Knee Complaints
Due to its structure and function, the knee joint is a highly vulnerable joint. Many factors can disturb the balance between load and load-bearing capacity of the knee. When the load exceeds the knee's capacity, complaints arise. That capacity can be temporarily reduced as a result of trauma. Common traumatic injuries include meniscus and knee ligament damage. These two conditions used to be lumped together under the name "footballer's knee", but the introduction of arthroscopy has since made it possible to clearly distinguish between the different types of injury.
Meniscus injury
The thigh bone and shin bone articulate in the knee across two joint surfaces. Each of these surfaces is covered by a crescent-shaped structure of fibrous cartilage. These structures are called the medial and lateral meniscus. The meniscus has three functions:
- Increasing the contact area of the joint surfaces.
- Acting as a shock absorber.
- Smoothing the rolling and gliding movement within the knee.
Most meniscus injuries occur when the body twists while the foot stays fixed in place. This puts the knee into an extreme position and generates abnormally large forces on the menisci, which can cause them to tear. If a small fragment of the meniscus becomes detached inside the knee, the knee can "lock". It can then no longer be moved either actively or passively, which is usually experienced as very painful.
Symptoms
With a torn meniscus, symptoms depend on the size and location of the tear. A common complaint is a feeling that the knee is about to give way. Bending and straightening the knee may produce a clicking sound, and a locked knee often releases with an audible click. Surgery is usually needed to reach a clear diagnosis; during this procedure, the surgeon assesses whether the meniscus can be repaired or needs to be removed. A meniscus injury is almost always accompanied by ligament damage.
Cause
If the knee is already damaged, even a normal load can cause pain. Overloading a healthy knee can likewise cause pain. The following factors place abnormal strain on the knee and can accelerate wear of the meniscus:
- Wearing unsuitable footwear, which changes the alignment of the foot and knee.
- Reduced muscle strength, for example after surgery.
- Increased load, for example from a lot of stair climbing or cycling.
- Excess body weight, which places too heavy a load on the knee.
- A change in training load.
- Misaligned legs: varus or valgus alignment (bow-legs or knock-knees) places extra strain on the knee.
Ligament injury
The ligaments in the knee guide joint movement and provide stability. There are four main ligaments in the knee: the medial collateral ligament, the lateral collateral ligament, the anterior cruciate ligament and the posterior cruciate ligament.
Damage to the medial collateral ligament (on the inside of the knee) is, after meniscus injury, the most common knee condition. It is typically caused by actions such as kicking hard against the ground, kicking against a blocked ball, or twisting the thigh while the lower leg stays fixed to the ground (frequently seen in skiers). The medial ligament can become strained or even torn. This condition responds very well to physiotherapy, and surgery is often unnecessary.
Damage to the lateral collateral ligament (on the outside of the knee) occurs far less often and is usually only seen alongside meniscus or cruciate ligament injury. Thorough examination is essential with this type of injury.
Anterior cruciate ligament injury is common among winter sports enthusiasts and is a fairly serious condition. A torn cruciate ligament makes the knee very unstable, which can accelerate meniscus wear. In 10 to 20 percent of cases, reconstructive surgery (in which a lost or deformed cruciate ligament is rebuilt) is needed straight away; in the remaining cases, surgery is not immediately necessary. Stability needs to be tested every few weeks, and if the recovery process isn't progressing sufficiently, surgery may still be decided on later. Recovery from an anterior cruciate ligament injury takes a long time and requires intensive guidance from a physiotherapist to achieve the best possible outcome. A brace is often worn during rehabilitation to support the knee as effectively as possible.
Posterior cruciate ligament injury is very rare and is caused by a hard blow to the front of the knee. As with anterior cruciate ligament injury, very intensive rehabilitation is required, and sometimes surgery too.
Steps you can take yourself after a trauma
If, after the trauma, you can still fully straighten your leg and bear your full weight on it, and you can still do so the following day, the injury is probably not too serious. If the pain immediately after the trauma is very severe and the knee swells quickly (within 20–30 minutes), a professional diagnosis is almost always necessary. If no doctor or physiotherapist is available at that moment, cool the knee yourself as quickly as possible with a bag of ice or a cold pack. Keep it in place for at least 30 minutes, with a tea towel between the pack and your skin. This reduces swelling and makes diagnosis easier later on. If the knee isn't too swollen, it will also stay more mobile, which is important for recovery. If you don't use your leg much, your muscles — particularly the quadriceps — will weaken. This muscle group sits at the front of the thigh and provides stability around the knee joint, so it needs to stay strong. Train it by bending and straightening your knee as far as you comfortably can. This shouldn't cause too much pain! Repeat a few times a day.
Physiotherapy treatment
Physiotherapy focuses on the following points:
- Reducing pain.
- Reducing swelling.
- Maintaining muscle strength.
- Increasing range of motion.
- Improving coordination.
What can you do yourself?
The most important thing is to restore the balance between load and load-bearing capacity. This can be done in various ways, and the approach depends on what caused the injury. To stop the complaints from getting worse, the load needs to come down in the meantime. So:
- Cycle as little as possible.
- If you do cycle, use a light gear, especially into the wind.
- Try to set your saddle as high as possible so the knee bends as little as possible.
- Use the stairs as little as possible.
- Adjust your training load and sporting activity.
- Check that your shoes are still in good condition, especially for running.
- If you have to sit for long periods, avoid bending your knees too far or for too long.
- Try not to stay in the same position for too long, and straighten your legs now and then.