Knee Injury (cont.)
IN THIS ARTICLE
Muscle Tendon Injuries, MCL and LCL Injuries, ACL Injuries, and Meniscus Tears
Muscle Tendon Injuries
Almost all of these strains are treated with ice, elevation, and rest. Sometimes compression with an Ace wrap or knee sleeve is recommended, and crutches may be used for a short time to assist with walking. Ibuprofen (Advil, Motrin) or naproxen can be used as an anti-inflammatory medication.
The mechanism of injury is either hyperextension, in which the hamstring muscles can be stretched or torn, or hyperflexion, in which the quadriceps muscle is injured. Uncommonly, with a hyperflexion injury, the patellar or quadriceps tendon can be damaged and rupture. This injury is characterized by the inability to extend or straighten the knee and a defect that can be felt either above or below the patella. Surgery is usually required to repair this injury.
Except for elite athletes, tears of the hamstring muscle are treated conservatively without an operation, allowing time, exercise, and perhaps physical therapy to return the muscle to normal function.
MCL and LCL Injuries
These ligaments can be stretched or torn when the foot is planted and a sideways force is directed to the knee. This can cause significant pain and difficulty walking as the body tries to protect the knee, but there is usually little swelling within the knee. The treatment for this injury may include a knee immobilizer, a removable Velcro splint that keeps the knee straight and keeps the knee stable. RICE (rest, ice, compression, and elevation) are the mainstays of treatment. Surgery may be an option for completely torn ligaments and the knee joint remains unstable with activity.
If the foot is planted and there is force applied from the front or back to the knee, then the cruciate ligaments can be damaged. Swelling in the knee occurs within minutes, and attempts at walking are difficult. The definitive diagnosis is difficult in the emergency department because the swelling and pain make it hard to test if the ligament is loose. Long-term treatment may require surgery and significant physical therapy to return good function of the knee joint. Recovery from these injuries is measured in months, not weeks.
The cartilage of the knee can be acutely injured or can gradually tear. Acutely, the injury is of a twisting nature; the cartilage that is attached to and lays flat on the tibia is pinched between the femoral condyle and the tibial plateau. Pain and swelling occur gradually over many hours (as opposed to an ACL tear which swells much more quickly). Sometimes the injury seems trivial and no care is sought, but chronic pain develops over time. There may be intermittent swelling, pain with walking uphill or climbing steps, or giving way of the knee that results in near falls. History and physical examination often can make the diagnosis, and MRI may be used to confirm it. MRI is also able to define the where within the meniscus that the tear has occurred and its appearance. This may help guide whether surgery, physical therapy or both would be appropriate.
Medically Reviewed by a Doctor on 3/13/2015
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