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Patient Guide to Knee Pain

Knee pain is a common complaint that affects people of all ages. Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions — including arthritis, gout and infections — also can cause knee pain.

Many types of minor knee pain respond well to self-care measures. Physical therapy and knee braces also can help relieve knee pain. In some cases, however, your knee may require surgical repair.

Symptoms

The location and severity of knee pain may vary, depending on the cause of the problem. Signs and symptoms that sometimes accompany knee pain include:

  • Swelling and stiffness
  • Redness and warmth to the touch
  • Weakness or instability
  • Popping or crunching noises
  • Inability to fully straighten the knee

When to see a doctor
Call your doctor if you:

  • Can’t bear weight on your knee
  • Have marked knee swelling
  • Are unable to fully extend or flex your knee
  • See an obvious deformity in your leg or knee
  • Have a fever, in addition to redness, pain and swelling in your knee
  • Feel as if your knee is unstable or your knee “gives out”

Causes

Knee pain can be caused by injuries, mechanical problems, types of arthritis and other problems.

Injuries
A knee injury can affect any of the ligaments, tendons or fluid-filled sacs (bursae) that surround your knee joint as well as the bones, cartilage and ligaments that form the joint itself. Some of the more common knee injuries include:

  • ACL injury. An ACL injury is the tearing of the anterior cruciate ligament (ACL) — one of four ligaments that connect your shinbone to your thighbone. An ACL injury is particularly common in people who play basketball, soccer or other sports that require sudden changes in direction.
  • Torn meniscus. The meniscus is formed of tough, rubbery cartilage and acts as a shock absorber between your shinbone and thighbone. It can be torn if you suddenly twist your knee while bearing weight on it.
  • Knee bursitis. Some knee injuries cause inflammation in the bursae, the small sacs of fluid that cushion the outside of your knee joint so that tendons and ligaments glide smoothly over the joint.
  • Patellar tendinitis. Tendinitis is irritation and inflammation of one or more tendons — the thick, fibrous tissues that attach muscles to bones. Runners, skiers, cyclists, and those involved in jumping sports and activities are prone to develop inflammation in the patellar tendon, which connects the quadriceps muscle on the front of the thigh to the shinbone.

Mechanical problems
Some examples of mechanical problems that can cause knee pain include:

  • Loose body. Sometimes injury or degeneration of bone or cartilage can cause a piece of bone or cartilage to break off and float in the joint space. This may not create any problems unless the loose body interferes with knee joint movement, in which case the effect is something like a pencil caught in a door hinge.
  • Iliotibial band syndrome. This occurs when the ligament that extends from the outside of your pelvic bone to the outside of your tibia (iliotibial band) becomes so tight that it rubs against the outer portion of your femur. Distance runners are especially susceptible to iliotibial band syndrome.
  • Dislocated kneecap. This occurs when the triangular bone (patella) that covers the front of your knee slips out of place, usually to the outside of your knee. In some cases, the kneecap may stay displaced and you’ll be able to see the dislocation.
  • Hip or foot pain. If you have hip or foot pain, you may change the way you walk to spare these painful joints. But this altered gait can place more stress on your knee joint. In some cases, problems in the hip or foot can refer pain to the knee.

Types of arthritis
More than 100 different types of arthritis exist. The varieties most likely to affect the knee include:

  • Osteoarthritis. Sometimes called degenerative arthritis, osteoarthritis is the most common type of arthritis. It’s a wear-and-tear condition that occurs when the cartilage in your knee deteriorates with use and age.
  • Rheumatoid arthritis. The most debilitating form of arthritis, rheumatoid arthritis is an autoimmune condition that can affect almost any joint in your body, including your knees. Although rheumatoid arthritis is a chronic disease, it tends to vary in severity and may even come and go.
  • Gout. This type of arthritis occurs when uric acid crystals build up in the joint. While gout most commonly affects the big toe, it can also occur in the knee.
  • Pseudogout. Often mistaken for gout, pseudogout is caused by calcium-containing crystals that develop in the joint fluid. Knees are the most common joint affected by pseudogout.
  • Septic arthritis. Sometimes your knee joint can become infected, leading to swelling, pain and redness. There’s usually no trauma before the onset of pain. Septic arthritis often occurs with a fever.

Other problems
Chondromalacia patellae (patellofemoral pain syndrome) is a general term that refers to pain arising between your patella and the underlying thighbone (femur). It’s common in athletes; in young adults, especially those who have a slight misalignment of the kneecap; and in older adults, who usually develop the condition as a result of arthritis of the kneecap.

Risk factors

A number of factors can increase your risk of having knee problems, including:

  • Excess weight. Being overweight or obese increases stress on your knee joints, even during ordinary activities such as walking or going up and down stairs. It also puts you at increased risk of osteoarthritis by accelerating the breakdown of joint cartilage.
  • Biomechanical problems. Certain structural abnormalities — such as having one leg shorter than the other, misaligned knees and even flat feet — can make you more prone to knee problems.
  • Lack of muscle flexibility or strength. A lack of strength and flexibility are among the leading causes of knee injuries. Tight or weak muscles offer less support for your knee because they don’t absorb enough of the stress exerted on the joint.
  • Certain sports. Some sports put greater stress on your knees than do others. Alpine skiing with its rigid ski boots and potential for falls, basketball’s jumps and pivots, and the repeated pounding your knees take when you run or jog all increase your risk of knee injury.
  • Previous injury. Having a previous knee injury makes it more likely that you’ll injure your knee again.

