Common Symptoms

Pain, swelling, and stiffness are the common symptoms of any damage or injury to the knee. If care is not taken during the initial phases of injury, it may lead to joint damage, which may end up destroying your knee.

Causes

The common causes of knee injury include:

• Fracture of the femur (thighbone), tibia and fibula (leg bones)
• Torn ligament (either anterior or posterior cruciate ligament)
• Rupture of blood vessels following a trauma that leads to the accumulation of extra fluid or blood in the joint
• Dislocation of the kneecap (patella)
• Torn quadriceps or hamstring muscles
• Patellar tendon tear

Diagnosis

If the pain and swelling are rapid, then immediate diagnosis and appropriate medical treatment are advised. Initial diagnosis includes physical and joint examination followed by an X-ray.

Treatment

Immediately following a knee injury and before being evaluated by a medical doctor, you should initiate the R.I.C.E. method of treatment.

• Rest: Rest your knee, as more damage could result from putting pressure on the injury.
• Ice: Ice packs applied to the injury will help reduce swelling and pain. Ice should be applied over a towel to the affected area for 15-20 minutes, four times a day for several days. Never place ice directly over the skin.
• Compression: Wrapping the knee with an elastic bandage or compression stocking can help minimize the swelling and support your knee.
• Elevation: Elevating the knee above heart level will also help reduce swelling and pain.

Acute or mild knee injuries do not require knee surgery. It can be treated with anti-inflammatory drugs. It is necessary to drain out accumulated extra joint fluid through a syringe or needle. If pain persists for a long time or appears at night or while at rest, it is important to visit your doctor.

Taping, massage, mobilization, stretching and strengthening exercises as well as exercises to improve your balance and agility are other treatment options that may be recommended.

In some cases, if the pain is intolerable, your doctor may recommend a cortisone injection. However, it is a good practice to avoid the use of cortisone, as it weakens and softens your cartilage, thereby leading to arthritis of the knee. More severe cases are treated by surgery followed by a period of rehabilitation to strengthen the knee.

What is Knee Arthritis?

The joint surface is covered by a smooth articular surface that allows pain-free movement in the joint. Arthritis is a general term covering numerous conditions where the joint surface or cartilage wears out. This surface can wear out for several reasons; often the definite cause is not known. Arthritis often affects the knee joint. When the articular cartilage wears out, the bone ends rub on one another and cause pain. The most common type of arthritis is osteoarthritis. It occurs with aging and use.

Causes

There are numerous conditions that can cause arthritis but often the exact cause is never known. In general, but not always, it affects people as they get older (osteoarthritis). Other causes include:

• Trauma (fracture) 
• Increased stress such as overuse and overweight
• Infection of the bone
• Connective tissue disorders
• Inactive lifestyle and obesity (overweight). Your weight is the single most important link between diet and arthritis, as being overweight puts an additional burden on your hips, knees, ankles, and feet.
• Inflammation (rheumatoid arthritis)

Symptoms

Knee arthritis causes pain and decreased mobility of the knee joint. The cartilage lining is thinner than normal or completely absent. In the arthritic knee, there is an absent joint space that shows on X-ray. In the normal knee, there is a normal joint space. The capsule of the arthritic knee is swollen. The degree of cartilage damage and inflammation varies with the type and stage of arthritis. Bone spurs or excessive bone can also build up around the edges of the joint. The combinations of these factors make the arthritic knee stiff and limit activities due to pain or fatigue. 

Diagnosis

Doctors diagnose knee arthritis with a medical history, a physical examination, and X-rays of the affected joint. During the physical examination, your doctor will examine the affected joint for swelling, pain, tenderness, and assess the joint’s range of motion. An X-ray of the knee may show a loss of the joint space and bone spur formation. 

There is no blood test for knee arthritis.

Treatment

There is no known cure for knee arthritis. However, there are several treatments and lifestyle modifications that can help you ease your pain and symptoms. The objective of the treatment is to reduce pain, improve joint movement, and prevent further damage to the joint.

What is Chondromalacia Patella?

Chondromalacia patella is a common condition characterized by softening, weakening and damage of the cartilage. The condition is most often seen in young athletes and older adults who have arthritis of the knee. It especially occurs in women.

Causes

There is no explicit reason why the cartilage gets damaged. It is associated with improper knee alignment or imbalance in the tightness of the muscles holding it in place. Overuse of the knee in certain sports activities may cause wear and tear of the cartilage. This may cause rubbing or grinding of the kneecap against the bone instead of it smoothly gliding over the knee joint. 

Chondromalacia patella may also be caused due to injuries such as fractures or dislocations or may develop as a part of your aging process.

Symptoms

Chondromalacia patella is the most common cause of knee pain. Called patellofemoral pain, it is characterized by the following:

• Pain in front, around or behind your knee
• Pain that gets worse when climbing up or down the stairs, sitting or standing for long periods, or when extreme pressure is applied on the knee 

Other symptoms may include:

• Grinding or cracking sensation or noise when you move your knee 
• Rarely, swelling or fluid effusion in your knee joint 

Diagnosis

Your doctor will conduct a physical examination by applying pressure on different areas of your knee and moving your leg in different positions. You may be asked to undergo imaging tests including an X-ray, CT scan and MRI scan to obtain detailed images of the bones and soft tissues of the knee.

