Knee Problems

By Billy Wilson

Chondromalacia

Chondromalacia is due to an irritation to the undersurface of the kneecap.

The undersurface is covered with a smooth layer of cartilage that normally glides across the knee effortlessly during bending of the joint. Chondromalacia occurs when the kneecap rubs against one side of the knee joint and causes an irritation in the cartilage.

Abnormal patellar tracking pulls the kneecap toward one side of the femur instead of pulling it in a straight line.

Chondromalacia

Chondromalacia

It is the most common cause or chronic knee pain

It is also sometimes called “housemaid’s knee”, “secretary’s knee”, or “runner’s knee”

Women are more commonly affected

Symptoms and Treatment

Symptoms Discomfort of the inner knee area

Aggravated by activity Aggravated by prolonged sitting

Tightness in knee area Loss of quadriceps muscle strength Mild swelling

Treatment NSAIDs and Ice for pain management Avoid motions that irritate the knee Rehabilitation focuses on the stretching and strengthening of the

quadriceps and hamstring muscle groups Possible surgery

Iliotibial Band Friction Syndrome

The iliotibial band is the superficial thickening of tissue on the outside of the thigh, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee

It is crucial to stabilizing the knee during running, moving from behind the femur to the front during the gait cycle

Continual rubbing of the band over the lateral femoral epicondyle may cause the area to become inflamed or the band itself may suffer irritation

Can also occur where IT band connects at hip, but this is less likely as a sports injury

Iliotibial Band Friction Syndrome

Ober’s Test

Patient laying on side with unaffected side down with unaffected knee and hip at 90 degrees

Examiner stabilizes the pelvis, then abducts and extends the affected leg until in line with rest of body

Affected leg then lowed into adduction

If band is tight leg will remain in abduction and pain will be experienced in lateral portion of knee

Symptoms and Treatment

Symptoms Pain to outside of knee or hip Local tenderness and inflammation Dull pain during run or sharp pain while running downhill

Treatment RICE NSAIDs Stretching the IT Band Ultrasound Deep-tissue massage Local steroid injection

Meniscus Tear

Results when the knee is weight bearing and experiences a rotational force while extending or flexing

Also caused by degenerative processes seen in older patients

Menisci are made of tough cartilage There are two menisci in our knee; each rests

between the femur and the tibia Medial meniscus is more likely to be injured than

the lateral meniscus

Meniscus Tear

Symptoms and Treatment

Symptoms Effusion developing over 48-72 hours Joint line pain Loss of motion Intermittent locking and giving away Pain with squatting If chronic: recurrent swelling, obvious muscle atrophy around knee, knee

collapsing, popping sensation Treatment

RICE Many people do nothing for their meniscus tear because they see no symptoms

and it doesn’t interfere with activity Surgery

Meniscus repair Meniscectomy

Meniscus Injuries

Other types of meniscus injuries: Longitudinal tear- a tear that occurs along the length

of the meniscus Bucket-handle tears- an exaggerated form of a

longitudinal tear where a portion of the meniscus becomes detached from the tibia forming a flap that looks like a bucket handle

Degeneration- frayed edge on the meniscus Radial tear- tear across the radius of the meniscus