Complications

Not all knee pain is serious. But some knee injuries and medical conditions, such as osteoarthritis, can lead to increasing pain, joint damage and disability if left untreated. And having a knee injury — even a minor one — makes it more likely that you’ll have similar injuries in the future.

Preparing for your appointment

You’re likely to start by seeing your family doctor. Depending upon the cause of your problem, he or she may refer you to a doctor specializing in joint diseases (rheumatologist), joint surgery (orthopedic surgeon) or sports medicine.

What you can do
Before your appointment, you may want to write a list of answers to the following questions:

  • When did you begin experiencing symptoms?
  • Did a specific injury make your knee start to hurt?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • What medications and supplements do you take regularly?

What to expect from your doctor
Your doctor may ask some of the following questions:

  • Do you exercise or play sports?
  • Do you experience any swelling, instability or locking of the knee?
  • Are you experiencing symptoms in other areas, or just in your knee?
  • Have you ever had knee pain before? If so, do you know what the cause was?

Tests and diagnosis

During the physical exam, your doctor is likely to:

  • Inspect your knee for swelling, pain, tenderness, warmth and visible bruising
  • Check to see how far you can move your lower leg in different directions
  • Push on or pull the joint to evaluate the integrity of the structures in your knee

Imaging tests
In some cases, your doctor might suggest tests such as:

  • X-ray. Your doctor may first recommend having an X-ray, which can help detect bone fractures and degenerative joint disease.
  • Computerized tomography (CT) scan. CT scanners combine X-rays taken from many different angles, to create cross-sectional images of the inside of your body. CT scans can help diagnose bone problems and detect loose bodies.
  • Ultrasound. This technology uses sound waves to produce real-time images of the soft tissue structures within and around your knee, and how they are working. Your doctor may want to maneuver your knee into different positions during the ultrasound, to check for specific problems.
  • Magnetic resonance imaging. MRI uses radio waves and a powerful magnet to create 3-D images of the inside of your knee. This test is particularly useful in revealing injuries to soft tissues such as ligaments, tendons, cartilage and muscles.

Lab tests
If your doctor suspects an infection, gout or pseudogout, you’re likely to have blood tests and sometimes arthrocentesis, a procedure in which a small amount of fluid is removed from within your knee joint with a needle and sent to a laboratory for analysis.

Treatments and drugs

Treatments will vary, depending upon what exactly is causing your knee pain.

Medications
Your doctor may prescribe medications to help relieve pain and to treat underlying conditions, such as rheumatoid arthritis or gout.

Therapy
Strengthening the muscles around your knee will make it more stable. Training is likely to focus on the muscles on the front of your thigh (quadriceps) and the muscles in the back of your thigh (hamstrings). Exercises to improve your balance are also important.

Arch supports, sometimes with wedges on one side of the heel, can help to shift pressure away from the side of the knee most affected by osteoarthritis. In certain conditions, different types of braces may be used to help protect and support the knee joint.

Injections
In some cases, your doctor may suggest injecting medications directly into your joint. Examples include:

  • Corticosteroids. Injections of a corticosteroid drug into your knee joint may help reduce the symptoms of an arthritis flare and provide pain relief that lasts a few months. The injections aren’t effective in all cases. There is a small risk of infection.
  • Supplemental lubrication. A thick fluid, similar to the fluid that naturally lubricates joints, can be injected into your knee to improve mobility and ease pain. Relief from one or a series of shots may last as long as six months to a year.

Surgery
If you have an injury that may require surgery, it’s usually not necessary to have the operation immediately. Before making any decision, consider the pros and cons of both nonsurgical rehabilitation and surgical reconstruction in relation to what’s most important to you. If you choose to have surgery, your options may include:

  • Arthroscopic surgery. Depending on your injury, your doctor may be able to examine and repair your joint damage using a fiber-optic camera and long, narrow tools inserted through just a few small incisions around your knee. Arthroscopy may be used to remove loose bodies from your knee joint, remove or repair damaged cartilage, and reconstruct torn ligaments.
  • Partial knee replacement surgery. In this procedure (unicompartmental arthroplasty), your surgeon replaces only the most damaged portion of your knee with parts made of metal and plastic. The surgery can usually be performed with a small incision, and your hospital stay is typically just one night. You’re also likely to heal more quickly than you are with surgery to replace your entire knee.
  • Total knee replacement. In this procedure, your surgeon cuts away damaged bone and cartilage from your thighbone, shinbone and kneecap, and replaces it with an artificial joint made of metal alloys, high-grade plastics and polymers.

Lifestyle and home remedies

Over-the-counter medications — such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve, others) — may help ease knee pain. Some people find relief by rubbing their knees with creams containing a numbing agent, such as lidocaine or capsaicin, the substance that makes chili peppers hot.