Treatment

The treatment of chondromalacia patella initially involves simple conservative procedures. You may be advised to rest your knee and avoid any activity that may strain the knee joint. Your doctor may prescribe painkillers and anti-inflammatory drugs to relieve pain and reduce swelling. Physical therapy may help you to improve the muscle strength, decrease stress on your knee and aid in correcting the misalignment. Wearing support braces and taping around the knee may help you protect your joint, reduce pain and improve alignment. Application of ice on the knee may be recommended after exercise.

When non-surgical treatment does not relieve pain, your doctor may recommend surgical treatment. Surgery may involve:

• Arthroscopy: Your doctor inserts a device called an arthroscope (a thin tube with a camera and light attached) through a small incision. This helps to clearly view the surgical site while other instruments are inserted to remove fragments of the damaged cartilage. 
• Realignment: Your surgeon may operate on your knee to realign the position of your kneecap and release pressure over the cartilage.

Your doctor will examine your condition and provide you with the best treatment option.

What is Jumper’s Knee?

Jumper’s knee, also known as patellar tendinitis, is inflammation of the patellar tendon that connects your kneecap (patella) to your shinbone. This tendon helps in the extension of the lower leg.

Causes

Jumper’s knee usually results from repetitive trauma or overuse, particularly from sports activities that involve jumping such as basketball or volleyball. Therefore, this condition is known as jumper’s knee. Rarely, this condition may also occur because of an acute injury to the tendon that has not healed properly.

Symptoms

Pain over the patellar tendon is the first symptom of jumper’s knee. You may also have pain during activities, especially jumping or kneeling. Rarely, swelling around the tendon may be seen.

Diagnosis

Your doctor will evaluate your condition based on your symptoms and physical examination. An X-ray of the knee may be ordered to ensure that there is no problem involving the bones or bone spur around the knee. An MRI scan can reveal degenerative changes in the patellar tendon.

Treatment

Conservative Treatment Options

Treatment options for jumper’s knee:

• Rest the injured knee and avoid activities such as running and jumping that worsen the condition.
• Non-steroidal anti-inflammatory medications (NSAIDs) may be prescribed to provide relief from pain and swelling associated with patellar tendinitis.
• Stretching before exercising is important to prevent the recurrence of patellar tendinitis. These exercises can also help strengthen the patellar tendon and nearby muscles such as the quadriceps, hamstrings and calf muscles.
• The application of ice to the affected area helps to control the inflammation and reduce the swelling.
• A knee support or strap (called an intrapatellar strap or a Chopat strap) can be worn to relieve pain by directing the force away from your tendon and into the strap.
• Iontophoresis involves the application of topical corticosteroid medication to the affected area with the help of a small device that uses an electric charge to deliver the medication through your skin.
• Corticosteroid injection may be administered directly into the sheath around the affected patellar tendon under the guidance of an ultrasound. This helps to relieve pain and perform strength exercises without any pain.

Surgery for Jumper’s Knee

In rare cases, if there is persistent pain, surgery may be considered when other treatment options fail. Surgery involves the removal of severely damaged parts of your tendon and repair of any tears in the tendon.

What is MPFL injury?

The medial patellofemoral ligament (MPFL) is a ligament that joins the kneecap (patella) to the thighbone (femur). Ligaments are fibrous connective tissue that attach bones to other bones.  The MPFL is attached to the inside of the patella and helps stabilize it and position it in a groove at the lower end of the femur called the trochlea. Trauma or a blow to the knee may cause a tear in the ligament.

Causes

An MPFL injury may occur due to knee injuries causing patellar dislocation or forceful twisting. This can occur due to:

• Sports injuries
• Automobile accidents
• Falls from a height
• A blow to the knee

Symptoms

Symptoms of a medial patellofemoral ligament injury include:

• Knee stiffness
• Swelling
• Pain
• Tenderness
• Knee instability
• Shifting of the patella
• Catching sensation on bending and straightening the knee
• Difficulty walking
• Cracking or crunching sound
• Restricted range of motion
• Discoloration near the injured area
• Bruising

Diagnosis

Your doctor will review your medical history and perform a physical examination where the knee and patella are assessed for range of motion, strength, and stability. Your doctor may also recommend imaging tests such as X-rays, CT scans, or an MRI scan to visualize the ligament injury and any damage to other structures.

Treatment

Treatment measures for medial patellofemoral ligament tears include:

Conservation Methods

• RICE Method: Your doctor will recommend rest, ice application, compression, and elevation of the affected knee to reduce inflammation and pain.
• Physical therapy: You will be instructed to carry out physical exercises to strengthen the knee muscles and improve flexibility
• Medications: Non-steroidal anti-inflammatory drugs and analgesics are recommended to treat pain and swelling.
• Knee brace: A brace maybe work to help support the knee.
• Special Footwear: This can help control your gait while walking or running and decrease the pressure on the kneecap.

If conservative methods failed to improve the symptoms, surgery will be recommended and may include:

• Medial patellofemoral ligament reconstruction: The torn MPF ligament is removed and reconstructed using a graft that is harvested from the hamstring tendons are fixed to the patella tendon using screws. The grafts are either taken from your own body (autograft) or a donor (allograft).
• Tibial tubercle osteotomy: Changing the insertion point of the patellar tendon to improve patellar alignment.
• Lateral release: The tight lateral ligaments of the kneecap are released to correct the patella position.
• Trochleoplasty: Reshaping the groove or trochlea at the lower end of the femur helps with positioning and smooth movement of the patella.

