Northern Michigan Sports Medicine

Knee Sprains

• A knee sprain is a generic term used to describe trauma to one of the ligaments of the knee
• The knee has four main stabilizing ligaments, any of which can cause problems if stretched or torn.  The ligaments are the ACL, MCL, LCL, and PCL. 
• A sudden trauma, such as a fall or a contact injury, is the most common way to sustain a knee sprain.

Symptoms

• Knee sprains can be graded 1-3:
  • Grade 1: Mild stretching/micro tearing of the ligaments. There is mild swelling and tenderness over the ligament if it is the MCL/LCL
  • Grade 2: Moderate stretch/partial tearing of the ligaments. There is moderate swelling and tenderness over the ligament and bruising may occur. Laxity is felt in the ligament and he knee feels unstable
  • Grade 3: Complete tear of the ligaments in the knee. There is significant swelling in the knee immediately. Severe laxity is felt when testing the ligament and the joint is very unstable.
• Running, twisting, and cutting usually cause pain.
• The knee joint often feels unstable, and people are usually hesitant to put full weight through the involved lower extremity.
• Pain is often felt in the middle of the inside or outside of the knee joint with MCL or LCL sprains, or deep inside the knee with ACL or PCL sprains

Treatment

• Regardless which ligament is injured, the basic components of treatment are similar.
• Compression, rest, ice, and elevation are initiated in the early treatment phase.
• Bracing is sometimes necessary to give the joint support and alleviate pressure on the healing ligament.
• Modalities such as electrical stimulation, heat or ice, ultrasound, and iontophoresis (anti-inflammatory medication delivered via an electrode), can help with pain and swelling.
• Exercises to strengthen weak muscles and stretching for tight muscles are begun very soon after injury. 
• Aquatic therapy is often initiated early to allow for restoration of joint function in a partial weight-bearing environment. 
• A progressive strength building and balance training program allows for increased joint stability and gradual return to activity.

Meniscus Injuries

• Commonly referred to as “torn cartilage,” a meniscus injury occurs when one or both of the pads between the upper and lower legs are torn.
• The menisci function to decrease shock to the knees and distribute weight bearing forces through the lower extremity.  They also stabilize the knee. 
• The mechanism of injury is usually a compression force associated with a twisting motion.
• It is also possible to have a torn meniscus without a specific injury.  The menisci can degenerate over time and gradually wear down.

Symptoms

• The size of meniscus tears varies greatly. 
• Small tears can be painful, but often do not significantly disrupt knee function.  Pain is often felt along the joint line of the knee.
• Large tears are often associated with clicking or locking of the knee, especially during activities which require twisting, cutting, or bending.
• The knee can “give out” or become locked when moderate to large tears are present.
• Swelling and/or a feeling of warmth may be present in the knee joint after a tear occurs or is re-aggravated

Treatment

• If the tear is small enough, the meniscus may heal on its own; however, if pain and decreased function persist, arthroscopic surgery may be required to repair the meniscus.
• Compression, rest, ice, and elevation are initiated in the early treatment phase.
• Bracing is sometimes necessary to give the joint support and prevent the cartilage flap from moving.
• Modalities such as electrical stimulation, heat or ice, ultrasound, and iontophoresis (anti-inflammatory medication delivered via an electrode), can help with pain and swelling.
• Exercises to strengthen weak muscles and stretching for tight muscles are begun very soon after injury. 
• Aquatic therapy is often initiated early to allow for restoration of joint function in a partial weight-bearing environment. 
• A progressive strength building and balance training program allows for increased joint stability and gradual return to activity.

Patello Femoral Pain Syndrome (PFPS)

• This term refers to general knee pain that manifests itself near or around the kneecap (patella). 
• PFPS can be associated with quadriceps tendonitis, patellar tendonitis, and chondromalacia patella (CMP)
• This syndrome can be caused by an acute injury, muscle imbalances, walking abnormalities, poor foot alignment, or misalignment of the kneecaps.
• Athletes and people whose work activities require lots of standing or walking are especially susceptible to PFPS.

Symptoms

•  
• Pain is often localized to the outer borders of the knee cap. It can also be felt directly under the patella.
• Activities which require deep-knee bending, such as squatting or kneeling, often increase pain. 
• Jumping and running can be especially painful.
• The knee may feel swollen or warm. 
• A clicking or cracking sound may be present on bending the knee.
• Sitting for long periods may be uncomfortable. This is known as the “Theatre Sign.”

Treatment

• Abnormal biomechanics of the hip, patella, lower leg, and feet can all contribute to the development of PFPS.
• Compression, rest, ice, and elevation are initiated in the early treatment phase.
• Bracing or taping of the patella is often necessary to help it move more evenly and prevent irritation.
• Modalities such as electrical stimulation, heat or ice, ultrasound, and iontophoresis (anti-inflammatory medication delivered via an electrode), can help with pain and swelling.
• Exercises and stretching to correct muscle imbalances are crucial to successful treatment.
• The feet are assessed to determine if poor foot alignment may be contributing to symptoms.
• Aquatic therapy is often initiated early to allow for restoration of joint function in a partial weight-bearing environment. 
• A progressive strength building and balance training program allows for increased joint stability and gradual return to activity.

Osteoarthritis (OA)

• This term refers to degeneration of the hard cartilage at the end of the thigh bone and/or lower leg bone.
• OA is characterized by gradual increase in pain with activities (walking, stairs, prolonged sitting, or standing).

Symptoms

• This is accompanied by gradual increase in pain with activities (walking, stairs, prolonged sitting, or standing).