Self-care measures for an injured knee include:

  • Rest. Take a break from your normal activities to reduce repetitive strain on your knee, give the injury time to heal and help prevent further damage. A day or two of rest may be all you need for a minor injury. More severe damage is likely to need a longer recovery time.
  • Ice. Ice reduces both pain and inflammation. A bag of frozen peas works well because it covers your whole knee. You can also use an ice pack wrapped in a thin towel to protect your skin. Although ice therapy is generally safe and effective, don’t use ice for longer than 20 minutes at a time because of the risk of damage to your nerves and skin.
  • Compression. This helps prevent fluid buildup in damaged tissues and maintains knee alignment and stability. Look for a compression bandage that’s lightweight, breathable and self-adhesive. It should be tight enough to support your knee without interfering with circulation.
  • Elevation. To help reduce swelling, try propping your injured leg on pillows or sitting in a recliner.

Alternative medicine

  • Glucosamine and chondroitin. Study results have been mixed about the effectiveness of these supplements for relieving osteoarthritis pain. People who have moderate to severe arthritis pain appear to get the most benefit from these supplements.
  • Acupuncture. Research suggests that acupuncture may help relieve knee pain caused by osteoarthritis. Acupuncture involves the placement of hair-thin needles into your skin at specific places on your body.

Prevention

Although it’s not always possible to prevent knee pain, the following suggestions may help forestall injuries and joint deterioration:

  • Keep extra pounds off. Maintain a healthy weight; it’s one of the best things you can do for your knees. Every extra pound puts additional strain on your joints, increasing the risk of injuries and osteoarthritis.
  • Be in shape to play your sport. To prepare your muscles for the demands of sports participation, take time for conditioning. Work with a coach or trainer to ensure that your technique and movement are the best they can be.
  • Get strong, stay limber. Because weak muscles are a leading cause of knee injuries, you’ll benefit from building up your quadriceps and hamstrings, which support your knees. Balance and stability training helps the muscles around your knees work together more effectively. And because tight muscles also can contribute to injury, stretching is important. Try to include flexibility exercises in your workouts.
  • Be smart about exercise. If you have osteoarthritis, chronic knee pain or recurring injuries, you may need to change the way you exercise. Consider switching to swimming, water aerobics or other low-impact activities — at least for a few days a week. Sometimes simply limiting high-impact activities will provide relief.

STOP YOUR KNEE PAIN TODAY. CALL +65 6471 2744 OR SMS TO +65 92357641 FOR APPOINTMENT

Patient Guide to Osteoarthritis

Osteoarthritis is the most common form of arthritis, affecting millions of people around the world. Often called wear-and-tear arthritis, osteoarthritis occurs when the protective cartilage on the ends of your bones wears down over time.

While osteoarthritis can damage any joint in your body, the disorder most commonly affects joints in your hands, neck, lower back, knees and hips.

Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis treatments can slow the progression of the disease, relieve pain and improve joint function.

Symptoms of Osteoarthritis:

Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:

  • Pain. Your joint may hurt during or after movement.
  • Tenderness. Your joint may feel tender when you apply light pressure to it.
  • Stiffness. Joint stiffness may be most noticeable when you wake up in the morning or after a period of inactivity.
  • Loss of flexibility. You may not be able to move your joint through its full range of motion.
  • Grating sensation. You may hear or feel a grating sensation when you use the joint.
  • Bone spurs. These extra bits of bone, which feel like hard lumps, may form around the affected joint.

When to see a doctor
If you have joint pain or stiffness that lasts for more than a few weeks, make an appointment with your doctor.

Causes of Osteoarthritis

Osteoarthritis occurs when the cartilage that cushions the ends of bones in your joints deteriorates over time. Cartilage is a firm, slippery tissue that permits nearly frictionless joint motion. In osteoarthritis, the slick surface of the cartilage becomes rough. Eventually, if the cartilage wears down completely, you may be left with bone rubbing on bone.

Risk Factors of Osteoarthritis:

Factors that increase your risk of osteoarthritis include:

  • Older age. The risk of osteoarthritis increases with age.
  • Sex. Women are more likely to develop osteoarthritis, though it isn’t clear why.
  • Bone deformities. Some people are born with malformed joints or defective cartilage, which can increase the risk of osteoarthritis.
  • Joint injuries. Injuries, such as those that occur when playing sports or from an accident, may increase the risk of osteoarthritis.
  • Obesity. Carrying more body weight puts added stress on your weight-bearing joints, such as your knees.
  • Certain occupations. If your job includes tasks that place repetitive stress on a particular joint, that joint may eventually develop osteoarthritis.
  • Other diseases. Having diabetes, underactive thyroid, gout or Paget’s disease of bone can increase your risk of developing osteoarthritis.

The complication of Osteoarthritis:

Osteoarthritis is a degenerative disease that worsens over time. Joint pain and stiffness may become severe enough to make daily tasks difficult. Some people are no longer able to work. When joint pain is this severe, doctors may suggest joint replacement surgery.

Stop the Pain and Cure your Osteoarthritis Today! Call +65 6471 2744 or SMS to +65 92357641 for Appointment

Knee Pain Clinic

Most athletes will experience some knee pain from time to time. Overuse, long training days or bumps and bruises from contact sports often result in minor knee pain that heals within a day or two with some rest and ice. But there are some clues that indicate more serious knee pain and injuries that may need to be seen by a doctor for a complete evaluation and treatment plan.

