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Knee injuries

Knee injuries are common, especially when taking part in sport. Injuries to soft tissues, such as ligaments, cartilage and tendons are the most common. You can also damage the bones that make up your knee joint.

There are many different structures inside and outside your knee. These include:

  • ligaments, which connect your bones together
  • articular cartilage, which covers the ends of your shin bone and thigh bone
  • two crescent-shaped cartilage discs called menisci, which act as 'shock absorbers' and helps to stabilise your knee
  • tendons, which connect your muscles to your bone

Injury to your knee can damage any one or more of these structures.

Knee ligament injuries

Your knee ligaments help to keep your knee stable.

The medial collateral (MCL) and lateral collateral ligaments (LCL) are found on either side of your knee joint. They limit the amount your knee can move from side to side. You can sprain or tear your MCL if your lower leg gets forced outwards. For example this can happen when being tackled in rugby or when skiing. Your LCL is less commonly injured, and this is more likely to happen when you have also damaged other ligaments.

Your anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) form a cross (cruciate) inside your knee. They help to keep your knee stable. ACL injuries are one of the most serious types of knee injury.

If you have injured your MCL or LCL, your GP may grade your injury according to how severe the damage is.

  • Grade 1 is a stretch of the ligament without tearing.
  • Grade 2 is a partial tear of the ligament.
  • Grade 3 is a complete tear through the ligament.

Other soft tissue injuries

There are other soft tissues around your knee that can be injured. Soft tissue means any tissue in your body that isn't bone.

Tearing the meniscus in your knee is one of the most common knee injuries. You can damage it if you play a sport that involves twisting your upper leg while your foot is planted on the ground. As you get older, your meniscus may become worn. This makes it more likely to tear after a minor injury or just getting out of a chair awkwardly.

If you’re a regular runner or take part in sports where you jump a lot, you may hurt your knee. You can irritate or tear the tendon that connects your kneecap (patella) to your thigh muscle. This tendon is called the quadriceps tendon. Or you may irritate soft tissue around your kneecap, including the patellar tendon, which is just below your knee cap (Jumper’s Knee).

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Details

  • Symptoms Symptoms of knee injuries

    You may feel or hear a popping or snapping when the injury happens. You may also find that you can't put your full weight on the injured leg.

    The symptoms for most ligament injuries will be similar. These include:

    • pain
    • swelling
    • instability – you may feel like your knee is giving way

    If you injure the meniscus in your knee, you may feel a locking sensation and severe pain. Pain may develop towards the inside or outside of your knee joint and you may see some swelling.

    If you have injured your knee and you think it’s more than a simple sprain, visit your GP or physiotherapist. Seek advice if it’s tender to the touch, very stiff, swollen, giving way, clicking painfully, locking or you can’t put your full weight on it.

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  • Diagnosis Diagnosis of knee injuries

    Your GP or physiotherapist will ask about your symptoms and examine you. This may include feeling for fluid in your knee joint by pressing gently around your kneecap. He or she will also ask you to describe how your injury happened, where your pain is and what type of pain it is.

    Your GP or physiotherapist may ask you to walk, sit or lie down. This is so he or she can test for injury to your knee ligaments or soft tissues. He or she will bend and straighten your knee and move your leg into different positions.

    Your doctor may refer you for other tests in a hospital or clinic, which may include:

    • an X-ray or CT scan – this may be used to check for a fracture or arthritis
    • an ultrasound - this may be used to look at the tendons in your knee
    • an MRI scan – this is the best all round test for injuries inside a joint to the cartilage or ligaments, and can also be used to identify stress fractures
  • Treatment Treatment of knee injuries

    There are different types of treatment that your doctor or physiotherapist may suggest, depending on the type and severity of the damage to your knee. It’s important to be patient when recovering from a knee injury. Your injury may take time to fully repair itself, so you may not be able to do all the things you’re used to doing for some time. Different injuries require different rehabilitation, so it’s best to talk to your GP or physiotherapist.

