Thursday, October 5, 2021 – Knee
- Mary Reed
- Nov 4, 2021
- 20 min read
I went this morning to an arthritis pain care center. My left knee has been painful for about three months. I went to physical therapy first for about a month. While I loved the knee massages and ice pack they put on it, nothing seemed to help the pain. Next, I got a cortisone shot in my knee which reduced the intensity of the pain by about half. Next, I got three weekly injections of EUFLEXXA® which is supposed to cushion the knee joint. It has not helped my pain. The arthritis pain care center was recommended to me, so I thought I would give it a try. It gives EUFLEXXA® injections, but also some other types of injections. I thought since EUFLEXXA® didn’t work for me, maybe one of the other ones would. Unfortunately, I was told that my insurance will only pay for knee injections every six months. So, I will have to wait until April. In the meantime, I will probably go to see the surgeon who replaced my right knee and see what he has to say about the left one. The knee is an incredibly complex piece of engineering in your body. Let’s learn more about it.
According to Wikipedia, in humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia (tibiofemoral joint), and one between the femur and patella (patellofemoral joint). It is the largest joint in the human body. The knee is a modified hinge joint, which permits flexion and extension as well as slight internal and external rotation. The knee is vulnerable to injury and to the development of osteoarthritis.
It is often termed a compound joint having tibiofemoral and patellofemoral components. The fibular collateral ligament is often considered with tibiofemoral components.
Structure
The knee is a modified hinge joint, a type of synovial joint, which is composed of three functional compartments: the patellofemoral articulation, consisting of the patella or "kneecap", patellar groove on the front of the femur through which it slides and the medial and lateral tibiofemoral articulations linking the femur or thigh bone with the tibia, the main bone of the lower leg. The joint is bathed in synovial fluid which is contained inside the synovial membrane called the joint capsule. The posterolateral corner of the knee is an area that has recently been the subject of renewed scrutiny and research.
The knee is the largest joint and one of the most important joints in the body. It plays an essential role in movement related to carrying the body weight in horizontal (running and walking) and vertical (jumping) directions.
At birth, the kneecap is just formed from cartilage and will ossify — change to bone — between the ages of three and five years. Because it is the largest sesamoid bone in the human body, the ossification process takes significantly longer.
Articular bodies
The main articular bodies of the femur are its lateral and medial condyles. These diverge slightly distally and posteriorly, with the lateral condyle being wider in front than at the back while the medial condyle is of more constant width. The radius of the condyles' curvature in the sagittal plane becomes smaller toward the back. This diminishing radius produces a series of involute midpoints i.e., located on a spiral. The resulting series of transverse axes permit the sliding and rolling motion in the flexing knee, while ensuring the collateral ligaments are sufficiently lax to permit the rotation associated with the curvature of the medial condyle about a vertical axis.
The pair of tibial condyles are separated by the intercondylar eminence composed of a lateral and a medial tubercle.
The patella also serves an articular body, and its posterior surface is referred to as the trochlea of the knee. It is inserted into the thin anterior wall of the joint capsule. On its posterior surface is a lateral and a medial articular surface, both of which communicate with the patellar surface which unites the two femoral condyles on the anterior side of the bone's distal end.
Articular capsule
The articular capsule has a synovial and a fibrous membrane separated by fatty deposits. Anteriorly, the synovial membrane is attached on the margin of the cartilage both on the femur and the tibia, but on the femur, the suprapatellar bursa or recess extends the joint space proximally. The suprapatellar bursa is prevented from being pinched during extension by the articularis genus muscle. Behind, the synovial membrane is attached to the margins of the two femoral condyles which produces two extensions similar to the anterior recess. Between these two extensions, the synovial membrane passes in front of the two cruciate ligaments at the center of the joint, thus forming a pocket direct inward.
Bursae
Numerous bursae surround the knee joint. The largest communicative bursa is the suprapatellar bursa described above. Four considerably smaller bursae are located on the back of the knee. Two non-communicative bursae are located in front of the patella and below the patellar tendon, and others are sometimes present.
