> Anterior Cruciate Ligament Injuries
An ACL sprain or tear is a very common knee injury. Quite often associated with high demand running and change of direction sports, the injury has been described as the classic plant pivot pop type of injury where the pop is the sensation as the knee gives way. The ACL injury may be catagorised as a grade 1, 2 or 3 injury, where grade 3 is complete rupture. Complete rupture presents with pain, swelling, instability and loss of range of motion. Surgical reconstruction is advised in most cases.
> Posterior Cruciate Ligament Injuries
The PCL is located at the back of the knee and stops the tibia moving backwards. It is less common to injure the PCL than other types of knee ligaments. Impact injuries like dash boards of cars hitting the knee or hyper-extension injuries are the typical mechanisms of injury. The PCL injury may be catagorised as a grade 1, 2 or 3 injury, where grade 3 is a complete rupture. Complete rupture presents with pain, swelling, instability and loss of range of motion. Surgical treatment may be advised if the patient wishes to return to a high level of function.
> Collateral Ligament injuries
Collateral ligaments of the knee are the ligaments which brace the sides of the knee joint. There is the Medial Collateral Ligament (MCL) and the Lateral Collateral Ligament (LCL). As with other types of ligament tears, collateral ligament injuries are catagorised as a grade 1, 2 or 3 injury, where grade 1 is slightly stretched and grade 3 is a complete tear or rupture. The MCL is more frequently damaged than the LCL due it being easier to create a valgus strain versus a varus strain. Pain, swelling and instability are the symptoms and typically immobilisaton without surgery is the recommended treatment.
> Combined knee Ligament injuries
Combined knee ligament injuries are complex injuries and an assessment of which ligaments have been affected and the recovery expectation of the patient need to be carefully considered. Multi ligament tears present with pain, swelling and inflammation. Treatment is often surgical and had best soon after the injury. Arthrofibrosis or scar tissue of the joint is a risk factor to consider for surgery of these conditions.
> Discoid Meniscus
A discoid meniscus is an abnormally shaped meniscus in the knee. People with discoid meniscus are more prone to injury than those with a normal meniscus. Squatting and twisting motions are the typical mechanisms of injury. Symptoms are more frequent in the young. There are 3 types of discoid meniscus, incomplete, complete and hypermobile wrisberg. Meniscal injuries present with pain, stiffness, swelling, catching, locking, and altered range of motion. MRI scans can verify meniscal pathology which is best treated surgically.
> Meniscal Tears
Meniscal tears are of the most common types of knee injuries. Meniscus is commonly described as cartilage and is the shock absorber of the knee sitting on the tibia and below the femur. It is relatively easily torn by heavy squatting and twisting movements. There is a medial meniscus and a lateral meniscus making up menisci of the knee. Tears are described as longitudinal tears, parrot beak, bucket handle, transverse, radial, flap, and mixed or comlpex tears. Meniscal injuries present with pain, stiffness, swelling, catching, locking, and altered range of motion. MRI scans can verify meniscal pathology which is best treated by surgical repair.
> Osgood - Schlatter Disease
Osgood-Schlatter disease is an overuse injury of the knee in adolescents resulting in pain, swelling and tenderness below the kneecap. Treatment involves managing the pain and inflammation usually by a course of non steroidal anti inflammatory drugs (NSAIDs). In some patients, Osgood-Schlatter's may last 2-3 years, but in most cases passes at the end of the growth spurt at 14-16 years old.
> Patellar Tendon Tear
The patellar tendon is the tendon below the kneecap joining the patellar to the tibia. It is a very strong tendon and resistant to injury. The mechanism of injury of a patellar tendon tear includes direct impact, a weakening of the tendon via overuse tendinitis or chronic disease caused by disrupted blood flow to the tendon. XRay and MRI scans will confirm rupture of the patellar tendon, which is best treated by surgical repair.
> Patellar Dislocation and Instability in Children
A child's kneecap should sit in the middle of the knee in a groove of the femur called the trochlear groove. During knee movement, the kneecap should move up and down within the groove. When the patella slips out of the groove, it is known as a partial or complete dislocation of the kneecap. This is a very painful experience associated with loss of movement, even if the kneecap returns to the groove after it has slipped out. If the kneecap remains dislocated the child should be taken to emergency to have it reduced. Pain and inflammation should be managed with physiotherapy including immobilisation and VMO quads strengthening. Surgical treatment is only necessary if the patient experiences multiple dislocations.
> Runner's Knee (Patellofemoral Pain)
Runner's knee is a term used to describe a number of medical conditions which cause pain around the front or anterior part of the knee. Often, malalignment of the patella caused by a number of different factors contribute to the condition. Adequate stretching and strengthening of the muscles of the knee are measures to prevent and treat runner's knee. Surgical treatment is available for severe cases where patella maltracking is frequent.
> Unstable Kneecap
When the knee is functioning properly, the kneecap runs smoothly in a grove of the femur called the trochlear groove. If the kneecap slides out of this groove, the kneecap will become unstable. Anatomy anomalies like shallow or uneven grooves may cause the kneecap to slide out, or an injury such as a heavy fall or sharp blow to the kneecap may cause it to dislocate. Bracing and strengthening exercises treat minor and single episode dislocations while surgery is advised to correct multiple dislocation injuries.
> Quadriceps Tendon Tear
The quads tendon sits above the knee, joining the quads muscles to the top of the patella. Tears are more common in middle aged populations. The mechanism of injury is an eccentric (lengthening) contraction of the quads resulting in a painful disabling condition. Tendon weakness caused by tendinitis or chronic disease will result in higher risk of sustaining a quads tendon tear. All quads tendon tears should be treated surgically.
> Shin Splints
The term "shin splints", refers to pain along the inner edge of the shin bone. Shin splints are an over use injury, involving inflammation of the muscles, tendons and bone of the tibia. Shin splints occur with a sudden change of frequency and load of exercise. Those with poor arch support or flat feet are at higher risk of developing shin splints. Shin splints may develop into stress fracture, tendinitis or chronic exertional compartment syndrome. Treatment involves rest from erxercise, inflammation management and arch supports for feet. Surgical treatment is not indicated.