What are shin splints?

Shin splints or medial tibial stress syndrome (MTSS) is pain around the tibia or shinbone due to inflammation of the tendons, muscles and bone tissue. It occurs because of vigorous exercises and sports activities. 

Causes

The common causes of shin splints are overuse from repetitive sports activities or a sudden change in the level of physical activity. Flat feet or rigid foot arches, and the use of inappropriate or worn-out footwear while exercising may increase your risk of developing shin splints. Runners, military recruits and dancers are at a high risk of developing shin splints.

Symptoms

The common symptoms of shin splints include pain in the front side of the lower leg, which can be sharp or dull, throbbing or sore to the touch. Pain may also be associated with mild swelling.

Diagnosis

Your doctor will diagnose the condition through a physical examination of your lower leg and may order imaging tests to rule out other problems.

Treatment

The treatment for shin splints may include nonsurgical options such as:

• Rest: Ensure that you take adequate rest and avoid activities that cause pain. You can instead perform low-impact exercises, such as swimming or stationary bicycling.
• Medication: Your doctor may prescribe non-steroidal anti-inflammatory medication to reduce pain and swelling.
• Ice: Apply ice packs wrapped in a cloth on the affected area for 15-20 minutes, four times a day for several days. Never place ice directly over the skin.
• Compression: Wrap your leg in an elastic bandage to reduce swelling.
• Flexibility exercises: Perform stretching exercises to reduce pain and improve muscle strength. 
• Supportive shoes: Wear shoes that provide good cushioning and support the feet as they help reduce stress on the shinbone.
• Orthotics: Shoe inserts may be helpful.

Surgical treatment is an option that is considered only in very severe cases when conservative methods fail to relieve the pain. 

Prevention

Shin splints can be prevented by following these measures:

• Wear well-fitting athletic shoes with good support.
• Warm up and stretch the leg muscles before starting any vigorous activities.
• Start any new activity slowly and progress gradually by increasing the duration and frequency of the exercise regimen.

What is Goosefoot Bursitis of the knee?

A bursa is a small fluid-filled sac found between soft tissues and bones. It lubricates and acts as a cushion, decreasing the friction between bones when they move. Bursitis refers to the inflammation and swelling of the bursa. Goosefoot bursitis or pes anserine bursitis is the inflammation of the bursa present between the tendons of the hamstring muscle and the tibia (shinbone) on the inner side of the knee.

Causes

Goosefoot bursitis is often caused due to repetitive friction on the bursa, overuse of the joints during sports, osteoarthritis of the knee, obesity, medial meniscus tear, tight hamstring muscles, and incorrect training techniques.

Symptoms

The primary symptom of goosefoot bursitis is pain on the inner side of the knee and/or on the center of the tibia, which may worsen with physical activity. 

Diagnosis

When you present to the clinic with these symptoms, your doctor diagnoses goosefoot bursitis by ruling out other conditions with a thorough physical examination of your knee and X-ray imaging studies.

Treatment

Goosefoot bursitis can be effectively treated with conservative therapy including rest, use of ice packs, anti-inflammatory drugs and injection of steroids at the region of the inflamed bursa to relieve inflammation and pain, and physical exercise to help improve range of motion at the affected region. Surgery is performed only when conservative treatment is ineffective, and involves the removal of the bursa.

What. is Bone Marrow Edema in the Knee?

Bone marrow edema, also known as bone marrow lesion, in the knee is a condition characterized by the accumulation of fluid in the bone marrow of the knee that may result in pressure and pain within the knee. This condition is visible on an MRI, but not on regular X-ray findings.

Bone marrow is a spongy, flexible, soft tissue that is present in the middle of bones. It consists of stem cells that further differentiate into various blood cells like RBC, WBC, and platelets.

Causes

Bone marrow edema is mainly caused due to the leakage of blood and fluid from the damaged capillaries surrounding the bone. This damage to the blood vessels may be caused due to various conditions that include:

• Trauma to the knee
• Inflammatory conditions affecting the knee joint
• Knee ligament injury
• Osteoarthritis of the knee
• Bone tumors
• Stress fractures in the knee
• Bone infection
• Knee tendinitis
• Septic arthritis of the knee
• Avascular necrosis in the knee joint
• Osteomyelitis of the knee

Symptoms

The edema in the bones within the knee joint creates a lot of pressure and swelling which results in intense knee joint pain. Some of the other common symptoms of bone marrow edema in the knee include:

• Swelling near the knee
• Difficulty walking
• Knee stiffness
• Limited movement of the knee joint
• Difficulty in weight-bearing
• Recurrent knee pain and tenderness
• Bruising of the knee

Diagnosis

Your doctor will review your medical history and symptoms and based on this a physical examination of the knee will be performed. Your doctor may also recommend the following diagnostic test:

• Blood tests: Blood tests are performed to look for increased levels of C-reactive protein and ESR that can indicate infection or any disease.
• Computed Tomography (CT) Scan: This scan uses multiple x-rays to produce detailed cross-sectional images of the knee joint to measure the amount of bone marrow edema.
• Ultrasound: This test produces images of the fluid accumulation within the knee joint using sound waves of high frequency.
• Magnetic Resonance Imaging (MRI) Scan: This is an imaging study that uses a large magnetic field and radio waves to detect any damage or swelling in the bone marrow.
• Bone marrow biopsy: A small sample of bone marrow is taken and observed under a microscope to detect the presence of any abnormal condition.