Cartilage
Cartilage is a thin, elastic tissue that protects the bone and makes certain that the joint surfaces can slide easily over each other. Cartilage ensures supple knee movement. There are two types of joint cartilage in the knees: fibrous cartilage — the meniscus — and hyaline cartilage. Fibrous cartilage has tensile strength and can resist pressure. Hyaline cartilage covers the surface along which the joints move. Collagen fibers within the articular cartilage have been described by Benninghoff as arising from the subchondral bone in a radial manner, building so called Gothic arches. On the surface of the cartilage these fibers appear in a tangential orientation and increase the abrasion resistance. There are no blood vessels inside of the hyaline cartilage, the alimentation is performed per diffusion. Synovial fluid and the subchondral bone marrow serve both as nutrition sources for the hyaline cartilage. Lack of at least one source induces a degeneration. Cartilage will wear over the years. Cartilage has a very limited capacity for self-restoration. The newly formed tissue will generally consist of a large part of fibrous cartilage of lesser quality than the original hyaline cartilage. As a result, new cracks and tears will form in the cartilage over time.
Menisci
The articular disks of the knee-joint are called menisci because they only partly divide the joint space. These two disks — medial meniscus and the lateral meniscus — consist of connective tissue with extensive collagen fibers containing cartilage-like cells. Strong fibers run along the menisci from one attachment to the other, while weaker radial fibers are interlaced with the former. The menisci are flattened at the center of the knee joint, fused with the synovial membrane laterally and can move over the tibial surface.
The menisci serve to protect the ends of the bones from rubbing on each other and to effectively deepen the tibial sockets into which the femur attaches. They also play a role in shock absorption and may be cracked or torn when the knee is forcefully rotated and/or bent.
Ligaments
The ligaments surrounding the knee joint offer stability by limiting movements and — together with the menisci and several bursae — protect the articular capsule.
Intracapsular
The knee is stabilized by a pair of cruciate ligaments. The anterior cruciate ligament or ACL stretches from the lateral condyle of femur to the anterior intercondylar area. The ACL is critically important because it prevents the tibia from being pushed too far anterior relative to the femur. It is often torn during twisting or bending of the knee. The posterior cruciate ligament or PCL stretches from medial condyle of femur to the posterior intercondylar area. Injury to this ligament is uncommon but can occur as a direct result of forced trauma to the ligament. This ligament prevents posterior displacement of the tibia relative to the femur.
The transverse ligament stretches from the lateral meniscus to the medial meniscus. It passes in front of the menisci. It is divided into several strips in 10% of cases. The two menisci are attached to each other anteriorly by the ligament. The posterior and anterior meniscofemoral ligaments stretch from the posterior horn of the lateral meniscus to the medial femoral condyle. They pass posteriorly behind the posterior cruciate ligament. The posterior meniscofemoral ligament is more commonly present — 30%; both ligaments are present less often. The meniscotibial ligaments or "coronary" stretches from inferior edges of the menisci to the periphery of the tibial plateaus.
Extracapsular
The patellar ligament connects the patella to the tuberosity of the tibia. It is also occasionally called the patellar tendon because there is no definite separation between the quadriceps tendon which surrounds the patella and the area connecting the patella to the tibia. This very strong ligament helps give the patella its mechanical leverage and also functions as a cap for the condyles of the femur. Laterally and medially to the patellar ligament the lateral and medial retinacula connect fibers from the vasti lateralis and medialis muscles to the tibia. Some fibers from the iliotibial tract radiate into the lateral retinaculum and the medial retinaculum receives some transverse fibers arising on the medial femoral epicondyle.
The medial collateral ligament — MCL a.k.a. "tibial" — stretches from the medial epicondyle of the femur to the medial tibial condyle. It is composed of three groups of fibers — one stretching between the two bones and two fused with the medial meniscus. The MCL is partly covered by the pes anserinus and the tendon of the semimembranosus passes under it. It protects the medial side of the knee from being bent open by a stress applied to the lateral side of the knee, a valgus force. The fibular collateral ligament — LCL a.k.a. "fibular" — stretches from the lateral epicondyle of the femur to the head of fibula. It is separate from both the joint capsule and the lateral meniscus. It protects the lateral side from an inside bending force, a varus force. The anterolateral ligament or ALL is situated in front of the LCL.
Lastly, there are two ligaments on the dorsal side of the knee. The oblique popliteal ligament is a radiation of the tendon of the semimembranosus on the medial side, from where it is direct laterally and proximally. The arcuate popliteal ligament originates on the apex of the head of the fibula to stretch proximally, crosses the tendon of the popliteus muscle and passes into the capsule.
Extensors
Quadriceps femoris muscle
The quadriceps femoris muscle — also called the quadriceps extensor, quadriceps or quads — is a large muscle group that includes the four prevailing muscles on the front of the thigh. It is the great extensor muscle of the knee, forming a large fleshy mass which covers the front and sides of the femur. The name derives from Latin four-headed muscle of the femur. The diagram shows the quadriceps femoris, with different muscles in different colors. Rectus femoris is in blue. Vastus lateralis is in yellow. Vastus intermedius is in green. Vastus medialis is in red.
