|Acute Knee Injuries (Front and outside)
This injury most frequently occurs when the foot is fixed to the ground, and the body and knee twist. Very common in basketball, and the football codes where the players ‘tags’ or ‘studs’ get caught in the grass and the athlete twists and changes direction, or when a person is tackled when the foot is fixed.
The degree of pain varies from mild to severe depending on the severity of injury with the athlete occasionally feeling a tearing sensation and pain on the knee joint line.
The athlete may experience the knee locking, and a lack of full range of movement.
To test whether this is the correct diagnosis squatting will cause marked pain, with pain on the joint line.
Squatting will reproduce pain on the joint line on the outside.
Anterior cruciate ligament (ACL) injury
This knee injury can occur in two types of ways, in a non-contact situation, when the athlete has landed from a jump, pivoting or deceleration/stopping suddenly, or when another athlete falls across the knee. Very common in the football codes, netball, gymnastics and downhill skiing. Quite often this injury occurs with a combination of a meniscal and medial collateral ligament tear.
Often the athlete describes hearing a ‘pop’ ‘crack’ or a tearing sensation and describes feeling like something ‘giving way, then going back in’
These injuries are very painful, especially in the first few minutes after the incident, with the athlete unable to continue activity. Generally the knee swells very quickly.
Posterior cruciate ligament (PCL) injury
This injury results from either a direct blow to the front of the knee, or landing from a jump with the leg extended. With the athlete hearing a ‘snap’ ‘crack’ or tearing type sound.
The pain is usually poorly localised and dull and is felt at the back of the knee, and occasionally in to the calf, there very rarely is observable swelling in the knee and often is seen in combination with other injuries, such as the lateral collateral ligaments.
Lateral collateral ligament (LCL) injury
This injury results from an opponent or another athlete falling over and hitting the inside of the athletes knee,while their foot is fixed to the ground, forcing the knee to bend and be overstretched outwards.
The athlete may hear a ‘snap’ ‘crack’ or tearing type sound on impact.
Depending on the severity the athlete may not be able to walk post injury, and the knee may swell, and feel ‘unstable’
Superior tibiofibular joint injury
This injury can occur either due to a direct blow, such as a kick to the outside of the leg below the knee, or due to excessive twisting and changing direction within a sport. The pain is usually felt on the outside of the leg just below the knee and aggravated by activities like twisting and changing direction at high speed.
Articular cartilage damage
This condition traditionally can occur either two ways, due to compression of the knee cap on to the articular cartilage surface, through landing from a jump on to the knees, or in combination with other knee injuries.
Generally it makes the knee feel sore deep to the Knee cap, and can cause it to repeatedly swell.
Fracture of the patella (knee cap)
This can occur either due to direct trauma to the knee cap, being hit by a hard ball, or landing directly on the knee cap, or due to a forced contraction of the Quadriceps muscle.
Pain is instant to the break, and is painful enough to cause a limp or even forced stopping of activity.
Generally occurs when the athlete experiences the knee ‘giving away’ when they were twisting or jumping, with a sudden onset of pain. The athlete may also state that they felt the Knee “popping out’ at the point of injury. Usually there is immediate swelling. The dislocation usually spontaneously reduces with knee straightening (extension) and so can be confused as an ACL, tear.
Patella tendon rupture
This occurs generally following a forced eccentric quadriceps contraction, such as stumbling during activity.
The pain is sudden and severe and sometimes a tearing sensation is felt by the athlete with the pain just below the knee cap, and a visible hollow between knee cap and shin bone compared to the other side.
Unusual injury however more common if the athlete has had a history of corticosteroid injections in to the tendon.
Fat pad impingement
This generally occurs following a hyperextension injury to the knee, and is extremely painful. The pain is just below and under the knee cap, and is extremely sore to palpate.
Fracture of the tibial plateau
This fracture is common amongst high speed activities and sports, where the individual has fallen on to the knee such as skiing, wave jumping and horse riding.
The person complains of severe pain in the knee joint and an inability to weight bear.
If this injury is suspected it is best to accurately diagnose with an xray.
This can occur due to a direct injury to the inside of the knee cap, or an overstretch of the small synovial fold.
Pain is generally very sharp, with a sharp pain in squatting, medially.
Arthroscopy required for accurate diagnosis
Pre-patellar bursitis (housemaids knee)
Can occur as a result of a direct blow to the front of the knee where the swelling and bleeding occurs in to the bursae, or as a result from repetitive trauma to the bursae, most commonly prolonged kneeling .Presents as swelling on the front of the knee cap, and pain with direct pressure to the area, such as kneeling.