We treat a variety of knee conditions at the Reading Hip & Knee Unit.

Click on the problem or injury that applies to you to find out more:

Anterior Cruciate Ligament (ACL) Injuries

 

The ACL is a commonly damaged ligament during sporting activities, especially in sports that involve pivoting e.g. football, rugby or netball. A rupture or tear of the ACL usually results from a twisting motion of a slightly bent knee when the foot is planted on the ground. The patient often feels a pop or click inside the knee and almost always has to leave the field of play. The same force is applied to the knee in a ski fall when the ski does not release its binding. Most people find the knee swells up very quickly which is associated with the torn ligament bleeding into the knee.

     

The management of ACL injuries has been refined over the last 15 years or so. Diagnosis is usually made clinically (by history and examination) but often an MRI scan is obtained to look for other injuries that can occur at the same time e.g. meniscal tears. Your consultant will discuss the treatment options available to you, which again can vary from non-operative options through to surgical reconstructions. The best treatment depends on what else is damaged, how unstable or wobbly the knee is on a day to day basis and what the patient's sporting ambitions are in the future. For more information on the injury and surgical reconstruction please download our pdf here and/or follow this link to the National Ligament Registry website.

 

View more images relating to ACL Injuries here

Normal Anteriorl Cruciate Knee Ligament
Torn ACL Knee Fibres xray
Ruptured knee ACL image

Sports Knee Injuries

 

A large number of our patients consult us having sustained a knee injury. This is usually a result of a twisting injury, and often during sports. Occasionally the knee can seem to flare up after activity such as walking or running.

 

Significant twisting injuries can sometimes result in damage to one or more of the major ligaments that support the knee. Also at risk, in twisting injuries, are the meniscal (shock absorbing) cartilages and the joint surfaces themselves (articular cartilage injuries). One of the most common types of sporting injury is an Anterior Cruciate Ligament (ACL) Injury. Read above for more information on this. Other types of sporting injury include:

 

Medial Collateral Ligament (MCL) Injuries

The MCL is the most commonly injured knee ligament. This usually occurs after a twisting motion or when the knee takes a blow from the outside, for example during a football tackle. MCL injuries are usually diagnosed clinically (by examination) but may be confirmed by an MRI scan. When the ligament is damaged on its own, it can usually be managed non-operatively with a specialised knee brace and a good course of physiotherapy and rehabilitation. In rare cases where there is chronic insufficiency of the ligament or the ligament ruptures into the joint (see picture below) surgery may be needed.

 

Posterior Cruciate Ligament (PCL) Injuries

The posterior cruciate ligament lies at the back of the knee and is the largest of the knee ligaments. It can be injured in isolation or in combination with other ligaments. Injury to the PCL tends to involve higher energy than injuries to the ACL. The typical mechanism of injury is the top of the shin bone being forced backwards with the knee bent (e.g. ‘dashboard injury’ in a road traffic collision). Usually a PCL injury can be diagnosed through a good clinical assessment, but sometimes it is confirmed with X-rays or MRI scan. PCL injuries can be managed non-operatively with a specialised brace and physiotherapy as well as with surgery. The best management option is dependant on the individual patient and the pattern of their particular injury.

 

Lateral Collateral Ligament (LCL) and Postero-lateral Corner (PLC) Injuries

Damage to the lateral (outside) collateral ligament or the back, outer corner of the knee are much less common. There is a group of structures collectively named the ‘postero-lateral corner’ which are damaged usually in combination with other ligaments after a significant high energy injury. Sometimes it is recommended that PLC injuries are repaired surgically in the acute setting. Patients with chronic injuries where there is on-going instability of the knee may require reconstructive surgery to stabilise the knee.

 

Meniscal Injuries

The meniscal shock absorbing cartilages (‘footballers’ cartilages’) are at risk of being damaged or torn during acute knee injuries. This typically involves a twisting force, especially when seen in the younger age groups. As we get older, the meniscus becomes easier to tear and such tears are frequently associated with ‘wear and tear’ or arthritic change within the knee. Clinical assessment can often pick up a meniscal tear but it is usually confirmed with an MRI scan. Small tears may not cause too many problems and the associated symptoms can sometimes settle with non-operative treatment. If a larger tear ‘flips and flaps’ around inside the knee, it can cause the inside of the knee to become inflamed and produce more fluid creating an effusion (swelling). Such an unstable tear can also cause mechanical symptoms such as catching, locking or giving out of the knee. Such symptomatic tears can be tackled with a keyhole operation called an arthroscopy. Depending on the nature and position of the tear it is either repaired or trimmed back to a ‘stable edge’. Please refer to the patient information guide regarding arthroscopy for further information.