Rectus femoris muscle
The rectus femoris muscle is one of the four quadriceps muscles of the human body. All four parts of the quadriceps muscle attach to the patella or kneecap by the quadriceps tendon.
The rectus femoris is situated in the middle of the front of the thigh; it is fusiform in shape, and its superficial fibers are arranged in a bipenniform manner, the deep fibers running straight down to the deep aponeurosis. Its functions are to flex the thigh at the hip joint and to extend the leg at the knee joint.
It arises by two tendons: one, the anterior or straight, from the anterior inferior iliac spine; the other, the posterior or reflected, from a groove above the rim of the acetabulum.
The two unite at an acute angle and spread into an aponeurosis that is prolonged downward on the anterior surface of the muscle, and from this the muscular fibers arise.
The muscle ends in a broad and thick aponeurosis that occupies the lower two-thirds of its posterior surface, and, gradually becoming narrowed into a flattened tendon, is inserted into the base of the patella.
The neurons for voluntary thigh contraction originate near the summit of the medial side of the precentral gyrus, the primary motor area of the brain. These neurons send a nerve signal that is carried by the corticospinal tract down the brainstem and spinal cord. The signal starts with the upper motor neurons carrying the signal from the precentral gyrus down through the internal capsule, through the cerebral peduncle, and into the medulla. In the medullary pyramid, the corticospinal tract decussates and becomes the lateral corticospinal tract. The nerve signal will continue down the lateral corticospinal tract until it reaches spinal nerve L4. At this point, the nerve signal will synapse from the upper motor neurons to the lower motor neurons. The signal will travel through the anterior root of L4 and into the anterior rami of the L4 nerve, leaving the spinal cord through the lumbar plexus. The posterior division of the L4 root is the femoral nerve. The femoral nerve innervates the quadriceps femoris, a fourth of which is the rectus femoris. When the rectus femoris receives the signal that has traveled all the way from the medial side of the precentral gyrus, it contracts, extending the knee and flexing the thigh at the hip.
Vastus lateralis muscle
The vastus lateralis —also called the ''vastus externus'' — is the largest and most powerful part of the quadriceps femoris, a muscle in the thigh. Together with other muscles of the quadriceps group, it serves to extend the knee joint, moving the lower leg forward. It arises from a series of flat, broad tendons attached to the femur and attaches to the outer border of the patella. It ultimately joins with the other muscles that make up the quadriceps in the quadriceps tendon, which travels over the knee to connect to the tibia. The vastus lateralis is the recommended site for intramuscular injection in infants less than 7 months old and those unable to walk, with loss of muscular tone.
The vastus lateralis muscle arises from several areas of the femur, including the upper part of the intertrochanteric line, the lower anterior borders of the greater trochanter to the outer border of the gluteal tuberosity and the upper half of the outer border of the linea aspera. These form an aponeurosis, a broad flat tendon that covers the upper three-quarters of the muscle. From the inner surface of the aponeurosis, many muscle fibers originate. Some additional fibers arise from the tendon of the gluteus maximus muscle and from the septum between the vastus lateralis and short head of the biceps femoris.
The fibers form a large fleshy mass, attached to a second strong aponeurosis, placed on the deep surface of the lower part of the muscle. This lower aponeurosis becomes contracted and thickened into a flat tendon that attaches to the outer border of the patella and subsequently joins with the quadriceps femoris tendon, expanding the capsule of the knee joint.
Vastus intermedius muscle
The vastus intermedius arises from the front and lateral surfaces of the body of the femur in its upper two-thirds, sitting under the rectus femoris muscle and from the lower part of the lateral intermuscular septum. Its fibers end in a superficial aponeurosis, which forms the deep part of the quadriceps femoris tendon.
The vastus medialis and vastus intermedius appear to be inseparably united, but when the rectus femoris has been reflected during dissection, a narrow interval will be observed extending upward from the medial border of the patella between the two muscles, and the separation may be continued as far as the lower part of the intertrochanteric line, where, however, the two muscles are frequently continuous.
Due to being the deeper middle-most of the quadriceps muscle group, the intermedius is the most difficult to stretch once maximum knee flexion is attained. It cannot be further stretched by hip extension as the rectus femoris can, nor is it accessible to manipulate with massage therapy to stretch the fibers sideways as the vastus lateralis and vastus medialis are.
