Knee Joint Injuries

What are knee joint injuries? How are they diagnosed?

What are knee joint injuries?

Knee joint injuries result from damage to the structures within your knee joint, which include the cartilage, menisci, ligaments, and synovium (inner joint capsule lining). Knee joint injuries can be caused by a variety of different ways, such as direct trauma to the knee through slips, falls, sports injuries, and high impact movements, or over time due to aging or poor knee joint alignment, causing repeated stress and wear and tear.

Knee joint injuries are isolated within the knee joint, and do not include injuries to the muscles and tendons located outside of the knee joint, such as the quadriceps and hamstrings muscles and their associated tendons.

How are they diagnosed?

History & Physical Exam

A thorough history and physical examination by your healthcare provider can help determine what type of knee injury you may have. Your healthcare provider will ask you questions about your symptoms and how and when your symptoms began to get a clearer picture of how your condition occurred. 

In addition to discussing your medical history, your healthcare provider will perform a physical examination to assess your knee for pain, swelling, and mobility. Your healthcare provider will feel the soft tissues around your knee to see if anything is tender to the touch, and bend and straighten your knee to see if your range of motion is affected or if certain motions are painful.

Your healthcare provider will also test the strength of your leg muscles and examine your ability to walk and move your knee joint.

Imaging 

Certain knee joint injuries, like an ACL or meniscus tear, present with distinct symptoms and causes of injury, while other knee joint injuries may have more vague symptoms and develop gradually without a definitive underlying cause. Imaging studies are often performed to determine a diagnosis and the underlying reason causing your knee pain. Different imaging methods can be used to examine the tissues and structures of your knee, which include:

• X-Ray: An x-ray is a 2-dimensional image produced by radiation that examines the structure of your bones. Your healthcare provider may order an x-ray to make sure that you do not have a broken bone or to check for signs of knee osteoarthritis.
• MRI: An MRI, or magnetic resonance imaging, is a 3-dimensional imaging scan that is produced by magnetic fields. MRIs more clearly illustrate soft tissues of the body and can be used to assess the integrity of structures within your knee like ligaments, tendons, and cartilage.

Imaging methods are most often needed to determine the extent of your knee joint injury and what is causing your pain. Conditions that can cause pain within your knee joint include:

• Meniscus tears
• Ligament tears (ACL or PCL)
• Cartilage tears
• Inflamed synovium (joint lining)
• Dislocated or misaligned patella (kneecap)
• Bone spurs (extra bone growth)

While an injury or tear to the MCL and LCL can also produce knee pain, these ligaments are located on the outside of the knee joint.

Knee Joint Injury Treatment Options (Surgical vs Non-Surgical)

The extent of injury and damage to structures within your knee joint and the potential for improvement with rehabilitation will help determine whether treatment for your knee joint injury will involve surgical or non-surgical options. 

Surgery – Knee Arthroscopy

Conservative treatment like rest, pain management, and physical therapy are often trialed first before undergoing knee arthroscopy. If pain and other symptoms still persist after three months of conservative treatment methods, your healthcare provider may recommend knee arthroscopy.

Knee arthroscopy is a minimally invasive surgical procedure to repair or remove damaged structures within the knee joint. During your operation, your surgeon will use an arthroscope, a tool the size of a pencil with a camera and light attached, to view the inside of your knee joint while using surgical tools to either remove or repair structures within your knee joint.

If you are generally healthy, the surgery will likely be performed in the outpatient surgical setting, so you will not have to stay overnight at a hospital. 

Non-Surgical Management of Knee Joint Injuries

Resting your knee from physical activity and use of ice, elevation, and compression can be used to help alleviate knee joint pain and swelling. Your healthcare provider may prescribe you medication like nonsteroidal antiinflammatory drugs (NSAIDs) to help control your pain initially after injury, and may consider giving you a cortisone injection into your knee to decrease pain and inflammation.

Non-surgical management also involves physical therapy to rehabilitate your knee to decrease pain and swelling, restore normal knee joint range of motion, and improve the strength of the muscles that control your hip, knee, and ankle joints to stabilize your leg. 

Many surgeons require that you try physical therapy for at least 1-3 months before determining if a knee arthroscopy is appropriate to address your condition. 

Knee Arthroscopy FAQs

General

How common is a knee arthroscopy?

A knee arthroscopy is a commonly performed orthopedic surgery with approximately 750,000 knee arthroscopies performed in the United States each year.

What conditions can be treated with a knee arthroscopy?

A knee arthroscopy can be used to treat ligament tears (ACL or PCL), meniscus tears, and cartilage tears. A knee arthroscopy can also be used to remove portions of inflamed synovium or bone spurs from the knee joint.

Treatment Decision

Who is not a good candidate for surgery?

People with significant comorbidities such as heart and lung problems and bleeding disorders may not be healthy enough to undergo any type of surgery and are usually not good candidates for a knee arthroscopy. People with mild knee joint injuries also aren’t the best candidates for surgery as they are likely to benefit from physical therapy and other conservative treatment options. Knee arthroscopy is often of little benefit for people with severe forms of knee osteoarthritis who will likely need a total knee replacement to alleviate their symptoms.

Can I wait to have surgery?

Waiting to have surgery while trying other treatment methods like pain medications, physical therapy, and cortisone injections is recommended for mild or moderate knee joint injuries. If your knee joint injury is severe and significantly limits your ability to walk and move your knee joint, surgery should be performed as soon as possible to facilitate recovery.

After Surgery

Can I shower or take a bath?

You should avoid taking a bath or shower for the first two to five days after surgery to protect your incisions. Avoid submerging your leg in water during the first two to three weeks after surgery to decrease the risk of your incisions reopening. 

When can I return to work/school?

If your job or school setting is generally sedentary, you can likely return to work or school within one to two weeks after surgery. For jobs that require prolonged standing, walking, or bending, you may not return to work until 6-8 weeks or more depending on your progress with rehabilitation and how physically demanding your job duties are.

How can I minimize scarring?

You can minimize scarring by avoiding picking at your surgical incisions and leaving your stitches or steri-strips in place until they naturally come off. Keeping your incisions clean and dry will also help avoid infection which can delay healing and worsen scarring.