Most common knee injuries & their treatments - Knee Clinic Manchester

1. Most Common Knee Injuries & Their Treatments

2. Introduction The human knee is the largest joint in the body. It is composed of the Tibia, Femur and Patella bones; the joint surfaces of which are covered in cartilage which allows smooth movement and gliding of the joint surfaces. There are multiple structures around the knee which hold the bones in place and allow the movement to occur and due to the significant forces generated, the knee is very prone to injury.

3. The Structures At Risk Of Injury • Ligaments – ACL / PCL / MCL / LCL • Meniscus • Patella • Cartilage

4. Ligaments – ACL / PCL / MCL / LCL ACL Injuries ACL stands for anterior cruciate ligament. The anterior cruciate ligament is one of a pair of cruciate ligaments in the centre of the human knee. These two ligaments form part of a complex ligamentous structure which provides stability to the human knee. The ACL is a relatively short ligament with two bundles and connects the top of the tibia to the end of the femur within the knee joint. Its main function is to provide stability to the knee mainly stopping the tibia from translating too far anteriorly. The ACL provides around 85% of the restraining force to this anterior tibial displacement. The ACL is the most injured ligament of the four located in the knee.

5. Ligament Injuries (Non ACL) Aside from the Anterior Cruciate Ligament (ACL), there are a number of other ligaments in the knee that can be injured including posterior cruciate ligament (PCL), the medial collateral ligament (MCL) and the lateral collateral ligament (LCL).

6. Meniscal Injury The meniscus is a form of cartilage which is C-shaped and triangular in cross section and sits in between the femur and the tibia on the medial and lateral sides of the knee. There are two menisci in the knee which differ slightly in their shape and biomechanics. The main function is to protect the femur and tibial cartilage joint surfaces from the incredible amount of force and load that passes through the knee joint on a daily basis from walking to intense exercise.  The meniscus is attached to the top of the tibia via the anterior and posterior horns and through the capsular attachments circumferentially around the knee.  It is through the capsule that the meniscus receives a little blood supply to its periphery.  The outer one third of the meniscus has blood flow going through it but the inner two thirds of the meniscus is avascular and has no blood flow.  

7. Patellofemoral Instability The patellofemoral joint is a very complex joint consisting of two bones at the front of the knee. The two bones are the patella (kneecap) and the front of the distal femur (thigh bone just deep to the kneecap.) The patella joins with the front of the femur in the area called the trochlea. This joint is made up of complex interplay of muscles, tendons, ligaments and boney anatomy. Problems with any of these can cause pain and instability around the patellofemoral joint.

8. Cartilage Injury This is a painful condition, where a small area of cartilage is damaged in an otherwise healthy knee. If left untreated, this can cause the surrounding cartilage to degrade and turn into full-blown Osteoarthritis. Unfortunately, the cartilage can be damaged from trauma or other pathologies like Osteochondritis Dissecans (OCD); this results in a painful lesion which if left untreated can progress to early joint degeneration and osteoarthritis.

9. What Is The Most Common Knee Injury In Sports? The Anterior Cruciate Ligament (ACL) rupture is the most prevalent knee ligament injury, comprising 90% of all cases. Around 15,000 ACL reconstruction surgeries are performed annually in the UK, and approximately 400,000 in the USA. The ACL, situated in the middle of the knee, stabilizes it throughout its range of motion. Female athletes face a higher risk, with a ratio of 4:1 compared to males, due to different landing biomechanics and neuromuscular activation. Non-contact pivoting injuries are the most common cause, often occurring in sports like football, basketball, and skiing. ACL injuries are frequently accompanied by damage to other knee structures, such as the meniscus and ligaments, in 60-70% of cases.

10. How Do I Know If My Knee Injury Is Serious? A significant "pop" sensation often accompanies an ACL rupture, followed by rapid swelling within the knee joint due to bleeding. This immediate swelling indicates a serious injury. In such cases, individuals may find it challenging to bear weight on the affected knee and experience a noticeable decrease in knee mobility, rendering movement difficult or impossible. These symptoms underscore the severity of the knee injury and warrant prompt medical attention.

11. Get The Best Treatment For Your Knee Injuries At The Knee Clinic Manchester. • In the immediate post injury phase, we would advise icing the knee asap and attending a hospital or specialist clinic like The Knee Clinic Manchester, for assessment. • In the current climate, waiting times in Accident and Emergency can be extremely frustrating. We are specialists in assessing and managing these injuries and have the highest quality team approach to get you moving and back on your feet asap. • The assessment involves an X-ray to exclude fracture and then an MRI scan. A brace can be fitted to help support the knee during the first 2-6 weeks and get it moving, and start rehabilitation.

12. Nonsurgical Treatment Numerous knee injuries respond well to straightforward treatments, including: • Immobilization: Your physician might suggest a brace to stabilize your knee or a cast to support bone healing. Crutches may also be provided to alleviate weight-bearing on the injured leg, promoting protection. • Physical therapy: Tailored exercises aid in knee function restoration and bolster the surrounding leg muscles for enhanced support. • Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications like ibuprofen and naproxen effectively alleviate pain and swelling, facilitating the healing process.

13. Surgical Treatment Many fractures and injuries around the knee require surgery to fully restore function to your leg. In some cases — such as for many ACL tears — surgery can be done arthroscopically using miniature instruments and small incisions. Learn more: Knee Arthroscopy Fractures, on the other hand, often require open surgery with a larger incision that provides your surgeon with a more direct view and easier access to the injured structures. SOURCE: Department of Research & Scientific Affairs, American Academy of Orthopaedic Surgeons. Rosemont, IL: AAOS; February 2014. Based on data from the National Ambulatory Medical Care Survey, 2010; Centers for Disease Control and Prevention. Get in touch for more details or if you want to discuss ACL reconstruction surgery.