Acute and Overuse Knee Injuries

Acute knee injuries occur suddenly - from falling awkwardly, a forced twisting of the knee, a blow to the knee, etc.

Acute knee injuries include knee sprain (torn knee ligaments - usually the acl), torn knee cartilage (torn meniscus), ruptured knee tendon, and knee fracture.

Overuse knee injuries are usually caused by increasing the intensity or duration of an activity increasing too quickly.

Overuse knee injuries include knee tendonitis, knee bursitis, iliotibial band syndrome, and muscle strains. Overuse also contributes to runners knee.

Read on for more information on these common knee injuries / conditions..

ACUTE KNEE INJURIES

Torn ACL (also called Knee Sprain or Torn Ligament)

Four ligaments help stabilize the knee. Ligaments of the knee limit how far the bones of the joint (the thighbone and shinbone) can move to prevent dislocation of the knee joint. The two cruciate ligaments cross over each other on the inside the knee joint and limit front-to-back motion. The two collateral ligaments are outside the knee joint and limit side-to-side motion.

Ligaments on the outside of kneecap usually heal by themselves. Ligaments in the center of the knee rarely heal by themselves (because they are bathed in joint fluid and lack a blood supply) and may require reconstructive surgery. Surgery is not always necessary.

The ACL (anterior cruciate ligament), located in the center of the knee, is the most commonly injured ligament in the knee. ACL injuries are most common in people who play sports and women in sports are much more likely than men to tear this ligament. Twisting the knee is a common cause of overstretched or torn ligaments of the knee.

Symptoms of Torn ACL:
The knee may give out suddenly when the ACL is torn and there may be a popping sound upon injury. Symptoms of a torn ACL include knee pain, swelling, stiffness, and bruising. Walking is painful and the knee feels instable. The feeling of instability is caused by the bones in knee joint sliding too far (this can result in damage cartilage).

Seek Immediate Medical Attention for Acute Knee Injuries. While waiting to see the doctor, to reduce swelling and pain apply ice immediately and leave on 15 - 20 minutes per hour. Elevate the knee above heart level if possible. Wrapping the knee in an ACE bandage (elastic bandage) provides compression and also helps limit swelling.

Treatment of Torn ACL
The ACL cannot heal because of lack of blood supply. If the tear is small, the knee may be relatively stable and surgery may not be necessary. Exercises to strengthen the muscles that support the knee can help compensate for the lack of ligament stability.

Whether or not surgery is considered depends upon whether a person is active in sports. Being able to function adequately in daily activities is often possible with a torn ACL. Being able to safely perform the pivoting and sharp turning movements required in many sports cannot be safely performed with a torn ACL.

ACL Reconstruction
If surgery is performed it is usually several weeks after the injury occurs to allow inflammation to subside. The ACL is not actually repaired, but reconstructed. The ACL is removed and reconstructed from a grafting a segment of a large tendon or ligament. As in any surgery, there are risks such as blood clots and infection.

Crutches are usually used for a couple of weeks following the surgery. Full recovery may take several months and varies from patient to patient. High-impact activities must be avoided until the knee has recovered sufficiently. Normal activities can be resumed before high-impact activities. Low-impact activities such as swimming help strengthen the muscles that support the knee joint (to take some load off the ligaments) without straining the joint.

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Torn Meniscus (Torn Cartilage)

The meniscus (meniscal cartilage) is a spongy shock absorber that separates the thighbone and shinbone. This is the cartilage referred to when you hear "torn cartilage." There are two menisci in the knee - the medial (inner) meniscus and the lateral (outer) meniscus.

Meniscal tears may occur during participation in sports, often when the knee is twisted. These types of tears are usually vertical. Degenerative changes occur in the meniscus with aging, and meniscal tears may occur as a result. These types of tears are often horizontal. The degenerative tear may occur while kneeling or without any specific incident. Sometimes the person may not recall any specific injury.

