The knee is one of the most common body parts to be injured, affecting people of all ages. Knee pain may be the result of an injury such as tendon, ligament or cartilage damage. Your knee ligaments are bands of tissue that help maintain stability by holding the bones together. Common symptoms of knee injury include instability, pain and swelling. Medical conditions such as arthritis, infections and gout can also cause knee pain.
Many types of knee pain can be treated at home with self-care measures, and you should start to feel better in a few days. Physiotherapy and knee braces can help relieve pain; however, your knee may require surgical repair if this does not relieve your symptoms. Contact your doctor if they persist or get worse.
Common Types of Knee Injuries
The knee is a complex structure and one of the most stressed joints in the body. It is the largest joint, crucial for movement and susceptible to injury. The knee allows people to bend and straighten their legs so they can sit, squat, jump, and run.
The knee is made up of four components: bones, cartilage, ligaments and tendons. The femur (thighbone) is at the top of the knee joint. The tibia (shinbone) sits below the knee. The patella (kneecap) covers the joint between the femur and the tibia. The cartilage is the tissue that protects the bones of the knee joint, allowing ligaments to slide easily over the bones and shielding them from impact. There are four ligaments in the knee that act like ropes, holding the bones together and stabilising them. The tendons connect the muscles that support the knee joint to bones in the upper and lower leg.
Knee pain can be caused by injuries, mechanical problems, arthritis and other problems such as:
ACL Injury
An ACL injury is a tear or sprain of the anterior cruciate ligament (ACL) which is one of the major ligaments located in your knee. An ACL injury is particularly common in people who play sports that involve sudden stops, changes of direction, jumping and landing such as football, rugby, basketball or skiing.
Fractures
A patella fracture is a break in the patella, the small bone that sits in front of the knee. The patella (kneecap) acts as a shield for your knee joint making it vulnerable to fracture if you fall directly on to your knee or hit it against a hard surface such as a dashboard. People whose bones are weak due to a medical condition such as osteoarthritis can sustain a knee fracture from something as simple as stepping incorrectly.
Dislocation
A dislocated kneecap is a common injury that is typically caused by a blow or sudden change in direction when the leg is planted on the ground, such as dancing or playing sport. The kneecap (patella) sits over the knee, gliding over a groove in the joint when you bend or straighten your leg. When the kneecap dislocates, it comes out of the groove and the supporting tissues can be torn or stretched.
Torn Meniscus
The meniscus is made up of two tough, rubbery wedges of cartilage that act as shock absorbers between your thighbone and shinbone. The meniscus can be torn if you suddenly twist your knee whilst bearing weight on it, such as when playing sport. It can also tear gradually due to aging. When the meniscus tears because of aging, it is referred to as a degenerative meniscus tear. A torn meniscus is one of the most common knee injuries and can cause pain, swelling and stiffness. In the case of a sudden meniscus tear, you may also hear or feel a pop in the knee.
Knee Bursitis
Some knee injuries cause inflammation in the bursa. Bursa are the small sacs of fluid that cushion the knee joints so that tendons and ligaments can glide smoothly over the joint. The sacs can swell and become inflamed due to overuse or repeated pressure from kneeling; this is referred to as bursitis. The majority of cases of bursitis are not serious and can be treated easily with self-care. However, sometimes you may require medication or aspiration; a procedure that uses a needle to withdraw excess fluid. Bursitis most frequently occurs over the kneecap or on the inner side of your knee, below the joint.
Patellar Tendinitis
Patellar tendinitis, also known as jumpers knee, is an inflammation of one or more tendons (thick, fibrous tissue that attaches the muscles to bones). The patellar tendon works alongside the muscles at the front of the thigh to extend the knee so you can jump, run and kick. Runners, cyclists, skiers, and people involved in jumping sports are more likely to develop inflammation in the patellar tendon. The majority of people with patellar tendinitis will have physiotherapy to stretch and strengthen the muscles around the knee.
Arthritis in the Knee
The two most common types of arthritis found in the knee are osteoarthritis and rheumatoid arthritis. Osteoarthritis, also known as degenerative arthritis is a wear and tear condition that occurs when the cartilage in your knee gradually deteriorates with age or due to overuse. Rheumatoid arthritis is an autoimmune condition that can affect the majority of joints in your body. Even though rheumatoid arthritis is a chronic disease, it tends to vary in severity and in some cases, can even come and go.