When to See a Doctor for Knee Pains

You should see a doctor for your knee pain if you have any of the following warning signs:

  • Pain that lasts more than 48 hours
    If you have knee deep within the knee joint for more than a day or two your should get checked by a doctor. The knee joint isn’t covered by muscle so pain here is rarely of muscular origin.
  • Swelling that lasts more than 48 hours
    The first thing that happens after an acute injury is swelling around the site of the injury. When soft tissue is damaged, it swells or possibly bleeds internally. This swelling causes pain and loss of motion, which limits use of the muscles or joints. Swelling is usually obvious and can be seen, but occasionally you may just feel as though something is swollen even though it look normal. Swelling within a joint often causes pain, stiffness, and may produce a clicking sound as the tendons snap over one another after having been pushed into a new position from the swelling.
  • Loss of range-of-motion in the joint
    Reduced range-of-motion can indicate significant internal swelling, as well as other joint injuries. If you have limited range-of-motion for more than a day, you should contact your doctor.
  • Instability: feeling that the knee will give out
    Any instability in the knee joint or any sensation that the knee may give out or collapse may indicate a ligament injury to the knee. The knee ligaments provide support and stability to the joint and instability; if they are stretched or torn due to an injury, instability is one of the most obvious warning signs.
  • Inability to put your full weight on the leg
    A difference in your ability to support your full body weight on one leg,compared to the other, is another tip-off to an injury that requires attention.
  • Deformity of the knee joint
    If the knee joint looks deformed compared to the pain-free side, you should see a doctor. A fracture, patella tracking injury or a dislocating kneecap might sound obvious, but there are varying degrees of injury.
  • Knee joint pain in an active child
    If a child has knee pain it should be checked out be a doctor to rule out Osgood-Schlatter Disease.

Find the Right Doctor for Knee Pain

If you have any of these signs, you may want to see a specialist for a complete evaluation and treatment plan.

Get your Knee Injury checked and cured today. Call +65 6471 2744 or SMS to +65 9235 7641 for Appointment (24 Hours)

Should my child have ACL Surgery?

ACL injury in child

ACL Tears in Children

ACL reconstruction surgery is the standard treatment for young, active people who sustain an ACL tear. But what happens when that person is a child? Should ACL surgery be delayed until the child is older, or should ACL reconstruction be performed before skeletal maturity?

Answer: Traditionally, when a child injured his anterior cruciate ligament (ACL), a connection within the knee important for joint stability, surgeons were reluctant to operate and reconstruct the ligament right away for fear of damaging the growth plate. The concern was that before a child has reached skeletal maturity (about 12-13 years old in girls or 14-15 years old in boys) this type of surgery presented a risk of injuring the growth plate. Growth plate problems resulting from ACL surgery could lead to unequal leg lengths or angular deformity. However, recent research shows that the risk of growth plate problems is much less then the risk of permanent knee damage if the ACL is not fixed.

Growth Plates in Children

The growth plates are the part of the bone that grows in length. Most bone growth occurs near to the ends of long bones in these areas called growth plates. Two of the most active growth plates in the body are just above and just below the knee joint. These growth plates contribute to the length of both the thigh bone (femur) and shin bone (tibia).Traditional ACL reconstructive surgery involves making a tunnel in the bone directly in the location of these growth plates. At the time of skeletal maturity, the growth plate closes. Once the growth plate is closed (or nearly closed) the risk of causing a growth disturbance is gone. However, by drilling a hole through an open growth plate, the body may close the growth plate early. This could lead to complete growth plate closure, causing leg length inequality, or partial growth plate closure, causing angular deformity. Angular deformity could in turn lead to knock knees (genu valgus) and bow legs (genu varus), These conditions progressively worsen with further growth and could lead to problems such as joint damage and arthritis.

ACL Tears in Children

Knees that are unstable as a result of ACL tears have a high chance of meniscus tears and cartilage injury. Many surgeons have recommended that ACL surgery in children be delayed until the child has reached skeletal maturity. The hope being that by delaying surgery, you could avoid the potential complications of growth plate injury as a result of ACL surgery.Two factors have lead to more surgeons recommending early ACL surgery, even in children. First, more recent research has evaluated the risk of growth plate injury in comparison to the downside of delaying surgical treatment of the torn ACL. The risk of meniscus tears and cartilage injury was found in a recent study to be higher than the risk of growth disturbances. Second, there are modifications to traditional ACL surgery that allow the growth plate to be minimally affected in children. Furthermore, your doctor may recommend a specific type of graft to help minimize the chance of growth plate injury if surgical treatment is pursued. Therefore, more surgeons are recommending early ACL surgery, even in children.

The bottom line is that the risks of waiting (joint instability, meniscus tears, and cartilage injury) appear to be greater than the risk of growth plate injury for early ACL reconstruction with current surgical approaches. As a result surgeons today are more likely to recommend early ACL reconstruction.

Cycling Knee Problems

Cycling is a great low-impact aerobic activity. Cyclists are usually more efficient on both hills and flat terrain when they pedal quickly (at about 80-85 rpm) rather than at slower cadences. Although cycling is considered a knee-sparing exercise because it does not require impact with the ground, the repetitive motion of pedalling can lead to a variety of overuse knee injuries. The majority of cycling injuries are indeed caused by overuse, which leads to cumulative tissue microtrauma and consequent symptoms. In overuse injuries the problem is often not acute tissue inflammation, but chronic degeneration.

