Knee Injury

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Knee Injury

The amount of force that is transmitted during knee trauma will determine the severity of a knee injury. It may be a soft tissue injury such as a knee sprain (or knee strain) or else there may be structural damage to the knee. This could be due to a meniscal tear, if shear forces were involved (twisting of knee under pressure). More force such as in a skiing accident can lead to ligamentous tears or even fractures.

Common ligamentous tears are an anterior cruciate ligament tear (ACL tear) or a medial or ulnar collateral ligament tear (CL tear). As there is a medial (MCL) and lateral collateral ligament (LCL), there can be MCL or LCL tears. Often with serious sports injuries there might be a combination of MCL tear with a medial meniscal tear and an ACL tear.

With more force eventually a piece of the hyaline cartilage of the internal joint surfaces can fracure off or else one of the articulating bones can fracture resulting in a tibia fracture, fibula fracture, patella fracture or femur fracture. Any of these fractures can be with or without angulation or displacement. X-rays, bone scans, CT scans and MRI scans can give more details about these injuries. These more serious injuries require a consult from an orthopedic surgeon. Once the diagnosis is confirmed through clinical examination and diagnostic imaging studies, specific therapy can be instituted.

In the case of a meniscal tear this might involve an arthroscopic examination and shaving off of the torn tissue. For a torn ACL an ACL reconstruction can be done arthroscopically.

A fracture can be treated conservatively when there is no displacement and a long leg cast for about 4 to 6 weeks might be all that is required followed by repeat X-rays to monitor bone healing and reactivation using physiotherapy and active exercises. However, there will be some fractures or fracture dislocations, where the orthopedic surgeon has to intervene operatively and "fix it". This is done with K-wires to hold bone pieces in place, special metal alloy plates and surgical screws. The plates are screwed across the fracture line and have to be strong enough to provide early remobilization. A fractured patella might be put back together with a figure of 8 wire.

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References:

1. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 157.

2. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 4.

3. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 270.

4. Wheeless' Textbook of Orthopaedics: http://www.wheelessonline.com/

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