Treatment

Treatment for bone marrow edema in the knee may vary based on the root cause and severity of the condition. This includes:

• RICE Method: This is an acronym that stands for Rest, Ice, Compression, and Elevation of the affected knee. This is usually an effective treatment for bone marrow edema due to traumatic injury or osteonecrosis of the knee.
• Medications: Your doctor may prescribe medications that include:
  • Prostaglandin derivatives: These medications help to increase blood circulation and promote regeneration of bone.
  • Antibiotics: These medications help to treat infection of the knee.
  • TNF-Inhibitors: These medications relieve inflammation by reducing the levels of tumor necrosis factor.
  • Anti-inflammatory drugs: Your doctor may prescribe non-steroidal anti-inflammatory drugs to reduce inflammation within the knee joint. 
• Steroid Injections: Steroid medications will be injected into the knee joint to reduce inflammation.
• Extracorporeal Shock-Wave Therapy (ESWT): In this procedure, a specialized probe is attached to the skin over the knee that sends shock waves into the bone marrow. This increases circulation and helps to promote healing and relieve pain.
• Physical Therapy: Your doctor may recommend physical therapy to strengthen the knee muscles and bones.
• Core Decompression: In this procedure, small holes are drilled into the area of bone marrow edema to relieve the pressure inside the bone. This relieves pain and allows the growth of new blood vessels that help to stimulate the growth of new bone.
• Subchondroplasty: This is a minimally invasive procedure in which a gel material is injected into the bone marrow to provide support to the bone at the site of the edema. This material is then slowly absorbed and replaced with a healthy bone that repairs the damaged bone.

What is knee pain?

Knee pain is a common condition affecting individuals of various age groups. It not only affects movement but also impacts your quality of life. An injury or disease of the knee joint or any structure surrounding the knee can result in knee pain. A precise diagnosis of the underlying cause is important to develop an appropriate treatment plan.

Causes

Some of the common causes of knee pain include:

• Arthritis, a condition associated with inflammation of the joint due to loss of articular cartilage
• Knee ligament injuries
• Meniscal tears
• Knee joint infection
• Dislocation of the kneecap or patella
• Patellar tendonitis, which is inflammation of the tendon connecting the kneecap to the shinbone
• Knee bursitis, which is inflammation of the bursae, small fluid-filled sacs located around the joints, usually between a tendon and bone
• Gout or accumulation of uric acid crystals in the joints causing severe attacks of joint pain, swelling and redness

Symptoms

Some of the common signs and symptoms that accompany knee pain include:

• Swelling and redness
• Inability to bend or extend the knee
• Difficulty walking
• Limping due to discomfort
• Difficulty weight-bearing
• Weakness or instability
• Popping or crunching noises

Diagnosis

Diagnosis involves a detailed review of your medical history and a physical examination of the knee. Your doctor may also conduct diagnostic imaging studies such as X-rays, MRI, CT, and ultrasound scans. Blood tests may be performed to identify infection or gout. Sometimes, a procedure called arthrocentesis may also be performed, where fluid from the knee joint is removed and sent to the laboratory for analysis. 

Treatment

Treatment options depend upon the underlying cause responsible for the knee pain.

Some of the common treatment options for knee pain include:

• RICE protocol: Rest, ice, compression, and elevation of the affected knee joint
• Medications
• Stretching and physical therapy
• Knee injections

Sometimes, a knee arthroscopy may be performed. Knee arthroscopy is a surgical procedure in which the internal structures of the joint are examined to diagnose as well as treat the underlying problem. In severe cases of knee pain, your doctor may advise a knee replacement as a permanent solution.

What is Patellar Dislocation?

Patellar dislocation occurs when the patella moves out of the patellofemoral groove, (trochlea) onto the bony head of the femur. If the kneecap partially comes out of the groove, it is called subluxation; if the kneecap completely comes out, it is called dislocation (luxation). 

Causes

Patella dislocation is commonly observed in young athletes between 15 and 20 years and commonly affects women because the wider pelvis creates a lateral pull on the patella. 

Some of the causes for patellar dislocation include a direct blow or trauma, twisting of the knee while changing direction, muscle contraction, and congenital defects. It also occurs when the MPFL is torn. 

Symptoms

The common symptoms include pain, tenderness, swelling around the knee joint, restricted movement of the knee, numbness below the knee, and discoloration of the area where the injury has occurred. 

Treatment

Your doctor will examine your knee and suggest diagnostic tests such as X-ray, CT scan, and MRI scan to confirm the condition and provide treatment. There are non-surgical and surgical ways of treating patellofemoral dislocation. 

Non-surgical or conservative treatment includes:

• PRICE (protection, rest, ice, compression and elevation)
• Non-steroidal anti-inflammatory drugs and analgesics to treat pain and swelling
• Braces or casts that will immobilize the knee and allow the MPF ligament to heal
• Footwear to control gait while walking or running and decrease the pressure on the kneecap

Physical therapy is recommended to control pain and swelling, prevent the formation of scar of soft tissue, and encourage collagen formation. Your physical therapist will extend your knee and apply direct lateral to medial pressure on the knee, which helps in relocation. It includes straightening and strengthening exercises of the hip muscles and other exercises which will improve range of motion.

