Knee joint is one of the most exposed joints of the body during sports hence most commonly injured.

Common injuries to knee joint are

• Patello-femoral strain/ dislocation
• Jumpers knee
• Meniscal tear
• Anterior cruciate ligament (ACL tear)
• PCL tear
• MCL injury

Patello-Femoral issues

Patellofemoral Pain Syndrome refers to the pain at the front of the knee. It is also called as anterior knee pain.

Patellofemoral pain syndrome occurs when the patella does not move or ‘track’ in a correct fashion when the knee is being bent and straightened. This movement can lead to damage of the surrounding tissues, such as the cartilage on the underside of the patella itself, which can lead to pain in the region.

Patellofemoral knee pain can also occur following a knee injury, if the muscles of the quadriceps (especially VMO) considerably weakened.

Other factors which contribute to the PFPS:

• Tight ligament on one side of patella
• Sports such as running, where repeated weight-bearing occurs, may result in PFPS.
• Pronating or ‘flat’ feet lead to an increased biomechanical stress on the knee joint. Other alignment issues that may affect the alignment of the patella particularly during movement.

Symptoms of patellofemoral pain syndrome

• Aching pain in the knee joint, particularly at the front, around and under the patella.
• The symptoms particularly worst on going up or down stairs. Difficulty in squatting, even on lunges or sitting cross legged.

On examination

• Tenderness around patella
• Swelling
• A clicking or cracking sound may be present on bending the knee.
• Sitting for long periods may be uncomfortable.
• Muscles wasting (Atrophy )in prolonged cases.
• Tight muscles
• X-rays May show bony abnormality while MRI may show cartilage or soft tissue damage.

Treatment:

Initial

• RICE
• Rest until there is no pain
• Immobilise Use a knee support
• Cold compress
• Elevation
• This is generally followed by good rehab to balance and strengthen the muscles, improve joint kinematics, Release of tight structures, Orthoses to correct soft deformity. Surgery for bony deformity.

ACL Injury

A torn ACL is an injury or tear to the anterior cruciate ligament (ACL). The ACL is one of the four main stabilising ligaments of the knee,). Any injury from the front with twist is likely to affect this ligament.

Symptoms of a torn ACL

• A feeling of initial instability, may be masked later by extensive swelling.
• Apply RICE
• Seek medical attention as soon as possible.

Jumpers knee / Patellar tendinopathy

The patella tendon / ligament joins the kneecap (patella) to the shin bone or tibia. This tendon is extremely strong and allows the quadriceps muscle group to straighten the leg. The quadriceps actively straighten the knee in jumping to propel the individual off the ground as well as functioning in stabilizing their landing.

As such this tendon comes under a large amount of stress especially in individuals who actively put extra strain on the knee joint such as those who regularly perform sports that involve direction changing and jumping movements. With repeated strain, micro-tears as well as collagen degeneration may occur in the tendon.

This is known as patellar tendinopathy or Jumpers Knee.

Symptoms of jumpers knee

• Pain on performing jumping activity or inability to kick, pain on front of knee on squatting or lunges are the first signs.
• Tenderness at the bottom and front of the kneecap especially when pressing in or palpating.
• Aching and stiffness after exertion.
• Pain when you contract the quadriceps muscles.
• Pain on kneeling down

On examination

• The affected tendon may appear larger than the unaffected side.
• May be associated with poor Vastus medialis obliquus (VMO)function
• Calf weakness may be present
• MRI may show increased signal in the tendon signifying the pathology

TREATMENT

• Conservative treatment
• Surgical treatment

Conservative (non-surgical) treatment

This is normally advocated initially after diagnosis of patellar tendinopathy. Care must be taken not overload the tendon. Treatment may involve:

• RICE

Quadriceps muscle strengthening program:

• Muscle strengthening of other weight bearing muscle groups, such as the calf muscles
• Ice packs to reduce pain and inflammation
• Correction of joint mechanics and change in training pattern

Most patient would respond to the conservative treatment

If symptoms persists Than initially local injection

• PRP – Platelet Rich Plasma
• Cortisone

Can be instituted along with rehabilitation. If the symptoms continue than surgical decompression is the modality of choice.

Meniscus Injury

Each knee joint has two crescent-shaped cartilage menisci. These lie on the medial (inside) and lateral (outside) of the upper surface of the tibia (shin) bone. They are essential components of the knee, acting as shock absorbers as well as allowing for the proper interaction and weight distribution between the tibia and the femur (thigh bone). They provide stability to the knee. As a result, injury to either meniscus can lead to critical impairment of the knee function itself.

The medial meniscus is more prone to injury than the lateral menicus. Any forces impacting from the outer surface of the knee, such as a rugby tackle, fall, twist, jerk, sudden abnormal movement can severely damage the medial meniscus. It is commonly associated injury with ACL tear.  Meniscus tear can be degenerative when seen in patients of Osteoarthritis changes that are associated with age.

MRI is the gold standard to pick up these injuries Symptoms

• Pain
• Clicking sound in knee
• Catching sensation
• Some times giving way
• Swelling of the knee within 48 hours of injury.
• Inability to bend knee fully- this may be associated with “Locking” or “giving way” of the knee when the torn piece of meniscus has gone and struck in the middle of the knee.
• Inability to weight bear on the affected side.

Treatmen

• Apply RICE.
• Wear a knee compression support
• Gentle exercises to maintain quadriceps strength, although care should be taken not to aggravate the symptoms.
• Consult a Sports Injury Specialist.

MRI scan.

• Decide if conservative treatment will be effective or if surgery may be required.

Treatmen Conservative

This may be indicated in the case of a small tear or a degenerative meniscus and may involve:

• Cold, compression and recommendation of NSAID’s
• Electrotherapy
• Release to decrease muscle tension.
• Manual therapy (mobilization and manipulation)
• Once pain has subsided, exercises to restore the range of movement, improve balance and increase muscle strength.

Surgical

In case of big tear, locked knee, giving way, than surgical intervention is required to avoid further damage to the knee.