Cycling is obviously very repetitive: during one hour of cycling a rider may average up to 5000 pedal revolutions. But which cyclists sustain overuse knee injuries? Basically, cyclists of every ability level are at risk: riding too hard, too soon and too far is the usual recipe for numerous knee problems. Touring cyclists often develop a knee overuse injury during or after one specific usually long ride. These sporadic high-mileage riders often do not train adequately. Patellar pain is the most frequent problem (for more information see our Patellofemoral problems page), followed by Iliotibial Band Syndrome. Bicycle maladjustments are also frequent in this group and amongst recreational cyclists.

Cyclists vs. Runners

Cycling and Running are two very popular sports, but compared to cycling, running seems to be a better way do build up leg bone density, while cycling regularly will improve on upper limb bone density. Runners have a bit less developed arm muscles. Apart from that, it seems that cycling and running have similar effects on body composition: participants in both have approximately 10% more leg muscle than the exercise abstainers.

Knee Pain

The knee is the most common site of overuse injury in the cyclist, with an estimated 40% to 60% of riders experiencing knee pain. Like other cyclists, mountain bikers can suffer overuse injuries. Such injuries have been studied little in mountain bikers. In one study involving 265 off-road cyclists, 30% had recently experienced knee pain associated with mountain biking, and 37% reported low-back pain while riding; wrist pain and hand numbness were each reported by 19% (4).

Overuse injuries: in chronic cases, continued activity produces degenerative changes that lead to weakness, loss of flexibility, and chronic pain. Thus, in overuse injuries, the problem is often not acute tissue inflammation, but chronic degeneration (hence, for example, patella tendinosis instead of tendinitis). Pain in overuse injuries typically has insidious onset, but it may have an acute-on-chronic presentation. Overuse injuries most likely occur when an athlete changes the mode, intensity, or duration of training.

When evaluating knee pain it is very important to consider cyclists and bicycle anatomy, seasonal variations (early cycling season), training distance and intensity, and numerous human anatomical factors such as inflexibility, muscle imbalance, patellofemoral malalignment, leg-length discrepancy, etc. Do check the leg length: if the difference is up to 10 mm you can correct it by putting spacers under one cleat. If one leg is shorter by more than 10 mm you should try a shorter crank arm on the short leg side. Generally using shorter cranks keeps pedal speed up and knee stress down. Too long crank arms increase forces on the entire knee, but patellar and quadriceps tendons are most affected.

Get your knee checked today. Call +65 6471 2744 or Email to info@boneclinic.com.sg for Appointment

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

Knee Pain in Sports Injury

One of the top sports injuries today is a knee injury. Athletes commonly suffer from knee injuries because their knees are unfortunately not protected and therefore more susceptible to injury. Sadly, for some athletes, knee injuries are not only painful they are also career ending. Therefore, protecting the knees becomes a priority. Those that suffer from knee problems understand the frustration of this and they sympathize with anyone that has knee pain. And athletes are actually not the only ones that suffer from knee related injuries. This type of knee pain affects many individuals. Therefore, read the following information for a guide on the basic knee problems that could affect those around you.

Where It Starts And What It Feels Like

Any pain in or around the knee can be very difficult to deal with. Stabbing pains are hard to ignore when trying to walk or move around, and dull, achy pains can wear a person down quickly. Whether a person is young or old, heavy or thin, an athlete, knee pain can strike. And when it does, it is a pain that no one wants to suffer from. It is aggravating, irritating, and often hard to treat.

Sometimes people get just pains from a ‘catch’ in a muscle or a nerve momentarily misfiring. Most of the time, though, the pain comes from something that is already a problem or could develop into one. That being said, it may not be a serious problem and a little bit of extra care could easily take care of it.

List Of Common Causes And Conditions of Knee Pain

The most common causes of knee pain are listed here, so anyone who’s suffering with this kind of problem can get some insight into what might be causing their discomfort. Hopefully this will aid individuals as they seek to understand why they are suffering from knee trouble. They are definitely not alone in their pain. There are a wide variety of knee problems that affect many.

Cartilage injuries – when a person damages the cartilage in his knee, it can sometimes cause the bones to actually grind together rather than rest on the cartilage cushion that was originally there. Obviously, that can cause a lot of pain and discomfort, and it’s not something that can be easily adjusted or corrected. However, because of sports, exercise, and an active lifestyle, it’s becoming more common today.
Arthritis – because arthritis can strike in any joint, one of the main areas that people often notice it in is the knee. It can cause both pain and stiffness, and it can also keep a person from doing all the activities that he wants to do, simply because it’s just so very uncomfortable. It can also get worse and cause serious debilitation.
A sprain or strain – it’s possible to injure the knee in such a way that it will heal and doesn’t do damage to the cartilage. In other words, there isn’t any permanent damage done but the pain and discomfort from it is very real. It can also take a long time to heal up, especially because the knee is such an integral part of the body
Patellar Tendonitis – this is tendonitis around the knee joint. It happens to the patellar tendon, which is the large tendon over the front of the knee
Chondromalacia patella – this condition causes knee pain under the kneecap. It usually occurs because the cartilage begins to soften. Most of the people who suffer from this condition are between the ages of 15 and 35.
Dislocating Kneecap – when the kneecap has been dislocated the individual can experience acute symptoms of pain during the dislocation. However, this condition can lead to chronic knee pain.
Baker’s Cyst – this usually occurs because of the result of a meniscus tear. It causes swelling in the back of the knee joint, resulting in knee pain.
Bursitis – this condition affects people that kneel for work (i.e. gardeners or carpetlayers), and it affects the joint above the kneecap.
Plica Syndrome – this is an uncommon cause of knee pain and it is difficult to diagnose, however it can happen and cause knee pain.
Osgood Schlatter Disease – this knee problem occurs in many adolescents and happens because of the irritation of the growth plate in the front of the knee joint.
Osteochondritis Dissecans – this is another growth related problem that causes problems in the knees of adolescents.
Gout – although not usually a cause of knee pain, the symptoms of gout can spread to the knees.