Symptoms of Meniscus Tear
There may be a popping sound upon injury. Most people are able to walk immediately after a meniscus tear but begin limping as swelling sets in. Symptoms include pain along the inner or outer side of the knee, stiffness, swelling, and sometimes “locking” of the knee. A piece of torn cartilage may get caught between moving parts of the knee joint and limit motion or lock the joint. A clicking sound may be heard when moving the knee. The pain may be worse when squatting.

Seek Immediate Medical Attention for Acute Knee Injuries. While waiting to see the doctor, to reduce swelling and pain apply ice immediately and leave on 15 - 20 minutes per hour. Elevate the knee above heart level if possible. Wrapping the knee in an ACE bandage (elastic bandage) provides compression and also helps limit swelling.

Treatment of Torn Meniscus
Unless it is a small tear on the outer edge, a torn meniscus will not heal on its own because of its lack of blood supply in its center. A meniscus tear sometimes can be repaired with sutures, but more often the damaged area of the meniscus is trimmed. The torn piece of meniscus may be surgically removed through arthroscopic surgery. As in any surgery, risks include blood clots and infection. Full recovery takes up to six weeks.

Not all meniscus tears require surgery. Some people can function with a torn meniscus. Pain and swelling often resolve within 6 weeks, even though the meniscus hasn’t actually healed.

Surgery is often recommended. Depending upon the nature of the tear, a torn piece of cartilage may cause damage to the smooth cartilage that covers the ends of the knee bones. If the knee becomes locked, normal functioning is not possible and the muscles that support the knee weaken from lack of normal use.

The meniscus plays an important role in absorbing shock. If the entire meniscus or a large part of the meniscus is removed, the knee usually develops degenerative arthritis (osteoarthritis) within ten years. The articular cartilage that covers knee bones to help them glide over one another breaks down. Avoiding high-impact activities may slow down damage to the articular cartilage. Strengthening the muscles that support the knee, especially the quadriceps, help take stress off the knee joint and may also slow down the development of osteoarthritis.

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Knee Fractures

Caused by a forceful blow to knee as in contact sports or a fall. Symptoms are knee pain, moderate to severe swelling, there may be an inability to walk or to withstand weight on leg and/or muscles going into spasms upon slightest movement of knee. X-ray can confirm fracture. Sometimes the knee being set in a splint or cast is enough. Whether or not surgery is required depends on the type of fracture.

Seek Immediate Medical Attention for Acute Knee Injuries. While waiting to see the doctor, to reduce swelling and pain apply ice immediately and leave on 15 - 20 minutes per hour. Elevate the knee above heart level if possible. Wrapping the knee in an ACE bandage (elastic bandage) provides compression and also helps limit swelling.

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Ruptured Tendon (Torn Tendon)

Tendons attach muscle to bone. The quadriceps tendon and patellar tendon connect to form one continuous tendon that covers the patella (kneecap). The quadriceps tendon connects quad muscles to the patella; the patellar tendon connects the patella to the shinbone.

If the quadriceps contract forcefully and suddenly (as when trying to break a fall), the tendon may tear where it attaches to the bone (either above or below the kneecap).

If the tendon is completely torn, bending and extending the leg will be difficult (not just because of the pain).

A completely torn tendon can be surgically reattached. If the tendon is only partially torn, surgery may not be necessary. A cast is usually worn for several weeks. When the leg is immobilized, muscles and tendons weaken. Rehabilitative exercises help restore strength and flexibility to the knee/leg.

Seek Immediate Medical Attention for Acute Knee Injuries. While waiting to see the doctor, to reduce swelling and pain apply ice immediately and leave on 15 - 20 minutes per hour. Elevate the knee above heart level if possible. Wrapping the knee in an ACE bandage (elastic bandage) provides compression and also helps limit swelling.

Tendonitis is inflammation of a tendon. Tendonitis of the knee may be caused an acute injury but is more often caused by overuse. See overuse knee injuries below.

