Anatomy: The large anterior thigh muscle (musculus quadriceps femoris) consists of four muscles (m vastus lateralis, m vastus medialis, m vastus intermedius & m rectus femoris). All the muscles fasten on the upper edge of the knee cap. The knee cap ligament (ligamentum patellae) connects the lower edge of the knee cap with the front part of the shin bone (tuberositas tibiae). The function of the knee cap ligament is therefore, when the knee is stretched, to transfer the power the large thigh muscle produces.

Symptoms: Jumping and similar activity will initially cause tenderness at the lower edge of the knee cap. The pain diminishes during the first weeks/months after warm-up. If the sport activity continues the pain will increase, resulting in the activity eventually becoming impossible.

Acute treatment: Click here.

Examination: Correct treatment from the outset is essential for a good result. A medical examination is consequently recommended as soon as possible after the initial onset of pain under the knee cap. The diagnosis is often made following a normal medical examination. At deterioration or lack of progress, an ultrasound scan should be performed which will be able to reveal a thickening of the ligament, granuloma, scar tissue formation, partial rupture, calcification in the ligament, bursitis and inflammation of the tissue surrounding the ligament (peridenitis) (Ultrasonic image) (article).

Treatment: The treatment consists of relief from the pain inducing activity (jumping, kicking) as soon as possible after the onset of symptoms. The injury can in some cases heal within a few weeks if the treatment is instigated quickly. A rehabilitation period of several months must be anticipated if the pain has been in evidence for some months, and especially if an ultrasound scan has found thickening or changes of the ligament. Emphasis is put on stretching and strength training of the anterior thigh muscle, by activating the muscle simultaneously with stretching (eccentric training). Ice treatment can be repeated every time tenderness is provoked in the knee cap during the rehabilitation period. If there is a lack of progress following relief and strict rehabilitation, medicinal treatment in the form of rheumatic medicine (NSAID) can be considered, or injection of corticosteroid in the area surrounding the thickened part of the ligament. Research has shown that ultrasound guided injection of corticosteroid is extremely effective in reducing the extent of the thickened ligament, allowing more active rehabilitation to begin (Ultrasonic image) (article-1), (article-2). As the injection of corticosteroid is always an element in the long term rehabilitation of a very serious, chronic injury, it is vital that the rehabilitation period lasts over several months in order to reduce the risk of a relapse or rupture. The ligament is naturally unable to accommodate maximum strain or load after a prolonged injury period following only a short rehabilitation period. If the diagnosis is made by use of ultrasound scanning, the injections are performed under guidance of ultrasound, and the rehabilitation is progressed in accordance with the guidelines mentioned, then the treatment involving corticosteroid injections has very few risks connected (article). It is not unusual for a rehabilitation period of six months before maximum strain or load in the form of jumping is permitted. During recent years, different types of experimental treatment have been seen such as sclerosis injection (where injections are performed around the tendon with a drug to destroy the small blood vessels (and nerves) that infiltrate the sick tendons), and shock-wave (ultrasound treatment). However, there is no sure or clear documentation for the effect of these kinds of treatment. If satisfactory progress is not made in the rehabilitation and conservative treatment, surgical intervention can be considered. Long-term results of operations are often disappointing (article).

Bandage: Some patients have the opinion that the application of tape or bandage around the shin bone directly under the knee cap can relieve the discomfort (tape-instruction).

Complications: In case of lack of progress it should be considered whether the diagnosis is correct or whether complications have arisen. Special consideration should be given to:

• Meniscus lesion
• Anterior cruciate ligament rupture
• Posterior cruciate ligament rupture
• Cartilage damage (osteochondral lesions)
• Bone membrane tear (periosteal avulsion)
• Tendonitis
• Fluid accumulation in the joint (traumatic arthritis/synovitis)
• Bursitis
• Inflamed mucous fold (plica synovialis)
• Knee cap ligament rupture

Special: Shock absorbing shoes or inlays will reduce the load.

Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin bone (tibia) and the knee cap (patella). The joint cavity is coated with a very thin synovial membrane.

Symptoms: Swelling of the joint. Pain upon movement of the knee joint. Trouble flexing the knee completely.

Acute treatment: Click here.

Examination: Swelling of joints always requires medical examination. The diagnosis is usually made following a normal medical examination, where it is not possible to show damage to other structures (ligaments, meniscus). Smaller fluid accumulations in the knee can only be seen with ultrasound (article).

Treatment: Relief. If the swelling does not decrease despite relief, the treatment can be supplemented with medicinal treatment in the form of rheumatic medicine (NSAID) or the injection of corticosteroid in the joint, possibly preceded by drainage and evaluation of the joint fluid which can advantageously be performed under ultrasound guidance (article).

