The knee is supported by four major ligaments: the ACL (anterior cruciate ligament), PCL (posterior cruciate ligament), MCL (medial collateral ligament) and LCL (lateral collateral ligament). Injuries to these ligaments are usually due to a bending or twisting of the joint against it’s usual movement pattern. Ligament injuries account for the majority of knee injuries going to the emergency department, with ACL (20.3%) and MCL (7.9%) injuries being the most common.
Typical symptoms include:
- Knee pain
- Knee swelling (usually fairly rapid for ACL injuries, and over the inside of the knee for MCL injuries)
- Instability in the knee
- Potentially a sensation of the knee giving way
- Potential bruising around the knee if the MCL and LCL was torn
The meniscus is a set of two circular or semicircular pads that sit in-between the bones of the knee. Their job is to act as a shock absorber, help stabilize the knee, aid the lubrication of the joint and improve joint proprioception/balance. Injuries to the medial meniscus (on the inside of the knee) account for 10.8% of knee injuries going to the emergency department and injuries to the lateral meniscus (on the outside of the knee) account for 3.7%. Symptoms of meniscal tears include:
- Knee pain
- Knee swelling (usually a more delayed onset)
- Clicking
- Catching or locking in the joint
- Potentially a sensation of the knee giving way.
Not all ligament or meniscal tears require surgery. Please discuss this further with your medical professional but if your knee is improving over time, feeling stable and regaining its range of motion there is a strong likelihood your injury will be managed conservatively. Meniscal tears (especially in the outer 1/3) and MCL have the ability to heal conservatively. Long term studies show that in many cases meniscal repair surgery in older individuals with degenerative tears end up with a worse outcomes than if these injuries had been managed non-operatively. This is likely because degenerative tears involve fraying of the meniscus have to be cut out instead of sewn back together. By removing part of the meniscus, the bones are subject to higher forces and the risk of osteoarthritis is increased.
Conservative care for these types of injuries focuses on:
- Regaining range of motion, decreasing swelling
- Bracing to protect tissues as they heal
- Strengthening knee and hip muscles
- Improving proprioception/balance
- Return to sport conditioning and plyometric training
All of this is covered in the Physio Fixes program. Please see below for more information!
DISCLAIMER: This information is not intended as medical advice or a substitute for medical counseling. By choosing to follow the information that follows, you recognize that despite all precautions taken by Physio Fixes Inc. there is a potential risk of injury and you expressly acknowledge such risks and waive, relinquish, and release any claim that you may have against Physio Fixes Inc. You should always get evaluated for exercise by a physician or medical professionals, especially if symptoms occur from a trauma or are worsening. The user agrees by purchasing this program that Physio Fixes will not be held responsible in the event that an injury occurs.
References
Arundale AJH, Bizzini M, Giordano A, Hewett TE, Logerstedt DS, Mandelbaum B, Scalzitti DA, Silvers-Granelli H, Snyder-Mackler L. Exercise-Based Knee and Anterior Cruciate Ligament Injury Prevention. J Orthop Sports Phys Ther. 2018 Sep;48(9):A1-A42. doi: 10.2519/jospt.2018.0303. PMID: 30170521.
Beaufils P, Hulet C, Dhénain M, Nizard R, Nourissat G, Pujol N. Clinical practice guidelines for the management of meniscal lesions and isolated lesions of the anterior cruciate ligament of the knee in adults. Orthop Traumatol Surg Res. 2009 Oct;95(6):437-42. doi: 10.1016/j.otsr.2009.06.002. Epub 2009 Sep 10. PMID: 19747891.
Logerstedt DS, Scalzitti DA, Bennell KL, Hinman RS, Silvers-Granelli H, Ebert J, Hambly K, Carey JL, Snyder-Mackler L, Axe MJ, McDonough CM. Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions Revision 2018. J Orthop Sports Phys Ther. 2018 Feb;48(2):A1-A50. doi: 10.2519/jospt.2018.0301. PMID: 29385940.
Majewski M, Susanne H, Klaus S. Epidemiology of athletic knee injuries: A 10-year study. Knee. 2006 Jun;13(3):184-8. doi: 10.1016/j.knee.2006.01.005. Epub 2006 Apr 17. PMID: 16603363.