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OVERUSE KNEE INJURIES

Often caused by the intensity or duration of an activity increasing too quickly, common overuse injuries include tendonitis, bursitis, muscle strains, and iliotibial band syndrome. Overuse injuries may develop over days, weeks,or months.

See Treatment of Overuse Knee Injuries below. Some injuries require additional treatment, e.g. stretching the iliotibial band is important in iliotibial band syndrome.

Tendonitis of the Knee

The quadriceps tendon hooks quad muscles (front thigh muscles) to the patella (kneecap); the patella tendon connects the patella to the shinbone. The quadriceps tendon and patella tendon actually connect to form one continuous tendon that covers the patella. Both tendons are activated by the quadriceps. The quadriceps muscles are used to extend the leg. These tendons are commonly irritated, especially the patellar tendon.

Patellar Tendonitis (also called jumper's knee) is generally caused by overuse of the quadriceps, especially jumping types of activities such as volleyball and basketball. The pain is directly over the patellar tendon, just below the knee. Inflammation may develop.

Quadriceps Tendonitis is also generally caused by overuse of the quadriceps. The pain is over the quadriceps tendon, above the knee. There may be inflammation.

Being less elastic have less blood supply than muscles, tendons are more easily injured and take longer to heal than muscles.

It is important to give sufficient the knee time to heal before returning to the activity that led to tendonitis. Activities that cause pain delay healing. Though inflammation is a part of the healing process, chronic inflammation causes progressive damage to tissues.

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Knee Bursitis

A bursa is a sac containing a small amount of fluid that is located between surfaces that need to move to reduce friction. Bursitis (Inflammation of a bursa) is usually caused by overuse.

The bursa in front of the kneecap (prepatellar bursa) is commonly irritated. Excessive kneeling often causes prepatellar bursitis (common in carpet layers, gardeners). The symptoms are knee pain and inflammation over the kneecap and sometimes a limited range of motion. The inflammation is within the bursa, not the knee itself.

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Muscle Strains

Overstretched (pulled) or torn muscles result in stiffness and pain. The main muscles supporting the knee are the quadriceps and hamstrings. Increasing the duration and intensity of exercise or any activity too quickly often cause muscle strain. Mild muscle strains heal quickly.

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Iliotibial Band Syndrome (ITBS)

The iliotibial band is a fibrous band of tissue that runs down the outer thigh, from the hip (ilium) to just below the knee, inserting into the shinbone (tibia). It helps provide stability to the outer side of the knee joint, particularly during running.

Iliotibial band syndrome is irritation / inflammation of the iliotibial band (the inflammation is usually not visible) that causes lateral knee pain. This condition is most common in long-distance runners and cyclists.

Symptoms of Iliotibial Band Syndrome (ITBS)
Though the pain usually occurs on the outer side of the knee just above the knee joint, it may also occur over the entire iliotibial band or just below the knee, where the iliotibial band inserts into the shinbone (tibia). The pain usually sets in slowly, often after running for several minutes. It is relieved by resting and aggravated by activity - running, cycling, or walking.

Causes and Contributing Factors of ITBS

Overuse: Increasing running or cycling distance too quickly and/or not giving the body time to recover between runs can lead to irritation and inflammation of the iliotibial band. Running uphill, downhill, on a slope, on hard surfaces, or on uneven ground increases the risk of ITBS.

Tightness of the Iliotibial Band
A tight iliotibial band causes excess friction over the outside of the knee – over the lower end of the thighbone – as the knee is bent and straightened. This leads to irritation and pain just above the knee joint. (A tight iliotibial band may also cause runners knee.)

Weak hip abductors (muscles involved in moving leg to side)
The hip abductors help support the knee. Strengthening these muscles help to support the knee and often helps improve ITBS.

Gait Problems
Some experts believe that gait problems may increase the risk of ITBS. Proper footwear may help.

Other Mechanical Errors.
Having one leg shorter than the other or having bowed legs increases the risk of ITBS.

