In the second part of this series, we looked at common causes and forms of injuries to the knee, a major joint that is both highly complex and highly delicate. In this installment, we will take a look at common symptoms of a knee injury.
Common Symptoms of Meniscus Injuries
A meniscus injury can make itself known in various ways. Sometimes the injured person experiences a “popping” sensation during an athletic event. It is important to note though that while tears are more commonly seen in athletes or those with demanding occupations where the knee is constantly at risk, they can also occur with seemingly innocuous activities such as jogging or squatting. There is usually significant pain along the joint on the side of the injury while some tear patterns will cause a portion of the torn menisci to be trapped between the joint causing the knee to lock where extension and flexion are impossible.
The following are common signs of meniscus injury:
- Pain
- Swelling
- Inability to fully extend or flex the knee without discomfort
- Locking or catching of the knee
- Weakness of the quadriceps evident when walking up or down stairs
- Continued popping, locking or buckling
ACL Sprain or Tear
An ACL tear is most often a sports related injury but can also occur during rough play, auto accidents, falls and work related injuries. Most ACL injuries in sports happen when pivoting or landing from a jump. Similar to meniscus injuries, patients of ACL tears often feel a “pop” and the knee usually gives out underneath them. Subsequent pain and swelling is to be expected. ACL tears do not necessarily require surgery. According to Doctor Jonathan Cluett, Board Certified Orthopedic Surgeon in Massachusetts, your daily activities and demands should be considered prior to opting for surgery.
For instance, do you regularly perform activities such as football, soccer, basketball, skiing, gymnastics, hockey, wrestling, lacrosse, rugby, singles tennis or cheerleading that require a normally functioning ACL? Secondly, is your knee stable? If not, you may not need ACL surgery. Many patients with ACL injuries feel better within a few weeks. The only persistent problem may be instability.
PCL Sprain or Tear
PCL injuries are most commonly experienced when the knee is bent and an object forcefully strikes the shin backwards. This type of injury can be experienced in a car collision when the shin strikes the dashboard. The other mechanism of injuring the PCL is in sports when an athlete falls on the front of the knee. The knee is hyperflexed with the foot held in a pointing downwards position. Symptoms of PCL injuries are quite similar to those of ACL injuries. In the weeks following the injury patients state that they can’t trust their knee or that it feels as it is going to give out.
MCL Sprain or Tear
MCL injuries occur when the knee is struck on the lateral part (Outside) of the body. Since the MCL is located in the inside part (Medial) of the knee and resists widening of the inside of the knee joint when the knee is struck from the outside with a force that causes lateral buckling it simultaneously separates and widens the medial portion of the knee joint causing the injury.
MCL tears are classified by their severity into three categories.
- Grade 1- This is an incomplete tear of the MCL. The tendon is still in continuity and there are minimal symptoms. The symptoms are pain on the MCL with minimal down time where most can return to their normal activities or sports within a few weeks’ time
- Grade 2- A grade two tear is also an incomplete tear but with more aggravated symptoms such as more intense swelling and pain along with a feeling of instability. A period of at least three to four weeks of rest is usually necessary.
- Grade 3- This is a complete tear of the MCL. There is significant swelling and pain with difficulty bending the knee. Instability or the knee giving out are common findings. A period of at least six weeks or longer is needed for healing to occur. Having a knee brace with lateral and medial stabilizers is recommended. Due to the good blood supply that the MCL has and usually responds well to non-surgical treatments, it is rarely treated with surgery.
LCL Sprain or Tear
LCL injuries are the complete opposite of MCL tears. They occur when the inside (medial part) of the knee is struck and pushed out or in sports where there are a lot of quick stops and turns as in soccer, basketball and skiing. LCL injuries are also classified by their severity with the classifications and symptoms similar to those of the MCL. However, the LCL does not heal as well as the MCL and in most cases a Grade 3 injury will require surgery.
