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: The diagnosis is often made following a normal medical examination, however, if there is any doubt surrounding the diagnosis an ultrasound scan should be performed which will be able to reveal a fraying out (fragmentation) of the bone at the apex of the knee cap (aseptic necrosis of the bone) (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. Emphasis is put on stretching of the anterior thigh muscle. Ice treatment can be repeated every time tenderness is provoked during the rehabilitation period at the apex of the knee cap.

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-description).

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
• cartilage damage (osteochondral lesions)
• Osgood-Schlatter

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

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), where children and adolescents have a growth zone. The function of the knee cap ligament is therefore, when the knee is stretched, to transfer the power the large thigh muscle produces.

Symptoms: Slowly insetting tenderness at the upper, front part of the shin bone (tuberositas tibiae) during and after the sports activity. If the discomfort has a long duration, the bone fastening on the shin bone will become more prominent and can become so large that kneeling will be a problem. It is especially boys in the 10-16 age group that have the symptoms, and the condition is very common and can be seen in almost all boys’ football teams. The symptoms will diminish at around age 17 when the growth zone on the shinbone closes.

Acute treatment: Click here.

Examination: The diagnosis can usually be made with certainty under a normal medical examination, revealing localised tenderness on the knee cap fastening on the upper, front part of the shin bone. If there is any doubt surrounding the diagnosis an ultrasound scan can be performed to identify the changes (ultrasonic image), however, this is seldom necessary in uncomplicated cases (article).

Treatment: The treatment comprises relief from the pain inducing activity (jumping, kicking). The injury can in some cases heal within a few weeks if the treatment is instigated quickly whereas a rehabilitation period of several months must be anticipated if the pain has been in evidence for some months. Emphasis is placed on stretching of the anterior thigh muscle. Ice treatment can be repeated every time tenderness is provoked in the knee cap ligament fastening during the rehabilitation period. If during the rehabilitation period pain is experienced when walking, medicinal treatment in the form of rheumatic medicine (NSAID) in gel form can be considered. Injection of corticosteroid should not be considered in the treatment (article). The sports activity can be cautiously resumed when the pain has diminished. Relapses will often occur, which should be followed as soon as possible with a period of relief. During the relief period it will usually be sufficient to abstain from the most stressful exercises (jumping), whilst many other training exercises can be performed without discomfort. In the majority of cases it will be therefore be possible to participate in at least a part of the sports activity (for example as goal-keeper).

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-description).

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
• cartilage damage (osteochondral lesions)
• bone membrane tear (periosteal avulsion)
• tendinitis
• bursitis
• inflamed mucous fold (plica synovialis)

A tearing of the knee-cap tendon from the fastening on the shinbone has only been described in very rare cases. The torn part of the bone (on which the knee cap tendon is fastened) can be fixed to the shinbone again under surgical operation (article).

Special: Shock absorbing shoes or insoles will reduce the load on the knee.

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 knee cap is held in place by the structures that fasten on the knee cap, especially the anterior thigh muscle, joint capsule and several ligaments (retiaculum patellae mediale & retiaculum patellae laterale) as well as the knee cap ligament.

Symptoms: Sudden insetting severe pain that renders continued sports activity impossible. The knee cap can become completely displaced to the external side of the knee in some cases, and the knee will consequently be locked in a flexed position (total luxation) until the knee cap suddenly slips into place again allowing the knee to be stretched once more. In other cases, the knee cap will only be partially displaced to the external side of the knee (subluxatio patellae).

Acute treatment: Click here.

Examination: The diagnosis can be difficult if the knee cap is in its correct position, and anyone with suspicions of displacement of the knee cap should always seek medical attention to ensure the diagnosis and correct treatment. The examination will typically provoke severe pain when the knee cap is pressed outwards (lateral) whilst the knee is flexed (Apprehension test). The knee cap will often be able to be pressed further out on an injured knee than a healthy one. An MR scan will be able to reveal more information regarding the cartilage condition in the knee after a partial or total luxation of the knee cap (article).

Treatment: Partial luxation should primarily be treated with relief and rehabilitation. There is no general consensus of opinion regarding treatment of total luxation of the knee cap, some recommend surgery whilst others advocate relief and rehabilitation (article 1), (article 2). Surgery should however be considered with repeated (total or partial) luxation.

Rehabilitation of non-operated, partial luxation of the knee cap (subluxatio patellae).

Bandage: Tape and bandaging has no documented preventive effect subsequent to previous total or partial luxation of the knee cap (article), however experience has shown that this is utilised to a large degree, (tape-description).

