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Traumatic Knee Injuries - The Complexity Surrounding Knee Injuries

PROHealth
10/1/2010

Traumatic Knee Injuries - The Complexity Surrounding Knee Injuries

 

Your knee is one of the largest joints in the human body. The knee joint is comprised of 3 bones, 4 stabilizing ligaments, muscles, tendons, and cartilage. Having a better understanding of the components that form the knee joint will allow a better understanding of the complexity of knee injuries.
 
During athletic participation and in every day life, knee injuries are bound to occur. Injuries can be classified as acute (often occurring from trauma) or chronic (more long term in nature), and will be graded on a 3-point scale; mild, moderate or severe.
 
ACL – The primary stabilizer of the knee
The ACL (Anterior Cruciate Ligament) is one of the four major ligaments in the knee. Its purpose is to provide stability to the knee joint and reduce excessive forward movement of the lower leg (tibia) in relation to the thigh bone (femur). The ligament is located in the middle of the knee joint, connecting the top/front part of the shin bone (tibia) to the bottom/back part of the thigh bone (femur). Injury to the ACL can cause a feeling of instability, resulting in the knee buckling or giving way particularly during twisting and cutting motions.
ACL Injury
Individuals participating in activities with quick change in direction (soccer, basketball) are at an increased risk to experience an ACL injury. Excessive force to the ACL can cause an injury. A direct force or sudden stop and/or twisting motion will translate force to the knee, and possibly sprain or rupture the ACL.
ACL Surgery
A surgical intervention may be necessary to repair the damaged ACL. While a surgeon is unable to repair the injured ACL, a tendon graft from another part of the patient’s body (autograph- hamstring or patella tendon) or a cadaver piece (allograft) can surgically replace the injured ACL. A common rehabilitation time for ACL surgery is 4-6 months and will require physical therapy during the rehabilitation process to increase the motion of the knee joint and increase strength of the muscles in the involved leg .

MCL
The MCL (Medial Collateral Ligament) has the purpose to stabilize the knee on the medial side (inside aspect of the knee) and to prevent a rotational movement as the knee shifts from side to side.
MCL Injury
A force causing the knee to buckle inward, applying stress to the medial aspect of the knee could possibly sprain or rupture the MCL. Although not a requirement, if there is a total rupture of the ligament, surgery may be an option. Rest and immobilization along with natural scarring around the MCL ligament often is sufficient for full recovery. You should discuss these options with your orthopedic surgeon to decide your best option. Physical therapy will assist in increasing the motion and strength of the involved knee after injury or after surgery.
 
Patella (knee cap) Injury
The knee cap is a bone that lies on the front of your knee. A knee cap can slip out of place, and be positioned to the side of the knee joint. If the knee cap slides out of and back into place, this is considered a patellar subluxation, where as a patella that does not spontaneously reduce is considered a dislocation. In severe cases of dislocation, manual relocation by a medical professional may be necessary, and potentially a surgery. In addition, a knee cap can develop arthritis along the smooth cartilage behind it and can be a source of pain. Physical therapy for stretching and strengthening can be very beneficial for this condition.
 
Meniscus Injury
The meniscus (type of cartilage) is a C-shaped disc , located on both sides of the knee joint (medial and lateral). Each knee joint contains two menisci with the purpose of providing cushioning between the upper leg bone (femur) and lower leg bone (tibia). Injury to the meniscus typically occurs with a sheering mechanism (twisting and compression) which causes the meniscus to tear. Depending on the severity o f the injury, surgery may be required.
 
Signs and Symptoms of Acute Knee Injuries
Knee injuries will present with pain, swelling, instability, and decreased range of motion of the knee joint. Other signs may include bruising, discoloration to the area or visible structural deformity.
 
Diagnosis of Acute Knee Injuries
After an injury it is important to seek treatment by a medical professional. Physical examination and testing should be able to give a general idea of the type of knee injury sustained, although additional testing such as an x-ray or MRI may be performed to further evaluate the injury.
 
Treatment for Acute Knee injuries
Depending on the type of injury, a knee immobilizer brace or compression wrap may be recommended for a certain period of time to prohibit movement, decrease swelling, and facilitate healing. Follow the RICE acronym (Rest, Ice, Compression, Elevation) to reduce pain and swelling. (For additional reading material on the RICE principle, please click on the link: http://www.proexpt.com/content.php?l=73&pro=1&id=24)
 
Rehabilitation for Knee Injuries
The main purpose of Physical Therapy after an injury will be to decrease pain and swelling, increase range of motion, function, and strength. Your Physician can write you a script for Physical Therapy, which will be performed on average 2-3 times a week.
 
Return to Activity Guidelines
After sustaining a knee injury it is important to take the appropriate amount of time to heal and recover before returning to strenuous activities and sport participation. It is imperative to receive medical clearance from a medical professional prior to returning to such activity.

Traumatic Knee Injuries - The Complexity Surrounding Knee Injuries

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