Symptoms of Knee Injuries
The site and severity of knee pain may differ, depending on the cause of the problem. Common symptoms experienced with a knee injury include:
- Stiffness and swelling
- Redness and warm to touch
- Bruising and tenderness
- Instability and weakness
- Popping or crunching noise and sensation
- Inability to straighten the knee completely
Ligament tear symptoms include:
- Pain
- Swelling
- Instability – feeling like your knee will give out
Meniscus injury symptoms include:
- Severe pain and swelling
- Inability to move your knee as normal due to a locking sensation
- You should still be able to walk a little on the affected leg
Torn tendon symptoms include:
- Your kneecap is sitting higher or lower than usual
- Inability to straighten your knee
- Pain and swelling
If knee pain becomes severe or lasts for longer than a week, contact your doctor or physiotherapist. Make sure you let them know if you are experiencing noticeable swelling, are unable to fully extend or flex your leg, cannot bear weight on your knee or feel like your leg is unstable. In cases of blunt force or trauma, immediately after the injury has occurred you should contact your doctor.
Diagnosis
Your doctor will start out with a physical exam. During the physical exam, your doctor is likely to assess the knee for pain, tenderness, swelling and visible bruising. They will ask you to move your leg in order to examine mobility and touch, push and pull the joint to evaluate the structures and integrity of the knee.
Your doctor will ask about your symptoms and ask you to describe how the injury occurred, where you feel the pain and what type of pain it is. If your doctor thinks that your knee injury will heal better with surgery, they will refer you to an Orthopaedic surgeon.
To confirm a diagnosis, your doctor may recommend some other tests such as:
X-ray or CT Scan
An X-ray or CT scan can help detect a broken bone (fracture) or arthritis.
MRI Scan
An MRI scan may help to show up damage to the cartilage or soft tissues such as ligaments of your knee following an injury.
Knee Aspiration
Joint aspiration is a procedure most often carried out on the knee to remove fluid from the joint using a needle and syringe. This is typically carried out under local anaesthetic to ease swelling and obtain fluid for analysis to diagnose a disorder or problem.
Knee Arthroscopy
Your doctor may recommend a knee arthroscopy to inspect inside your knee, using a telescope attached to a tiny camera (an arthroscope). This can help to identify if there is damage to the meniscus, cartilage or ligament. During arthroscopy, your doctor may treat your injury at the same time.
Blood Test
If your doctor suspects an infection, they are likely to carry out blood tests which are sent to a laboratory for analysis.
Treatment of Knee Injuries
Different treatments for knee injuries will be suggested depending on the cause of the injury, pain and severity of the damage. In cases of overuse injuries or strain, RICE (rest, ice, compression and elevation) will usually allow the knee to heal over time. Treatment may also involve physiotherapy to help encourage movement and medication to help manage pain and inflammation.
In some cases, your doctor may recommend injections in to the knee. Corticosteroids are the most common knee injections that can help reduce symptoms of arthritis and offer pain relief that can last a few months. Platelet rich plasma (PRP) may also be recommended. PRP contains many different growth factors that help reduce inflammation and encourage healing. These injections generally work best on people whose knee pain is caused by tendon tears, sprains or injury.
Tears or other trauma-related knee injuries may need bracing/splinting, popping the knee back into place, or surgery. If surgery is required, it is likely you will be unable to use the knee for a period following the procedure, and may need crutches or a wheelchair during your recovery.
Surgical Options for Knee Injuries
Arthroscopic Surgery
Arthroscopic (keyhole) surgery is a minimally invasive technique used to diagnose and treat knee conditions or injuries, using small incisions and a camera (arthroscope). Arthroscopy may be used to remove or repair damaged cartilage and reconstruct torn ligaments.
ACL Reconstruction
ACL reconstruction surgery is usually carried out by arthroscopic surgery. A new ligament or graft is created to take the place of the torn ACL. This type of surgery is recommended for individuals who wish to return to sporting activities that require lateral pivoting of the knee.
Partial Knee Replacement Surgery
During a partial knee replacement, only the most damaged parts of the knee will be replaced with metal or plastic. The surgery can usually be carried out with small incisions enabling you to heal quicker than with surgery to replace the entire knee.
Total Knee Replacement Surgery
During total knee replacement surgery, the doctor cuts away any damaged bone and cartilage from your thighbone, shinbone and kneecap, and replaces it with an artificial joint made of metal, high-grade plastics and polymers.
Outlook
It is not always possible to prevent knee injuries; however, a person can take precautions to reduce the risk. For example, people who run or play sports need to wear the appropriate shoes and protective equipment. Stretching before and after exercise can help prevent injury to the knee.
Regular exercise to keep your fitness levels up means that your muscles are stronger and more flexible so they can support your joints and prevent knee injuries. It is also important that if you are experiencing pain you do not exercise as it can worsen the condition.
Need Help?
If you are experiencing pain in your knee which you think is from an injury, you can be seen by a Consultant Orthopaedic Knee Surgeon One Ashford Hospital, usually within 48 hours. One Ashford Hospital is well placed to see patients with knee injuries from Ashford, Maidstone, Canterbury, Folkestone, Dover and all surrounding villages. To book an appointment, call the hospital direct on 01233 423 000 or email here.
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