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Causes of Knee Injuries and Pain

1. Anterior Knee Pain/Chondromalacia/Patellofemoral Pain Syndrome

anatomy diagram illustrating knee structure and runners knee condition also known as Anterior Knee Pain/Chondromalacia/Patellofemoral

Condition: Anterior Knee Pain/Chondromalacia/Patellofemoral Pain Syndrome is a condition that develops from overuse, injury, excess weight or a kneecap that is not properly aligned. Anterior Knee pain indicates that the cartilage under the kneecap is damaged by wear and tear or by injury. This condition can lead to knee surgery and is more common in adolescents and young adults. The main symptom is knee pain especially when sitting with bent knees, squatting, jumping or using the stairs. It is also common to experience knee buckling or have a catching, popping or grinding sensation while walking.

Treatment: Selective strengthening of the inner portion of the quadriceps muscle helps normalize the tracking of the patella. Stretching and strengthening the quadriceps and hamstring muscle groups is critical for an effective and lasting rehabilitation of chondromalacia patella. "Quad sets1" are the foundation of such a physical therapy program. Quad sets are done by contraction the thigh muscles while the legs are straight and holding the contraction for a count of 10. Sets of 10 contractions are done between 15-20 times per day.

 

2. Osteochondritis Dissecans

 anatomical diagrame illustrating knee joint suffering from osteochondritis dissecans

Condition: Osteochondritis dissecans occur when a piece of cartilage and a thin layer of bone separate from the end of the bone due to a loss of blood supply. The loose piece either stays in place or falls into the joint space, causing the joint to become unstable. This condition causes pain and sometimes lack of joint movement. Children and adolescents have a higher rate of Osteochondritis Dissecans and it usually develops among those that are highly active. It can develop from a joint injury or from frequent activity like running and jumping. There can be associated pain if the loosened piece of cartilage and bone gets caught between the moving parts of the joint, however if the cartilage and bone stays in place there can be little to no pain.

Treatment: Arthroscopy Is a surgery intended to fix tears in the soft tissue around the knee or hip and remove both the damaged and freefloating cartilage pieces. The surgeon inserts a fiberoptic video camera through a small incision which allows the surgeon to see inside the joints without making a large incision.

A number of conditions are treated with Arthroscopy such as:

  • Bone spurs or loose bone fragments
  • Damaged or torn cartilage, especially the meniscal cartilage
  • Inflamed joint lining, such as the synovial membrane
  • Joint infections
  • Torn ligaments or tendons
  • Scarring or tissue overgrowth within joints
  • Damaged joint surfaces or softening of the articular cartilage known as Chondromalacia
  • Abnormal alignment or instability of the kneecap

After Surgery
After knee arthroscopy there will be swelling around the knee, which can take anywhere from 7–15 days to completely settle. It is important to wait until there is no swelling before doing any serious exercise or extensive walking, because the knee will not be fully stable; extensive exercise may cause pain and in some cases cause the knee to swell more.

At Home
Many patients can return home the same day or the next morning after surgery. The dressing will be need to be kept dry however in one to two weeks the wound should begin healing. Your surgeon will advise you on the timeline you can expect to return to your normal activities however following their advice and regularly performing the exercises for rehabilitation.

When to Seek Medical Advice
Complications are rare however if there is severe or increasing pain in the joint, swelling, discolour or discharge from the wound, numbness or tingling or you have a high temperature you should contact your physician.

3. Torn Meniscus

anatomical diagram illustrating knee join damaged by a torn meniscus

Condition: Torn Meniscus is caused by activity that requires a continuous twisting motion or rotation of your knee, especially if your full weight is placed on the knee. A torn meniscus causes pain, swelling and stiffness. It may also be difficult to extend your knee fully. Ice and rest can be enough to heal this type of injury, however if it’s worse it may require surgical repair.

