Meniscal tear
The menisci are two fibro-cartilaginous pads which sit within the knee joint, they act as shock absorbers to prevent excessive forces being directed onto the bony surfaces. If excessive torsions or weight bearing forces are placed on the joint, damage can occur to these menisci.
Although it is possible to injure the structures through relatively trivial movements, damage most commonly occurs during sporting activities, especially when the individual is required to make a sudden change in direction or a twisting motion, with the knee in a slightly bent position i.e. activities such as in skiing and football.
Patients who have damaged their menisci often report an immediate, sharp pain within the knee joint which is accompanied by an audible click or popping sound at the time of injury. Typically, swelling will occur almost instantly, however it is also not unusual for this to develop slowly over the fore coming days.
Kneeling, bending, twisting and weight bearing activity may all reproduce pain in the knee joint. The knee may also feel unstable and click, lock or give way during certain movements.
Anterior/posterior cruciate ligament strain
Commonly referred to as ‘ACL’ and ‘PCL’, strains or tears of these structures are generally caused through sporting or traumatic injuries. The level of damage can be classified as a grade 1 to 3 tear, this ranges from minor impairment of the ligament to a full rupture. The cruciate ligaments sit within the centre of the knee joint and cross to provide a high level of stability at the tibio-femoral joint. The anterior cruciate ligament (ACL) is the most commonly injured. The three main movements that place highest degree of stress upon the ACL are; twisting motions, hyperextension and forward movement of the tibia (lower leg) against the femur (upper leg). The posterior cruciate ligament (PCL) is typically affected in road traffic accidents as it is the backwards movement of the tibia beneath the femur which places the highest degree of stress on the structure.
Patients may report hearing a snap or tearing sound, this is quickly followed by swelling and stiffness at the knee with pain felt around the back of the leg and calf. Full ruptures may initially produce extreme pain but this can quickly subside. A sense of Instability and vulnerability at the joint is common.
Medial/lateral collateral ligament strain
The collateral ligaments are found on either side of the knee joint. The lateral collateral ligament is on the outside and braces the femur with the fibula and the medial collateral ligament is on the inside bracing the femur with the tibia. Together, these ligaments control sideways movement from the knee. The medial collateral ligament is damaged when extreme stress or force is placed on the outside of the knee taking it past its end of range. Typically, this is seen in aggressive football tackles. The lateral collateral is less commonly injured and occurs when stresses are delivered to the inside of the knee joint forcing it outwards past its end of range. Symptoms are usually immediate swelling, pain and tenderness and the sense of vulnerability is as if the knee is going to give way.
Patellofemoral pain syndrome
Patellofemoral pain syndrome is also known as runner’s knee. This condition occurs when the stress of activities such as, you guessed it, running, can cause irritation or tissue damage to structures beneath and around the patella (kneecap). In a healthy functioning knee, the patellar should normally move in a direct superior course on contraction of the quads. The action of the four heads of quadriceps controls patella tracking mechanism and ensures that the forces applied to the knee cap during activity are evenly dispersed. If a muscular imbalance is present it may alter the tracking of the patellar (direction which it moves) and overload specific areas. This can cause damage to the cartilage and connective tissues.
This is a very common condition and in the majority of cases is caused by a muscular imbalance. Typically, the quadricep on the outer part of the thigh (vastus lateralis) becomes stronger and tighter than the quadricep on the inner part (vastus medialis). This creates tension which drives the patella out of line and causes irritation. There are a number of reasons why this can occur and can be explained in greater detail by your osteopath.
The symptoms which are usually experienced with patellofemoral pain syndrome are specifically; pain under, around or beneath the kneecap, and also, joint stiffness, occasional aching around the back of the knee and soreness at night. This discomfort is usually described as a diffuse ache which can become sharp on specific movements and activity. Aggravating factors may be walking for long periods (especially up or down hills and stairs), heavy lifting, bending the knee, jumping or running and prolonged sitting.
Iliotibial band syndrome
This is due to friction of the iliotibial band at the lateral condyle of the femur (a small bony protuberance at the base of the femur, just above the outside of the knee). Commonly mistaken for a bone or thick tendon, the iliotibial band is in fact, a long, thin length of facia that helps stabilise the outer part of the knee throughout its range of motion. It extends from the top of the hip, where it blends with muscles glueus maxiumus and tensia fascia latae, all the way down to the fibula head. Iliotibial band syndrome occurs when the fascia is subjected to repetitive friction and rubbing over the femoral condyle causing irritation and pain. This condition is common in runners and cyclists. It is often due to weak hip and gluteal muscles, poor running technique or increased activity levels, such as long distance running.
Some of the symptoms commonly described are a sharp or burning pain above the outer part of the knee, pains which worsens with the continuance of running, swelling or thickening of the facia, pain and an audible squeaking at 30degrees of knee flexion.
Osgood-schlatter’s
This is a condition which typically affects teenagers that participate in many sports, there tends to be a higher prevalence of the condition in boys than girls. It is characterised by inflammation of the attachment site of the patella (kneecap) tendon at the tibial tuberosity (upper part of the shin bone). A common cause is thought to be overuse of the quadriceps. When the quadriceps contract they cause a pulling motion on the patella tendon which attaches at the site of irritation. Because this is a condition which only affects adolescents, the tibia hasn’t stopped growing and is not durable enough to withstand the stresses placed on it and a tearing epithelial growth plate occurs.
Symptoms may include local inflammation, pain, tenderness and tuberosity below the knee cap may be enlarged.
Chondromalacia patella
This is due to a softening of the cartilage on the underside of the patella. There is no apparent reason for the condition to develop but it may possibly be associated with a degree of incongruence between the femur (thigh bone) and the patella (kneecap). The condition is far more prevalent in teenage girls who are associated with strenuous sporting activity.
There is commonly swelling and effusion around the knee cap which can be tender to touch. Pain is commonly experienced in the front of the knee and made worse by walking up and down stairs.