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 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 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 with movement under load or strain. Difficulties in the start up phase are often experienced, alleviated after warm-up, but with pain again after a prolonged period under load. Swelling of the joint (synovitis) in occasional cases. With pronounced swelling, a fluid filled bursa can develop in the hollow (popliteal space) of the knee (Baker cyst).

Examination: Normal medical examination is usually sufficient to make the diagnosis, however, it is also often necessary to perform an x-ray (or ultrasound scan or MR scan) to make the diagnosis.

Treatment: Treatment comprises relief from the pain inducing activities until the swelling has gone down, after which training can commence with the primary aim to strengthen the muscles surrounding the joint and retain joint mobility (article). There is no treatment which can restore the damaged cartilage (and bone). Cartilage transplants are, as yet, not suitable for general degenerative arthritis. In cases of swelling in the joint (and popliteal space), inflammation of the synovial membrane (synovitis) can be attempted subdued by using rheumatic medicine (NSAID), or by draining the fluid and injecting corticosteroid. The injections can be performed to advantage by utilising an ultrasound guided method (Ultrasonic image). Pain without swelling of the joints is best treated with paracetamol. In severe cases of degenerative arthritis where there is pain when resting (at night), it may be necessary to replace the joint.

Rehabilitation: Rehabilitation is primarily aimed at strengthening the thigh muscles, whereby the joint can be stabilised and relieved to a certain extent.

Complications: Degenerative arthritis which is positioned on the weight-bearing parts of the joint surfaces represents one of the most serious sports injuries, and often results in an end to the sporting career. It is usually possible to participate in sports with lesser knee straining activity (i.e. swimming), whereas sports with great knee straining activity (i.e. running, football) should be treated with reservation.

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

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.