 

Chondral Injuries

The joint surfaces (articular chondral cartilage) are also at risk during a knee injury. These ‘surface’ injuries can accelerate ‘wear and tear’ arthritis in the knee, so need to be identified early to ensure the best early treatment plan is followed. If small pieces of cartilage are ‘knocked off’ during an injury, they can float around the knee as a loose body, again causing troublesome mechanical symptoms such as locking or instability. An arthroscopy is a very powerful tool to diagnose such injuries because they sometimes don’t show up clearly on MRI scans. Various management options for the different types of chondral damage are available. These options are dependent of the individual patient and injury pattern. A micro fracture is one such technique and is shown here.

 

 

Knee Arthritis

 

Osteoarthritis is when the smooth surface of joint cartilage wears away to expose the underlying bone. It often causes joint swelling and stiffness. The pain is typically a dull ache but it can cause sharp pains too. Most pains start off with exercise but as the condition progresses patients can experience pain at rest and/or at night.

 

Factors which can lead to osteoarthritis include:

 

1.   Hereditary (genetic) factors i.e. passed down in families

2.   The alignment (shape) of the leg and the distribution of weight through the knee

3.   Type and amount of activities (work & sport)

4.   Previous knee injuries including fractures and ligament ruptures

5.   Previous removal or damage to meniscal (shock absorber) cartilages

 

Arthritis is usually diagnosed with X-rays (taken when weight-bearing) which help to show which parts of the knee are affected.

 

The early stages of arthritis can usually be well managed with non-operative treatments - for example, pain control medication, strengthening exercises and weight reduction. If these treatments are no longer effective there are different surgical options available. Your consultant will discuss all the options available to you, so you are fully informed before making any decisions.

Cartilage Problems

 

Cartilage problems are often triggered by sporting injuries. Common types of cartilage problems are mensical and chondral.

 

Meniscal Injuries

The meniscal shock absorbing cartilages (‘footballers’ cartilages’) are at risk of being damaged or torn during acute knee injuries. This typically involves a twisting force, especially when seen in the younger age groups. As we get older,  the meniscus becomes easier to tear and such tears are frequently associated with ‘wear and tear’ or arthritic change within the knee. Clinical assessment can often pick up a meniscal tear but it is usually confirmed with an MRI scan. Small tears may not cause too many problems and the associated symptoms can sometimes settle with non-operative treatment. If a larger tear ‘flips and flaps’ around inside the knee, it can cause the inside of the knee to become inflamed and produce more fluid creating an effusion (swelling). Such an unstable tear can also cause mechanical symptoms such as catching, locking or giving out of the knee. Such symptomatic tears can be tackled with a keyhole operation called an arthroscopy. Depending on the nature and position of the tear it is either repaired or trimmed back to a ‘stable edge’. Please refer to the patient information guide regarding arthroscopy for further information.

 

Chondral Injuries

The joint surfaces (articular chondral cartilage) are also at risk during a knee injury. These ‘surface’ injuries can accelerate ‘wear and tear’ arthritis in the knee, so need to be identified early to ensure the best early treatment plan is followed. If small pieces of cartilage are ‘knocked off’ during an injury, they can float around the knee as a loose body, again causing troublesome mechanical symptoms such as locking or instability. An arthroscopy is a very powerful tool to diagnose such injuries because they sometimes don’t show up clearly on MRI scans. Various management options for the different types of chondral damage are available.

 

 

Knee Cap Problems

 

In a normal knee, the kneecap (patella) glides up and down in the centre of the groove on the front of the femur as the knee bends and straightens. If your anatomy (“the way you are made”) is slightly unusual or the muscle actions on this joint are not ‘balanced’ then the kneecap (patello-femoral) joint can (over time) be subjected to abnormal forces which can cause symptoms. Some patients present with pain over the front of the knee which is worsened by ‘bending’ activities such as squatting or climbing up and down stairs.

 

In other patients these forces can be enough to cause the kneecap to ‘pop’ out or feel as though it might (patella instability). Instability can present with different symptoms, from a feeling of “it might go” right through to a complete dislocation (“popping out”). A ‘normal’ kneecap can also dislocate following a significant twisting injury during a fall or certain sports activities.

 

Knee cap problems can be tricky to treat so an accurate assessment and investigations are essential to secure a precise diagnosis and allow an appropriate treatment plan to be made.

Knee Ligament Injuries

 

Significant twisting injuries can sometimes result in damage to one or more of the major ligaments that support the knee. Also at risk, in twisting injuries, are the meniscal (shock absorbing) cartilages and the joint surfaces themselves (articular cartilage injuries). One of the most common types of sporting injury in is an Anterior Cruciate Ligament (ACL) Injury. Read above for more information on this. Other types of sporting injury include:

 

Medial Collateral Ligament (MCL) Injuries

The MCL is the most commonly injured knee ligament. This usually occurs after a twisting motion or when the knee takes a blow from the outside, for example during sports. MCL injuries are usually diagnosed clinically (by examination) but may be confirmed by an MRI scan. When the ligament is damaged on its own, it can usually be managed non-operatively with a specialised knee brace and a good course of physiotherapy and rehabilitation. In rare cases where there is chronic insufficiency of the ligament or the ligament ruptures into the joint (see picture below) surgery may be needed.