    Self-help

    You should follow the PRICE procedure for any soft tissue injury to your knee. PRICE stands for the following.

    • Protect your knee from further harm.
    • Rest your knee for the first two to three days, possibly using crutches. Then reintroduce movement so that it doesn’t become stiff and you don't lose muscle strength.
    • Ice the painful area with a cold compress such as ice or a bag of frozen peas wrapped in a towel. This will help reduce swelling and bruising. Do this for 15 to 20 minutes every two to three hours. Don't apply ice directly to your skin as it can damage it.
    • Compress the joint with an elastic bandage or Tubigrip to support the knee and help decrease swelling. Don’t leave the bandage on while you sleep.
    • Elevate your knee by resting it above the level of your heart and keep it supported.

    There are certain things you shouldn’t do in the first three days after your injury so you don’t damage your knee further. You can remember these as HARM.

    • Heat. Don’t take hot baths, showers or saunas, or use a heat pack.
    • Alcohol. Drinking alcohol can increase bleeding and swelling in the affected area.
    • Running or other forms of exercise, which may cause further damage.
    • Massaging the injured knee. This can cause more swelling or bleeding.

    Medicines

    You can buy over-the-counter painkillers such as paracetamol to treat mild and moderate pain. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help to reduce inflammation and swelling, as well as relieve pain. NSAIDs are available as gels, creams and sprays that you can put directly onto your skin, as well as tablets that you take by mouth.

    Your GP may prescribe stronger painkillers if your pain is severe. Always read the patient information that comes with your medicine and if you have questions, ask your pharmacist or doctor for advice.

    Physiotherapy

    If your injury is more severe or complex, your GP may refer you to a physiotherapist (a health professional who specialises in movement and mobility). You can also choose to see a physiotherapist privately. He or she will develop a programme of rehabilitation exercises to gradually strengthen your knee and stretch your muscles. These exercises will vary depending on the type of injury you have and how severe it is.

    Some people have braces or strapping to support the knee during rehabilitation, usually when an injury has been severe.

    Surgery

    For some types of knee injury, your GP or physiotherapist may recommend that you have surgery to repair the damage to your knee – especially if other forms of treatment haven’t worked. Your GP will refer you to an orthopaedic surgeon for assessment.

    The surgeon is more likely to suggest surgery if you have one of the following injuries.

    • You have torn your ACL and you do a lot of sport or have also torn the meniscus. ACL reconstruction involves taking a piece of tendon (usually from your hamstring) to replace the damaged ligament.
    • Your knee remains painful or locks after an injury to your meniscus.

    You may be able to have a type of keyhole surgery called knee arthroscopy to access the damaged area of your knee. Rarely, surgery may involve opening up your knee joint to repair it.

  • Physiotherapy

    At our Bupa Health Centres, we offer self-pay health services for a wide range of conditions, including physiotherapy.

  • Causes Causes of knee injuries

    You may injure your knee if:

    • an impact moves your knee beyond its usual range of movement, for example, if you have a fall or land awkwardly
    • you play a sport that combines running, jumping and stopping with quick changes of direction, such as football
    • you have a condition such as arthritis or gout, which can affect your joints, or are very overweight, which can put pressure on your knees
    • your knees hit the dashboard in a car accident – this is one way to damage the posterior cruciate ligament
    • your footwear is not right for your feet, your running style or the sport, or you have poor training methods or flexibility
  • Prevention Prevention of knee injuries

    There are some precautions you can take to try to reduce the risk of damaging your knee ligaments.

