The amount of force that is transmitted during a knee injury will determine the severity of it.
It may be a soft tissue injury such as a knee sprain (or knee strain) or else there may be structural damage to the knee. This could be due to a meniscal tear, if shear forces were involved (twisting of knee under pressure). More force such as in a skiing accident can lead to ligamentous tears or even fractures.
Ligamentous tears
Common ligamentous tears are an anterior cruciate ligament tear (ACL tear) or a medial or ulnar collateral ligament tear (CL tear). As there is a medial (MCL) and lateral collateral ligament (LCL), there can be MCL or LCL tears. Often with serious sports injuries there might be a combination of MCL tear with a medial meniscal tear and an ACL tear.
Knee injury can be due to many structures
Fractures around the knee
With more force eventually a piece of the hyaline cartilage of the internal joint surfaces can fracture off or else one of the articulating bones can fracture resulting in a tibia fracture, fibula fracture, patella fracture or femur fracture. Any of these fractures can be with or without angulation or displacement. X-rays, bone scans, CT scans and MRI scans can give more details about these injuries. These more serious injuries require a consult from an orthopedic surgeon. Once the confirms the diagnosis through clinical examination and diagnostic imaging studies, he can formulate a specific treatment plan.
Treatment of knee injuries
In the case of a meniscal tear this might involve an arthroscopic examination and shaving off of the torn tissue. For a torn ACL the physician can do an ACL reconstruction arthroscopically.
A fracture can be treated conservatively with a long leg cast for 4 to 56 weeks when there is no displacement. Following this the patient gets repeat X-rays to monitor bone healing and reactivation using physiotherapy and active exercises. However, there will be some fractures or fracture dislocations, where the orthopedic surgeon has to intervene operatively and “fix it”. This is done with K-wires to hold bone pieces in place, special metal alloy plates and surgical screws. The plates are screwed across the fracture line and have to be strong enough to provide early remobilization. A fractured patella might be put back together with a figure of 8 wire.
References
1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 157.
2. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 4.
3. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 270.
4. Wheeless’ Textbook of Orthopaedics: http://www.wheelessonline.com/ortho/arthritis
5. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders
6. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
7. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
8. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008