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

• cartilage damage (osteochondral lesions)
• cartilage damage on the knee cap (chondromalacia patellae)
• knoglebrud
• meniscus lesion
• anterior cruciate ligament rupture
• posterior cruciate ligament rupture
• bone membrane tear (periosteal avulsion)

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 (ACL) and ligamentum cruciatum posterius (PCL).

Symptoms: Sudden pain on the inside 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. An x-ray examination is recommended as many ligament injuries in children and adolescents can be accompanied by damage to the bone at the point of attachment of the ligaments (article). The doctor can perform various knee tests (internal side-instability-test), to examine the stability of the knee. If the knee is stable the injury is called a “sprain” of the inner 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 inner side-ligament involves relief and rehabilitation. If the knee is markedly loose, you can, for a short period, use a support splint (Don Joy). Surgical treatment previously considered has today largely been abandoned in uncomplicated ruptures of the inner side-ligament (article-1)(article-2). (However if the rupture of the inner side-ligament is combined with other ligament ruptures, many would recommend surgery).

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 of the inner meniscus
• rupture of the anterior cruciate ligament
• rupture of the posterior cruciate ligament
• cartilage damage (osteochondral lesions)
• membrane tear (periosteal avulsion)
• fluid accumulation in the joint (traumatic arthritis/synovitis)

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 (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 (ACL) and ligamentum cruciatum posterius (PCL)).

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. An x-ray examination is recommended as many ligament injuries in children and adolescents can be accompanied by damage to the bone at the point of attachment of the ligaments (article). 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 ultrasoundexamination 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 (article). 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 of the outer meniscus
• rupture of the anterior cruciate ligament
• rupture of the posterior cruciate ligament
• cartilage damage (osteochondral lesions)
• membrane tear (periosteal avulsion)
• tendinitis
• fluid accumulation in the joint (traumatic arthritis/synovitis)

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 (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 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 (ACL) and ligamentum cruciatum posterius (PCL)).

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 examination is often more difficult in adolescents. 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: Caution will normally be exercised regarding operating on children in the pre-teenage age group, however, teenagers nearing a fully grown state will usually be advised surgery with the insertion of a new cruciate ligament (article-1) (article-2) (article-3).

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:

• Fluid accumulation in the joint (traumatic arthritis/synovitis)
• Outer collateral ligament rupture
• Inner collateral ligament rupture
• Rupture of the posterior cruciate ligament
• Meniscus lesion
• 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 (article).
In children and adolescents there is a risk of affecting the development of the leg operated upon, as it is necessary to pierce the growth zone to insert the artificial cruciate ligament (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 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 (ACL) and ligamentum cruciatum posterius (PCL)).

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. The examination is often more difficult in children and adolescents. 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).

A 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:

• fluid accumulation in the joint (traumatic arthritis/synovitis)
• anterior collateral ligament rupture
• meniscus lesion
• cartilage damage (osteochondral lesions)
• bone membrane tear (periosteal avulsion)

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). The articular surfaces of the thigh bone, shin-bone and knee cap are lined with a cartilage covering of a few millimetre’s thickness which serves to reduce the load or strain on the joint surfaces.

Symptoms: Pain in the joint when under load or strain, especially with bent knee (for example stairway steps). A sensation of stiffness in the knee after a prolonged period of sitting. Swelling of the joint (synovitis) in occasional cases.

Examination: Normal medical examination is often sufficient. A characteristic of the condition is that the pain occurs when the knee cap presses against the thigh bone, producing a rough, grating sensation. If there are any doubts regarding the diagnosis the examination can be supplemented by X-rays, arthroscopic examination or an MR-scan. (article).

Treatment: Treatment comprises relief from the painful activities until the pain is no longer experienced, after which gradual re-training can be commenced primarily aimed at strengthening the thigh muscles. There is no treatment that can restore the damaged cartilage on the knee cap. For children, treatment of chondromalacia (a softening of the articular cartilage) is non-operative, as the condition has a good prognosis in the younger age groups (article). Several different surgical treatments have been attempted with unsatisfactory results (article).

Bandage: Some patients have felt that the discomfort from cartilage damage behind the knee cap has been helped by applying a knee bandage that holds the knee cap slightly to the side. Alternatively, knee cap stabilising tape can be used, (tape-description).

Complications: If smooth progress is not achieved it should be considered whether the diagnosis is correct, which will often require supplementary examination (X-ray, ultrasound scanning, MR scanning or arthroscopy). The following should especially be considered:

• meniscus lesion
• 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)
• tendonitis
• fluid accumulation in the joint (traumatic arthritis/synovitis)
• bursitis
• inflammation of the mucous fold