Have you ever grappled with knee issues? If so, you're not alone! Today, we will delve into common knee conditions and address some prevalent questions such as:
Should I get a scan?
Do I need surgery?
And, most importantly, how long before I can get back to tango dancing?
Let's first explore the anatomy of the knee.
Did you know the knee is the largest joint in the body? It may appear straightforward, but it is a complex structure composed of ligaments, tendons, meniscus, articular cartilage, and three bones - the femur (thigh bone), tibia (shin bone), and patella (knee cap). Surrounding the knee are numerous muscles that contribute to its strength and stability.
Types of Knee Conditions:
Ligament Injuries: Ligaments connect bone to bone, and common injuries include the Anterior or Posterior Cruciate Ligament (ACL, PCL) and medial or lateral collateral ligament (MCL, LCL). These injuries often occur when the knee undergoes substantial stress, such as sudden stops, rotation with a bent knee or side-on impacts. Ligament tears can make the knee feel loose and unstable to stand and walk on.
Cartilage Injuries: Damage to the meniscus (the cushioning between the bones) is a frequent cartilage injury, often caused by rotational forces on the knee.
Osteoarthritis: A degenerative condition where the articular cartilage that covers the ends of bones gets thinner over time, and osteophytes (bone spurs) form. For more information on this check out on our previous blog here
Tendinopathies: simply meaning pathological tendon, in the past the term tendonitis was used. -itis refers to inflammation however tendon pathology typically is not inflamed even though it can certainly hurt. These injuries usually occur as a stress response in the tendon (tendons join muscle to bone) when overloaded and may or may not be associated with a tendon tear.
Baker's cyst: is a collection of fluid in the back of the knee. The presence of a baker's cyst is a sign of an underlying problem in the knee, often OA or a meniscal injury. It will go up and down depending on how happy or unhappy the knee is. Draining doesn't help as it will fill back up again. Dealing with the underlying issue is the solution. Its presence also isn’t terribly limiting except to fully bending the knee which it often can’t anyway due to other issues.
Ligament and tendon injuries can be graded according to the severity of the injury. Some grading systems use a grade 4 to describe a complete tear, with grade 3 almost completely torn. Either way a grade 3 is a significant trauma!
Should I Get a Scan?
The decision to undergo a scan depends on whether it will significantly impact the treatment plan. A thorough assessment often provides sufficient information, and treatment in most cases may proceed without a scan. However, there are situations where a scan can offer valuable insights:
Suspected significant or complete tear of ligament, tendon, or meniscus
Persistent pain worsening, or not improving over time with treatment
Persistent inability to weight bear through the knee due to pain or weakness
A persistently locked knee joint post injury
When symptoms and their causes are not clear through a clinical assessment alone and symptoms are significant and / or persistent and / or non-responsive to conservative treatment
In such cases, a scan aids in diagnosis and helps determine if surgery may be required or to persist with conservative treatment.This may be in the form of an X-ray, Ultrasound scan, CT scan or MRI scan.
Typically Xray and MRI are most common and helpful.
Is surgery the best option for me?
The decision to undergo knee surgery depends on various factors, and it is not always the first line of treatment. Conservative approaches such as Physiotherapy/ Osteopathy, medications, and lifestyle modifications are often attempted before considering surgical interventions. Here are some considerations:
Severity of the injury: The extent of the knee injury plays a crucial role in determining whether surgery is necessary. Minor ligament sprains or small cartilage tears may often be managed with non-surgical methods. On the other hand, complete ligament tears or significant meniscal tears may require surgical intervention.
Effectiveness of conservative treatments: If conservative treatments like Physiotherapy/Osteopathy, pain management, rest and gradual loading have not provided relief or improved the condition, surgery may be considered as the next step.Â
Impact on daily activities: The decision to undergo surgery may be influenced by how much the knee condition interferes with daily activities and the patient's quality of life. If the knee problem significantly limits mobility or causes persistent pain, surgery may be recommended.
Age and health status: The patient's age and overall health are important factors in determining the feasibility of surgery. Some surgeries may be more challenging for older individuals or those with certain health conditions.
Patient preferences: Personal preferences and goals are important in the decision-making process. Some individuals may prioritise conservative treatments and prefer to avoid surgery unless absolutely necessary, while others may opt for surgical intervention for a potentially quicker resolution.
It is important to highlight that most common acute knee injuries can be managed non-operatively. Traditionally, early surgical intervention has been considered the gold standard for addressing an ACL rupture. However, emerging research suggests that conservative management, coupled with a robust rehabilitation program, can also be a viable option, especially if there is full knee extension and ability to fully weight bear. There is also increasing evidence of the ability of the ACL to heal after being torn, which till fairly recently was thought not to be possible.
Elite athletes such as Sam Kerr, the Australian women's soccer team captain tore hers in early January this year and had surgery very quickly. For a recreational sports person surgery is less likely to be so urgent.
Meniscal injuries in years gone by frequently ended up in the hands of orthopaedic surgeons. Going back decades they used to do an open incision and remove the whole meniscus! Something we find is a horrifying action that would never happen now. More common is key hole or arthroscopic surgery to simply trim away the torn sections. Even this is becoming less common than in the past as they are not as successful as once thought. We see many clients who opt for non-surgical treatment in the form of manual therapy and specific prescribed exercise and in many cases irritable knees with meniscal injuries do settle down. Exceptions will be to locked joints that persistently cannot weight bear.
Decisions to consider surgery or not are best made through collaborative discussions with your therapist, GP, and orthopaedic surgeon, weighing the individual factors that influence the most suitable course of action for your specific situation.
In summary, the knee is a very complex joint and there can be many different causes for knee pain. If you do have an acute injury, getting a scan can be useful but is not always essential in guiding the course of treatment. Surgery may be an option for some injuries but conservative management is often sufficient for many cases. It is essential to discuss the potential need for surgery and treatment options with healthcare providers, considering individual factors and circumstances.Â
Early Surgical Reconstruction Versus Rehabilitation for Patients With Anterior Cruciate Ligament Rupture: A Systematic Review and Meta-Analysis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10494743/Â
Non-operative Management of Acute Knee Injuries https://link.springer.com/article/10.1007/s12178-023-09875-7
Evidence of ACL healing on MRI following ACL rupture treated with rehabilitation alone may be associated with better patient-reported outcomes: a secondary analysis from the KANON trial https://bjsm.bmj.com/content/57/2/91Â