Knee Injuries and Disorders
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1 Knee Injuries and Disorders Introduction The knee lets the leg bend and straighten. It also provides support for the body. Knee problems can cause pain and difficulty walking. There are many injuries and disorders that can affect the knee. Treatment for knee injuries and disorders depends on the cause. Treatment may include medicine, surgery or other treatments. This reference summary will help you understand injuries and disorders that affect the knee. It covers common injuries and disorders of the knee, as well as treatment options. The Knee The knee is the largest joint in the body. It connects the thigh bone to the shin bone. The thigh bone is also called the femur. The shin bone is also called the tibia. Thigh Bone The patella is also included in the knee joint. The patella is a floating bone that gives the knee its round shape. These bones are covered by special tissue called cartilage or meniscus. The smooth surface of the meniscus allows for smooth and painless movement at the knee joint. Patella Synovium Shin Bone Between the two pieces of cartilage in a joint, there is a little bag lined by special tissue. The tissue is known as synovium. The synovium secretes fluid that helps lubricate the joint. Tendons in the knee connect muscles of the leg to bone. Muscles and tendons help the knee joint move. The knee joint allows the leg to bend up and down only, not side to side. 1
2 Ligaments connect the bones in the knee joint and help stabilize the knee. They protect the knee from going sideways and getting injured. Two ligaments are located on the sides of the knee. These are called the medial collateral ligament, or MCL, and the lateral collateral ligament, or LCL. There are also two ligaments in the center of the knee that cross each other. These are called the anterior cruciate ligament, or ACL, and the posterior cruciate ligament, or PCL. Even though the joint allows movement, the muscles of the legs perform the actual motion. Symptoms Many knee injuries and disorders have similar symptoms. The main symptoms are pain and swelling in or around the knee joint. The pain may be dull or more severe. It can get worse when doing certain activities, such as climbing stairs or straightening the knee. In some cases, the pain may be relieved by rest. Other common symptoms of knee injuries and disorders are: A knee that locks or buckles. A stiff knee. Clicking or popping noises from the knee. Weakness in the knee. Some knee injuries and disorders may also cause: A knee that is red and warm to the touch. A tender, bony bump below the kneecap. Difficulty bending, extending or lifting the leg. Talk to your health care provider if you notice any of these symptoms or other changes. Finding a problem early makes treatment easier in most cases. Arthritis Arthritis is the most common disease that affects the knees. The cartilage in the knee gradually wears away. This causes pain and swelling. There are many types of arthritis. Almost all types of arthritis can affect the knee. The following types are the most common. 2
3 Osteoarthritis is due to chronic wear and tear. The cartilage wears away and causes changes to the bone. It is more common in older people. Post-traumatic arthritis is due to trauma to a joint. Trauma may happen during a car accident or a sports injury, for example. Rheumatoid arthritis involves swelling, redness and tenderness in the joint. It is an autoimmune disease. This means the immune system attacks parts of the body. In rheumatoid arthritis, the synovium is attacked and becomes inflamed. This leads to the destruction of the synovium as well as the underlying joint. Other rheumatic diseases can also affect the knee joint. These include: Ankylosing spondylitis. Gout. Infectious arthritis. Lupus. Psoriatic arthritis. Ankylosing spondylitis is an inflammatory type of arthritis. It primarily affects the spine but can also affect the knee. Gout is a very painful type of arthritis. It happens when crystals of uric acid build up in the joints. Uric acid is a waste product of the body. Infectious arthritis is an infection in the joint. The infection comes from a bacterial, viral or fungal infection that spreads from another part of the body. Lupus is an autoimmune disease. This means the immune system attacks healthy cells and tissues by mistake. Lupus can cause many symptoms, including joint pain or swelling. Psoriatic arthritis is a type of arthritis that often happens with psoriasis. Psoriasis is a skin disease. It causes itchy or sore patches of thick, red skin with silvery scales. Unfortunately, there is no cure for most types of arthritis. But arthritis can be slowed and controlled. Medicines can decrease inflammation in the body. Physical therapy can help keep joints affected by arthritis in shape. Splints are commonly used to prevent, slow down or make up for joint deformities. 3
4 If other treatments are unsuccessful, surgery may be done. The type of surgery depends on the type of arthritis. In severe cases, a knee replacement surgery can be done. It involves removing damaged parts of the joint and replacing those parts with man-made materials. Ligament Injuries Ligament injuries are common in sports. Two ligaments in the knee that are commonly injured are the ACL and PCL. These ligaments are in the center of the knee. The ACL is often injured by a sudden twisting motion. This may cause the ACL to tear. The PCL is often injured by a direct impact. This could be caused by a car accident or football tackle. The MCL and LCL may also be injured. The MCL runs along the inside of the knee joint. The LCL runs along the outside of the knee joint. The MCL and LCL may be injured by a blow to the outer side of the knee. This can happen in sports, such as football or hockey. The ligaments may be sprained or they may tear. A ligament injury may cause your knee to swell. This can make walking painful. Your knee may also feel unstable. Right after the injury happens, ice packs may be used to reduce swelling. Physical therapy and rehabilitation use exercises to help