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The knee joint is active during almost all forms of sport and exercise. Whether going for a gentle walk or skiing in the Alps, forces will be passing through the joint with the potential to cause injury. Due to the high activity of the knee joint any injury and pain is particularly troublesome, affecting everyday life and not just your sporting ambitions.
The knee joins the thigh bone (femur) to the shin bone (tibia). The kneecap (patella) and the second bone of the lower leg (fibula) also form part of the joint. Four ligaments work to keep the knee stable.
The Anterior Cruciate Ligament (ACL) is connected to the femur and tibia in the front part of the joint, this prevents the lower leg from sliding forward. ACL injuries can be caused with a change of direction, deceleration and landing from a jump. Many high profile football players have suffered from this injury including Arsenal F.C. forward Theo Walcott.
To prevent the tibia from sliding backwards the Posterior Cruciate Ligament (PCL) is located behind the ACL and again connects to the femur and tibia. A blow to the front of the knee can cause PCL injuries.
There are ligaments on either side of the knee joint, with the Medial Collateral Ligament (MCL) on the inside and the Lateral Collateral Ligament (LCL) on the outside. These ligaments help to prevent sideways movement at the joint; the MCL is more commonly injured from any movement which forces the foot outwards and knee in. Where the femur and tibia meet there is a layer cartilage called meniscus. This absorbs some of the force which passes through the joint and protects the bones. The degeneration of this meniscus is the cause of pain and stiffness suffered by people with Osteoarthritis. The structure of the knee and the large forces passing through the joint make it susceptible to injury.
Knee injuries can occur following a variety of reasons, whether it is as a result of sport, a fall or even due to a degenerative condition.
Sports injuries can occur through overuse, where the body becomes tired and the individual has pushed themself too far. An injury can equally occur following a bad fall or tackle and is one of the main contributors to ACL damage in professional footballers.
Outside of sport you may incur an injury from a bad fall or slipping on a wet floor which could result in anything from bruising following the initial impact to ligament damage should you experience a twisting of the joint.
Degenerative conditions are those which we have little control of and whilst in cases such as osteoarthritis they are incurable they can still be managed conservatively or through surgery in extreme cases.
Some of the more common knee injuries include:
Patella Tendonitis – The kneecap (patella) is connected to the shin bone via the patella tendon. It is part of the mechanism which straightens the leg and is often seen with people who carry out repetitive jumping actions. In fact patella tendonitis is sometimes referred to as ‘jumper’s knee’. The tendon becomes damaged and inflamed causing pain, especially when jumping or kneeling. A crunching sensation may occur with movement of the joint.
For more information visit our patella tendonitis section.
Osteoarthritis – This is the most common form of arthritis in the UK. It affects the joints, most commonly at the knee, hip, spine and hands. Osteoarthritis occurs due to the protective cartilage becoming damaged and thinning, in severe cases the cartilage no longer covers the end of the bones and they begin to rub together.
For more information visit our knee osteoarthritis section.
Meniscal Tears – Meniscus is the c-shaped cartilage that helps to protect the joint. This can be damaged by knee movement, such as a squat and twist during sport, or in older people as themeniscus becoming damaged due to it thinning and weakening over time. Meniscus tears can also occur at the same time as injury to the ACL and MCL.
For more information visit our meniscal injury section.
Ligament Damage – Ligaments are the tough bands of tissue connecting the bones within the joint and are responsible for stabilisation, allowing you to walk, run and jump. It is a common knee injury experienced by both professionals and amateurs alike, with the ACL being the most prone to injury. Any damage here can vary in severity and graded one to three, with one being a minor sprain and three being a complete rupture or tear of the ligament.
For more information visit our knee ligament injury section.
It depends on the type of injury you have suffered as to whether physiotherapy would be recommended. For a minor injury, a sprain or a knock you should be back on your feet within a couple of days. Should there be no signs of the injury having improved in this time then it is advisable to seek a professional diagnosis. Physiotherapy is one of the treatment options available to you and works on strengthening the affected region through stretches and exercises. It is this process which allows you to return to action and also minimise the risk of the injury happening once again in the future, since there is always an inherent weakness following the initial injury. A physiotherapist will also be able to work with you on developing a training programme which you can adhere to outside of your sessions.
The short answer is no. Ultimately it depends on the condition you have been diagnosed with as to the type of treatment you require. Surgery is often reserved for the most severe injuries and conditions and where the body would not be able to heal naturally i.e. tears and ruptures of ligaments and in degenerative conditions.
In considering the ligaments within the knee there are three different grades of severity, with surgery only typically used for a grade three where there is a complete rupture which can lead to instability of the joint compromising mobility. Full ligament ruptures can however be treated conservatively through the use of bracing and physiotherapy for those who don't want to or can't commit to being out of action for any length of time.
If we look at degenerative conditions then osteoarthritis is one of the more common conditions affecting the knee. The key with managing osteoarthritis is early diagnosis so that conservative approaches can be introduced which can delay the need for surgery, which would involve a partial or full knee replacement. This is a major form of surgery and can take up to 9 months for a patient to fully recover. It also worth noting that the lifespan of a knee replacement is 10-15 years so surgery is often avoided on the younger patient to avoid a replacement of the replacement.
Ultimately surgery may be part of the discussions you have with your doctor following diagnosis but it is important to understand that other options are available to you.
In recent years the visibility of bracing has increased both on the professional circuit and those at home. In general bracing is designed to offer a degree of protection whilst allowing you to return sooner to your sport of choice.
There are a variety of knee supports available on the market and the most important thing is to select one which is designed to manage the condition you have been diagnosed with, so check the indications for use before adding it to your basket. As different braces ae designed to manage differet conditions they all work in a slightly different way however in general they offer compression, stability or a combination of both. Following surgery you will typically be given a immobilises or (limited) range of motion brace. Compression is designed to manage inflammation or swelling whilst offering pain relieving qualities which can allow you to remain active for longer. Stability is required where there is damage to the ligaments, minimising the risk of your knee moving beyond its normal range of motion and keeping you on your feet.
If you are unsure as to the type of brace required then you should speak with your doctor or a clinician.
Braces and supports are not designed for long term use, but a means of offering an additional level of protection or support during your recovery to reduce the risk of you suffering a reoccurence. A knee support will often be recommended for use when active outside of your physiotherapy sessions but shouldn't be worn when working on stretching and strengthening exercises as you want your body to do the work and to heal naturally.
Once you begin your recovery the objective is to become less reliant on the brace itself. You can work with your physiotherapist on a phased removal of the brace itself as you return to full fitness.