Acute knee injuries are common, particularly among athletes and physically active individuals. These injuries can range from mild to severe and involve different structures within the knee, such as ligaments, cartilage, and tendons.
Causes
- Trauma: Direct blows to the knee or abnormal twisting, bending, or falling.
- Sports Injuries: Common in sports that involve jumping, pivoting, or contact.
- Overuse: Repetitive strain can lead to acute exacerbation of underlying chronic conditions.
- Awkward Movements: Sudden changes in direction or speed can cause internal knee damage.
Diagnosis
- Patient History: Understanding the mechanism of injury, onset of pain, and any associated symptoms like swelling or instability.
- Physical Examination: Assessing tenderness, swelling, range of motion, and stability of the knee. Special tests like the Lachman test for ACL injury, McMurray’s test for meniscal tears, etc., may be performed.
- Imaging:
- X-rays: To rule out fractures.
- MRI: To visualize soft tissue injuries (ligaments, tendons, meniscus).
- CT Scan: Occasionally used to assess complex fractures.
- Arthroscopy: In some cases, this surgical procedure might be used for both diagnosis and treatment.
Differential Diagnosis
- Anterior Cruciate Ligament (ACL) Injury: Commonly caused by sports-related trauma, characterized by a “popping” noise and knee instability.
- Posterior Cruciate Ligament (PCL) Injury: Typically caused by a direct impact to the front of the knee.
- Medial Collateral Ligament (MCL) Injury: Caused by a force on the outside of the knee.
- Lateral Collateral Ligament (LCL) Injury: Caused by a force on the inside of the knee.
- Meniscal Tears: Pain and locking or catching of the knee; often a result of twisting injuries.
- Patellar Dislocation: The kneecap slides out of position, often laterally.
- Tendon Tears: Such as quadriceps or patellar tendon tears.
- Bursitis: Inflammation of the fluid-filled sacs can mimic internal injury due to pain and swelling.
- Osteoarthritis Flare-ups: Can cause acute pain and mimic trauma.
- Gout or Pseudogout: Can cause acute swelling and pain, mimicking an internal injury.
Management
- Conservative Treatment:
- R.I.C.E. Therapy (Rest, Ice, Compression, Elevation): Immediately following the injury to reduce swelling and pain.
- NSAIDs: For pain and inflammation.
- Physiotherapy: To strengthen the muscles around the knee and improve flexibility.
- Surgical Intervention:
- Indicated for severe injuries like complete ACL tears, complex meniscal tears, or tendon ruptures.
- Arthroscopic Surgery: Minimally invasive and used for a range of knee injuries.
- Rehabilitation: Post-surgical or injury rehabilitation is crucial for recovery and prevention of future injuries.
- Activity Modification: Avoiding activities that stress the injured knee until fully healed.
- Preventive Measures: Wearing appropriate sports gear, proper training techniques, and maintaining good physical fitness.
Conclusion
The management of acute internal knee injuries depends on the specific injury’s severity and the individual’s activity level. An accurate diagnosis followed by appropriate treatment is essential for optimal recovery and to prevent long-term complications such as chronic pain or instability. Regular follow-up and adherence to a rehabilitation program are key to successful recovery.