THE STRUCTURES OF THE KNEE JOINT
Knee pain is the most common complaint among the patients who visit Orthopedic clinics. Knee joint is the largest in the body and covers the widest surface.
It is comprised of the bones Femur,Tibia and Patella.Because it has a different harmony compared to other joints in the body,it is injured more often.Actually the proximal bone Femur and the distal bone Tibia are in anatomical discordinance.This discordinance is functionally ceased by statical structures like cartilage,meniscus and the connecting ligaments.Muscles and tendons are peripheral structures that dramatically help to cease this discordinanace.Inside the joint are inner and outer meniscuses which work as a gasket that absorbs the weight beared in the joint.Besides this,anterior and posterior cruciate ligaments prevent forward and backward sliding of the joint.The lateral ligament prevents the lateral expansion of the knee,hence the medial ligament prevents the medial expansion of the knee.All these structures help stabilization of the knee joint.
It can be seen in every age group.
Foot and ankle disorders
Physical examination and evaluation
WHAT ARE THE MOST COMMON KNEE PROBLEMS?
ACL (Anterior Cruciate Ligament) injuries
MCL-LCL (Medial-Lateral Collateral Ligaments) injuries
Meniscus is like a gasket between two long bones.Meniscus actually limits the load by shock absorbing,it also supports the surface area and ease the movement of the joint.Meniscus is like a cartilage,each knee has two meniscus;lateral and medial.
%95 of the meniscus injuries are associated with non-contact traumas.Instant turns,sprains can cause ruptures of the meniscus.The symptoms are; pain,swelling,joint locking during squatting and going downstairs.
The treatment of meniscus rupture is initiated after the evaluation of the joint by an Orthopedist.Nowadays the treatment of the meniscus rupture is done by Arthroscopic surgery, in which the contorted part is removed.Lateral meniscus rupture has higher potential of healing; with Arthroscopy it can be repaired.Hence there won’t be tissue loss and the meniscus is saved.
Post- operative Rehabilitation program must be started inorder to restore the muscle strength,gain range of motion and resume to daily and sportive activities.
Today surgery technics and rehabilitation programmes such improved that sportsmen/women resume to their professional life in 3-4 weeks.
In the first week; Electric stimulation for anti-edema,exercises for quadriceps muscle control and range of motion are started.
2.week; strenghtening of weight-bearing muscles: Theraband exercises,cycling,proprioception (balance),postural stabilization,advanced balance exercises,rhytmic gait and jogging exercises.
3.week; more intense (Cybex) isotonic weight-bearing exercises,postural stabilization,advanced balance exercises,accelerated jogging programmes are done.
4.week; in case of success,outdoor activities are added.Field exercises including jumping,jogging,ball exercises improve the athletes’ talent.This period differs according to healing of the tissues,physical and psycologic features.It can be earlier or later.
In case the meniscus is repaired; that means sutured,then the rehabilitation period can be different.
The period will depend on the surgeon,the technique and the materials used.With the developement of techniques recent years in arthroscopic meniscus repair and menisectomi,the healing process is almost the same,the duration for returning to sports has become similar.This is why it is wise to consult the orthopedist about the surgery done, as the duration of the rehabilitaton program may vary.
Joint cartilage is the structure that covers the surface of the bones,lubricates them and aids them on sliding on each other.
Besides aging and rheumatoid disorders,weight-bearing activities that cause overuse in athletes and structural anatomical disorders may cause cartilage wear. Sometimes instant traumas soften the cartilage tissue and cause seperation of the cartilage from the bone.The main symptom of the cartilage trauma is pain at the site.There may be swelling if the joint fluid is accumulated.Swelling increases with activity and sports and ceases with rest.It may cause locking,pressure and locking in the joint.Joint cartilage tissue does not have nerve endings.That’s why there is no pain in cartilage injuries at the beginning.In case the cartilage destruction enhances and reaches the underlying bone,pain may be sensed.
