All You Need To Know About Knee Pain – Part – 2

This article is in continuation to the previous knee pain article. If you missed the previous one, click here to read.

Meniscus degeneration/impingement/tear

 

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Medial and lateral meniscus. Courtesy Grays anatomy

 

Meniscus is a horseshoe shaped cartilaginous structure present in knee. There are 2 meniscus in each knee – medial meniscus and lateral meniscus. They act as shock absorber for the knee joint and also help in reducing friction between the joint.

Injury to meniscus can cause pain, swelling, clicking, limited range of motion and knee joint dysfunction. Meniscus can be affected by overtime degeneration, impingement due to change in knee mechanics, or tear from an injury or trauma.

Causes

  • Poor lower limb mechanics
  • Deep squatting movement
  • Forceful pivoting or twisting movement
  • Weak knee musculature

Treatment

  • Get a proper diagnosis done by a Physiotherapist or an orthopedic
  • In suspect cases patient have to undergo MRI investigation
  • Know what are the contributing factors to your problem and start working on them
  • Strengthening knee musculature
  • Change in ergonomics and activity modification
  • Electrotherapy
  • Icing

** Meniscus tear cases have to undergo surgery if meniscus doesn’t heal and symptoms persist. Depending upon the age, physical activity level and type of tear in meniscus the surgery is decided – meniscectomy (removal of torn part of meniscus) or meniscal repair (stitching the torn area)

 

Knee ligament injury

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Pic showing all 4 ligaments. Courtesy Grays anatomy

 

There are 4 main ligaments in a knee joint. They all provide stability to the knee joint in different directions

  • ACL – Anterior Cruciate Ligament
  • PCL – Posterior Cruciate Ligament
  • MCL – Medial Collateral Ligament
  • LCL – Lateral Collateral Ligament

 

Three different grades of injury to ligament are:

Grade 1 – Strain to ligament (overstretched) with no tear

Grade 2 – Partial tear

Grade 3 – Complete tear

 

  • ACL – Anterior Cruciate Ligament

This is one of the most commonly injured ligament in knee. The function of ACL is to prevent forward gliding of tibia (leg bone) on femur (thigh Bone) and internal rotation of tibia.

 

ACL injuries are mostly seen in sporting population. Multi-directional sports contact or non-contact which requires lots of cutting movements and impact like (soccer & rugby).

Depending on grade of injury and sporting background, conservative and operative treatment is decided.

Grade 1 & 2 can be managed conservatively but for grade 3 athletes have to go for surgical reconstruction.

Conservative treatment non- operated ACL

Initial phase

  • Rest icing
  • Bracing if suggested by your attending physiotherapist or orthopedic.
  • Electrotherapy

Later phase

  • Muscle strengthening Specially Hamstring muscle as they support ACL
  • Proprioceptive/ joint awareness exercises
  • Taping

Post op management

Post op rehab will last from 6 to 9 months depending on individual base athletic level.

Your Physiotherapist will plan out your rehab program which will have different phases such as 0-6 week’s phase 1 and so on. Each phase will have its goals, duration, exercises and treatment techniques. The duration of each phase can change during the rehab depending on your progress.

 




  • PCL – Posterior Cruciate Ligament

It works exactly opposite to ACL. It prevents backward gliding of tibia (leg bone) on femur (thigh bone).

Commonly injured due to fall on knee when there is impact on the tibia (leg bone).

Grade 1 & 2 PCL can be managed with conservative treatment and heals better. But for Grade 3 surgery is required.

Conservative treatment would be same as above except

  • Brace to lock knee in extension for initial 4- 6 weeks
  • Focus more on Quadriceps strengthening than hamstring

Post-operative management would bit longer than ACL lasting around 12 months.

 

  • MCL – Medial Collateral Ligament

The function of MCL is to provide stability from the inner – side of the knee joint. It holds the joint and acts against valgus stresses (which will tend to separate the inner- side (Medial) of the knee)

MCL gets injured if the landing is improper or there is a traumatic force directed inwards from outer (lateral) side of the knee for e.g, getting kicked hard.

All 3 grades of MCL can be treated conservatively. If there is involvement of other ligaments or meniscus, or if there is an ongoing instability after completion of conservative treatment, then patient needs to have surgery.

Conservative treatment

  • Icing
  • Electrotherapy
  • Bracing for grade 2-3
  • Strengthening exercises focus more on hip abductor muscles
  • Proprioceptive/joint awareness exercises
  • Taping

 

  • LCL – Lateral Collateral Ligament

Runs parallel to MCL on outer side of the knee and functions are just opposite to MCL.

It works against varus forces (which will tend to separate outer side of the knee).

If there is excessive varus forces on the knee from direct trauma/blow, the LCL gets injured.

Mostly LCL injuries are treated conservatively. Only in rare cases where symptoms are ongoing, surgery is considered.

 

Conservative treatment

  • Icing
  • Bracing
  • Strengthening exercises
  • Proprioceptive / joint awareness exercises
  • Taping

 

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