Ana’s Knee

Knee Structure - Bones

• 3 bones:• Femur (thigh bone)

• Knee cap (patella) - protects the knee joint and through tendons and ligaments supports the leg muscles

• Tibia (shin bone)

• Bones are connected to other bones by ligaments

Knee Structure - Ligaments

• 4 ligaments:

• Collateral

• Lateral collateral ligaments (LCL)

• Medial collateral ligament (MCL)

• Cruciated

• Anterior cruciated ligament (ACL)

• Posterior cruciated ligament (PCL)

• Ligaments: strong ropes to hold bones together and keep stability

A) LCL - limits sideway motion and runs along the outside of the knee.

B) ACL - limits rotation and the forward motion of the tibia. Crosses from the back of the femur to the front of the tibia.

C) MCL - limits sideway motion and runs along the sideway motion and runs along the inside of the knee joint.

D) PCL - limits backward motion of the tibia

Knee Structure - Ligaments

Quadricep Muscles - Large muscles at the front of the thigh that holds the patella against the thighbone.

Patella Tendon - Attaches the patella to the tibia.

Menisci - Cartilage pads that help distribute weight and force.

Knee Structure – Muscles and cartilages

Knee Injuries

• Injured ligaments are considered "sprains" and are graded on a severity scale.• Grade 1 Sprains. The ligament is mildly damaged in a Grade 1 Sprain. It

has been slightly stretched, but is still able to help keep the knee joint stable.

• Grade 2 Sprains. A Grade 2 Sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.

• Grade 3 Sprains. This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, and the knee joint is unstable.

• If they're not treated at the time, ligament injuries may act up months or years later!!!! (hmmm, quiet possibly my case)

My Symptoms

• Instability

• Popping sound

• Inside of the knee hurts

• Crunching feeling when extend and flex my leg (right knee)

• Crack feeling when extend and contract leg (left knee)

• Pain in the middle of the knee, from the front (right knee)

• Limitation of motion caused by pain and swelling. Limitations were seen in flexion and extension of the leg.

• Noticed this after the injured knee has been held in one position for a while. I attempted to move the knee and gradually gained motion (very painful I must say).

• Not “locking” but “gelling or stiffness” feeling.

My Symptoms

• Pop or snap and knee abruptly goes out. The initial burst of pain is usually sharp, it then becomes dull and aching.

• Knee doesn’t feel right – INSTABILITY, hence a “give away” feeling.

• It hurts when: ascending/descending hills or stairs, squatting, weight bearing, ballet plie position, after sitting for long periods of time with knee flexed (theater symptom), someone kicks (sigh).

Injuries (that I remember) so far…

• 1998 – left knee. Playing soccer, hurt it by just running.

• 2000 – left knee. Soccer, abrupt stop.

• 2002 – left knee. Kick on the back.

• 2003 – left knee. Soccer, fast twist in motion while running.

• 2004 – left knee. Gymnastics, hurdle (skip step) before front attempting to perform a silly handspring.

• 2004 – right knee. Gymnastics, hit the inside of the knee with balance beam while falling off in an attempt to perform an aerial.

• 2009 – right knee. Soccer, my foot kind of entangled to another girl’s.

• 2010 – right knee. Soccer side tackle.

• 2010 – right knee. Uneven sidewalk, miss stepped and ankle rolled (no ankle sprain).

• 2011 – left knee. While stretching in a split position (right leg in front), popped, it hurt but nothing compared to other times.

• 2011 – right knee. Gave away while squatting to pick up something. So far the most stupid way of hurting it.

WORST one ever!

Interesting Facts

• Acute knee injuries in sports include: contusions, sprains, strains, fractures, and dislocations.

• 90% of the time ACL tear is misdiagnosed.

• Severe ligament injuries: hallmark sign of which is instability.

• Unanticipated moves can result in dynamic (musclotendinous) or static (capsilar, meniscal, ligament).

• A snapping, popping, ripping, or tearing sensation at the time of injury is generally indicative of a severe injury.

• After an injury knowing that full extension of the knee was possible practically preludes the possibility of a dislocation, locked, buckle-handed meniscus tear.

ACL Injury

• Largest numbers are sustained in the running/jumping sports: football, basketball, soccer, gymnastics.

• Usually is a result of a cutting, or turning maneuver or abrupt deceleration. Isolated tears of the menisci or ACL are usually a result of deceleration or rotational forces on the weight-bearing knee as may occur in any running or jumping activity.

• In jumping activities the injury is caused by a mislanding (not my case but worth to take a note).

• Isolated sprains or anterior cruciate ligament are almost never the result of contact or collision (contradicts with my right knee’s first and most devastating injury)

• A snap or pop during a deceleration or cutting maneuver implies ACL or meniscal injury until proven otherwise.

ACL Injury

• Symptoms:• Pop/snap and knee abruptly going out. Athlete

falls to the ground in SEVERE pain.• Pain – usually sharp at first and then becomes

dull• Swelling – in the form of effusion of

hemarthrosis • Instability – knee doesn’t feel right

ACL Injury

• Past history may be contributory. Patellar subluxations and dislocations tend to be recurrent. Prior ACL tears may predispose to meniscal injuries.

• Any incomplete rehabilitated prior injury may render the knee vulnerable to recurrent

Chronic Anterior Knee Pain

• Past history may be contributory. Patellar subluxations and dislocations tend to be recurrent. Prior ACL tears may predispose to meniscal injuries.

• Any incomplete rehabilitated prior injury may render the knee vulnerable to recurrent

• Chronic Anterior Knee Pain – stems from either extensor mechanism problems or degenerative joint disease. Three conditions:• Patellofemoral dysfunction – aka chondromalacia or

runner’s knee• Patellar tendinitis• Osgood-Schlatter disease

Chronic Anterior Knee Pain

• Vastus medialis muscle (smallest of the 4 components of the quads). Because of its direction of pull, it is the most important from the standpoint of positioning and stabilizing the patella.

• Successful treatment: strengthening, exercise.

• Patellofemoral dysfunction often is noted as a residual of an acute knee injury.

• Patellofemoral dysfunction – ascending/descending hills or stairs, squatting, weight bearing, ballet plie position, after sitting for long periods of time with knee flexed (theater symptom).

• Running and jumping is associated with all 3 conditions

• Patellofemoral dysfunction pain usually is localized in over the medial retinaculum (inside of the knee)

• Patellar tendinitis pain is usually located at the inferior pole of the patella (sounds familiar :/)

Chondromalacia Patellae

• Degenerative change in the articular cartilage of the patella.

• Caused by abnormal compression or shearing forces.

• 4 stages:• Articular cartilage shows softening or blistering• Fissures appear in cartilage• Fibrillation of the cartilage occurs• Full cartilage defects are present and subchondral bone is

exposed

• Treatment: medial quad strengthening, hamstring flexibility. Use a knee sleeve with a patellar cut-out.

Meniscus Tear

• Pain at the inside of the knee can indicate a tear to the medial meniscus. Pain at the outer side of the affected knee may indicate a tear to the lateral meniscus.

• Moderate-large tear• Pain at the side or in the center of

the knee• Knee feel stiff and limit bending• Sharp pain when twisting or

squatting• Pieces of the torn meniscus can

float into the joint space. This can make the knee catch, pop, or lock

• Knee can also feel "wobbly" or unstable, or give way without warning

Conclusion: My suspicions…

Either one or a combination of:

1. ACL

2. Some sort of chronic anterior knee pain, most likely patellofemoral dysfunction

3. Medial meniscus tear

4. MCL tear (?)

Inside of the knee

Ana: Get an MRI, end of story!!