Surgical treatment is recommended for recurrent patella dislocation. Some of these surgical options include:

• Lateral release: The tight lateral ligaments that pull the kneecap from its groove, increase pressure on the cartilage and cause dislocation are loosened or released. 
• Medial patellofemoral ligament reconstruction: The torn MPF ligament is removed and reconstructed using a graft. Grafts are usually harvested from the hamstring tendons, located at the back of the knee and are fixed to the patella tendon using screws. The grafts are either taken from your own body (autograft) or a donor (allograft). 
• Tibia tubercle realignment or transfer: The tibial tubercle is a bony attachment below the patella tendon, which sits on the tibia. In this procedure, the tibial tubercle is moved towards the center and held by two screws. The screws hold the bone in place so that it can heal faster and prevent the patella from sliding out of the groove. 

These procedures can be performed using an arthroscope.

What is an Articular Cartilage Defect?

The articular or hyaline cartilage is the tissue lining the surface of the two bones in the knee joint. Cartilage helps the bones move smoothly against each other and can withstand the weight of your body during activities such as running and jumping. Articular cartilage does not have a direct blood supply to it, so has less capacity to repair itself. Once the cartilage is torn it will not heal easily and can lead to degeneration of the articular surface, leading to the development of osteoarthritis.

Causes

The damage of the articular cartilage can affect you regardless of your age. It can be damaged by trauma such as accidents, mechanical injury such as a fall or from degenerative joint disease (osteoarthritis) occurring in older people.

Symptoms

The symptoms of articular cartilage damage include joint pain, swelling, stiffness and a decrease in the range of motion of the knee.

Treatment

The damaged cartilage needs to be replaced with healthy cartilage. The procedure is known as cartilage replacement. It is a surgical procedure performed to replace the worn-out cartilage and is usually performed to treat small areas of cartilage damage usually caused by sports or traumatic injuries. It is not indicated for advanced arthritis of the knee.

Cartilage replacement helps relieve pain, restore normal function, and can delay or prevent the onset of arthritis. The goal of cartilage replacement procedures is to stimulate the growth of new hyaline cartilage. Various arthroscopic procedures involved in cartilage replacement include:

• Microfracture
• Drilling
• Abrasion arthroplasty
• Autologous chondrocyte implantation (ACI)
• Osteochondral autograft transplantation

What is Patellar Instability?

Any damage to the supporting ligaments may cause the patella to slip out of the groove either partially (subluxation) or completely (dislocation). This misalignment can damage the underlying soft structures such as muscles and ligaments that hold the kneecap in place. Once damaged, these soft structures are unable to keep the patella (kneecap) in position. Repeated subluxation or dislocation makes the knee unstable. This condition is called knee instability. Patellar (kneecap) instability results from one or more complete or partial dislocations (subluxations). 

Symptoms

The signs and symptoms of patellar instability include:

• Pain, especially when standing up from a sitting position
• Feeling of unsteadiness or tendency of the knee to give way or buckle
• Recurrent subluxation
• Recurrent dislocation
• Severe pain, swelling and bruising of the knee immediately following subluxation or dislocation
• Visible deformity and loss of function of the knee, which often occurs after subluxation or dislocation 
• Changes in sensations such as numbness or even partial paralysis, which can occur below the dislocation because of pressure on the nerves and blood vessels

Causes

Various factors and conditions may cause patellar instability. Often a combination of factors can cause this abnormal tracking and include the following:

• Anatomical defect: Flat feet or fallen arches and congenital abnormalities in the shape of the patella bone can cause misalignment of the knee joint. 
• Abnormal “Q” Angle: The “Q” angle is a medical term used to describe the angle between the hips and knees. The higher the “Q” angle, such as in knock knees, the more the quadriceps pull on the patella, causing misalignment.
• Patellofemoral Arthritis: Patellar misalignment causes uneven wear and tear and can eventually lead to arthritic changes in the joint.
• Improper Muscle Balance: Quadriceps, the anterior thigh muscles, function to help hold the kneecap in place during movement. Weak thigh muscles can lead to abnormal tracking of the patella, causing it to subluxate or dislocate.

Diagnosis

Your surgeon diagnoses the condition by collecting your medical history and physical findings. He may also order certain tests such as X-rays, MRI or CT scans to confirm the diagnosis. 

Treatment

The treatment for instability depends on the severity of the condition and is based on diagnostic reports. Initially, your surgeon may recommend conservative treatments such as physical therapy, use of braces and orthotics. Pain relieving medications may be prescribed for symptomatic relief. However, when these conservative treatments yield unsatisfactory response, surgical correction may be recommended.

Considering the type and severity of the injury, your surgeon decides on the surgical correction. A lateral retinacular release may be performed, where your surgeon releases or cuts the tight ligaments on the lateral side (outside) of the patella, enabling it to slide more easily in the femoral groove. 

Your surgeon may also perform a procedure to realign the quadriceps mechanism by tightening the tendons on the inside or medial side of the knee. 

If the misalignment is severe, tibial tubercle transfer (TTT) will be performed. This procedure involves removal of a section of bone where the patellar tendon attaches on the tibia. The bony section is then shifted and properly realigned with the patella and reattached to the tibia with two screws. 

What is a Quadriceps Tendon Rupture?

