Knee Injuries in the Weekend Warrior

I promised to talk a bit about some of the more common knee injuries as part of the series on weekend warriors. I’d say that half of my practice deals with treating knees. Half again of those are arthritic knees who eventually need knee replacements (arthroplasty). That leaves 25% of my practice focused on the patient with knee trauma.

The Knee is More Than a Hinge

The Knee is a rather simple joint when compared to other joints, like the elbow for example, but it is not a simple hinge joint as you might expect. It bends, but also rolls back. It pivots, and it opens laterally and medially a bit as well.

The structures that allow these movements are called ligaments, and to some extent, the cartilage cushioned called menisci (or meniscus for one–we have two in each knee). The ligaments on the sides of the knee are the collaterals (medial and lateral) and in the middle of the knee are the cruciates (anterior and posterior).

knee anatomyThe joint surfaces, on the ends of the femur and tibia bones which make up the weight bearing parts of the knee are coated with hyaline cartilage like on the end of a chicken bone. These surfaces, coated by a slippery substance called synovial fluid, create the articulation where the actions occur–similar to the contact between a ball-bearing in an engine, or a piston, coated with oil.

Internal Derangements of the Knee

Any of these structures can be damaged or injured during a twist, fall, contusion or a pull. If the bone on either side of the joint don’t break, then the ligaments, menisci and even some of the tendons from the large leg and thigh muscles which pass by the knee can tear.

Knee-anatomy-570I typically see meniscal tears and ligament injuries. Occasionally we see fractures of the top of the tibia, knee cap (patellar) or end of the femur either alone or less commonly associated with the soft tissue injuries.

Meniscal Tears

A meniscal tear usually results from a twisting injury or some type of force to the knee outside of the normal anatomic mechanical motions that happen when we walk, run, climb, kneel, crawl or jump. Forces which result in injuries may be minor–the perfect twist–or major as in a soccer collision, a motor vehicle accident or a major fall from height.

Meniscal injuries can be left alone in young people if they occur in an area of good supply–and that’s really limited to the back of the medial meniscus. Unfortunately most meniscal injuries, even in young patients, do not heal and may go on to create early-onset degenerative osteoarthritis in the knee if they act as an irritant to the hyaline cartilage surfaces, particularly in the area of the tear. They may require repair (if in an area of good blood supply) or excision, where we trim out the torn area using a minimally invasive procedure called arthroscopy.Anterior-Cruciate-Ligament-ACL-Injury

Ligament Injuries

Some ligament injuries require surgery, some are better left alone to heal. A medial collateral ligament–the ligament on the medial or inner side of the knee–will typically heal if braced to avoid stress. An anterior cruciate ligament injury–if completely ruptured and causing instability of the knee–usually needs to be reconstructed. Lateral collateral ligaments and posterior cruciate ligaments may or may not need repair/reconstruction and generally depend on the patient’s lifestyle, age, and the surgeon’s experience and clinical examination.

I probably reconstruct at least 4 to 6 anterior cruciate ligaments each month–sometimes more, sometimes less. We use the small hamstrings of the thigh or the middle third of the tendon that attaches the knee cap (patella) to the leg (tibia) in order to create a new ligament. Bracing, cryotherapy, and a significant course of physical therapy are required to recover from this injury in most patients.

The Knee of the Weekend Warrior

A typical weekend warrior injury is a twist that results in pain, swelling, stiffness and decreased weight bearing tolerance. If this does not clear up with rest, ice, gentle ,movement and elevation of the leg after 2 or 3 dthCAZTK19Uays, then you should see your doctor for a physical examination. Xrays, ultrasound and clinical findings can diagnose most major knee issues that would require immediate attention. MRI’s are typically reserved for unresolving symptoms that do not get better over a few days or a short number of weeks in spite of a good effort at nonoperative therapies.

An MRI will help to better identify hidden fractures, ligament tears and meniscal tears.

To book a visit with Dr. Smith Auguste, please ask your family doctor to send a referral to fax: 416 352 5123.

The Benefits of Physiotherapy

doac45aPhysiotherapy is not just for patients who have recently had surgery, although it does offer a great way to regain motion, strength and eliminate pain, swelling and weakness.

People with back pain, sport injuries, chronic fatigue and even those starting a new weight loss or fitness program can benefit from the various physical therapy modalities offered in most rehab and physio clinics.

According to the Vancouver Physiotherapy and Sports Clinic, physical therapy has come a long way since the early nineteenth century when massage and manipulation were seen as being outside of the realm of medical science. Physical therapy traditionally involved the use of heat, electrical stimulation and water applications to aid movement and function. After World War II, physiotherapists slowly began to align themselves with medical practitioners and today, the profession is a field within the realm of medical practice with referrals from not only chiropractors and sport trainers, but doctors, physiatrists and surgeons alike.

Today physiotherapies include a wide range of treatments from traditional heat therapy and electricity (TENS) to manipulation, shock wave therapy, and exercises including stretches, strengthening and cardio. Some physical therapist employ accupuncture, spinal traction and parafin treatments. Many physical therapy clinics employ or are affiliated with chiropractors who engage in spinal and extremity manipulation and adjustments.

As the lines between “alternative” therapies and mainstream medicine blur in this era of health consciousness and preventive medicine, physiotherapists are an integral part of the holistic healthcare experience.

Visit Downsview Orthopaedic and Arthritis Centre for more information.