Knees need help

By: Dr Isabelle Duck

 It seems to me that a lot of people come to the doctor quite late after a knee injury, but it is important to be assessed early, because in most cases early intervention improves the outcome.

The knee is a complex and fascinating joint. It consists of a lot more than just a few bones, as it takes a lot of important structures to assist with the smooth function of the joint. When these are damaged it can affect stability, movement, strength and can cause a lot of pain.

Those key structures are ligaments, tendons, and the menisci (single: meniscus). The menisci are the ‘shock absorbers’ of the knee. There are two: the medial and the lateral.  One common injury is a tearing of the meniscus, often caused by a twisting of the knee when stepping with full weight. This can cause swelling and pain. It is most common to tear the medial meniscus. Minor tears often settle with a bit of physiotherapy, more serious tears occasionally warrant surgery, which involves trimming a bit of the meniscus away.

Various ligaments are involved in the stabilisation and movement of the knee joint.  The medial and lateral collateral ligaments sit on either side of the joint. They can sometimes be sprained by a force to the side of the knee during contact sports such as rugby or football. Again, this is usually a relatively minor injury that settles on its own or with a few sessions of physio.

The two cruciate ligaments (the anterior, and the posterior) sit inside the joint, and form a cross behind the kneecap. These are otherwise known as the ACL and the PCL. They help to stabilise and bend the joint forwards and backwards. One of the more serious injuries to a knee is an ACL tear. This is not an uncommon injury on the skifields. These injuries often require surgery and/or intensive rehabilitation. Patients with an ACL tear often can’t walk after their accident, and have a large amount of swelling.

Sometimes a single accident can cause many different structures to become damaged.  The classic ‘unhappy triad’ happens when the medial meniscus, the medial collateral ligament and the ACL are torn.   

Two exercises that are less likely to cause knee injuries are swimming and cycling and these are often recommended to help rehabilitate the knee after an injury.

If you have injured your knee, please see your doctor, sports physician or physiotherapist who will be able to assess and advise you.

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