Our knee is the largest joint in our body. It's also the most vulnerable because it bears our weight while providing flexible movement. When we walk, our knees support 1.5 times our body weight. When climbing stairs, the pressure on our knees is about 3 to 4 times our body weight. And squatting puts about 8 times our weight on this joint.
The knee connects the femur to the tibia, or in layman's terms our thigh bone to our shin bone. It is covered by the patella, or kneecap. There are actually two joints in the knee working together to make a hinge that will both bend and straighten our legs as well as slightly rotating them from side to side.
Typical Knee Injuries and Illnesses:
- Ligament Injuries/Sprains (ACL, MCL, PCL)
- Meniscus Tear
- Osgood-Schlatter Disease
- Runner's Knee - Patellofemoral Pain
- Knee Tendon Bursitis
- Arthritis of the Knee
Orthopaedic Services for Knees:
- ACL Reconstruction
- Total Knee Replacement
Knee Ligament Injuries (Knee Sprain)
There are four primary ligaments in your knee. Ligaments are the strong fibrous tissues that join bone to bone. Because Southlake Orthopaedics specializes in sports medicine, it often sees patients with knee ligament injuries that occur during athletic activities:
- Anterior Cruciate Ligament (ACL), in the center of the knee, limits rotation and forward movement of the tibia. The ACL is often injured by rapid change of direction in football, basketball and skiing. ACL Reconstruction (See ViewMedica below)
- Medial Collateral Ligament (MCL), connects the femur and tibia, providing stability to the inner part of the knee.
- Lateral Collateral Ligament (LCL), connects the femur and fibula and provides stability to the outside of the knee. This can be injured by hyperextension.
- Posterior Cruciate Ligament (PCL), also in the center of the knee, connecting the femur to the tibia.
Many ligament injuries can be successfully treated without surgery. Treatments such as icing, bracing and physical therapy are often effective.
When someone says they have torn cartilage in their knee, they are probably referring to a torn meniscus. The meniscus is a rubbery cushion inside your knee that is shaped like a crescent. Each knee has two of these discs to keep your knee steady, balancing your weight across the knee.
Meniscal injuries can happen during sports, or they can happen due to wear and tear that comes with age. However the meniscus is torn, you may hear a popping sound when it happens.
Conservative treatment includes ice, rest, simple exercises and taking an anti-inflammatory drug like ibuprofen. If your condition does not improve, surgery may be required.
Fractures of the Knee
You can break a bone just above your knee (distal femur) or just below your knee (proximal tibia). Symptoms of knee fractures are commonly perceived: pain, inability to walk or bear weight on the leg, deformity or instability of the leg, and occasionally, loss of feeling in the foot.
Whether your orthopaedist treats these knee fractures with or without surgery, it is important that both the injured bone and any related damage to the surrounding soft tissues (ligaments, tendons, cartilage) be treated at the same time.
Fractures of the Growth Plate (in Children)
Children have a unique anatomical structure at the ends of their bones called the growth plate. As you may expect from the name, it is where the bones continue to elongate and grow as a child matures. These plates are susceptible to break because they are not yet fully hardened into bone.
When a fracture occurs in the growth plate, it is very important to get immediate medical attention. The healing process is much faster in children than with adults, so the bone should be set as quickly as possible.
Osgood-Schlatter disease is caused by stress on the patellar tendon which attaches the quadriceps muscle of the thigh to the tibia below the knee. Teens who participate in running sports and gymnastics are most at risk for this disease.
The primary symptom is knee pain which is sometimes accompanied by lumps just below the knee. Treatment may include the use of nonsteroidal anti-inflammatory drugs, wrapping the knee, bracing, shoe inserts, or physical therapy aimed at reducing the pain and swelling so your child can return to normal activity.
Runner's Knee (Patellofemoral Pain)
Runner's knee is a broad term used to refer to a number of medical conditions that cause patellofemoral pain. This pain is localized to the front of the knee cap and may be caused by overuse, injury, excess weight, or improper alignment of the knee cap. The pain is generally most noticeable when the knee bends in an activity like climbing or descending stairs, kneeling or squatting.
Treatment is usually conservative. If not medically contraindicated, taking anti-inflammatory medications such as aspirin or ibuprofen usually helps.
Often, your orthopaedist will recommend following the RICE approach:
- Rest. Avoid putting weight on the painful knee. Consider switching weight bearing sports for non-weight bearing activity such as swimming.
- Ice. Apply cold packs short periods several times a day.
- Compression. Use an elastic bandage such as a simple knee sleeve.
- Elevation. Raise and rest the knee higher than your heart.
If your knee does not improve, see your orthopaedist for a complete medical evaluation and diagnosis.
Knee Tendon Bursitis
Bursitis is an inflammatory condition which develops in the fluid-filled sacs that help muscles and tendons glide across bone. When the bursae are irritated, the resulting friction creates pain. The irritation is normally brought about by overuse, and is commonly found in runners as well as people who have osteoarthritis.
The pes anserinus is the anatomic term used to identify the place where a group of three tendons join their respective muscles to the tibia. Bursitis of the knee is known as pes anserine bursitis. Athletes with pes anserine bursitis should carefully modify their workout program to reduce the inflammation. Other conservative treatments include: rest, ice, steroid injection, shoe inserts, and physical therapy.
Arthritis of the Knee
Most arthritis found in the knee is osteoarthritis (OA). This type of arthritis is a degenerative disease in which the joint cartilage gradually wears away. It most often affects people over 40 or those with prior knee injury.
There are a variety of non-surgical steps that can be taken to lessen the pain, swelling and stiffness of OA. In many cases, simple modifications to your lifestyle such as finding alternate means of exercise, losing weight, and minimizing activities that aggravate the condition can help. Using supportive devices, like a cane, walker, or crutches is also a useful approach. Orthotics and braces can also help.
Several types of medications can be used in treating arthritis of the knee. Because every patient is different, and because not all people have the same response to medications, your orthopaedist will recommend medicine based on your specific condition. These may include oral or injected steroids, supplements such as glucosamine or chondroitin, as well as hyaluronic acid.
Total Knee ReplacementWhen your knee is disabled by arthritis or injury, your pain may be unmitigated by conservative treatments. It may impair your ability to walk and participate in normal activities.
While every patient is different, a qualified orthopaedic surgeon can perform a total replacement of the knee in a procedure known as arthroplasty. If your physician agrees that non-operative means have been exhausted, he may recommend this type of reconstructive surgery.
Total knee replacements have been performed on patients of all ages and stages, and quite often provide a new lease on life.