Vastus medialis muscle
The vastus medialis — vastus internus or teardrop muscle — is an extensor muscle located medially in the thigh that extends the knee. The vastus medialis is part of the quadriceps muscle group.
The vastus medialis is a muscle present in the anterior compartment of thigh and is one of the four muscles that make up the quadriceps muscle. It is the most medial of the "vastus" group of muscles. The vastus medialis arises medially along the entire length of the femur and attaches with the other muscles of the quadriceps in the quadriceps tendon.
The vastus medialis muscle originates from a continuous line of attachment on the femur, which begins on the front and middle side anteromedially on the intertrochanteric line of the femur. It continues down and back posteroinferiorly along the pectineal line and then descends along the inner medial lip of the linea aspera and onto the medial supracondylar line of the femur. The fibers converge onto the inner medial part of the quadriceps tendon and the inner medial border of the patella.
The obliquus genus muscle is the most distal segment of the vastus medialis muscle. Its specific training plays an important role in maintaining patella position and limiting injuries to the knee. With no clear delineation, it is simply the most distal group of fibers of the vastus medialis.
Flexors
Sartorius muscle
The sartorius muscle is the longest muscle in the human body. It is a long, thin, superficial muscle that runs down the length of the thigh in the anterior compartment.
The sartorius muscle originates from the anterior superior iliac spine and part of the notch between the anterior superior iliac spine and anterior inferior iliac spine. It runs obliquely across the upper and anterior part of the thigh in an inferomedial direction. It passes behind the medial condyle of the femur to end in a tendon. This tendon curves anteriorly to join the tendons of the gracilis and semitendinosus muscles in the pes anserinus, where it inserts into the superomedial surface of the tibia.
Its upper portion forms the lateral border of the femoral triangle, and the point where it crosses adductor longus marks the apex of the triangle. Deep to sartorius and its fascia is the adductor canal, through which the saphenous nerve, femoral artery and vein and nerve to vastus medialis pass.
Biceps femoris muscle
The biceps femoris is a muscle of the thigh located to the posterior, or back. As its name implies, it has two parts one of which — the long head — forms part of the hamstrings muscle group.
It has two heads of origin:
The long head arises from the lower and inner impression on the posterior part of the tuberosity of the ischium. This is a common tendon origin with the semitendinosus muscle and from the lower part of the sacrotuberous ligament.
The short head arises from the lateral lip of the linea aspera between the adductor magnus and vastus lateralis, extending up almost as high as the insertion of the gluteus maximus from the lateral prolongation of the linea aspera to within 5 cm. of the lateral condyle and from the lateral intermuscular septum.
The two muscle heads join together distally and unite in an intricate fashion. The fibers of the long head form a fusiform belly, which passes obliquely downward and lateralward across the sciatic nerve to end in an aponeurosis which covers the posterior surface of the muscle and receives the fibers of the short head. Inferiorly, the aponeurosis condenses to form a tendon which predominantly inserts onto the lateral side of the head of the fibula. There is a second small insertional attachment by a small tendon slip into the lateral condyle of the tibia.
At its insertion the tendon divides into two portions, which embrace the fibular collateral ligament of the knee joint. Together, this joining of tendons is commonly referred to as the conjoined tendon of the knee.
From the posterior border of the tendon a thin expansion is given off to the fascia of the leg. The tendon of insertion of this muscle forms the lateral hamstring; the common fibular or peroneal nerve descends along its medial border.
Semitendinosus muscle
The semitendinosus is a long superficial muscle in the back of the thigh. It is so named because it has a very long tendon of insertion. It lies posteromedially in the thigh, superficial to the semimembranosus.
The semitendinosus — remarkable for the great length of its tendon of insertion — is situated at the posterior and medial aspect of the thigh.
It arises from the lower and medial impression on the upper part of the tuberosity of the ischium, by a tendon common to it and the long head of the biceps femoris; it also arises from an aponeurosis which connects the adjacent surfaces of the two muscles to the extent of about 7.5 cm. from their origin.
The muscle is fusiform and ends a little below the middle of the thigh in a long round tendon which lies along the medial side of the popliteal fossa; it then curves around the medial condyle of the tibia and passes over the medial collateral ligament of the knee joint — from which it is separated by a bursa — and is inserted into the upper part of the medial surface of the body of the tibia, nearly as far forward as its anterior crest.
