Knee

Anterior knee pain is a characterized by a chronic pain over the front and center of the knee joint. It is common in athletes, active adolescents (especially girls) and overweight individuals. Anterior knee pain refers to a variety of conditions which include runner’s knee or patellar tendinitis and chondromalacia of the patella. There is an inter-individual variation in the duration and presentation of pain.

The knee joint is a large, complex joint in the body comprising of three bones, i.e. the lower end of the thigh bone or femur, upper end of the shinbone or tibia, and the kneecap or patella. The patella moves over the joint and allows bending of the knee and straightening of the leg. There are a few major ligaments situated around the knee joint which hold the joint firmly in position and contribute to the stability of the knee.

Arthritis is a general term covering numerous conditions where the joint surface or cartilage wears out. The joint surface is covered by a smooth articular surface that allows pain free movement in the joint. This surface can wear out for a number of reasons; often the definite cause is not known.

The knee is a complex joint made up of different structures – bones, tendons, ligaments and muscles. They all work together to maintain the knee’s normal function and provide stability to the knee during movement. As we age, the muscles get weaker and the ligaments get looser, causing our knees to become less stable. Weakened tendons and muscles increase our chances of tweaking, spraining, or otherwise injuring our knees.

Knee pain is a common condition affecting individuals of different age groups. It not only affects movement, but also impacts your quality of life. In addition to natural aging of the knee joints, other factors can also make you more prone to pain. Osteoarthritis, trauma, increased body weight, and inadequate muscle strength and flexibility can all cause or contribute to knee issues.

The condition in which a blood clot forms in the deep veins of the body is referred to as Deep Vein Thrombosis (DVT). Clots form when blood thickens and clumps together. DVT occurs most often in the deep veins of the leg and thighs.

A bursa is a small fluid-filled sac found between soft tissues and bones. It lubricates and acts as a cushion to decrease friction between bones when they move. Bursitis refers to the inflammation and swelling of the bursa. Goosefoot bursitis or pes anserine bursitis is the inflammation of the bursa present between the tendons of the hamstring muscle and the tibia (shinbone) on the inner side of the knee.

Goosefoot bursitis is often caused due to repetitive friction on the bursa, overuse of the joints during sports, osteoarthritis of the knee, obesity, medial meniscus tear, tight hamstring muscles and incorrect training techniques.

The anterior cruciate ligament, or ACL, is one of the major ligaments of the knee that is located in the middle of the knee and runs from the femur (thigh bone) to the tibia (shin bone). It prevents the tibia from sliding out in front of the femur. Together with posterior cruciate ligament (PCL) it provides rotational stability to the knee.

An ACL injury is a sports related injury that occur when the knee is forcefully twisted or hyperextended. An ACL tear usually occurs with an abrupt directional change with the foot fixed on the ground or when the deceleration force crosses the knee. Changing direction rapidly, stopping suddenly, slowing down while running, landing from a jump incorrectly, and direct contact or collision, such as a football tackle can also cause injury to the ACL.

Pressure applied on the knees with constant kneeling, conditions such as gout and rheumatoid arthritis, a direct blow to the kneecap while playing sports such as basketball, football and wrestling, or due to infection.

Meniscal tears are one of the most frequently reported injuries to the knee joint. The meniscus is a C-shaped fibrocartilaginous structure in the knee incompletely covering the surface of the tibia where it articulates with the femur. It consists of the medial meniscus, on the inner part of the knee, and the lateral meniscus on the outer aspect of the knee.

The menisci act as shock absorbers protecting the articular surface of the tibia as well as assisting in rotation of the knee. As secondary stabilizers, the intact menisci interact with the stabilizing function of the ligaments and are most effective when the surrounding ligaments are intact.

Osgood-Schlatter disease is a condition characterized by swelling of the bump (anterior tibial tubercle) present on the upper part of the tibia, below the knee. It is the most common cause of knee pain in young athletes. Osgood-Schlatter disease affects children participating in sports activities such as football, gymnastics, basketball, and sprinting. Any sporting activity creates stress over the growth plate, at the top of tibia. A growth plate is a layer of cartilage present at the end of bone which is responsible for bone growth. It affects girls in the age group of 10 to 11 years and boys in 13 to 14 years age group and generally resolves with age.

Osteonecrosis is a condition in which death of a section of bone occurs because of lack of blood supply to it. It is one of the most common causes of knee pain in older women. Women over the age of 60 years of age are commonly affected, three times more often than men.

Osteonecrosis of the knee is most commonly seen in the femoral condyle, usually on the inner side of the knee (the medial femoral condyle). However, the condition can also occur on the outside of the knee (the lateral femoral condyle) or on top of the shin bone (the tibial joint surface), known as the tibial plateau.

Posterior cruciate ligament (PCL), one of four major ligaments of the knee is situated at the back of the knee. It connects the thighbone (femur) to the shinbone (tibia). The PCL limits the backward motion of the shinbone.

PCL injuries are very rare and are difficult to detect than other knee ligament injuries. Cartilage injuries, bone bruises, and ligament injuries often occur in combination with PCL injuries. Injuries to the PCL can be graded as I, II or III depending on the severity of injury. In grade I the ligament is mildly damaged and slightly stretched, but the knee joint is stable. In grade II there is partial tear of the ligament. In grade III there is complete tear of the ligament and the ligament is divided into two halves making the knee joint unstable.

Runner’s knee, also called patellofemoral pain syndrome refers to pain under and around your kneecap. Runner’s knee includes a number of medical conditions such as anterior knee pain syndrome, patellofemoral malalignment, and chondromalacia patella that cause pain around the front of the knee. As the name suggests, runner’s knee is a common complaint among runners, jumpers, and other athletes such as skiers, cyclists, and soccer players.

The knee joint is one of the largest joints in the body. This highly complex joint has several tissues supporting and stabilizing its movement:

• Condyles and menisci: Bony protrusions of the thigh bone called condyles fit snugly into the depressions of the lateral and medial menisci(spongy cartilage) of the shin bone
• Ligaments: bands of tissue criss cross across the joint bones, connecting and holding them in place
• Capsules: tissue that connects the bones of the knee, by forming a sleeve over the joint
• Muscles: provide secondary stability

Damage to any of these supportive structures causes the instability of the knee joint. This can be caused by sudden twisting of the knee, tears of the meniscus, ligament or capsule, osteoarthritis of the knee (wear and tear of the cushioning cartilage tissue between bones) and sports injuries. When these tissues get injured, the patella or knee cap can move out of its groove in the knee joint and lead to instability. An unstable knee causes pain, swelling, stiffness and a tendency of the joint to buckle or “give way”.

The anterior cruciate ligament is one of the four major ligaments of the knee that connects the femur (thigh bone) to the tibia (shin bone) and helps stabilize the knee joint. Anterior cruciate ligament (ACL) injury is one of the common injuries of the knee. An injury to the ACL commonly occurs during sports or activities that involve twisting, overextension, landing from a jump incorrectly and abrupt change in direction or speed of movements.

ACL injuries are more common in women than men due to anatomical differences which include:

• Women have a smaller ACL, a wider pelvis and an increased incidence of inward knee pointing.
• Women have less strength in the muscles as compared to men. In addition, women use their quadriceps muscles more than men for stability and take more time to develop muscular force resulting in greater stress on the ACL.
• Women have looser knees and a greater range of motion as compared to men.