    • Exercise regularly to maintain a good level of fitness, and include some resistance training (training with weights). This will mean your muscles are stronger and better able to support your joints, including your knees. If you haven't been active for a while, start gently and gradually increase the intensity.
    • Spend five to 10 minutes warming up before doing any exercise to increase blood flow to your muscles and reduce the chance of an injury. Most sports professionals advise stretching your muscles after warming up and again after cooling down. There is little evidence to show that stretching before or after exercise reduces injuries, but staying flexible is important for everybody.
    • Wear the right footwear. There are many different models of trainers available and it’s important to find some that fit well and offer the support and cushioning you need. If you’re not sure, it’s a good idea to go along to a specialist sports shop and ask for advice.
  • FAQs FAQs

    I have sprained a ligament in my knee. How long will it take to heal?

    Answer

    The time it takes for your sprain to heal depends on which part of your knee you have injured and how badly it’s affected. For example, for a mild sprain to the medial collateral ligament, full recovery may take as little as one to two weeks. But if your injury is more severe, or if you require surgery, return to sport can take up to 12 months.

    Explanation

    Sprains, strains and tears in knee ligaments and damage to knee cartilage take time to repair themselves. The most important way to help your injury to heal is to follow the PRICE method immediately after the injury. PRICE stands for protection, rest, ice, compression and elevation. If your symptoms don't improve or any pain or swelling gets worse, talk to your GP about physiotherapy or other treatment. It may be that you will need to have reconstruction surgery.

    It’s also important to follow the advice and exercise recommendations your GP or physiotherapist give you.

    Can homeopathic arnica help with my knee injury?

    Answer

    It's unlikely. There is no convincing evidence that taking homeopathic arnica remedies can help with sprains and strains.

    Explanation

    Arnica is often promoted as a treatment to help relieve soft-tissue injuries such as sprains and strains. You can buy arnica as a homeopathic medicine, but studies don’t show any convincing evidence that it can help with sprains or strains. Therefore, doctors don’t recommend it.

    I recently sprained my medial collateral ligament while skiing. Are there any exercises that I can do to help me recover?

    Answer

    There are exercises you can do to help your ligament recover from an injury. But it’s important that you don’t do too much too soon otherwise you will do more damage to your knee. Immediately after your injury, it’s important to follow PRICE (protection, rest, ice, compression and elevation).

    Explanation

    Your GP or physiotherapist may recommend that you wear a hinged knee brace to help your recovery. He or she will be able to recommend some simple exercises that you can do at home to help you recover from your injury. They will also advise you when to start doing them. The exercises are designed to help build your range of movement at the joint and strengthen the muscles surrounding your knee.

    You may be advised to try gently and slowly transferring some of your body weight onto your affected leg at first. You can also try lying on the floor with a ball under your knee for support and gently extending your leg as far as you can without pain. Or you can try slowly raising your injured leg while it’s extended straight in a lying or sitting position.

    After two or three weeks you might be able to start transferring more weight onto your affected leg. Eventually, you will be able to stand on just the affected leg without pain. Once you can bend and straighten your knee without any pain, you may want to strengthen your leg muscles with squats, lunges and weight-bearing movements. This will help prepare you to take part in sport again.

    It’s important to take things slowly and only move your knee within a range that is painless. Stop if the movement is uncomfortable or painful. As your ligament recovers, you will gradually be able to put more weight on the affected leg and move the joint a little further without pain. This information is given as a guide only, as recovery times vary between people. The amount you can do and how quickly you can do it will also depend on how severe your injury is.

    Is a knee injury more likely because I have osteoarthritis?

    Answer

    Osteoarthritis can sometimes cause damage to knee ligaments. It may also cause muscle weakness in the muscles surrounding your knee, putting extra strain on the ligaments. Likewise, certain injuries such as anterior cruciate ligament rupture, meniscal tears and articular cartilage injury, may increase your chances of developing osteoarthritis.

    Explanation

    Osteoarthritis affecting the knee can sometimes cause damage to your ligaments and muscles. However, by keeping active and regularly exercising your knee, you can strengthen muscles to help prevent injury. Exercise may also reduce the pain of knee osteoarthritis and help to prevent longer-term disability.