 

Posterior Cruciate Ligament (PCL) Injuries

The posterior cruciate ligament lies at the back of the knee and is the largest of the knee ligaments. It can be injured in isolation or in combination with other ligaments. Injury to the PCL tends to involve higher energy than injuries to the ACL. The typical mechanism of injury is the top of the shin bone being forced backwards with the knee bent (e.g. ‘dashboard injury’ in a road traffic collision). Usually a PCL injury can be diagnosed through a good clinical assessment, but sometimes it is confirmed with X-rays or MRI scan. PCL injuries can be managed non-operatively with a specialised brace and physiotherapy as well as with surgery. The best management option is dependant on the individual patient and the pattern of their particular injury.

 

Lateral Collateral Ligament (LCL) and Postero-lateral Corner (PLC) Injuries

Damage to the lateral (outside) collateral ligament or the back, outer corner of the knee are much less common. There is a group of structures collectively named the ‘postero-lateral corner’ which are damaged usually in combination with other ligaments after a significant high energy injury. Sometimes it is recommended that PLC injuries are repaired surgically in the acute setting. Patients with chronic injuries where there is on-going instability of the knee may require reconstructive surgery to stabilise the knee.

 

Knee Pain

 

Knee pain affects patients of all ages and has a large variety of causes. At your outpatient appointment our consultants will assess your pain and examine your knee in detail. They will also want to understand exactly how your knee pain affects you, as this will have implications on what sorts of treatment would be most effective. Often investigations such as x-rays or MRI scans are arranged to confirm a clinical diagnosis.

 

The most common causes of knee pain we see are due to:

 

 

 

Tendonitis

A tendon is a structure that attaches a muscle to a bone. Tendonitis is a general term that describes inflammation (“angriness”) of a tendon often in the region of its attachment to the bone. The most common ‘knee’ tendon to be affected by tendonitis is the patella tendon which joins the knee cap (patella) to the top of the shin bone (tibia). This is commonly known as 'jumpers knee' as it typically affects sporty people who participate in ‘explosive’ activities. Other tendons around the knee can also become inflamed.

 

Tendonopathy (“diseased tendon”) is a separate term which can describe some degeneration within the tendon or more chronic damage to the tendon that can occur after repeated bouts of acute tendonitis. 

 

Tendonitis is usually diagnosed by the history (symptoms) - pain, stiffness and localised swelling around the front of the knee - and a detailed clinical examination. Sometimes this diagnosis is confirmed by an investigation such as an MRI scan or an Ultra sound scan. There are a variety of treatments that can be used to treat tendonitis - from physiotherapy and injections to surgery – and choosing the correct one depends on a variety of patient factors. Surgical options are usually only used after exhausting non operative treatments.

 

View images relating to Tendonitis here

Overuse Injuries

 

Plica Syndrome 

A plica is an extra fold of tissue lining the inside of the knee. It is usually found on the inner side of the joint. Having a plica is a common occurrence and the majority of people who have plicae do not have symptoms. It is often found incidentally during a knee arthroscopy (keyhole procedure).

 

‘Plica syndrome’ is a condition which occurs when a normally thin plica becomes irritated, enlarged, or inflamed. This most often happens as a result of repetitive ‘bent knee’ sports e.g. cycling. The thickened plica can then catch on the front of the thigh bone during knee flexion (bending).

 

Treatment of plica syndrome initially focuses on reducing the local inflammation.

 

Non-steroidalanti inflammatories (NSAIDs) are often used in conjunction with various physiotherapy techniques. In rare resistant cases a knee arthroscopy and surgical excision of a plica is necessary.

 

View images here

 

 

Ilio-tibial Band (ITB) Friction Syndrome

ITB friction syndrome is a relatively common cause of lateral (outer) knee pain and localised swelling. It is usually seen in runners and active people and is caused by an inflammation of the ITB tendon as it crosses the outer side of the knee joint (femur) before inserting into the top of the shin bone (tibia). The cause is often due to the underlying anatomy (“the way you are made”) together with ‘overuse’. It frequently presents after patients increase their running mileage when in training for an event. Tight hips, bow legs and flat feet have all been implicated in causing ITB symptoms. Diagnosis is usually from the history (story) and examination but can be confirmed with an MRI scan which sometimes shows the inflamed area. The vast majority of cases are successfully treated with non-operative measures which include anti-inflammatories, rest, stretching techniques and localised physiotherapy. If the symptoms do not settle, a steroid injection may be used or a small surgical releasesettle a small surgical release of the tight ITB can be performed.

 
 
 
 
 
 
 
 

Knee Conditions & Injuries

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