Treatment: Initially you will want to rest the affected knee and apply ice to reduce swelling. Physical therapy can help you strengthen the muscles around your knee and in your legs to help stabilize and support the knee joint. Arch supports or other shoe inserts can help to distribute force more evenly around your knee or decrease stress on certain areas of your knee.

If your knee remains painful, stiff or locked, you may require surgery. It is possible to repair a torn meniscus, especially in children and young adults. If the tear can't be repaired, the meniscus may be surgically trimmed. Surgery may be done through tiny incisions using an arthroscope.

Arthroscopy
Arthroscopy Is a surgery intended to fix tears in the soft tissue around the knee or hip and remove both the damaged and freefloating cartilage pieces. The surgeon inserts a fiberoptic video camera through a small incision which allows the surgeon to see inside the joints without making a large incision. A number of conditions are treated with Arthroscopy such as:

  • Bone spurs or loose bone fragments
  • Damaged or torn cartilage, especially the meniscal cartilage
  • Inflamed joint lining, such as the synovial membrane
  • Joint infections
  • Torn ligaments or tendons
  • Scarring or tissue overgrowth within joints
  • Damaged joint surfaces or softening of the articular cartilage known as Chondromalacia
  • Abnormal alignment or instability of the kneecap

After Surgery
After knee arthroscopy there will be swelling around the knee, which can take anywhere from 7–15 days to completely settle. It is important to wait until there is no swelling before doing any serious exercise or extensive walking, because the knee will not be fully stable; extensive exercise may cause pain and in some cases cause the knee to swell more.

At Home
Many patients can return home the same day or the next morning after surgery. The dressing will be need to be kept dry however in one to two weeks the wound should begin healing. Your surgeon will advise you on the timeline you can expect to return to your normal activities however following their advice and regularly performing the exercises for rehabilitation.

When to Seek Medical Advice
Complications are rare however if there is severe or increasing pain in the joint, swelling, discolour or discharge from the wound, numbness or tingling or you have a high temperature you should contact your physician.

4. Patellar Tracking Disorder

anatomical diagram illustrating knee join with patellar tracking disorder/floating patella

Condition: Patellar Tracking disorder occurs when the kneecap, or Patella, shifts out of place as the leg bends or straightens. Most commonly, the kneecap shifts too far to the outside of the leg while in some cases the kneecap shifts too far to the inside of the leg. Your knee joint is a complex hinge that joins the two bones of the lower leg, your tibia and fibula, to the thigh bone you femur, thus playing an integral part in daily movements. The kneecap sits in the small groove of the thigh bone held in place by tendons on the top and bottom and by ligaments on the sides. Cartilage lines the underside of the kneecap helping it glide along the groove in the thighbone. Any problems in these particular workings of the knee can result in Patellar Tracking Disorder. PTD is caused by a number of factors such as:

  • Weak thighs muscles
  • Muscles, tendons or ligaments in the leg that are too tight or too loose
  • Activities that stress the knee, especially twisting motions.
  • A traumatic injury to the knee, such as a blow that pushes the kneecap to the outer side of the leg.
  • Bone structure problems in the knee or misalignment

You are more likely to develop PTD if you have any of the above conditions and you are overweight, run or perform activities with repetitive jumping, bending or squatting. Some symptoms to look out for are:

  • Pain in the front of the knee, especially when squatting, jumping, kneeling, or using stairs.
  • A feeling of popping, grinding, slipping or catching in your kneecap when you bend or straighten your leg.
  • A feeling that your knee is buckling or giving way, as if your knee can't hold your weight.

Treatment: This condition can be frustrating to treat because it can take a lot of time to repair the problem. Generally exercise is the answer. Strengthening the muscles around your kneecap to help it stay in place. You consider using a brace or kinesiology tape to help control your knee and reduce pain. As pain decreases expand your exercises to include those that help strengthen your leg and hip. Typically surgery is not employed as a solution unless the kneecap has been dislocated.

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