    Aim to do a combination of different types of exercise. Strengthening exercises will help the muscles around your joints – this will help to stabilise your joints and also help with your pain. Your doctor or physiotherapist may ask you to do some quadriceps (thigh muscle) exercises. Your quadriceps muscles become weaker when you have osteoarthritis so exercising to strengthen them is important.

    Also, try to do some aerobic activity, such as swimming or cycling – anything that increases your heart rate and makes you slightly out of breath. This type of exercise can help to reduce pain, and also improve your general health and wellbeing. Aerobic activity can also help you to lose excess weight or control your weight. This reduces your chances of your knee problems getting worse in the future.

    Range-of-movement exercises and stretches may also be important in keeping you flexible and mobile. This type of exercise involves moving your joints through their full range of movement and then trying to move a little further beyond this.

    It's important to get advice about which types of exercise are best for you. This will help prevent you putting strain on individual joints and muscles that can lead to injury and longer-term problems. Your doctor may refer you to a physiotherapist, specialist nurse or rheumatologist (a specialist dealing with the musculoskeletal system, the joints and surrounding tissues) for specialist advice.

  • Resources Resources

    Further information

    Sources

    • Soft tissue knee injury. Medscape. www.emedicine.medscape.com, published 8 April 2013
    • Meniscal tears. American Association of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published February 2009
    • MacAudley D. Oxford handbook of sport and exercise medicine. 1st ed. Oxford: Oxford University Press, 2007:216
    • Sprains and strains. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published October 2012
    • Runner’s knee (patellofemoral pain). American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published February 2007
    • Quadricpes tendon tear. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published August 2009
    • Knee injuries – assessment. Map of Medicine. www.mapofmedicine.com, published 26 October 2012
    • Knee sprains and meniscal injuries. The Merck Manuals. www.merckmanuals.com, published February 2012
    • Meniscal injury. Medscape. www.emedicine.medscape.com, published 18 January 2012
    • Anterior cruciate ligament. American Association of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published March 2009
    • Posterior cruciate ligament injury. Medscape. www.emedicine.medscape.com, published 13June 2013
    • Knee ligament tears. Map of medicine. www.mapofmedicine.com, published 26 October 2012
    • Anterior cruciate ligament pathology treatment & management. eMedicine. www.emedicine.medscape.com, published 19 March 2012
    • Meniscal tears. Map of Medicine. www.mapofmedicine.com, published 26 October 2012
    • Resistance training and injury prevention. American College of Sports Medicine. www.acsm.org, accessed 17 June 2013
    • Basic injury prevention concepts. American College of Sports Medicine. www.acsm.org, published January 2012
    • Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. ACSM Position Stand. Medicine & Science in Sports & Exercise 2011; 43(7):1334–59
    • Footcare for sport. Institute for Chiropodists and Podiatrists. www.iocp.org.uk, accessed 18 June 2013
    • Medial collateral knee ligament injury. Medscape. www.emedicine.medscape.com, published 3 October 2012
    • Efficacy of homeopathic arnica. Bandolier. www.medicine.ox.ac.uk, published April 2000
    • Bruising. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published March 2010
    • Osteoarthritis. Medscape. www.emedicine.medscape.com, published June 2013
    • Exercise for osteoarthritis. Arthritis Research UK. www.arthritisresearchuk.org, accessed 20 June 2013
    • Exercising with osteoarthritis. Arthritis Foundation. www.arthritistoday.org, accessed 20 June 2013
    • How can physiotherapy help? Arthritis Research UK. www.arthritisresearchuk.org, accessed 2 July 2013
    • Personal communication, Dr Leon Creaney, Consultant Physician in Sport and Exercise Medicine, Bupa Musculoskeletal Centre of Excellence, Barbican, August 2013
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    Reviewed by Natalie Heaton, Bupa Health Information Team, 30 August 2013.

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