15 Nov Treating and Preventing Knee Injuries
Knee injuries range from discomfort to career-ending results. Below are some insights to help you in the prevention and treatment of knee injuries.
Prevention
• Neuromuscular training with bent-knee landing and pivoting can be helpful in injury reduction
• Strength training of thighs, hips and lower leg may help prevent injury
• Proper warm up and stretching may also decrease knee injuries
• Use ice treatment after knee exercise training
Guidelines for Return To Play
• Full weight bearing ability
• Pain resolved or minimized
• Motion up to 90% compared to uninjured knee
• Swelling mostly resolved
Additional Considerations
With any complaint of knee pain, clinicians must also rule out hip or back injury causing referred pain to the knee
• Knee injury may result from bone, ligament, or meniscal trauma
• Combination injuries often occur
• Terrible Triad: Injury to ACL, MCL and medial meniscus
Common Injury Types, Signs and Treatment
Patellar Fracture
Results from direct blow to patella (kneecap)
Signs
• Generalized pain or lateral dislocation of patella
Evaluation
• Physical exam and x-rays
Treatment
• Minimally displaced may be non-operative but displaced/comminuted fractures need surgery. Usually immobilized for 2-4 weeks
Patellar Dislocation
Results from direct blow or twisting injury
Signs
• Laterally displaced patella more common than medial
Evaluation
• Physical exam and x-rays will demonstrate lateral dislocation
Treatment
• Normally non-operative
• Knee sleeve with patellar stabilization
• Crutches and avoidance of twisting motions
• Physical therapy
Meniscus Injury
Results from rotation stress on a weight-bearing knee
Signs
• Medial or lateral joint line tenderness
• Locking, clicking, popping sensations in knee
Evaluation
• Clinical knee exam
• MRI may be done
Treatment
• Surgical repair or debridement
Ligamentous Injury
• Results from direct or indirect trauma to knee
• Often occurs when body rotates around a fixed/planted foot
Types:
• ACL-can be from non-contact deceleration injury such as landing from jumps
• PCL-often results from hyperextension of knee; common dashboard injury in car accidents
• MCL-results from direct blow to outside of knee (valgus force)
• LCL-results from blow to inside of knee (varus). Less common than MCL injury
Signs
• Instability, giving way
• Tenderness over inside or outside of knee
Evaluation
• Clinical knee exam
• MRI may be done for confirmation
Treatment
• Surgical reconstruction for ACL via patient’s own tissue (autograft) or cadaver tissue (allograft)
• No surgery usually needed for PCL, MCL, LCL injuries
• Physical therapy for operative and non-operative injuries