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Knee Pain / Knee Injuries

 Shin plints - periostium

Knee pain can be related to overuse where small stresses are placed a large number of times on knee without allowing adequate recovery, for example running too much too soon, or excessive jumping. Or knee pain can be acute where the injury is caused by an impact or twisting of the knee such as an anterior cruciate ligament injury. An overuse injury can also be considered to be acute if it is painful or inflammed.

Bones of the knee joint

The knee is made up of four main bones- the femur (thigh bone), the tibia (shin bone), fibula (outer shin bone) and patella (kneecap). The main movements of the knee joint occur between the femur, patella and tibia. Each are covered in articular cartilage which is an extremely hard, smooth substance designed to decrease the frictional forces as movement occurs between the bones. The patella lies in an indentation at the lower end of the femur known as the intercondylar groove. At the outer surface of the tibia lies the fibula, a long thin bone that travels right down to the ankle joint.

The knee joint capsule

Shin plints - periostium

The joint capsule is a thick ligamentous structure that surrounds the entire knee. Inside this capsule is a specialized membrane known as the synovial membrane which provides nourishment to all the surrounding structures. Other structures include the infrapatellar fat pad and bursa which function as cushions to exterior forces on the knee. The capsule itself is strengthened by the surrounding ligaments.

Ligaments of the knee joint

The stability of the knee owes greatly to the presence of its ligaments. Each has a particular function in helping to maintain optimal knee stability in a variety of different positions.

  1. Medial Collateral Ligament (MCL) - This band runs between the inner surfaces of the femur and the tibia. It resists forces acting from the outer surface of the knee- valgus forces.
  2. Lateral Collateral Ligament (LCL) - This ligament travels from the outer surface of the femur to the head of the fibula. It resists impacts from the inner surface of the knee- varus forces.
  3. Anterior Cruciate Ligament (ACL) - The ACL is one of the most important structures in the knee- not least because injury to it may require extensive surgery and rehabilitation. The cruciate ligaments are so called because they form a cross in the middle of the knee joint. The ACL, travels from the anterior (front) of the tibia to the posterior (back) of the femur and prevents the tibia moving forward. It is most commonly injured in twisting movements.
  4. Posterior Cruciate Ligament (PCL) - This ligament travels from the posterior surface of the tibia to the anterior surface of the femur and in doing so wraps around the ACL.

Menisci (knee cartilage)

Each knee joint has two crescent-shaped cartilage menisci. These lie on the medial (inner) and lateral (outer) edges of the upper surface of the tibia bone. They are essential components, acting as shock absorbers for the knee as well as allowing for correct weight distribution between the tibia and the femur.

Muscle Groups surrounding the knee joint

The two main muscle groups of the knee knee joint are the quadriceps and the hamstrings. Both play a vital role, both moving and stabilizing the knee joint.

  • Quadriceps- The quadriceps muscle group is made up of four different individual muscles which join together forming the quadriceps tendon. This thick tendon connects the muscle to the patella which in turn connects to the tibia via the patellar tendon. Contraction of the quadriceps, pull the patella upwards and leads to knee extension.
  • Hamstrings-The hamstrings function in flexing the knee joint as well as providing stability on either side of the joint line.
Lateral Knee Pain (outside of the knee)

Runners Knee (Iliotibial band syndrome)
Knee pain - Another common knee injury to the outside of the knee caused by the iliotibial band rubbing on the outside of the knee and becoming inflamed.

Lateral Meniscus Tear / cartilage tear

Knee pain - Knee injury involving torn cartilage or meniscus towards the outside of the knee. Caused by internally rotating the knee with the foot, over bending the knee backwards or forwards, or from over use.

Lateral Cartilage Meniscus Abnormality
Knee pain - Knee injury involving pain similar to that in Iliotibial Band Friction syndrome. The lateral meniscus becomes inflammed or has degenerated.

Osteoarthritis of the knee.
Osteoarthritis (also called degenerative joint disease) is the degradation and degeneration of this articular cartilage. As the disease progresses, the cartilage itself becomes thinner and in some cases may wear away altogether.

Patellofemoral Pain Syndrome
One of the most common knee injuries with knee pain originating from the patella or kneecap. A common overuse injury and running injury.

Medial Knee Pain (inside of the knee)

Medial Cartilage Meniscus Injury
Knee pain - Knee injury to the medial cartilage or meniscus causing knee pain to the inside of the knee. Can be caused by twisting the knee, over flexing (bending) or over use.

Medial Ligament Sprain
Knee pain - Sprain or tear to the medial colateral ligament of the knee. Often caused by impact to the outside of the knee. One of many common knee injuries caused in contact sports such as football and rugby.

Osteoarthritis of the knee.
Osteoarthritis (also called degenerative joint disease) is the degradation and degeneration of this articular cartilage. As the disease progresses, the cartilage itself becomes thinner and in some cases may wear away altogether.

Synovial Plica / Patella Plica
The synovial plica is a synovial fold found along the inside border of the knee cap.

Posterior Knee Pain (back of the knee)

Bakers cyst (Popliteal cyst)
A prominent swelling at the back of the knee, often caused by some disorder within the knee joint.

