The dreaded knee injury: when the patient reports a slip, twist or tackle and they hear a pop or crack followed by pain and difficultly walking and moving the knee. Thankfully these incidences are rare. However, accurate assessment and diagnosis are key to the successful recovery from such an injury because delayed or misdiagnosis can lead to a life time of physical changes to the knee and a change in performance ability or sporting activities.
The importance of joint cartilage preservation in the knee was recently highlighted to me again during a teaching evening on the knee lead by Mr Mandalia, Consultant Knee Surgeon. Many people have heard of a ‘menisici tear’ of the knee. The knee has two extra discs of cartilage called menisici which can get torn or damaged with a twisting knee injury or general wear but what I am talking about is the articular (joint) cartilage that covers the ends of all bones where there is a joint. Damage to this surface and the underlying bone that if isn’t identified quickly can lead to post traumatic arthritis. Ultimately this means excessive wear in the knee joint prematurely potentially at worse leading to complicated cartilage transplant surgery or knee replacements. The knee joint takes huge amounts of load across its joint surfaces and if there is a whole or gap within this (I have heard consultants talk about it as a ‘divot in the surface’) this causes significant changes in the loading pattern across the knee with excessive wear occurring.
The signs and symptoms reported and found if a significant knee injury has occurred are: inability or difficulty taking weight on the knee, pain++, locking sensation, giving way, painful clicking, and significant swelling immediately, and warmth over the knee area. This isn’t an exhaustive list but perhaps the most significant reported signs and symptoms. The difficulty is when you are the patient is that rest will improve many of these findings over a period of time however, there is only a small window of between 4-6 weeks to repair successfully an osteochondral fragment (bone – joint cartilage fragment). Likewise a significant ligament injury to the knee or menisci tear will again settle with rest most often and may or may not need further investigation and / or treatment to regain the previous structural integrity and strength.
Please do remember that such injuries are rare but should you find yourself with a significant knee injury it is certainly important to rest until the acute symptoms of settled but do consider more formal assessment of the knee to ensure that something more significant has not been missed.
Chartered Physiotherapist MSc, BSc (Hons), MCSP, MHCPC
Owner First Physio
Disclaimer: The opinions expressed are those of First Physio only and do not constitute medical advice.