Knee – Joint Clinic Paarl

Knee Pain Types

Daan Botes — Mon, 25 Jan 2021 16:02:48 +0000

Knee pain is a common complaint that affects people of all ages. Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions such as arthritis, gout, pseudogout and infections can also cause knee pain. Whether we are talking about osteoarthritis, rheumatoid arthritis or any other form of arthritis, it is important to understand that big joints are almost always affected.

A knee injury can affect any of the ligaments, tendons or fluid-filled sacs (bursae) that surround your knee joint as well as the bones, cartilage and ligaments that form the joint itself.

Some of the more common knee injuries include:

ACL injury
Fractures
Torn meniscus
Knee bursitis
Patellar tendinitis

Some examples of mechanical problems that can cause knee pain include:

Loose body
Iliotibial band syndrome
Dislocated knee cap
Hip or foot pain

Knee Osteoarthritis | Degenerative Joint Disease

marius — Sat, 30 May 2020 15:36:02 +0000

Knee Osteoarthritis (OA) is a type of joint disease that results from breakdown of joint cartilage and underlying bone. The most common symptoms are joint pain and stiffness. Usually the symptoms progress slowly over years. Initially they may only occur after exercise, but can become constant over time. Other symptoms may include joint swelling, decreased range of motion, and, when the back is affected, weakness or numbness of the arms and legs.

The most commonly involved joints are the two near the ends of the fingers and the joint at the base of the thumb; the knee and hip joints; and the joints of the neck and lower back. Joints on one side of the body are often more affected than those on the other. The symptoms can interfere with work and normal daily activities. Unlike some other types of arthritis, only the joints, not internal organs, are affected.

Causes include previous joint injury, abnormal joint or limb development, and inherited factors. Risk is greater in those who are overweight, have legs of different lengths, or have jobs that result in high levels of joint stress. Osteoarthritis is believed to be caused by mechanical stress on the joint and low grade inflammatory processes. It develops as cartilage is lost and the underlying bone becomes affected. As pain may make it difficult to exercise, muscle loss may occur. Diagnosis is typically based on signs and symptoms, with medical imaging and other tests used to support or rule out other problems. In contrast to rheumatoid arthritis, in osteoarthritis the joints do not become hot or red.

Osteonecrosis of the Knee (ONK)

marius — Thu, 28 May 2020 15:37:56 +0000

Osteonecrosis of the Knee, is the result of vascular arterial insufficiency to the medial femoral condyle of the knee resulting in necrosis and destruction of bone. It is often unilateral and can be associated with a meniscal tear.

The condition is usually characterized by a sudden onset of knee pain, worse at night, or during weight-bearing such as standing or running. Nevertheless, it can also occur during rest or without any weight-bearing.

About 94% of the cases affect the medial condyle of the femur. This is because the blood supply for the medial condyle is less than the blood supply for the lateral condyle of the femur. The condition may deteriorate, causing asymmetrical walking or running pattern. Sometimes, they have a history of osteoporosis or osteopenia.

Kneecap Conditions – Patella

Daan Botes — Thu, 28 May 2020 12:54:24 +0000

Kneecap conditions (Patella) manifests as pain at the front or inner side of the knee. This is common in adults of all ages especially when engaging in soccer, gymnastics, cycling, rowing, tennis, ballet, basketball, horseback riding, volleyball, running, combat sports, figure skating, snowboarding, skateboarding and even swimming. The pain is typically felt after prolonged sitting.

Posterior Cruciate Ligament (PCL) Injury

marius — Tue, 26 May 2020 15:38:57 +0000

The posterior cruciate ligament (PCL) function is to prevent the femur from sliding off the anterior edge of the tibia and to prevent the tibia from displacing posterior to the femur.

Common causes of PCL injuries are direct blows to the flexed knee, such as the knee hitting the dashboard in a car accident or falling hard on the knee, both instances displacing the tibia posterior to the femur.

Anterior Cruciate Ligament (ACL) Tear

marius — Tue, 26 May 2020 15:34:59 +0000

Anterior Cruciate Ligament tears occurs when the anterior cruciate ligament (ACL) is either stretched, partially torn, or completely torn. The most common injury is a complete ACL tear. Symptoms include pain, a popping sound during injury, instability of the knee, and joint swelling. Swelling generally appears within a couple of hours. In approximately 50% of cases, other structures of the knee such as surrounding ligaments, cartilage, or meniscus are damaged.

The underlying mechanism often involves a rapid change in direction, sudden stop, landing after a jump, or direct contact to the knee. It is more common in athletes, particularly those who participate in rugby, football (soccer), squash or netball.

Diagnosis is typically made by physical examination and is sometimes supported by magnetic resonance imaging (MRI). Physical examination will often show tenderness around the knee joint, reduced range of motion of the knee, and increased looseness of the joint.

Other Knee Ligament Conditions

Daan Botes — Tue, 26 May 2020 12:55:52 +0000

Depending on the grade of the knee ligament injury, the lowest grade (grade 1) can take between 2 and 10 weeks for the injury to fully heal. Recovery times for grades 2 and 3 can take several weeks to several months.

Treatment of a partial tear or stretch injury is usually conservative. Sports medicine therapists should be a first choice option for diagnosis and treatment of injuries to this structure. This includes measures to control inflammation as well as bracing.

