Anyone who has suffered a knee injury could express how important knees are to everyday life. Something as simple as pressing down a gas pedal or climbing the steps can feel impossible with knee pain. And for athletes of all ages, a knee injury left untreated can be career ending.
While not everyone has experienced an injury to the knee, it’s safe to say everyone knows someone who has. Unfortunately, according to the American Academy of Pediatrics, knee injuries are on the rise in kids and teens, but this is a problem faced by active patients at every age.
Why is there a rise in knee injuries? There are several reasons. Many adults are pursuing more active lifestyles with recreational sports teams, running clubs and CrossFit, yet they spend their weekdays in front of computer screens sitting for hours at a time. A lack of sufficient activity and preventative training during the week creates opportunity for injury on the weekend. Likewise, young athletes are starting to play sports earlier and with greater frequency. It’s not unusual for a high school athlete to participate in some form of competitive sports year round, leaving little time for appropriate training, rest or recovery.
This increase has made knee pain and treatment options a commonplace subject within active and athletic communities. As a result, patients are more aware of potential problems and there is greater emphasis on prevention.
Fortunately, now more than at any other time in history, the healthcare community is more equipped to prevent, diagnose and treat these injuries and return patients to the activities they love.
Anatomy of the Knee
Before discussing some of the most common knee injuries in active adults and athletes, it’s important to understand the mechanics of the knee. Proper knee function is dependent upon four major ligaments (anterior and posterior cruciate ligaments, and medial and lateral collateral ligaments) plus two kinds of cartilage (articular and meniscus).
Three Most Common Knee Injuries in Active or Athletic Individuals:
1. Anterior Cruciate Ligament (ACL) Injury
Most ACL injuries happen as a result of rapid deceleration, sudden change in direction or a direct blow to the knee. Many people describe hearing or feeling a “pop” in the knee followed by sudden swelling, extreme soreness and a buckling or “giving way” when walking or returning to play.
Who is at risk? Athletes or active adults under the age of 40 most commonly experience ACL injuries, but it can also be the result of a slip or fall at any age.
How is it treated? Most often, ACL injuries are treated with surgical reconstruction; however, in rare cases for some older, less active patients the injury can be managed with physical therapy. Platelet-rich plasma therapy, known as PRP, is also used in some cases to augment healing.
How long is average recovery? Following surgery, on average, patients return to normal activity and play in 6 to 8 months. Physical therapy is also recommended to both strengthen the knee and prevent future injury.
2. Chondral Injury (Articular Cartilage Injuries)
Chondral injuries are acute (sudden) injuries to the knee’s articular cartilage, the shiny surface on the end of the bone. This is different than arthritis, which is the gradual wearing down of this surface. As such, the symptoms and treatment options are different.
A chondral injury may occur as a result of a pivot or twist on a bent knee or a direct blow. Small pieces of the articular cartilage can also break off and float around as loose bodies creating swelling, catching or locking. Unlike with an ACL or meniscus tear, symptoms aren’t always obvious and can simply present as swelling. Patients may also experience pain with prolonged activity, or giving way, locking or catching and sometimes a clicking noise from the knee during movement.
Who is at risk? Athletes or active adults under the age of 40 most commonly experience chondral injuries, but it can also be the result of a direct blow at any age.
How is it treated? Chondral treatment efforts are intended to encourage the cartilage to regrow, or in some cases, to replace it. This may involve smoothing or replacing the cartilage tissue, or stimulating regrowth through procedures such as microfracture or bone marrow stimulation techniques like platelet-rich plasma therapy. In every case, a physician can give advice about the best treatment or combination of treatments for a given situation.
How long is average recovery? Time is quite variable and recovery depends on the severity of the injury, as well as the treatment option pursued. In most cases, patients return to normal activity or play within 2-10 months.
3. Meniscal Injury
Think of the meniscus like a leathery pad that can soften and wear with age. This important pad or cushion is found inside the knee joint and helps to absorb or minimize stress on articular cartilage and stabilize the knee. A tear is typically the result of a twisting injury, common during golf or repetitive squatting. An injury or tear to the meniscus may not result in much swelling or discomfort from walking, but squatting, running, or heightened activity can cause swelling and pain.
Who is at risk? The above 40 set is generally at greater risk of a meniscus injury simply because age causes this important cushion within the knee to soften and wear. This softening makes the meniscus more vulnerable to injury or tearing.
How is it treated? If conservative methods have failed, a meniscus tear can be corrected with surgery followed by physical therapy.
How long is average recovery? In most cases, patients return to sport or high activity within 1-2 months.
Preventing Knee Injury
In general, the key to preventing knee injury is to improve overall leg strength and increase flexibility. It’s important to strengthen hamstrings and quadriceps and improve the flexibility of tendons around the knees through proper stretching techniques, particularly hamstring stretches. Athletes of all ages should be trained on correct landing and cutting mechanics. This is something to practice at every level of sport. Whether for professional athletes or weekend warriors, the importance of prevention cannot be overemphasized.
Future of Treatment
The treatment of knee injuries, like those described above, is evolving as the field of orthobiologics continues to take shape. Orthobiologics are natural products found in the body which aid in the healing of broken bones, injured muscles, tendons and ligaments. Orthobiologic substances include matrix (or scaffolds), growth factors and stem cells. When used in higher concentrations, they may speed up the healing process.
Research within this field is advancing new treatment options and informing changes to some traditional methods. Orthopedic surgeons have many more options for treating patients today, and new discoveries are made each year that will continue to shape the future of the practice.
When to consult a physician
While some knee injuries can be treated at home with conservative methods, it’s important to see a physician if any of the following symptoms occur:
- continued pain despite icing, resting, and use of anti-inflammatory medication
- significant swelling in or around the knee
- feeling a pop or experiencing pinching or catching in the knee
- instability, such as with a knee that buckles or doesn’t support
- pain severe enough to require crutches
Pete Edwards, MD, Orthopedic Sports Medicine Surgeon, Physician Partner is a board-certified orthopedic surgeon, fellowship trained in sports medicine. www.OrthopedicONE.com.
