The menisci are two crescent shaped pieces of cartilage that cushion the knee joint. Meniscal tears are the number one knee injury. They can occur just like that – you were playing basketball and you felt something twist and pop. Or they can occur over time, with general wear and tear and minor injuries setting the stage for that moment when you are doing something routine, you step or twist a certain way and you feel that pop.
Meniscal tears range from mild to severe, and therefore treatment will depend on the severity of the tear. With mild tears, rest and first line treatments may be adequate for rehabilitation. Severe tears may require surgery to recover full motion and capabilities.
There are four major ligaments in the knee that join the upper leg bone to the lower leg bone: the collateral ligaments on the sides of the knee, and the cruciate ligaments, which cross each other to form an “X” on the inside of your knee. (The ACL is the anterior cruciate ligament.) All of these ligaments can be injured, typically during high impact sports or activities, such as football, basketball, soccer, and skiing. Ligament injuries can range from partial tears to rupture (a rupture is when the ligament is completely torn and separated, making the knee joint unstable).
Generally speaking, you know when you have injured a ligament — you feel or hear a distinct pop and your knee gives way. There will also be pain and swelling and you will probably experience difficulty walking. As with meniscal tears, treatment will depend upon the severity of the tear. Mild tears may be treated with non-surgical methods such as rest, ice, and immobilization, followed by physical therapy. Ruptures that produce ongoing instability may require surgery.
When other knee injuries occur, such as traumatic ligament injury or meniscal tears, frequently there is damage to the surrounding cartilage. Pain and loss of mobility are the most common symptoms of cartilage injury (see “When to See a Doctor”). This injury can range is severity from cracking or fissuring, to detachment of cartilage fragments. Loose fragments often require surgical treatment as they can cause significant damage to the internal knee structure. Minor forms of cartilage damage will often respond to more conservative treatments.
Cartilage injury may also occur as a result of the ageing process – known more commonly as arthritis. This is most often treated with anti-inflammatory medication, activity modification, physical therapy, and selective injections. Most people will experience improvement as a result of these conservative treatments. Only in instances where symptoms persist is surgical treatment indicated.
Muscle and Tendon Injuries
The hamstrings and the quadriceps are two strong sets of muscles that work together to flex and extend the leg at the knee. Strains (a pull or tear) in these muscles are a common injury, particularly among those who plays sports. Injury is frequently accompanied by a popping or snapping sensation, and pain is immediate and severe.
It is very important to follow the proper treatment for these injuries (usually non-surgical) and allow them time to heal. Activity modification or re-education may be required to prevent future injuries.
Tendonitis and bursitis (inflammation of the bursae, which are fluid filled sacs that provide padding and cushion at the points where the bones meet) are common conditions at all ages. In most situations, these conditions respond well to non-surgical treatment. Tendon ruptures are not common, but they do occur, such as a patellar tendon rupture or quadriceps tendon rupture. These injuries (with rare exception) do require surgical treatment.