List Of Common Treatment Options for Knee Pain

Treating knee pain can be difficult, largely because a lot of people just try to live with it. They aren’t sure what’s causing it, and they worry that it might be something serious. Because they worry, they avoid going to their doctor and trying to get it corrected, when it could actually be something simple. Here are some of the most common treatment options for knee pain.

• Surgery – while not something a lot of people want to think about, surgery for knee injuries is quite common. Because of doctors’ ability to go in laproscopically through small incisions, knee surgery is much easier than it’s been in the past. The recovery is faster and there is a lot less pain while the knee heals.
• Medications – arthritis can be treated with medications more easily now than it could in the past. That’s great news for anyone who’s dealing with knee pain as a result of arthritis and who doesn’t really know what else to do in order to feel better.
• Knee braces and over-the-counter pain relievers are also good choices for knee pain.
• Rest is a common treatment for knee pain. One of the only ways that knee pain will heal is if the individual decides to stay off their knees. This might mean that they have to take it easy for a while.
• Physical Therapy is extremely important for many knee injuries because it will build back the strength in the knee area. There are a variety of different techniques that physical therapists use, however most of them are useful at allowing the sufferer to overcome knee pain and be able to walk again without pain.
• Ice and heat are also recommended to reduce inflammation in the knee area. Often, this is the best treatment for knee pain and many patients forget this simple procedure.
• Injections are a powerful medication that will help reduce and even treat inflammation. They are used commonly with people that suffer from knee problems. It is important to talk to the doctor concerning this option before proceding.

Holistic Approach

There are also alternative forms of treatment that may prove beneficial with specific knee pain. Many people choose to go this route, especially because knee pain is a constant problem that often does not disappear overnight. Here are some suggestions.

• Glucosamine and chondrotitin and two substances that aid in knee pain problems. They occur naturally in cartilage and can be purchased over the counter as supplements. They help relieve pain for a wide variety of conditions and can even reduce inflammation. Both are an effective natural remedy.
• Acupuncture is also a top holistic approach for knee pain. Research suggests acupuncture is one of the leading methods to treat knee pain. The needles actually help several people that are suffering with this issue. Most people believe that the pain relief comes from the release of endorphins. It’s always a good idea to ask the doctor about acupuncture possibilities. It is a good option for many cases of knee pain.

When To See A Doctor for Knee Pain

At certain times a doctor’s help may be required to treat knee pain. This is important to recognize. While some knee injuries are basic sprains or bruises that require rest or ice, others may need to be evaluated by the proper medical expert. The sooner it is evaluated the sooner healing will begin. Here are some guidelines to help individuals assess whether or not a doctor is necessary.

• Visit the doctor when it becomes difficult to walk comfortably on the leg that has knee pain.
• See the doctor if the knee pain is combined with a deformity around the joint. This is not normal and should be addressed quickly.
• Go to the doctor for knee pain that happens during the knee or during rest.
• Visit the doctor if the knee locks or becomes difficult or impossible to bend.
• See the doctor if the joint or calf area begins to swell.
• Let the doctor check out the knee if there are signs of infection such as fever, redness, and warmth.
• Go to the doctor if anything unusual occurs with knee pain or if it persists for a long time.

Managing Knee Pain

Since knee pain is difficult to treat unless the injury requires surgery, pain management must be kept up individually. This means that each person should listen to the advice of his or her doctor. What activities do they knee to avoid? What stretches and activities should they incorporate to promote healing? These types of questions will guide them as they seek to overcome the pain they experience from knee issues.

Lastly, pain management can be hard and overlooked. Do not overdo it. Try to avoid activities that place too much pressure on the knees to promote healing and avoid further pain.

Stop your Knee Pain Today. Call us at +65 6471 2744 / Email to: info@boneclinic.com.sg

About Knee Pain Overview

If you are suffering from knee pain, see a doctor / orthopedic surgeon who can determine the cause and prescribe an appropriate treatment and pain management plan.

This site covers only the more common types of knee pain. It will familiarize you with various causes, treatments, and prevention of knee pain, but please do not attempt to diagnose yourself.

The knees are the most easily injured part of the body. The largest and most complicated joint, the knee is used for everything from standing up, sitting, to walking, running, etc. It’s a weight-bearing joint that straightens, bends, twists and rotates. All this motion increases your risk of acute or overuse knee injuries.