The semitendinosus is more superficial than the semimembranosus — with which it shares very close insertion and attachment points. However, because the semimembranosus is wider and flatter than the semitendinosus, it is still possible to palpate the semimembranosus directly.
At its insertion it gives off from its lower border a prolongation to the deep fascia of the leg and lies behind the tendon of the sartorius and below that of the gracilis, to which it is united. These three tendons form what is known as the pes anserinus, so named because it looks like the foot of a goose.
Gastrocnemius muscle
The gastrocnemius muscle is a superficial two-headed muscle that is in the back part of the lower leg of humans. It runs from its two heads just above the knee to the heel, a three-joint muscle— knee, ankle and subtalar joints. The muscle is named via Latin, from Greek γαστήρ (gaster) 'belly' or 'stomach' and κνήμη (knḗmē) 'leg', meaning 'stomach of leg' — referring to the bulging shape of the calf.
The gastrocnemius is located with the soleus in the posterior or back compartment of the leg. The lateral head originates from the lateral condyle of the femur, while the medial head originates from the medial condyle of the femur. Its other end forms a common tendon with the soleus muscle; this tendon is known as the calcaneal tendon or Achilles tendon and inserts onto the posterior surface of the calcaneus or heel bone. It is considered a superficial muscle as it is located directly under skin, and its shape may often be visualized through the skin.
Deep to the gastrocnemius —farther from the skin — is the soleus muscle. Some anatomists consider both to be a single muscle — the triceps surae or "three-headed [muscle] of the calf" —since they share a common insertion via the Achilles tendon. The plantaris muscle and a portion of its tendon run between the two muscles, which is involved in "locking" the knee from the standing position. Since the anterior compartment of the leg is lateral to the tibia, the bulge of muscle medial to the tibia on the anterior side is actually the posterior compartment. The soleus is superficial to the mid-shaft of the tibia.
Popliteus muscle
The popliteus muscle in the leg is used for unlocking the knees when walking, by laterally rotating the femur on the tibia during the closed chain portion of the gait cycle — one with the foot in contact with the ground. In open chain movements when the involved limb is not in contact with the ground, the popliteus muscle medially rotates the tibia on the femur. It is also used when sitting down and standing up. It is the only muscle in the posterior or back compartment of the lower leg that acts just on the knee and not on the ankle. The gastrocnemius muscle acts on both joints.
The popliteus muscle originates from the lateral surface of the lateral condyle of the femur by a rounded tendon. Its fibers pass downward and medially. It inserts onto the posterior surface of tibia, above the soleal line. The muscle arises within the capsule of knee joint and its tendon separates the lateral meniscus from the lateral ligament of the joint.
Blood supply
The femoral artery and the popliteal artery help form the arterial network or plexus surrounding the knee joint. There are six main branches: two superior genicular arteries, two inferior genicular arteries, the descending genicular artery and the recurrent branch of anterior tibial artery.
The medial genicular arteries penetrate the knee joint.
Clinical significance
Knee pain is caused by trauma, misalignment and degeneration, as well as by conditions like arthritis. The most common knee disorder is generally known as patellofemoral syndrome. The majority of minor cases of knee pain can be treated at home with rest and ice but more serious injuries do require surgical care.
One form of patellofemoral syndrome involves a tissue-related problem that creates pressure and irritation in the knee between the patella and the trochlea — patellar compression syndrome — which causes pain. The second major class of knee disorder involves a tear, slippage or dislocation that impairs the structural ability of the knee to balance the leg — patellofemoral instability syndrome. Patellofemoral instability syndrome may cause either pain, a sense of poor balance or both.
Prepatellar bursitis also known as housemaid's knee is painful inflammation of the prepatellar bursa — a frontal knee bursa — often brought about by occupational activity such as roofing.
Age also contributes to disorders of the knee. Particularly in older people, knee pain frequently arises due to osteoarthritis. In addition, weakening of tissues around the knee may contribute to the problem. Patellofemoral instability may relate to hip abnormalities or to tightness of surrounding ligaments.
Cartilage lesions can be caused by:
- Accidents — fractures.
- Injuries.
- The removal of a meniscus.
- Anterior cruciate ligament injury.
- Posterior cruciate ligament injury.
- Posterolateral corner injury.
- Considerable strain on the knee.
Any kind of work during which the knees undergo heavy stress may also be detrimental to cartilage. This is especially the case in professions in which people frequently have to walk, lift or squat. Other causes of pain may be excessive on — and wear off — the knees, in combination with such things as muscle weakness and overweight.
Common complaints:
- A painful, blocked, locked or swollen knee.