Complications: If smooth progress is not achieved, it should be considered whether the diagnosis is correct or whether complications have arisen. Amongst others the following should be considered:

• Cartilage damage (osteochondral lesions)
• Outer collateral ligament rupture
• Inner collateral ligament rupture
• Rupture of the anterior cruciate ligament
• Rupture of the posterior cruciate ligament
• Meniscus lesion
• Inflamed mucous fold (plica synovialis)
• Degenerative arthritis (osteoarthritis)

Anatomy: The tendons from the thigh to the shin bone pass the knee joint on the inner and outer sides, as well as to the front and rear of the knee.

Symptoms: Pain upon applying pressure along the tendon, aggravated when stretching or activation of the muscle tendon.

Acute treatment: Click here.

Examination: Medical examination is not necessarily required in slight cases. Severe cases or cases that are not improved by relief should be medically evaluated to ensure a precise diagnosis. The diagnosis is usually made on the basis of a normal medical examination, however, if any doubts surround the diagnosis an ultrasound scan can be performed as this is the best type of examination to ensure the diagnosis.

Treatment: Relief, stretching and slowly increasing load within the pain threshold. If there is not sufficient progress with relief and regular rehabilitation, medical treatment in the form of rheumatic medicine (NSAID) or the injection of corticosteroid along the inflamed tendon can be considered. As the injection of corticosteroid is always a part of a long term rehabilitation of a chronic injury, it is often necessary for the rehabilitation period to stretch over several weeks to reduce the risk of relapse and ruptures. The tendon is naturally unable to accommodate maximum strain or load after a prolonged injury period after only a short rehabilitation period. If the diagnosis is made by use of ultrasound scanning and the injections are performed under ultrasound guidance, and the rehabilitation is progressed in accordance with the guidelines mentioned, then the treatment involving corticosteroid injections has very few risks connected. In cases of lack of progress with rehabilitation and medicinal treatment, surgery can be considered. However, this is very rarely necessary after a regular and strict rehabilitation period.

The rehabilitation is dependant upon which tendons are involved, but it is usually the tendons in the popliteal space of the knee (tendons contributing to the flexing of the knee).

Complications: If smooth progress is not achieved, it should be considered whether the diagnosis is correct or whether complications have arisen. Amongst others the following should be considered:

• Meniscus lesion
• Inflammation of the mucous fold
• Rupture of the anterior cruciate ligament
• Rupture of the posterior cruciate ligament
• Inner collateral ligament rupture
• Outer collateral ligament rupture
• Cartilage damage (osteochondral lesions)
• Bone membrane tear (periosteal avulsion)
• Fluid accumulation in the joint (traumatic arthritis/synovitis)
• Bursitis

Special: Shock absorbing shoes or inlays will reduce the load. In case of lack of progress or recurrence after successful rehabilitation, a running style analysis can be considered to evaluate whether correction of the running style is indicated.

Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin bone (tibia) and the knee cap (patella). The articular surfaces on the thigh bone, shin bone and the knee cap are covered with a few mm thick cartilage coating which serves to reduce the strain on the articular surfaces. There is a ring-formed cartilage disk (meniscus) internally and externally in the joint. The knee joint is strengthened by a joint capsule which is in turn strengthened on the sides by an outer and an inner collateral ligament (ligamentum collaterale laterale (LCL) and ligamentum collaterale mediale (MCL)). The internal meniscus is attached to the inner collateral ligament, whereas the external meniscus is not attached to the outer collateral ligament.

Symptoms: Pain along the joint line when applying pressure and when rotating the knee. The pain often occurs suddenly when performing certain movements, and can be accompanied by swelling of the knee. In some instances the knee can lock due to a splinter from the meniscus becoming jammed. In other cases, a small and tender outpouching of fluid can be sensed at the joint line (meniscus cyst). Prolonged discomfort will often cause the thigh muscle to diminish.

Acute treatment: Click here.

Examination: A medical examination is always necessary if there is any suspicion of injury within the knee joint. A normal clinical examination is often not sufficient. The doctor can perform various knee tests (meniscus test), however, there is typically tenderness along the joint line which is aggravated when rotating the knee joint. It is often necessary to perform an arthroscopy (telescopic examination of the joint), MR-scan or ultrasound scan to make the diagnosis (article) (Ultrasonic image).

