Traumatic Knee Injury, Part 2

Damage to the meniscus can be caused by sudden rotations of the knee joint while the foot remains stationary. Pain occurs when attempting to straighten the knee. Swelling and inflammation can ensue, which may be worsened if the joint was previously damaged and not allowed to heal properly.

On exertion, the joint may pop, lock and feel weak. Symptoms, however, may “wax and wane.” This injury may be treated medically, but in the athlete, assessment and treatment may require an MRI and surgical repair and even removal of the damaged meniscus. Removal of the meniscus could increase the risk of developing osteoarthritis. This should be considered and discussed with the physician. Most young athletes can resume their activity after meniscal surgery.

Minor tears to the meniscus may be medically treated with the help of physical therapy and include specific exercise regimens.

These include walking, leg bending and stretching exercises.

Ligament damage is of considerable importance in high-impact athletics such as football, hockey, basketball, soccer and skiing. The posterior ligament in the knee is often the most critical structure affected by direct impact. Initially, ligament damage may not always cause pain. A differential diagnosis results from an assessment of the nature of the injury and when the individual reports that the leg collapses when standing. An MRI is often useful in making the diagnosis of ligament injury. When an incomplete ligament tear occurs, conservative therapy is warranted, often stressing exercises that compensate for the ligament damage by strengthening the surrounding muscle groups. In the active athlete, a tear of the anterior cruciate ligament will, in most cases, require surgery and significant rehabilitation time. Rest and moderation of the exercise activity best treat medial and collateral ligament damage such as a sprain, which may now also including icing to reduce additional swelling that may occur.

Tendonitis (inflammation of the tendon) or tendon ruptures are usually the sequelae of overuse. Basketball players often complain of “jumper’s knee,” which is tendonitis of the patellar tendon. This condition results from repetitive muscle contractions that considerably stress the patellar tendon. Tendonitis is painful, and the damaged knee may often swell. If the tendon is ruptured, the individual will not be able to lift the leg against gravity. In the case of a limited tendon tear, a cast may suffice and surgery may not be required. If surgery is indicated, the ends of the ruptured tendon will be reattached, a cast put on for three to six weeks and crutches employed to limit impact loading on the damaged knee. When the diagnosis is tendonitis, the therapy is rest, elevation and ice packs if a limited exercise regimen is included. Aspirin and ibuprofen may be prescribed to control pain and inflammation. Exercise rehabilitation is generally more moderate to treat tendonitis than for ligament damage.

All joint injury should receive medical attention. Ignoring even a small joint injury may have long-term consequences.

The possibility that untreated joint damage may result in significant changes to the joint articular cartilage and bone requires that a physician make an accurate diagnosis and an appropriate course of action be developed to allow the joint to resume normal activity.