Acute knee injuries (including torn ligaments and torn cartilage) are often caused by twisting the knee or falling. Sports that involve running and jumping and sudden stopping and turning, such as soccer, basketball, volleyball, tennis, and baseball, as well as contact sports such as football, wrestling, and hockey increase the risk of an acute knee injury.

But more common than sudden knee injuries are injuries caused by overuse

Overuse knee injuries (including muscle strain, tendonitis and bursitis) may develop gradually over days or weeks. Pain is often mild and intermittent in the beginning and worsens over time. When muscles and tendons are stressed even slightly beyond their capabilities, microscopic tears occur. (Inflammation, which is part of the healing process, is what causes the pain). These tears must be given a chance to heal before subjected to the same activity to avoid overuse injury. Treat overuse injuries early to prevent chronic problems.

Knee pain is commonly caused by doing too much too soon when you haven’t exercised for a long period of time – especially high-impact aerobics; walking, running or jumping on hard surfaces or uneven ground; excessive running up and down stairs (When you walk upstairs you are putting pressure on your knees that is equivalent to four times your body weight, when running up the stairs it can be eight times your body weight).

Knee osteoarthritis is a common cause of knee pain. The risk increases with age. Osteoarthritis is a form of arthritis involving degeneration of the cartilage. Exercise is vital to maintain strength and flexibility of muscles supporting the knee, which reduces the stress on the knee joint.

People with knee osteoarthritis may also need to take pain medications and/or other complementary pain treatments.

Runners knee (also called patellofemoral pain or anterior knee pain) is a common cause of knee pain in young people (not just in runners). The pain is usually diffuse pain behind the kneecap. Symptoms often worsen after climbing stairs, jumping, running, or after a period of sitting. Caused by poor tracking of the kneecap, appropriate exercises prescribed by a doctor or physical therapist is the main treatment in correcting runners knee. Stay away from high-impact activity if you have this condition.

Prevent knee pain by keeping the muscles that support your knees strong and flexible. Start out slowly. Walk before you run – before you engage in a strenuous high impact activity such as jogging or running, try walking for a week. If walking causes knee pain, you shouldn’t be running. Warm up before working out. Give your body a chance to recover from exercise. If you do high impact activities take every other day off. Avoid running up and down stairs and full squats. Doing knee exercises to strengthen and stretch the muscles that support the knee are vital for knee pain and injury prevention. Proper footwear is also important, especially if walking or running on hard surfaces. Keep your weight under control. Reducing one’s weight reduces stress upon the knee.

Most knee pain is treated conservatively, but there are situations in which surgery is required. Athletes are at an elevated risk for sudden injuries that may require surgery, such as torn ligaments in the center of the knee or certain types of fractures. People with advanced knee osteoarthritis may need knee replacement surgery if they are severely limited in day-to- day activities because of their condition. This is optional surgery and is a last resort.

Most knee conditions respond to a combination of non-invasive treatments such as applying heat or cold, temporarily restraining from activities that aggravate pain, and medications that target pain and inflammation. Exercises to strengthen the muscles that support the knee help reduce stress on the knee joint and prevent re-injury.

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About Knee Pain

What Do the Knees Do?

The knees provide stable support for the body. They also allow the legs to bend and straighten. Both flexibility and stability are needed to stand, walk, run, crouch, jump, and turn. Other parts of the body help the knees do their job. These are:

  • Bones
  • Cartilage
  • Muscles
  • Ligaments
  • Tendons

Who Gets Knee Problems?

Men, women, and children can have knee problems. They occur in people of all races and ethnic backgrounds.

What Causes Knee Problems?

Mechanical knee problems can be caused by:

  • A direct blow or sudden movements that strain the knee
  • Osteoarthritis in the knee, resulting from wear and tear on its parts.

Inflammatory knee problems can be caused by certain rheumatic diseases, such as rheumatoid arthritis and systemic lupus erythematosus (lupus). These diseases cause swelling that can damage the knees permanently.

How Are Knee Problems Diagnosed?

Doctors diagnose knee problems by using:

  • Medical history
  • Physical examination
  • Diagnostic tests (such as x rays, bone scan, CAT scan, MRI, arthroscopy, and biopsy).

Arthritis in the Knees

The most common type of arthritis of the knee is osteoarthritis. In this disease, the cartilage in the knee gradually wears away. Treatments for osteoarthritis are:

  • Medicines to reduce pain, such as aspirin and acetaminophen
  • Medicines to reduce swelling and inflammation, such as ibuprofen and nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Exercises to improve movement and strength
  • Weight loss.

Rheumatoid arthritis is another type of arthritis that affects the knee. In rheumatoid arthritis, the knee becomes inflamed and cartilage may be destroyed. Treatment includes:

  • Physical therapy
  • Medications
  • Knee replacement surgery (for a seriously damaged knee).

Cartilage Injuries and Disorders

Chondromalacia (KON-dro-muh-lay-she-uh) occurs when the cartilage of the knee cap softens. This can be caused by injury, overuse, or muscle weakness, or if parts of the knee are out of alignment. Chondromalacia can develop if a blow to the knee cap tears off a piece of cartilage or a piece of cartilage containing a bone fragment.

