Stokewood Injury Clinic

Knee Injuries

Knee pain can be related to overuse where small stresses are repeated a large number of times without allowing adequate recovery, for example running too much too soon, or excessive jumping. Or injuries can be acute where the injury is caused by an impact or twisting such as an anterior cruciate ligament injury. An overuse injury can also be considered to be acute if it is painful or inflamed.

A torn ACL is an injury or tear to the anterior cruciate ligament (ACL). The ACL is one of the four main stabilising ligaments of the knee, the others being the Posterior Cruciate Ligament (PCL), Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL). The ACL attaches to the knee end of the Femur (thigh bone), at the back of the joint and passes down through the knee joint to the front of the flat upper surface of the Tibia (shin bone).

It passes across the knee joint in a diagonal direction and with the PCL passing in the opposite direction, forms a cross shape, hence the name cruciate ligaments.

The role of the Anterior Cruciate Ligament is to prevent forward movement of the Tibia from underneath the femur. The Posterior Cruciate Ligament prevents movement of the Tibia in a backwards direction. Together these two ligaments are vitally important to the stability of the knee joint, especially in contact sports and those that involve fast changes in direction and twisting and pivoting movements. Therefore a torn ACL has serious implications for the stability and function of the knee joint.

How does a torn ACL occur?

A torn ACL or acl injury is a relatively common knee injury amongst sports people. A torn ACL usually occurs through a twisting force being applied to the knee whilst the foot is firmly planted on the ground or upon landing. A torn ACL can also result from a direct blow to the knee, usually the outside, as may occur during a football or rugby tackle. This injury is sometimes seen in combination with a medial meniscus tear and MCL injury, which is termed O’Donohue’s triad.

Anterior cruciate ligament injuries are more frequent in females with between 2 and 8 times more females suffering a rupture than males, depending on the sport involved and the literature reviewed. The reason for this is as yet unknown, however areas of current research include anatomical differences; the effect of oestrogen on the ACL and differences in muscle balance in males and females.

Symptoms of a torn ACL

  •  
  • There may be an audible pop or crack at the time of injury
  • A feeling of initial instability, may be masked later by
  • extensive swelling.
  • A torn ACL is extremely painful, in particular immediately
  • after sustaining the injury.
  • Swelling of the knee, usually immediate and extensive, but
  • can be minimal or delayed).
  • Restricted movement, especially an inability to fully
  • straighten the leg
  • Possible widespread mild tenderness
  • Positive signs in the anterior drawer test and Lachman's
  • test.
  • Tenderness at the medial side of the joint which may
  • indicate cartlidge injury.
    • Treatment for an Anterior Cruciate Rupture

      What can the athlete do?

      •  
      • Immediately stop play or competition
      • Apply RICE(Rest, Ice, Compression, Elevation) to the knee
      • immediately
      • Seek medical attention as soon as possible.

IT Band Syndrome. The Iliotibial band is a sheath of thick, fibrous connective tissue which attaches at the top to both the iliac crest (hip bone) and the Tensor fascia latae muscle.

It then runs down the outside of the thigh and inserts into the outer surface of the Tibia (shin bone). Its purpose is to extend the knee joint (straighten it) as well as to abduct the hip (move it out sideways). 

As the ITB passes over the lateral epicondyle of the femur (bony part on the outside of the knee) it is prone to friction. At an angle of approximately 20-30 degrees the IT band flicks across the lateral epicondyle. When the knee is being straightened it flicks in front of the epicondyle and when it is bent, it flicks back behind.

Iliotibial band syndrome is common in runners as 20-30 degrees is the approximate angle at the knee when the foot strikes the ground during running. In persons who run regularly this may lead to irritation of the ITB commonly known as iliotibial band friction syndrome.

Signs and Symptoms of Iliotibial Band Syndrome:

  •  
  • Pain on the outside of the knee (at or around the lateral epicondyle of the femur).
  • Tightness in the iliotibial band.
  • Pain normally aggravated by running, particularly downhill.
  • Pain during flexion or extension of the knee, made worse by pressing in at the side of the knee over the sore part.
  • Weakness in hip abduction.
  • Tender trigger points in the gluteal area may also be present.

    •  
      What can the athlete do to prevent Runners knee?
      • Rest. Avoid painful stimuli, for example downhill running.
      • Apply cold therapy or ice to reduce any inflammation.
      • Stretch the Iliotibial band after training.
      • Self massage techniques can also be very helpful in correcting excessive ITB tightness.
      • See a sports injury specialist.
      • A sports injury specialist or clinician may:
      • Perform soft tissue or deep friction massage.
      • Prescribe anti-inflammatory medication such as NSAID’s e.g.Ibuprofen.
      • Use Myofascial release techniques which have been shown to be highly effective.
      • Perform dry-needling techniques.
      • Outline a rehabilitation strategy which may include stretches and exercises to strengthen the hip abductors.
      • Use electrotherapeutic treatment techniques such as Tens or ultrasound to reduce pain and inflammation.
        • In acute or prolonged cases a steroid injection into the site of irritation may provide pain relief.

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