Chondromalacia Patella
Chondromalacia Patella is the degeneration of the cartilage between your patella and femur. Your kneecap, which sits over the front of the knee joint, glides over the Femur as your knee bends or extends. Chondromalacia Patella (also called “Patellofemoral Syndrome”, “Runners Knee”, “Patellar Tendinitis” or “Jumpers Knee”) begins when the kneecap does not move properly and rubs against the lower part of the femur.
There can be various causes for this occurrence:
- The kneecap is in an abnormal position(also called poor alignment of the Patellofemoral joint)
- Tightness or weakness of the muscles on the front or back of thigh
- Flat feet
- Too much physical activity that places extra stress on the kneecap (such as running, jumping, twisting, skiing, soccer, heavy leg extensions, load bearing squats with a bounce at the bottom, and using competitive knee wraps habitually using a tight placement which applies extra pressure to the patella and makes it rub harder against the femur).
Symptoms of Chondromalacia Patella are pain behind, below or on the sides of the kneecap being more noticeable while climbing up or down stairs, performing deep knee bends, standing for long periods and running downhill.
Prepatellar Bursitis
Prepatellar Bursitis is the common cause of swelling and pain on top of the kneecap. The bursa are thin sacks filled with the body’s own natural lubricating fluid. The bursa are very thin slippery sacks that are situated around our joints to prevent muscles, tendons and skin from catching on bony surfaces throughout the body. When there is trauma, repetitive use or injuries to the knee, the bursa can swell and either fill up with blood or fluid, which in turn causes pain and swelling of the knee. If the trauma is associated with a tear in the skin the bursa can become infected, this is called infected bursitis.
Common causes for bursitis are trades and professions such as carpet layers, housemaids and any other repetitive activity that puts you in a daily kneeling position for extended periods of time. A sedentary lifestyle has also been reported to increase the possibility of developing prepatellar bursitis.
Symptoms of Prepatellar Bursitis are:
- Swelling over the kneecap
- Limited motion of the knee
- Painful movement of the knee
Bursitis of the knee can be treated by draining the bursa sac and in cases where infection is possible, an antibiotic is prescribed. In mild cases, simply resting the site along with ice therapy and anti-inflammatory medication may work just fine.
References
1. Collado H., Fredericson M., Patellofemoral pain syndrome. Clin Sports Med. 2010:29:379-398
2. De Cardo M, Armstrong B. Rehabilitation of the knee following sports injury. Clin Sports Med. 2010:29:81-106
3. Steiner T., Parker RD., Patella subluxation and dislocation. DeLee and Dree’s Orthopaedic Sports Medicine 3rd ed.
4. Clark, J. M. (1990). “The organization of collagen fibrils in the superficial zones of articular cartilage.” J Anat 171: 117-30.
5. Mechanics of human joints” Physiology, Pathophysiology, and treatment. Unsworth, A. 1993
6. Basic Orthopaedic Biomechanics, Second Edition, Van C. Mow, Wilson C. Haynes, 1997
7. Medial Collateral Ligament Tears, Cedars-Sinai, 2012, a 501(c)(3)
8. Arthroscopic repair of traumatic longitudinal meniscal tears, K Roeddecker, G.D. Giebel, C. Lohscheidt and M. Nagelschmidt, 1993, Vol 7 Num 1
9. Meniscus tear recovery time, Benjamin Wedro, MD, FACEP, FAAEM, 2012
10. Bursitis, The Basics, What you should know about bursitis, 2012 Carol Eustice, ASCP, ARHP
About the Author
Felix Doval is the founder and owner of Pro-Active Wellness, a leading South Florida Health and Fitness education provider whose curriculums are taught using the private training facilities of Active Bodyz Fitness Training located in Davie Fl.Felix holds a Master Certification with the NFPT, and is NSCA and NAHF certified. He is a graduate of a two year Natural Health Consultant program at Stratford Career Institute in Washington DC, and from the Professional Career Development Institutes’ Professional Fitness and Nutrition program in Atlanta, GA. His advanced knowledge includes multiple specialty studies in the fields of diabetes, heart disease, arthritis, lung disease, and osteoporosis. He has directed and developed wellness programs around the nation and is currently responsible for developing, staffing and coordinating the NFPTs’ worldwide workshop division.
