pivoting during sports. In severe cases, the patient has trouble even with activities of daily living.

How does the ACL get injured?

Most ACL injuries tend to be a result of a deceleration injury. The foot gets trapped in a tackle or uneven ground and the weight of the body rotates around the knee thereby causing the ligaments to rupture.

When you tear an ACL, you will often feel or hear a pop. You will also feel the knee shift out of place and develop significant swelling in just a few hours. Most people are unable to continue play and some will have severe pain and be unable to bear weight at all.

What should we do immediately after an injury?

Play should be discontinued. The knee should be iced and the leg elevated. A commonly used regime is to ice the knee for 20 to 30 minutes every two to three hours.

Pain killers and anti-inflammatory medication are useful for patient comfort and a sports physician, an orthopaedic surgeon or a phsiotherapist should evaluate the injury. A Magnetic Resonance Imaging (MRI) scan is usually ordered to confirm the diagnosis and to exclude injury to the other ligaments in the knee as well as the articular cartilage and the meniscus.

Who should go for surgery?

If the ACL has been torn, surgical reconstruction of the ligament may be indicated, as the ligament rarely heals by itself. However not everyone who tears an ACL will need surgery.

Individuals who should consider surgery are those who are keen to continue playing sports as well as those who have instability (giving way) during daily or sporting activities. Patients with associated injuries to the other structures in the knee and those who are young should consider surgery.

Current thinking is that recurrent instability in the knee will cause damage to the cartilage and menisci (crescent-shaped cartilage pad between the two joints formed by the thigh bone and the shin bone) and lead to accelerated degenerative arthritis.

The rationale behind surgery is to stabilise the knee for twisting and pivoting activities and to slow down the development of arthritis.

What happens during a surgery?

In surgery, the ACL is recreated by using a “graft” which can be taken from the patient’s own tissue.

The surgery is performed via an arthroscopic or ‘key-hole’ technique. This allows for a rapid recovery and less pain compared to non-arthroscopic techniques. Most times the surgery can be done as a day surgery procedure.

Post Surgical Rehabilitation

The patients’ commitment to a rehabilitation programme is of the utmost importance in determining the success or failure of the surgery. Non-compliance or poor compliance with the rehabilitation programme is a common cause of inability to return to sports.

The rehabilitation programme consists of range of motion, strengthening and finally sports-specific agility training.

Returning to sports will vary from individual to individual but generally nine to twelve months is the norm.

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Anterior Cruciate Ligament (ACL) injury

Injured your Knee ACL? Suspect your ACL Torn? Get professional opinion about your Knee Injury. Call us +65 6471 2744 or email to: info@boneclinic.com.sg for appointment

Definition of Anterior Cruciate Ligament (ACL) Injury

The anterior cruciate ligament, or ACL, is one of four major knee ligaments. The ACL is critical to knee stability, and people who injure their ACL often complain of symptoms of their knee giving-out from under them. Therefore, many patients who sustain an ACL tear opt to have surgical treatment of this injury.

What is the ACL (Anterior Cruciate Ligament)?

The anterior cruciate ligament, also called the ACL, is one of the four major ligaments of the knee. The ACL prevents excessive motion of the knee joint–patients who sustain an injury to their ACL may complain of symptoms of the knee “giving out.”

Sign of an ACL Tear:

The diagnosis of an ACL tear is made by several methods. Patients who have an ACL tear often have sustained an injury to the knee. The injury is often sports-related. They may have felt a “pop” in their knee, and the knee usually gives-out from under them.

ACL tears cause knee swelling and pain. On examination, your doctor can look for signs of instability of the knee. These special tests place stress on the ACL, and can detect a torn ligament.

An MRI may also be used to determine if the ligament is torn, and also to look for signs of any associated injuries in the knee.

Is ACL surgery necessary?

ACL tears do not necessarily require surgery. There are several important factors to consider before undergoing ACL surgery. First, do you regularly perform activities that normally require a functional ACL? Second, do you experience knee instability? If you don’t do sports that require an ACL, and you don’t have an unstable knee, then you may not need ACL surgery.

There is also a debate about how to treat a partial ACL tear. If the ACL is not completely torn, then ACL reconstruction surgery may not be necessary.

Many patients with an ACL tear start to feel better within a few weeks of the injury. These individuals may feel as though their knee is normal again, but the problems with instability may persist.

Surgery of an ACL tear:

The usual surgery for an ACL tear is called an ACL reconstruction. A repair of the ligament is rarely a possibility, and thus the ligament is reconstructed using another tendon or ligament to substitute for the torn ligament.

There are several options for how to perform ACL surgery. The most significant choice is the type of graft used to reconstruct the torn ACL. There are also variations in the procedure, such as the new ‘double-bundle’ ACL reconstruction.

Risks of ACL surgery include infection, persistent instability and pain, stiffness, and difficulty returning to your previous level of activity. The good news is that better than 90% of patients have no complications with ACL surgery.

Read more about Anterior Cruciate Ligament (ACL) Reconstuction

Read more about Should My Child Have ACL Surgery

Read more about Getting Back to Sports after ACL Injuries

Read more about Other Ligament Injuries

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