Good clinical results can be achieved with conservative care of grade II sprains, but poor results in grade III sprains. As a result, more severe grade III and IV injuries to the MCL that lead to ongoing instability may require arthroscopic surgery. However, the medical literature considers surgery for most MCL injuries to be controversial. Isolated MCL sprains are common. For higher grade tears of the MCL with ongoing instability, the MCL can be sutured or replaced.

Knee Tendon Conditions

Daan Botes — Mon, 25 May 2020 12:57:05 +0000

Tendons usually attach muscle to bone. In the knee the quadriceps and patellar tendon can sometimes tear. The injuries to these knee tendons occur when there is forceful contraction of the knee. If the tendon is completely torn, bending or extending the leg is impossible.

A completely torn tendon requires surgery but a partially torn tendon can be treated with leg immobilization followed by physical therapy.

Cartilage Surface Injuries

marius — Sun, 24 May 2020 15:35:46 +0000

Cartilage, most notably the cartilage surface that which is found in the knee joint, is generally characterized by very low friction, high wear resistance, and poor regenerative qualities. It is responsible for much of the compressive resistance and load bearing qualities of the knee joint and, without it, walking is painful to impossible.

Osteoarthritis is a common condition of cartilage failure that can lead to limited range of motion, bone damage and invariably, pain. Due to a combination of acute stress and chronic fatigue, osteoarthritis directly manifests itself in a wearing away of the articular surface and, in extreme cases, bone can be exposed in the joint.

Some additional examples of cartilage failure mechanisms include cellular matrix linkage rupture, chondrocyte protein synthesis inhibition, and chondrocyte apoptosis. There are several different repair options available for cartilage damage or failure.

A recent review of more than 30,000 knee arthroscopies by Curl revealed that more than 60% of patients had evidence of Grade III or IV
chondral lesions. When broken down by location:

48% of patients had an defect in the medial compartment of the knee,
45% in the patellofemoral compartment, and
25% in the lateral compartment.

Articular cartilage has limited potential to heal, and defects left untreated often result in continued pain, limited mobility, and progressive degenerative changes.

Although a variety of surgical treatment options are
available, a variety of factors – including lesion size, location, degree of bone loss, and presence of multiple lesions – play an important role in formulating the optimal treatment plan for these injuries.

Meniscus Tear

marius — Sat, 23 May 2020 15:37:23 +0000

A Meniscus Tear is a rupturing of one or more of the fibrocartilage strips in the knee called menisci. When doctors and patients refer to “torn cartilage” in the knee, they actually may be referring to an injury to a meniscus at the top of one of the tibiae. Menisci can be torn during innocuous activities such as walking or squatting. They can also be torn by traumatic force encountered in sports or other forms of physical exertion. The traumatic action is most often a twisting movement at the knee while the leg is bent.

In older adults, the meniscus can be damaged following prolonged ‘wear and tear’. Especially acute injuries (typically in younger, more active patients) can lead to displaced tears which can cause mechanical symptoms such as clicking, catching, or locking during motion of the joint. The joint will be in pain when in use, but when there is no load, the pain goes away.

It is important to know if there was trauma involved, the symptoms are new as well as the stability of the tear. A stable tear is much less likely to require surgery than an unstable tear. Knowing the heavy correlation between meniscus deficiency and osteoarthritis, doctors are doing everything they can to try and repair – or at least save some of the meniscus rather than removing it entirely.

Different types of meniscus tears are encountered, namely:

Radial tear:
It is the most common tear, the damaged parts will be trimmed away.
Longitudinal tear:
Longitudinal tears can be sutured if it is in the red zone.
Horizontal tear:
In the case of a horizontal tear, the surgeon will try to sew the circumferential fibers together.
Incomplete tear:
if an incomplete tear is considered stable on a MRI scan an operation may not be necessary.
Complex tear:
A complex tear is where there are several tear patterns and the torn segments are removed.
Flap tear:
A Flap tear causes a catching sensation, resecting a small section can resolve the problem.
Degenerative tear:
A Degenerative tear usually occurs as a result of wear and tear and may need a partial meniscectomy.
Bucket handle tear:
A Bucket handle tear involves a large portion of the meniscus, the knee becomes “locked”, requires urgent surgery to try and save the meniscus.
Root tear:
A Root tear dislodges the end of the meniscus and makes the meniscus unstable, it could be degenerative or caused by trauma. Most root tears that occur in the setting of moderate to severe arthritis should not be fixed. Fixing a medial meniscus root tear might slow the progression of osteoarthritis. When a root tear is accompanied by an ACL tear both should be fixed at the same time.
Ramp tear:
A Ramp tear is a longitudinal peripheral lesion of the posterior medial meniscus or meniscocapsular junction, previously called a ‘hidden lesion’. Ramp tears are mostly associated with ACL tears and their diagnosis requires a high index of suspicion Posteromedial tibial bone bruising was found to be an important secondary MRI finding of ramp lesions. The treatment alternatives are reported as non-operative, inside-out repair, and all inside repair. Currently, the optimal management and technique regarding meniscal repair in root tears and ramp lesions is still evolving and remains debatable and controversial.