Treatment of Iliotibial Band Syndrome

Treat pain and inflammation with RICE.

If the condition is mild, temporarily reducing high impact activities, doing exercises that stretch the iliotibial band, and short-term use of anti-inflammatory medications may be sufficient.

For persistent cases, physical therapy may be necessary. Though most cases improve with conservative treatment, surgery is occasionally performed.

*Always get a proper diagnosis from a qualified medical professional.

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Runners Knee

Runners are at an increased risk for this condition but it can affect anyone. The symptoms are diffuse pain behind or around the kneecap. The knee may click or crack when straightened. The knee may feel unstable. Running, kneeling, climbing stairs, and sitting for long periods, aggravates the symptoms.

Poor knee tracking appears to be the main cause of runners knee. The kneecap glides in a groove in the thighbone. If the kneecap is pulled to one side, excessive friction on the back of the cartilage of the kneecap during motion causes irritation. It may be caused by a simple muscle imbalance that can be corrected with exercises. Click here for more information on runners knee.

Osgood Schlatter Disease

Osgood Schlatter disease is a common overuse condition causing pain and inflammation just below the knee, over the bump on the front upper part of the shinbone, which the patellar tendon attaches to. This condition only occurs while a person is still growing.

Teens or preteens that develop this condition are usually highly active in sports that involve a lot of running and jumping. Cick here for more information on Osgood Schlatter disease.

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Treatment of Overuse Knee Injuries

Rest, Ice, Compression, Elevation (RICE)

*See a doctor immediately if your knee is giving out or if there is swelling or redness. Otherwise, see a doctor if the pain persists or is getting worse after 3 days

Rest: (Not total rest) Reduce your activity until the swelling and pain subsides, usually 3 or 4 days. Avoid activities that cause pain. Do not return to the activity (kneeling, running, jumping) that caused the problem until your physician advises you it is safe to so. It is usually recommended you return to activities that caused the injury gradually and stop if pain occurs.

Ice: Apply ice wrapped in cloth every 15 minutes per hour the first day then every 3 to 4 hours for the second and third day. Leaving the ice on for over 20 minutes can cause frostbite. (Moist cold - applying a wet towel between the skin and the ice pack - penetrates more deeply and quickly than dry cold)

Compression: Wrapping the knee in an ACE bandage (elastic bandage) can limit swelling and relieve pain. If the leg becomes colder than the other leg, the bandage is too tight. Remove the wrap before bedtime. Bandages are also useful for holding on a bag of ice.

Elevation: Elevate knee above the level of heart (place on pillow) while icing to further reduce inflammation.

Applying Heat
After four or five days, providing the swelling has subsided, applying heat to the knee may be beneficial. Heat helps to increase the blood supply, which promotes healing and also helps to relax tight muscles. Apply heat for 15 minutes several times per day. (Moist heat penetrates more quickly and deeply than dry heat) Wait at least an hour between heat applications to prevent the overheating of tissues.

* NEVER apply heat to an inflamed joint. There already is increased blood supply with inflammation. Heat will increase the inflammation.

Medications
Your doctor may prescribe medications for pain and inflammation.

Total healing may take two to six weeks, depending upon the severity on the injury.

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Prevention of Overuse Knee Injuries:

The best ways to prevent overuse knee injuries or to prevent reoccurrences are to:

• Strengthen the muscles that support the knee with knee exercises. Click here for knee exercises.



• Slowly increase the duration and intensity of activities you are not accustomed to.



• Warm up before activities that involve running and jumping.



• Limit high-impact activities to every second day to give your body a chance to recover.



• Keep your weight under control. As the knees are weight-bearing joints, weighing less decreases stress on the knees.



• Proper Footwear: Adequate cushioning to help absorb shock, adequate support for those who tend to overpronate to prevent excessive internal rotation of the lower leg and knee.

*Always get a proper diagnosis from a qualified medical professional.

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