In order to understand your knee pain, you must first understand the anatomy of the knee.
THIS PICTURE SHOWS THE LIGAMENTS SURROUNDING THE KNEE!
The ligaments of the knee can tear. Here is a brief explanation of some of the types of ligament injuries to the knee. There are four major ligaments that stabilize. The Medial Collateral Ligament, The Lateral Collateral Ligament, The Anterior Cruciate Ligament, The Posterior Cruciate Ligament.
MEDIAL COLLATERAL LIGAMENT (MCL)
The Medial Collateral Ligaments job is to prevent opening of the knee or buckling of the knee. Therefore it is most often damaged when there is trauma to the outside of the knee that put pressure on the inside MCL. This type of injury is often seen in football "clipping" hits. The MCL attaches from the femur to the tibia.
SYMPTOMS OF MEDIAL COLLATERAL LIGAMENT INJURY
The most common symptom of MCL injury is pain directly over the ligament. Swelling is common. In more severe injuries the knee may buckle or become unstable.
There three grades of ligament injuries. Grade 1,2,3.
Grade 1 injury: is the least traumatic and usually involves a stretching of the ligament. This type of injury is usually last one to two weeks.
Grade 2 injury: this type of injury involves moderate tearing of the ligament. It is often followed with bruising and swelling. Pain usually occurs when attempting to pivot or cut (football, soccer). Healing time is usually 3-4 weeks and involves the use of physical therapy. Joint strengthening is recommended.
Grade 3 injury: this is the most traumatic type of ligament tear and involves a complete tear of the ligament. Patient often presents with significant swelling, pain and instability. A knee brace is recommended with an MRI to see the amount of damage. A surgical consultation is also appropriate.
ANTERIOR CRUCIATE LIGAMENT (ACL)
The Anterior Cruciate Ligament attaches the top of the knee to the bottom of the knee and prevents anterior or forward motion of the femur on the tibia and fibular. The ACL forms a cross with two ligaments hence the name cruciate ligament. The ACL ligament can tear from jumping or stopping quickly and is often but not always heard with a popping sound followed by knee instability and a feeling of the knee buckling or giving way underneath a person.
SYMPTOMS OF ACL INJURY
ACL injuries usually present with pain in the anterior portion of the knee. The three grades of ligament injuries apply to the ACL. A popping sound is often heard after the injury followed by joint instability. Diagnosis may be made with a serious of test sometimes depending on the severity MRI. Rehabilitation is very important after an ACL tear to prevent scar tissue from forming and prevent future injury.
LATERAL COLLATERAL LIGAMENT (LCL)
The Lateral Collateral Ligament goes from the Fibular to the Femur on the outside of the leg. It is responsible for preventing the leg from buckling to the outside. Therefore injuries to the LCL usually take place on the medial aspect of the knee buckling the lateral aspect of the knee.
SYMPTOMS OF LATERAL COLLATERAL LIGAMENT INJURY
Symptoms of LCL injury usually present with pain on the outside of the knee. Sometimes the knee seems to catch and become unstable. If the knee is bent to 25 degrees and pressure is place on the inside of the knee pain may be felt on the outside of the knee where the LCL is torn. Rehabilitation is important to restore normal joint function and prevent scar tissue formation.
POSTERIOR CRUCIATE LIGAMENT (PCL)
The Posterior Cruciate Ligament attaches from the femur to the tibia and is shaped in a cross hence the name cruciate ligament. It job is to prevent backward displacement of the tibia on the femur.
SYMPTOMS OF POSTERIOR CRUCIATE LIGAMENT INJURY
The PCL is thicker then the ACL and is less likely to be torn. Impact to directly to the tibia driving it posterior on the femur usually results in PCL tears. Very often the lateral meniscus is injured when the PCL is injured. Pain is usually in the back of the knee with swelling. Sometimes the calf is also sore and it is painful to walk. The draw test is one test to help diagnosis a PCL tear. There are three levels of PCL tears, grade 1,2,3. Sometimes an MRI is necessary to determine which level of tear is present. Rehabilitation is always important in a PCL tear to prevent scar tissue and restore normal range of motion back to the joint.
MEDIAL MENISCUS AND LATERAL MENISCUS
There exists two wedge-shaped, thick rubbery menisci located on the medial (inner side) and the lateral (outer side) if the knee joint. Medial meniscus is slightly larger and not as mobile. The medial meniscus is C shaped and the lateral meniscus is O shaped. The meniscus are held in place by coronary ligaments. The wedge shape of the meniscus is to prevent the femur from sliding off the tibia. The meniscus are divided into zones based on the blood supply. The red zone is on the peripheral which has the most blood supply, red-white zone with blood supply only on the outer region and the white zone (central meniscus) which lacks blood supply.
The medial meniscus is asymmetrical with the anterior horn wider than the posterior horn. It is approximately 3.5 cm in length and is attached to the medial collateral ligament. Fibers also attach to the anterior cruciate ligament and the joint capsule.
FUNCTIONS OF THE MENISCUS
RICE-Rest Ice Compression Elevation. Physical Therapy should begin as soon as possible to reduce scar tissue and improve healing. MRI should be done when a serious tear is suspected. When therapy fails to improve the healing surgery may be necessary to repair the cartilage.
SHOCK ABSORBER, PROTECTS THE ARTICULAR CARTILAGE, HELPS LUBRICATE THE CARTILAGE, HELPS STABILIZE THE KNEE, HELPS DISTRIBUTE THE BODY WEIGHT, HELPS ABSORB LOAD BEARING.
SYMPTOMS OF INJURY TO THE MENISCUS
Twisting or abnormal pressure on the meniscus to get jammed between the bones resulting into tearing o splitting of the meniscus. This is known as a meniscus tear. Symptoms of meniscus tears: pain in the knee, swelling in the knee, increased temperature in the knee (inflammation), stiffness and tightening of the knee, flexing is possible but extending the knee is painful, difficulty squatting, difficulty walking, instability of the knee, knee clicking, knee catching, knee locking. Knee locking occurs when a piece of cartilage gets stuck inside the joint and you can not fully extend your leg. Happens with severe tears.
TREATMENT FOR MENISCUS INJURY