The quadriceps can rupture after a fall, direct blow to the leg and when you land on your leg awkwardly from a jump. Quadriceps tendon rupture most commonly occurs in middle-aged people who participate in sports that involve jumping and running. Other causes include tendonitis (inflammation of quadriceps tendon), diseases such as rheumatoid arthritis, diabetes mellitus, infection and chronic renal failure, which weaken the quadriceps tendon. Use of medications such as steroids and some antibiotics also weakens the quadriceps tendon.

When the quadriceps tendon tears, the patella may lose its anchoring support in the thigh, as a result, the patella moves towards the foot. You will be unable to straighten your knee and upon standing the knee buckles upon itself.

Diagnosis

To identify a quadriceps tendon tear, your doctor will review your medical history and perform a physical examination of your knee. Some imaging tests, such as an X-ray or MRI scan, may be ordered to confirm the diagnosis. An X-ray of the knee is taken to determine the position of the kneecap and MRI scan to know the extent and location of the tear. 

Treatment

A quadriceps tendon tear can be treated by non-surgical and surgical methods. 

Non-surgical treatment involves the use of knee braces to immobilize the knee. Crutches may be needed to prevent the joint from bearing weight. Physical therapy may be recommended to restore the strength and increase range of motion of the knee.

Surgery is usually performed on an outpatient basis. The goal of the surgery is to reattach the torn tendon to the kneecap and restore the normal function of the knee. Sutures are placed in the torn tendon which is then passed through the holes drilled in the kneecap. The sutures are tied at the bottom of the kneecap to pull the torn edge of the tendon back to its normal position.

What is a Patellar Tendon Rupture?

The patellar tendon works together with the quadriceps muscle and the quadriceps tendon to allow your knee to straighten out. Patella tendon rupture is the rupture of the tendon that connects the patella (kneecap) to the top portion of the tibia (shinbone). 

Causes

A patellar tendon tear most commonly occurs in middle-aged people who participate in sports that involve jumping and running. It can rupture due to a fall, direct blow to the knee or landing on your foot awkwardly from a jump. The other causes may include patellar tendonitis (inflammation of patellar tendon), diseases such as rheumatoid arthritis, diabetes mellitus, infection, and chronic renal failure. The use of medications such as steroids can cause increased muscle and tendon weakness.

Symptoms

When the patellar tendon tears, the patella may lose its anchoring support on the tibia, as a result, when the quadriceps muscle contracts, the patella may move up into the thigh. You are unable to straighten your knee and upon standing, the knee buckles upon itself. In addition to this, you may have pain, swelling, tenderness, a tearing or popping sensation, bruising and cramping. 

A patellar tendon tear can be a partial or complete tear. 

• In a partial tear, some of the fibers in the tendon are torn, but the soft tissue is not damaged. 
• In a complete tear, the soft tissues are disrupted into two pieces. 

Diagnosis

To identify a patellar tendon tear, your doctor will review your medical history and perform a physical examination of your knee. Some imaging tests, such as an X-ray or magnetic resonance imaging (MRI) scan may be ordered to confirm the diagnosis. 

Treatment

Patellar tendon ruptures can be treated by non-surgical and surgical methods. 

Non-surgical treatment involves the use of braces or splints to immobilize the knee. Physical therapy may be recommended to restore the strength and increase the range of motion of the knee.

The goal of the surgery is to reattach the torn tendon to the kneecap and restore the normal function in the affected leg. Surgery is performed under regional or general anesthesia on an outpatient basis. An incision is made on the front of the knee to expose the ruptured tendon. Holes are made in the patella. Strong sutures are tied to the tendon and threaded through these holes. These sutures are tied in place to pull the torn edge of the tendon back to its normal position on the kneecap.

Severe damage can make the patellar tendon very short, and in such cases, reattachment will be difficult. Your surgeon may attach a tissue taken from a donor (allograft) to lengthen the tendon. 

What is knee dislocation?

Knee dislocation is a condition that occurs when the bones that form the knee joint, namely the femur or thigh bone get separated from the shin bone. This can cause serious damage to the nerves, blood vessels, and ligaments surrounding the knee, leading to a decline in strength and overall health of the leg.

Causes

Dislocation of the knee is rare. When it does occur, it is usually caused due to high impact injuries from automobile accidents, severe falls, or sports.

Symptoms

The dislocation of the knee can occur quickly. You may hear a popping sound at the time of the injury. Other symptoms can include:

• Severe pain
• Visible deformity at the knee joint
• Swelling
• Instability of the knee joint
• Limitations in the movement of the knee

Diagnosis

Your doctor will review your symptoms and medical history and perform a thorough physical examination to check for a range of motion and any damage to the ligaments, blood flow, stability, and skin color. The following diagnostic tests may be performed for further evaluation of the injured knee.

• X-rays: During this study, high electromagnetic energy beams are used to produce images of the bones
• CT scan: Special x-rays are used to produce images of any damage in the knee

Treatment

You will be instructed to apply an ice pack and keep your knee in an elevated position to reduce swelling. Depending on your condition, your doctor will place the affected leg in a therapeutic brace to keep it stable and may prescribe medications to reduce pain and swelling. You may need surgery to repair any damaged ligaments, blood vessels, nerves, or any adjacent structures of the knee.

What is a Medial Gastrocnemius Strain?

A medial gastrocnemius strain (MGS), also sometimes called “tennis leg”, is an injury to the calf muscle in the back of the leg. It occurs when the calf muscle is stretched too far resulting in a partial or total tear or rupture within the muscle.