The meniscus (meh-NISS-kus) is a C-shaped piece of cartilage that acts like a pad between the femur (thigh bone) and tibia (shin bone). It is easily injured if the knee is twisted while bearing weight. A partial or total tear may occur. 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. The seriousness of the injury depends on the location and the size of the tear.

Treatment for cartilage injuries includes:

  • Exercises to strengthen muscles
  • Electrical stimulation to strengthen muscles
  • Surgery for severe injuries.

Illustration depicting a lateral view of the knee, showing the location of: Quadriceps tendon; Patella; Lateral collateral ligament; articular cartilage; Patellar tendon; Meniscus; Tibia; Medial collateral ligament; Anterior cruciate ligament; Posterior cruciate ligament; and Femur.

Ligament Injuries

Two commonly injured ligaments in the knee are the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). An injury to these ligaments is sometimes called a “sprain.” The ACL is most often stretched or torn (or both) by a sudden twisting motion. The PCL is usually injured by a direct impact, such as in an automobile accident or football tackle.

The medial and lateral collateral ligaments are usually injured by a blow to the outer side of the knee. This can stretch and tear a ligament. These blows frequently occur in sports such as football or hockey.

Ligament injuries are treated with:

  • Ice packs (right after the injury) to reduce swelling
  • Exercises to strengthen muscles
  • A brace
  • Surgery (for more severe injuries).

Tendon Injuries and Disorders

The three main types of tendon injuries and disorders are:

  • Tendinitis and ruptured tendons
  • Osgood-Schlatter disease
  • Iliotibial band syndrome

Tendon injuries range from tendinitis (inflammation of a tendon) to a ruptured (torn) tendon. Torn tendons most often occur from:

  • Overusing a tendon (particularly in some sports). The tendon stretches like a worn-out rubber band and becomes inflamed.
  • Trying to break a fall. If thigh muscles contract, the tendon can tear. This is most likely to happen in older people with weak tendons.

One type of tendinitis of the knee is called jumper’s knee. In sports that require jumping, such as basketball, the tendon can become inflamed or can tear.

Osgood-Schlatter disease is caused by stress or tension on part of the growth area of the upper shin bone. It causes swelling in the knee and upper part of the shin bone. It can happen if a person’s tendon tears away from the bone, taking a piece of bone with it. Young people who run and jump while playing sports can have this type of injury.

Iliotibial band syndrome occurs when a tendon rubs over the outer bone of the knee causing swelling. It happens if the knee is overused for a long time. This sometimes occurs in sports training.

Treatment for tendon injuries and disorders includes:

  • Rest
  • Ice
  • Elevation
  • Medicines such as aspirin or ibuprofen to relieve pain and reduce swelling
  • Limiting sports activity
  • Exercise for stretching and strengthening
  • A cast, if there is a partial tear
  • Surgery for complete tears or very severe injuries.

Other Knee Injuries

Osteochondritis dissecans (OS-tee-oh-kon-DRI-tis DIS-secans) occurs when not enough blood goes to part of the bone under a joint surface. The bone and cartilage gradually loosen and cause pain. Some cartilage may break off and cause sharp pain, weakness, and locking of the joint. A person with this condition may develop osteoarthritis. Surgery is the main treatment.

  • If cartilage fragments have not broken loose, a surgeon may pin or screw them in place. This can stimulate new blood flow to the cartilage.
  • If fragments are loose, the surgeon may scrape the cavity to reach fresh bone and add a bone graft to fix the fragments in position.
  • Research is being done to investigate cartilage and tissue transplants.

Plica (PLI-kah) syndrome occurs when bands of tissue in the knee called plicae swell from overuse or injury. Treatments for this syndrome are:

  • Medicines such as aspirin or ibuprofen to reduce swelling
  • Rest
  • Ice
  • Elastic bandage on the knee
  • Exercises to strengthen muscles
  • Cortisone injection into the plicae
  • Surgery to remove the plicae if the first treatments do not fix the problem.

What Kinds of Doctors Treat Knee Problems?

Injuries and diseases of the knees are usually treated by an orthopaedist (a doctor who treats problems with bones, joints, ligaments, tendons, and muscles).

How Can People Prevent Knee Problems?

Some knee problems (such as those resulting from an accident) can’t be prevented. But many knee problems can be prevented by doing the following:

  • Warm up before playing sports. Walking and stretching are good warm-up exercises. Stretching the muscles in the front and the back of the thighs is a good way to warm up the knees.
  • Make the leg muscles strong by doing certain exercises (for example, walking up stairs, riding a stationary bicycle, or working out with weights).
  • Avoid sudden changes in the intensity of exercise.
  • Increase the force or duration of activity slowly.
  • Wear shoes that fit and are in good condition.
  • Maintain a healthy weight. Extra weight puts pressure on the knees.

What Types of Exercise Are Best for Someone With Knee Problems?

Three types of exercise are best for people with arthritis:

  • Range-of-motion exercises. These exercises help maintain or increase flexibility. They also help relieve stiffness in the knee.
  • Strengthening exercises. These exercises help maintain or increase muscle strength. Strong muscles help support and protect joints with arthritis.
  • Aerobic or endurance exercises. These exercises improve heart function and blood circulation. They also help control weight. Some studies show that aerobic exercise can reduce swelling in some joints.