Treatment: In uncertain cases the treatment comprises relief and rehabilitation of the knee. If the discomfort does not slowly diminish, if there are instances of “locking” or if it is clear that the meniscus lesion is large (e.g. assessed from an ultrasound scan), surgery should be considered. Under an operation, it can be attempted to sew the torn piece of meniscus back (which will require a considerably longer rehabilitation period, but will probably in the long term reduce the risk of degenerative arthritis in the knee) (article). The torn piece of meniscus is usually removed, but in rare cases the whole meniscus is taken out.

Following an operation, exerting load on the knee can commence as soon as the pain and swelling in the knee has diminished. In the best cases, full activity is possible after a period of a few weeks. In uncomplicated cases, it should be possible to resume a full level of sports activity during the course of a month. Rehabilitation must not be allowed to cause increased swelling (or pain) in the knee.

Complications: If insufficient progress is made prior to an operation it must be considered if the diagnosis is correct. Supplementary examinations will often be required (X-ray, ultrasound or MR scan). In particular the following should be considered:

• Cartilage damage (osteochondral lesions)
• Inner collateral ligament rupture
• Outer collateral ligament rupture
• Rupture of the anterior cruciate ligament
• Rupture of the posterior cruciate ligament
• Bone membrane tear (periosteal avulsion)
• Tendinitis
• Fluid accumulation in the joint (traumatic arthritis/synovitis)
• Bursitis
• Degenerative arthritis
• Inflamed mucous fold (plica synovialis)

Following an arthroscopy, fluid accumulation in the joint (traumatic arthritis/synovitis) should be considered, and infection in the scar or knee joint, which will always require medical attention as soon as possible. Special: Since there is a risk that the injury can cause permanent disability, the injury should be reported to your insurance company.

Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin bone (tibia) and the knee cap (patella). There is furthermore a small joint between the shin bone and the calf bone (fibula). The knee joint is strengthened by a joint capsule which is in turn strengthened on the sides by an outer and an inner collateral ligament (ligamentum collaterale laterale (LCL) and ligamentum collaterale mediale (MCL)). Inside the knee there are two ligaments, the anterior and posterior cruciate ligaments (ligamentum cruciatum anterius and ligamentum cruciatum posterius).

Symptoms: Usually a snap can be heard or felt and continued sports activity must be aborted. The knee can swell within the first few hours, after which the knee can not bend completely. You can subsequently often sense that the leg gives way (knee failure).

Acute treatment: Click here.

Examination: If a partial or complete rupture of the cruciate ligament is suspected, you should seek medical attention (casualty ward) immediately, to obtain a diagnosis. The doctor can perform various tests on the knee (rear drawer looseness) to examine the stability of the knee. It should be noted that the looseness in the knee can often only be demonstrated after two weeks. It is often necessary to supplement the examination with a MR-scan, ultrasound scan (Ultrasonic image) (article), or arthroscopy to make the diagnosis with certainty.

Treatment: Treatment of a rupture of the posterior cruciate ligament usually comprises relief and rehabilitation. It is only in cases of pronounced looseness, or if the rupture is combined with other ligament ruptures, that surgery is recommended (article).

An intensive rehabilitation period of at least six months is to be expected.

Bandage: Hinge bandages (Don-Joy) can be utilised the first few weeks. Tape treatment of cruciate ligament ruptures in the knee has no sure effect.

Complications: If smooth progress is not achieved, it should be considered whether the diagnosis is correct or whether complications have arisen. Amongst others the following should be considered:

• Tendinitis
• Fluid accumulation in the joint (traumatic arthritis/synovitis)
• Bursitis
• Anterior collateral ligament rupture
• Meniscus lesion
• Cartilage damage (osteochondral lesions)
• Bone membrane tear (periosteal avulsion)
• Inflamed mucous fold (plica synovialis)

Special: Since there is a risk that the injury can cause permanent disability, the injury should be reported to your insurance company.

Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin bone (tibia) and the knee cap (patella). There is furthermore a small joint between the shin bone and the calf bone (fibula). The knee joint is strengthened by a joint capsule which is in turn strengthened on the sides by an outer and an inner collateral ligament (ligamentum collaterale laterale (LCL) and ligamentum collaterale mediale (MCL)). Inside the knee there are two ligaments, the anterior and posterior cruciate ligaments (ligamentum cruciatum anterius and ligamentum cruciatum posterius).

Symptoms: Usually a snap can be heard or felt and continued sports activity must be aborted. The knee swells within the first few hours, after which the knee can not bend completely. You can subsequently often sense that the leg gives way (knee failure).

Acute treatment: Click here.