Basically, the calf is made of three major muscles; the medial and lateral gastrocnemius and the soleus. These muscles unite to form the Achilles tendon and attach to the heel bone. The most commonly injured muscle when a calf strain occurs is the medial gastrocnemius as its muscular movement is more than the other two muscles.

MGS typically happens during physically demanding activities and/or sports such as running, jumping, soccer, tennis, etc., where the muscle is overstretched due to sudden changes in speed or direction. This occurs due to the rupture of the medial head of the gastrocnemius muscle or rarely, because of a deep vein thrombosis (blood clot). 

Symptoms

Usually, an audible pop occurs at the moment of the injury. Other symptoms of a medial gastrocnemius strain include:

• Sharp pain in the back of the leg (on the inner side of the knee or calf muscle).
• Swelling of the calf and bruising of the calf down to the ankle.
• Tenderness along the entire medial gastrocnemius muscle.

What if the Condition is Left Untreated?

If MGS is left untreated, the condition may lead to a complete tear of the muscle and serious leg injury due to limping and favoring of the injured leg.

Diagnosis

The doctor may assess the injury report and perform a physical examination that includes palpation to check for tenderness of the entire medial gastrocnemius muscle. 

A diagnostic ultrasound imaging test may be ordered to confirm the gastrocnemius tear and to determine the level of the injury. If a deep venous thrombosis is suspected, a Doppler ultrasound or an MRI might also be used.

Treatment

A medial gastrocnemius strain can usually be treated conservatively with rest and activity modifications and the typical “RICE” technique.

Once the initial phases of the treatment are completed, the doctor may recommend therapeutic activities and gentle stretching of the calf. Subsequently, strengthening exercises such as isometric exercises can be started and continued until the injury heals completely.

• Rest: Avoid activities that cause pain. Crutches may be used for a few days or a week to allow the pain to settle down.
• Icing: Apply ice to reduce swelling and pain and ease the inflammation. The icing is one of the most useful treatments in the early phase of the therapy.
• Compression: Pressure helps to control swelling, support the muscle and reduce spasm. A simple compression sock or sleeve can serve the purpose.
• Elevation: You should elevate the leg above heart level to help decrease swelling.

Generally, surgery is not required for a medial gastrocnemius strain. Typical recovery from MGS may take about six weeks.

Of the menisci within the knee, it is the medial that is more easily injured. Differences in the anatomical attachments of the medial meniscus compared to the lateral, mean that the medial meniscus becomes distorted during combined flexion and rotation movements in a manner not experienced on the lateral side.

Medial meniscal injuries are usually considered as either traumatic or degenerative. Whilst degenerate tears may present with a gradual history of increasing symptoms, traumatic injuries will usually occur as the knee is extended and rotated from a flexed position against resistance. This may occur as a single event during a sporting endeavor or during a period of unaccustomed squatting such as laying flooring or playing with children. The most commonly injured area is the posterior horn.

Symptoms

The exact presentation of a medial meniscal injury will vary according to the morphology of the tear sustained. Meniscal tears can be simply divided into vertical longitudinal, vertical radial, horizontal or complex. Presentation of a meniscal tear may be as a result of:

Locking: The inability to extend the affected knee to the same extent as the contra-lateral side. Crucially, this is due to a mechanical block and whilst pain may be a feature, it is not the sole reason the knee is unable to extend. This presentation is caused by a bucket handle tear (an unstable vertical longitudinal tear) prolapsing out of position creating the mechanical block to movement.

Pain: This is characteristically intermittent in nature and associated with activities such as stair climbing or running. Patients will often complain of an inability to squat fully. Patients will also exhibit tenderness along the joint line of the affected knee.

Swelling: In large peripheral tears, the injury may be associated with a post-traumatic effusion. More commonly, the irritation caused by the damaged meniscus causes recurrent effusions associated with exacerbation of the symptoms. Another form of swelling is the localized meniscal cyst caused by a complex meniscal tear acting as a flap valve to synovial fluid leading to the gradual formation of a parameniscal cyst that may be apparent clinically.

Clicking: Patients will often complain of, and sometimes be able to reproduce clicking. This is a palpable demonstration of the ongoing damage that is being caused by the displaced meniscal fragment. The description patients find most easy to understand is of a broken tooth within a gearbox jamming the machinery.

Diagnosis

Ultrasound: Very rarely indicated, except when confirming the presence of a meniscal cyst. MRI is the preferred investigation for this, as it will confirm the presence of a meniscal tear.

X-ray: This is useful in the assessment of additional knee pathology, such as osteoarthritis that may impact on the prognostic information given to the patient.

MRI: This is the most useful investigation for cases where diagnostic doubt exists. It is highly sensitive and specific but it is important to remember that both false negatives and positives do occur.

Treatment

Conservative Treatment: In cases where a meniscal injury is associated with degenerative change within the knee, it may be difficult to ascertain which pathology is causing the majority of the symptoms. In such cases, an unwise intervention may lead to a perceived deterioration in knee function and the torn meniscus may be best left in situ.

Arthroscopic excision: This is the most commonly performed treatment option and provides an excellent, long term symptom relief for the majority of patients. Although the majority of patients will experience improvement within a few weeks of surgery, some may require longer periods due to extensive quadriceps atrophy or other intra-articular pathology.