- Sufferers sometimes feel as if their knees are about to give way or may feel uncertain
about their movements.
Overall fitness and knee injury
Physical fitness is related integrally to the development of knee problems. The same activity such as climbing stairs may cause pain from patellofemoral compression for someone who is physically unfit, but not for someone else or even for that person at a different time. Obesity is another major contributor to knee pain. For instance, a 30-year-old woman who weighed 120 lbs at age 18 years before her three pregnancies, and now weighs 285 lbs has added 660 lbs of force across her patellofemoral joint with each step.
Common injuries due to physical activity
In sports that place great pressure on the knees — especially with twisting forces — it is common to tear one or more ligaments or cartilages. Some of the most common knee injuries are those to the medial side: medial knee injuries.
Anterior cruciate ligament injury
The anterior cruciate ligament is the most commonly injured ligament of the knee. The injury is common during sports. Twisting of the knee is a common cause of overstretching or tearing the ACL. When the ACL is injured, a popping sound may be heard, and the leg may suddenly give out. Besides swelling and pain, walking may be painful, and the knee will feel unstable. Minor tears of the anterior cruciate ligament may heal over time, but a torn ACL requires surgery. After surgery, recovery is prolonged and low impact exercises are recommended to strengthen the joint.
Torn meniscus injury
A tear of a meniscus is a rupturing of one or more of the fibrocartilage strips in the knee called menisci. When doctors and patients refer to "torn cartilage" in the knee, they actually may be referring to an injury to a meniscus at the top of one of the tibiae. Menisci can be torn during innocuous activities such as walking or squatting. They can also be torn by traumatic force encountered in sports or other forms of physical exertion. The traumatic action is most often a twisting movement at the knee while the leg is bent. In older adults, the meniscus can be damaged following prolonged wear and tear. Especially acute injuries — typically in younger, more active patients — can lead to displaced tears which can cause mechanical symptoms such as clicking, catching or locking during motion of the joint. The joint will be in pain when in use, but when there is no load, the pain goes away.
A tear of the medial meniscus can occur as part of the unhappy triad — also known as a blown knee — together with a tear of the anterior cruciate ligament and medial collateral ligament.
The menisci act as shock absorbers and separate the two ends of bone in the knee joint. There are two menisci in the knee, the medial (inner) and the lateral (outer). When there is torn cartilage, it means that the meniscus has been injured. Meniscus tears occur during sports often when the knee is twisted. Menisci injury may be innocuous, and one may be able to walk after a tear, but soon swelling and pain set in. Sometimes the knee will lock while bending. Pain often occurs when one squats. Small meniscus tears are treated conservatively but most large tears require surgery.
Fractures
Knee fractures are rare but do occur, especially as a result of road accident. Knee fractures include a patella fracture and a type of avulsion fracture called a Segond fracture. There is usually immediate pain and swelling and a difficulty or inability to stand on the leg. The muscles go into spasm and even the slightest movements are painful. X-rays can easily confirm the injury and surgery will depend on the degree of displacement and type of fracture.
Ruptured tendon
Tendons usually attach muscle to bone. In the knee, the quadriceps and patellar tendon can sometimes tear. The injuries to these tendons occur when there is forceful contraction of the knee. If the tendon is completely torn, bending or extending the leg is impossible. A completely torn tendon requires surgery, but a partially torn tendon can be treated with leg immobilization followed by physical therapy.
Overuse
Overuse injuries of the knee include tendonitis, bursitis, muscle strains and iliotibial band syndrome. These injuries often develop slowly over weeks or months. Activities that induce pain usually delay healing. Rest, ice and compression do help in most cases. Once the swelling has diminished, heat packs can increase blood supply and promote healing. Most overuse injuries subside with time but can flare up if the activities are quickly resumed. Individuals may reduce the chances of overuse injuries by warming up prior to exercise, by limiting high impact activities and keep their weight under control.
Varus or valgus deformity
There are two disorders relating to an abnormal angle in the coronal plane at the level of the knee:
Genu valgum is a valgus deformity in which the tibia is turned outward in relation to the femur, resulting in a knock-kneed appearance.
Genu varum is a varus deformity in which the tibia is turned inward in relation to the femur, resulting in a bowlegged deformity.
The degree of varus or valgus deformity can be quantified by the hip-knee-ankle angle, which is an angle between the femoral mechanical axis and the center of the ankle joint. It is normally between 1.0° and 1.5° of varus in adults. Normal ranges are different in children.
Comments