Examination: If a partial or complete rupture of the cruciate ligament is suspected, you should seek medical attention (casualty ward) immediately, to obtain a diagnosis. The doctor can perform various tests on the knee (front drawer looseness, Lachmann, Pivot shift) to examine the stability of the knee. It should be noted that the looseness in the knee can often only be demonstrated after two weeks. The fluid in the knee can be drained. Blood in the knee provides a very strong suspicion of a rupture of the anterior cruciate ligament. The bleeding that occurs after a rupture of the anterior cruciate ligament can usually be seen in an ultrasound scan (Ultrasonic image) (article) or MR-scan. Arthroscopy (a telescopic examination of the knee) is the best suited examination if there is any doubt in the diagnosis.

Treatment: Young athletes or others with physically demanding work will usually be advised surgery with the insertion of a new cruciate ligament (article).

An intensive rehabilitation period of at least six months is to be expected. It is important that the knee is stretched completely at least twice a day. The surgeon should be consulted if problems occur with stretching the knee completely.

Bandage: Hinge bandages (Don-Joy) can be utilised the first few weeks. Tape treatment of cruciate ligament ruptures in the knee has no sure effect.

Complications: In case of lack of progress you should consider various complications to the surgery:

• Fluid accumulation in the joint (traumatic arthritis/synovitis)
• Outer collateral ligament rupture
• Inner collateral ligament rupture
• Rupture of the posterior cruciate ligament
• Meniscus lesion
• Inflamed mucous fold (plica synovialis)
• Cartilage damage (osteochondral lesions)

In cases where the knee cap tendon is used as a new cruciate ligament an inflammation, is often seen where the knee cap tendon has been removed. With prolonged discomfort which does not diminish following relief, medical treatment in form of rheumatic medicine (NSAID) or injection of corticosteroid along the inflamed part of the knee cap tendon can be attempted (article).
Less than half the athletes suffering a rupture of the anterior cruciate ligament are able to resume sports activity on the same level as prior to the injury (article).

Special: Since there is a risk that the injury can cause permanent disability, the injury should be reported to your insurance company.

Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin bone (tibia) and the kneecap (patella). There is furthermore a small joint between the shin bone and the calf bone (fibula). The knee joint is strengthened by a joint capsule which is in turn strengthened on the sides by an outer and an inner collateral ligament (ligamentum collaterale laterale (LCL) and ligamentum collaterale mediale (MCL)). Inside the knee there are two ligaments, the anterior and posterior cruciate ligaments (ligamentum cruciatum anterius and ligamentum cruciatum posterius).

Symptoms: Sudden pain on the outside of the knee. Occasionally a snap is felt when the ligament ruptures. In severe cases the athlete complains about a sense of looseness in the knee.

Acute treatment: Click here.

Examination: If a total or partial rupture of the ligaments in the knee is suspected, you should seek medical attention for a diagnosis. The doctor can perform various knee tests to examine the stability of the knee (external side-instability-test) . If the knee is stable the injury is called a “sprain” of the outer side-ligament. If the knee is loose the injury is called a “rupture” of the ligament. The diagnosis is usually made from a normal medical examination. If there are any doubts surrounding the diagnosis, an ultrasound scan can be performed which will reveal the rupture and the bleeding along the ligaments (Ultrasonic image).

Treatment: The treatment of a partial or total rupture of the outer side-ligament involves relief and rehabilitation. If the knee is markedly loose, you can, for a short period, use a support splint (Don Joy). With pronounced sideways looseness surgery can be considered (article). (However if the rupture of the outer side-ligament is combined with other ligament ruptures, as is often the case, surgery is recommended).

Bandage: Hinge bandages can be used initially (Don Joy). Tape treatment of ligament ruptures in the knee have no sure effect.

Complications: If smooth progress is not achieved, it should be considered whether the diagnosis is correct or whether complications have arisen. Supplementary examinations (X-ray, ultrasound, MR scan or arthroscopy) will often be required. The following should be considered:

• Meniscus lesion
• Rupture of the anterior cruciate ligament
• Rupture of the posterior cruciate ligament
• Cartilage damage (osteochondral lesions)
• Bone membrane tear (periosteal avulsion)
• Tendinitis
• Fluid accumulation in the joint (traumatic arthritis/synovitis)
• Bursitis
• Inflamed mucous fold (plica synovialis)

An inflammation by the ligament fastening is sometimes seen later in the course of the injury, and in some cases bursitis at the ligament fastening is seen. The inflammation and bursitis can possibly be treated with medication (rheumatic medicine (NSAID) or the injection of corticosteroid), if further relief has no effect (article).

Special: Since there is a risk that the injury can cause permanent disability, the injury should be reported to your insurance company.