restore the knee to its pre-injury condition. Sometimes a knee-brace is used to give the knee support. Surgery may be done for more severe injuries. It may also be done if the patient wants to return to sports that put a high demand on the knees. Cartilage Injuries and Disorders Cartilage covers the bones in the knee joint. It allows for smooth and painless movement at the knee joint. When cartilage is injured or damaged, the knee does not move as smoothly. This can cause pain when moving or straightening the knee joint. It can also cause the knee to lock or make a clicking noise. The most common problems involving cartilage are arthritic issues discussed earlier. The rest of this section is about the other problems that can affect cartilage. Chondromalacia is a disorder that affects the cartilage of the kneecap. It causes the cartilage under the kneecap to soften. This lets the kneecap rub against the thigh bone. Eventually the cartilage may be worn away. 4
5 Chondromalacia is more common in young adults. It can be caused by: Injury. Misalignment of the kneecap. Overuse of the joint. Weak muscles around the hip and knee. The meniscus may also be injured. The meniscus is a C-shaped piece of cartilage. It acts like a cushion between the thigh bone and shin bone. The meniscus is easily injured if the knee is twisted while supporting weight. When injured, the meniscus may tear. If the tear is small, the meniscus stays connected to the front and back of the knee. If the tear is large, the meniscus may only be connected by a small thread of cartilage. Treatment for cartilage injuries and disorders often includes exercises to strengthen muscles. The exercises focus on muscles around the hip and knee. Exercises may include: Riding a stationary bicycle. Swimming or exercising in a pool. Using a cross-country ski machine. Electrical stimulation may be used to treat cartilage injuries and disorders. It can help strengthen muscles. For more severe injuries, surgery may be needed. During surgery, cartilage fragments can be removed. Any tears or other types of damage can be repaired as well. Tendon Injuries and Disorders Tendons connect muscle to bone. There are three main types of tendon injuries and disorders that can affect the knee. These include: Tendinitis and ruptured tendons. Osgood-Schlatter disease. Iliotibial band syndrome. Tendon 5
6 Tendinitis is inflammation of a tendon. A ruptured tendon is when a tendon tears. These problems may be caused by: Overusing a tendon. This may be caused by playing certain sports. Trying to break a fall. This is more likely to happen in older people. If a tendon is overused, it stretches and can become inflamed. One example of tendinitis is called jumper s knee. It affects the lower tendon of the kneecap. This tendon is called the patellar tendon. Jumper s knee happens in sports that require a lot of jumping. One example of a sport that requires jumping is basketball. Treatment for tendinitis often involves resting and elevating the joint. Applying ice and taking NSAID medicines can help reduce swelling. Exercises may also be helpful. NSAID stands for nonsteroidal anti-inflammatory drug. Some examples of these drugs are aspirin or ibuprofen. If a tendon ruptures, surgery can be done to reattach the ends. A cast is worn after surgery. Crutches are used to allow the tendon time to heal. Osgood-Schlatter disease affects the growth area of the upper shin bone. It is caused by repeated stress or tension to this area. The disease often affects active young people, especially boys ages 10 to 15. Osgood-Schlatter disease may be caused by sports with a lot of running or jumping. It is also associated with an injury where the tendon tears away from the tibia. When the tendon tears away, it takes a piece of bone with it. Usually Osgood-Schlatter disease will improve without treatment. But applying ice can help reduce inflammation. Exercises may also help strengthen the knee. Sports activities may need to be avoided until the disease goes away. Iliotibial band syndrome happens when a band of tissue rubs over the bone of the knee. It may be caused by: Direct injury to the knee. Long-term overuse of the knee, especially with running. Iliotibial band syndrome often goes away after a person reduces activity. Stretching exercises and muscle strengthening exercises can help a person return to activities over time. Rarely, surgery can be done to split the tendon so that it is not as tight. 6
7 Other Knee Injuries There are also some other common knee injuries, including: Osteochondritis dissecans. Plica syndrome. Osteochondritis dissecans happens when part of the bone in a joint does not get enough blood. This causes the bone and cartilage to slowly loosen. Some cartilage may break off. It can cause sharp pain and locking of the knee joint. The main treatment for osteochondritis dissecans is surgery. Loose cartilage fragments can be pinned or screwed in place. Loose fragments can be reattached. Plica syndrome affects bands of tissue in the knee called plicae. When these bands of tissue swell, it is called plica syndrome. Plica syndrome is caused by overuse or injury. Treatment of plicae syndrome may include: Ice or medicines to reduce swelling. Resting the joint. Elastic bandage on the knee. Exercises to strengthen muscles. Cortisone injections into the plicae. Surgery to remove the plicae if other treatments are unsuccessful. Summary The knee lets the leg bend and straighten. It also provides support for the body. Knee problems can cause pain and difficulty walking. There are many injuries and disorders that can affect the knee. These include: Arthritis. Ligament injuries. Cartilage injuries and disorders. Tendon injuries and disorders. Other knee injuries. Treatment for knee injuries and disorders depends on the cause. Treatment may include medicine, surgery or other treatments. It may also include exercises, knee braces and reduced activity. Talk to your health care provider if you notice any abnormal changes or knee symptoms. Finding a problem early can make its treatment easier. 7
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