Arthroscopic repair: In certain specific cases, the meniscus may be able to be repaired. This is usually restricted to those cases where a fresh, peripheral tear is identified at arthroscopy in a young patient. The limited application for meniscal repair is due to the poor blood supply found within the majority of the meniscus meaning only the outer 25% has viable healing potential. It is an important consideration for many patients that a meniscal repair will necessitate a much prolonged period of rehabilitation when compared to a simple excision.

What is Osgood Schlatter Disease

Osgood-Schlatter disease refers to a condition in older children and teenagers caused by excessive stress to the patellar tendon (located below the kneecap). Participants in sports such as soccer, gymnastics, basketball, and distance running are at higher risk for this disease.

Causes

The causes of Osgood-Schlatter disease include:

Outdoor sports activities involving a lot of running and jumping exerts stress on the thigh muscles, which in turn pulls the patellar tendon that connects the kneecap to the tibia. Repeated stress can cause the tendon to shift away from the tibia, causing pain and swelling of the affected knee. In some cases, the body may try to close the gap with new bone growth which results in a bony lump in that region. 

Symptoms

The main symptoms of Osgood-Schlatter disease include:

• Knee pain
• Swelling
• Tenderness below the kneecap area

Diagnosis

Diagnosis of Osgood-Schlatter disease includes a review of your symptoms and medical history. A physical examination will be performed by your doctor to check the affected knee for pain, swelling, and inflammation. X-ray or MRI scanning may be ordered to view the bones of the knee and examine the tendon and tibia more closely.

Treatment

The goal of treatment is to reduce pain and swelling. The treatment includes the use of anti-inflammatory medications and physical therapy. Physical therapy may include strengthening exercises for the thigh muscles to help stabilize the knee joint. Most Osgood-Schlatter symptoms disappear after the adolescent growth spurt has ended.

What is Pseudogout?

Pseudogout is a type of arthritis that is characterized by the development of a painful swelling that occurs suddenly in one or more joints. It is also known as calcium pyrophosphate deposition disease (CPPD) because of the type of crystals that are deposited on the joint during the disease process.

Symptoms

During a pseudogout attack, the following signs and symptoms may be experienced in the affected joints:

• Swelling
• Warmth
• Severe pain

Causes

Pseudogout has been associated with the deposition of pyrophosphate dihydrate crystals inside the joint, although most people with such crystal deposits do not develop pseudogout.  These crystals increase in number as you grow older and are present in at least half of the population over the age of 85 years. 

Risk Factors

The following factors put you at a higher risk of developing pseudogout:

• Age: Your risk for developing pseudogout increases as you grow older.
• Traumatic joint injury: Having sustained serious joint trauma or undergoing surgery increases your risk.
• Genetic predisposition: You may be at a higher risk for pseudogout if other members of your family have the condition.
• Mineral imbalance: High blood levels of calcium and iron, and low levels of magnesium increase your risk for pseudogout.
• Certain medical conditions: Pseudogout has been linked with the presence of an underactive thyroid gland or an overactive parathyroid gland.

What is Anterior Knee Pain?

Anterior knee pain is characterized by chronic pain over the front and center of the knee joint. It is common in athletes, active adolescents (especially girls) and overweight individuals. Anterior knee pain refers to various conditions, which include runner’s knee or patellar tendinitis, and chondromalacia of the patella. There is an inter-individual variation in the duration and presentation of pain. 

Causes

Anterior knee pain usually develops due to improper movement of the kneecap, causing it to rub against the lower end of the femur bone. This may occur secondary to an imbalance or poor flexibility of the thigh muscles that stabilize the knee joint, problems with alignment of the knee joint, flatfoot, tightness or weakness of the front and back muscles of the thigh, excessive sports activities, improper sports training techniques or improper use of equipment. Other possible causes for anterior knee pain include arthritis, cartilage injury and dislocation or fracture of the patella or kneecap. 

Symptoms

Pain is the predominant symptom and is usually gradual in onset. Patients may experience a dull aching pain around the sides, below or behind the kneecap. Sometimes, climbing stairs and standing up or walking after prolonged sitting may produce a popping or cracking sound in the knee. The pain may also present at night and be exaggerated by any repetitive knee bending activity such as jumping, squatting, running or weight lifting. Any changes in the activity level, playing surface or equipment may also result in pain. 

Diagnosis

The diagnosis of anterior knee pain includes a medical history and a physical examination along with imaging tests such as X-ray and MRI scan. Physical examination determines the cause of pain and other related problems while X-rays and MRI scan aid in confirming the condition by providing visualization of the internal structures.

Treatment

You may usually respond to conservative treatment which includes application of ice, rest and well-programmed rehabilitation exercises. Ice helps to relieve the swelling and inflammation, rest protects the joint from repetitive injury, while stretching and mobilization exercises improve muscle strength, flexibility, and range of motion. Sometimes, if needed, pain relieving medication and anti-inflammatory drugs may be prescribed. Surgical treatment is rarely indicated.

Prevention

Chronic persistent pain needs to be reported to your doctor immediately. Once the pain has been treated, a recurrence can be prevented by following a few simple measures which include:

• Wearing appropriate shoes for your sporting activities
• Performing warm-up exercises before any physical activity
• Discontinuing any activity causing pain in your knees
• Modulating the intensity of activity depending on your condition