Cartilage injuries can be classified in four groups:Grade 1:Softening of the cartilage.Grade 2:Surface cracking of the cartilage.Grade 3:Crater-like deeper injuries.Grade 4:Bone destruction phase.Pieces torn from cartilage move freely in the joint space and may cause blocking,pain and degeneration in the joint.The evaluation of the pain is of importance for diagnosis.When did it start?Is there swelling? In what conditions does the edema increase? What makes the pain increase or cease? Is there pain during rest? Which areas are more susceptible to pain?Physical examination and X-Ray,MR Images lead the physician to correct diagnosis.The main problem of the joint cartilage injuries is that cartilage tissue doesn’t have blood circulation and nutrition is via the synovial fluid.That’s why the cartilage cannot rejuvenate itself.
In Grade 1-2 degeneration,analgesics,non-steroidal anti-inflammatory drugs (NSAI),cartilage supplements,cold pack fomentation,knee joint exercises are sufficient.In Grade 3,Intraarticular injections and Physical Therapy is recommended.In Grade 4 where the bone is worned-out,surgery may be necessary.If the surfaca area is less than 2cm and the patient is under 30 years,micro fracture system can be beneficial.Mosaicplasty system is administered by taking cartilage bone cylinders from the healthy, non weight-bearing areas to the weight-bearing injured part of the cartilage.Another method is to increase the amount of cartilage in laboratory and transfer these cell culture cells to the defected,cartilage-deficient area via surgery.Sometimes other disorders like meniscus ruptures,free cartilage bodies in the synovial fluid,Patellar shift may be the cause of the cartilage defects.These disorders must be treated initially.I case low-graded cartilage damages don’t respond to medical therapy and home exercises,Physical Therapy and rehabilitation is recommended.
ANTERIOR CRUCIATE LIGAMENT (ACL) INJURY
The Cruciate ligaments are found inside the knee joint.They cross each other to form an ‘X’,with the ACL in front and the PCL in the back.The cruciate ligaments control the back and forth motion of the knee.
The ACL runs diagonally in the middle of the knee.It prevents the Tibia from sliding out in front of the Femur,as well as provides rotational stability to the knee.
About half of all injuries to the ACL occur along with damage to other structures in the knee such as articular cartilage,meniscus or other ligaments.Injured ligaments are considered ‘sprains’ anda re graded on a severity scale.
Grade1 Sprain; The ligament is mildly damaged and stretched, but the knee joint is still stable.
Grade2 Sprain; Stretches the ligament so that it becomes loose.It is called as a ‘Partial Tear’.
Grade3 Sprain; It is most commonly referred as a’Complete Tear’of the ligament.The knee is unstable.
Changing direction rapidly,stopping rapidly,
Slowing down while running,landing incorrectly from a jump
You may hear a ‘popping’ noise and feel that your knee has slipped.
Pain,tenderness and swelling
Loss of full range of motion
Discomfort during daily activities
Physical Examination and Patient history
X-ray (In case a broken bone is suspected),MRI scan
The treatment for an ACL injury will depend on the patient’s age,profession and life style.Young nal athletes will most likely require surgery to safely return to sports.The less active,older individuals who have a more simple and sedanter life style,may not require surgery.
Non-Surgical Treatment may be effective for patients who are elderly or have a low activity level and the stability of the knee is intact.Your physician may recommend a brace for protecting your leg from instability and crutches from putting weight on your leg.
Physical Therapy; Specific devices and exercises are used to increase range of motion,.restore function and stability to the knee and to strenghten the muscles that support it.
Surgical Treatment; most ACL tears cannot be sutured.In order to repair the ligament and restore the knee stability of the knee,tissue graft obtained from the muscle tendons of the leg will be replaced in place of the torn ligament.Because the regrowth takes time,it may be six months or more before an athlete can return to sports after surgery.
Physical Therapy and Rehabilitation: whether your treatment involves surgery or not,physical therapy and rehabilitation plays a vital role in getting you back to your daily activities.