Knee injury (fractures, dislocations, sprains, ligament tears) is among the main causes and one of the most common reasons people seek medical help from an orthopedist. The knee is a complex joint with many components which are prone to a variety of painful injuries. Many knee injuries are successfully treated with simple measures – bracing, rehabilitation and exercises – while other conditions may require surgery.
Anatomy of the knee
The knee is the largest joint in the body and is made up of four main components:
• bones
• cartilage
• collateral ligaments
• tendons
Three bones meet to form the knee joint: the thighbone (or femur), shinbone (or tibia) and the kneecap, also known as the patella.
The ends of the femur and the tibia and the back of the patella are covered with articular cartilage, which is slippery substance that helps knee bones glide smoothly.
Two wedge-shaped pieces of meniscal cartilage act as shock absorbers between the femur and the tibia. The meniscus is tough and rubbery. It helps cushion the joint and make it more stable.
Bones are connected to each other with ligaments (found on the sides of each knee) which hold the bones together and keep the knee stable.
The medial collateral ligament is found on the inside of the knee, while the lateral collateral ligament is on the outside. These ligaments control the sideways motion of the knees and brace them against unusual movements.
Cruciate ligaments are found inside the knee joint. The cruciate ligaments control the back and forth motion of each knee. They cross each other to form an X with the anterior cruciate ligament in front and the posterior cruciate ligament in the back.
Muscles are connected to the bones by tendons. The quadriceps tendon connects the muscles in the front of the thigh to the patella. The patellar tendon is stretching from the patella to the shinbone.
Among the most common knee injuries are:
• fractures
• dislocation
• sprains
• tears of soft tissues and ligaments
Often injuries involve more than one damaged structure in the knee.
Pain and swelling are among the most common signs of injury of the knee. In some cases the knee may catch or lock up. Some knee injuries cause instability.
Fractures of the knee
Patellar fracture
Among the most common bone fractured in the knee area is the patella. The ends of the femur and tibia also can be fractured. Many breaks in the knee area are caused by high-energy trauma. These include falls from heights and motor vehicle collisions.
Dislocation of the knee
A dislocation is when the bones of the knee move out of place, completely or partially. The femur and tibia can be forced out of alignment due to various traumatic incidents. The patella can also slip out of place, particularly in sports trauma. Dislocations can be caused by an abnormality in the structure of the knee.
In most cases dislocations are caused by high energy trauma - falls, impact, motor vehicle crashes, sports-related injuries.
Anterior cruciate ligament injury
The anterior cruciate ligament (ACL) is often injured during sports and similar activities. Patients participating in sports like football and basketball are very likely to injure the anterior cruciate ligaments. Changing direction rapidly or landing incorrectly from a jump can cause tearin the ligament.
Posterior cruciate ligament injury
Usually the posterior cruciate ligament is injured by a blow to the front of the knee, i.e. during motor vehicle crashes and sports-related injuries. Posterior cruciate ligament tears are usually partial tears and have potential to heal on their own.
Collateral ligament injuries
Injuries of the collateral ligaments are caused by a sideways pushing force and are often contact injuries, caused by a blow to the outside of the knee (also usually sports-related). Lateral collateral ligament tears occur less frequently than other injuries to the knee.
Meniscal tears
Sudden meniscal tears often occur with twisting, cutting, pivoting or being tackled. Meniscal tears sometimes occur as a result of arthritis and aging.
Tendon tears
The quadriceps and patellar tendons are common among middle-aged patients involved in sports such as running.
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