Biceps Femoris Tendinopathy
Knee pain - Inflammation of the hamstring tendons as they insert into the knee. An overuse knee injury causing knee pain.

Biceps Femoris Avulsion
Avulsion of the biceps femoris tendon, is the complete pulling away of the tendon from the bone.

Deep Vein Thrombosis / DVT
Deep Vein Thrombosis is a blood clot in a vein. It is more common in the calf muscle area, particularly following surgey.

Inflammation of hamstring tendons / tendinitis
Knee pain - Inflammation of the hamstring tendons as they insert into the knee. An overuse knee injury causing knee pain.

Posterior cruciate ligament sprain
Knee pain - Injury to the posterior cruciate ligament, often caused by hyperextension or bending the knee back the wrong way.

Rupture of hamstring tendons / tendon strain
Knee pain - Knee pain caused by a rupture or partial rupture of one of the hamstring tendons.

Knee joint injuries (sprains and other conditions)

Anterior cruciate ligament sprain
Knee pain - Sprain or rupture of the anterior cruciate ligament, often caused by twisting the knee or an impact to the side of the knee.

Articular Cartilage Injury
Or Osteochondritis dessicans - damage or flakes off the hard cartilage that lines the ends of bones.

Lateral Ligament Sprain
Knee pain - Sprain or tear to the lateral ligament on the outside of the knee, often caused by impact to the inside of the knee which over stretches the ligament.

Lateral Meniscus Tear / cartilage tear
Knee pain - Knee injury involving torn cartilage or meniscus towards the outside of the knee. Caused by internally rotating the knee with the foot, over bending the knee backwards or forwards, or from over use.

Medial Ligament Sprain
Sprain or tear to the medial colateral ligament of the knee. Often caused by impact to the outside of the knee. One of many common knee injuries caused in contact sports such as football and rugby.

Medial Cartilage Meniscus Injury
Knee pain - Knee injury to the medial cartilage or meniscus causing knee pain to the inside of the knee. Can be caused by twisting the knee, over flexing (bending) or over use.

Posterior cruciate ligament sprain
Knee pain - Injury to the posterior cruciate ligament, often caused by hyperextension or bending the knee back the wrong way.

Patella Disclocation
Dislocation of the patella or knee cap.

Tibiofibular Joint Dislocation
Dislocation of the proximal tibiofibular joint occurs most commonly when the athlete sustains an impact or falls with their knee in a fully flexed position, with their foot pointing inwards (inversion) and downwards.

Acute Knee Injuries (sudden onset knee pain)

Acute Patellar Injury
Contusion to the patella or fracture of the patella

Anterior cruciate ligament sprain
Knee pain - Sprain or rupture of the anterior cruciate ligament, often caused by twisting the knee or an impact to the side of the knee.

Articular Cartilage Injury
Or Osteochondritis dessicans - damage or flakes off the hard cartilage that lines the ends of bones.

Biceps femoris avulsion
Avulsion of the biceps femoris tendon, is the complete pulling away of the tendon from the bone.

Coronary Ligament Sprain
The coronary ligament is part of the fibrous joint capsule or the knee. It attaches to the edge of the cartilage meniscis and to the adjacent part of the tibia or shin bone.

Fat Pad Impingement
The fat pad is soft tissue between the patella and the femoral condyle (end of the thigh bone). It gets pinched, often as the result of a hyperextension (bending back) of the knee resulting in knee pain.

Hamstring tendon rupture / strain 
Rupture of the hamstring tendons as they insert into the back of the knee.

Lateral Ligament sprain
Knee pain - Sprain or tear to the lateral ligament on the outside of the knee, often caused by impact to the inside of the knee which over stretches the ligament.

Lateral Meniscus Tear/ cartilage tear

Knee pain - Knee injury involving torn cartilage or meniscus towards the outside of the knee. Caused by internally rotating the knee with the foot, over bending the knee backwards or forwards, or from over use.

Medial Ligamnet sprain
Sprain or tear to the medial colateral ligament of the knee. Often caused by impact to the outside of the knee. One of many common knee injuries caused in contact sports such as football and rugby.

Medial Cartilage menisucs pain
Knee pain - Knee injury to the medial cartilage or meniscus causing knee pain to the inside of the knee. Can be caused by twisting the knee, over flexing (bending) or over use.

Posterior cruciate ligamnet sprain
Knee pain - Injury to the posterior cruciate ligament, often caused by hyperextension or bending the knee back the wrong way.

Patella Dislocation
Dislocation of the patella or knee cap.

Patella Tendon Rupture
Rupture or tear of the patella tendon.

Pre Patella Bursitis/ Housmaids Knee
Inflammation or swelling of the bursa or sac of fluid on the front of the knee cap.

Quadriceps Tendon Rupture
Ruptures of the quadriceps tendon mainly occur in middle aged individuals during sporting activities.

Tibial Plateau Fracture
Fracture to the upper surface of the tibia or shin boneusually from high velocity accidents

Tibiofibular Joint Dislocation
Dislocation of the proximal tibiofibular joint occurs most commonly when the athlete sustains an impact or falls with their knee in a fully flexed position, with their foot pointing inwards (inversion) and downwards.

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