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Old 05-10-2006, 08:09 AM
EricT EricT is offline
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(Sorry if some of this is a repeat)

Knee Pain
From Elizabeth Quinn,

Part 1 Anatomy and Physiology
Injuries to the knee are the most common reason people see an orthopedic physician. The structure and stress placed upon the knee make it vulnerable to a variety of injuries. The largest joint in the body is the knee. It is comprised of the lower end of the femur and the upper end of the tibia. The patella (kneecap) slides in a groove on the end of the femur, and covers the joint. Several large ligaments support the knee on either side. The meniscus and cartilage cushion the knee and act as a shock absorber during motion.

Muscles
In addition to these structures, there are two groups of muscles at the knee. The quadriceps muscle in front straightens the leg from a bent position. The hamstring muscles, in the back, bend the knee.

Ligaments
Ligaments are strong, elastic bands of tissue that connect bone to bone. They provide strength and stability to the joint. Four ligaments connect the femur and tibia:

The medial collateral ligament (MCL) provides stability to the inner (medial) aspect of the knee.
The lateral collateral ligament (LCL) provides stability to the outer (lateral) aspect of the knee.
The anterior cruciate ligament (ACL), in the center of the knee, limits rotation and the forward movement of the tibia.
The posterior cruciate ligament (PCL), also in the center of the knee, limits backward movement of the tibia.

Tendons
Tendons are tough cords of tissue that connect muscle to bone. In the knee, the quadriceps tendon connects the quadriceps muscle to the patella and provides power to extend the leg. The patellar tendon connects the patella to the tibia.

Types of Knee Pain

Ligament Injuries
Knee injuries are very common in sports that require stopping and starting or quickly changing directions. These extreme forces on the knee can result in torn ligaments. The anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) are the most often injured, but the posterior cruciate ligament (PCL) can also be injured.
ACL tears can occur when an athlete changes direction rapidly, twists the upper body and hips while the feet are planted, slows down when running, or lands a jump awkwardly. Injuries to the MCL usually are caused by a blow to the outside of the knee. Such contact forces often are encountered in sports such as football, rugby or soccer. The PCL can be injured during a sports activity when the athlete receives a blow to the front of the knee or makes a simple misstep on the playing field, and hyperextends the knee.

Injury to a cruciate ligament may not cause pain, but may cause a loud popping sound, and the leg may buckle. An MRI is usually used to diagnose an ACL tear, but arthroscopy may be the only reliable means of detecting a partial tear.

An MCL injury may result in a pop and the knee may buckle to the side. Pain and swelling are common. An MRI is helpful in diagnosing injuries to these ligaments.

Torn Knee Cartilage
Torn cartilage in the knee can occur in any athlete. When people talk about torn knee cartilage, they usually are referring to a torn meniscus. The meniscus is a tough, rubbery cartilage that is attached to the knee's ligaments. It acts like a shock absorber. In athletic activities, meniscus tears usually occur when twisting, cutting, pivoting, decelerating, or being tackled. This is typically a contact injury.

There are several manual tests that a physician may use to detect torn cartilage.

Chondromalacia
This term refers to softening of the surface on the underside of the kneecap. This injury can occur in young adults and is often caused by trauma, overuse, poor alignment of the knee joint, or muscle imbalance. Such rubbing can result in a slight abnormality of the surface of the cartilage or a surface that has been worn away completely to the bone. It is often identified by a dull pain around or under the kneecap that worsens when walking down stairs or hills. Pain with stair climbing or other weight bearing exercise can also indicate chondromalacia.

Arthritis of the Knee
Osteoarthritis is the most common type of arthritis experienced by athletes. It is a degenerative disease where cartilage in the joint gradually wears away. Stress on the knee joint, overuse, structural abnormalities, or excess body weight can cause osteoarthritis. Typical signs and symptoms of osteoarthritis include knee pain, swelling, and a decrease in the range of motion of the knee. Morning stiffness is common.

Tendonitis and Ruptured Tendons
Tendonitis is simply an inflammation of a tendon whereas a ruptured tendon has torn. Overuse often leads to an inflammation of the tendons, often called jumper's knee, because sports requiring jumping can strain the tendon. The tendon may become inflamed or tear after repeated stress. Acute traumatic movements (trying to break a fall) more often result in excessive contraction of the quadriceps muscles and tear the quadriceps tendon. Tendonitis is often identified due to tenderness at the point where the patellar tendon meets the bone. It may also cause pain during faster movements, such as running, cycling, or jumping.

Iliotibial Band Syndrome
This is typically an overuse inflammatory condition due to constant rubbing of the tendon over the lateral condyle of the knee. It causes an ache or burning sensation at the side of the knee during activity.

There are a variety of methods used by orthopedic surgeons to treat knee injuries in athletes. The most important advice is to seek treatment as soon as possible. A common method used by orthopedic surgeons to treat mild knee injuries is R.I.C.E. (rest, ice, compression, and elevation). Rest the knee by staying off it or walking only with crutches. Apply ice to control swelling. Use a compressive elastic bandage applied snugly but loosely enough so that it does not cause pain. Finally, keep the knee elevated.
Specific Treatments for Knee Injuries

Chondromalacia
Many doctors recommend that patients with chondromalacia perform low-impact exercises that strengthen muscles, without injuring joints (swimming, cycling, walking).

At times a physician may perform arthroscopic surgery to smooth the surface of the articular cartilage and clean and smooth out cartilage fragments that rub on the surface of the femur.

Meniscus Tear
If the tear is minor and the pain and other symptoms go away, the doctor may recommend a visit to a Physical Therapist for a muscle-strengthening program. If the tear to a meniscus is more extensive, arthroscopic surgery may be performed. The meniscus can be repaired in some cases. If the tear is more extensive, a small piece may be removed to even the surface. In some cases, the doctor removes the entire meniscus. However, degenerative changes, such as osteoarthritis, are more likely to develop in the knee if the meniscus is removed. Researchers are developing procedures that may replace a meniscus in the near future.

Cruciate Ligament Tears
For an incomplete CL tear, a doctor may recommend a visit to a Physical Therapist to strengthen surrounding muscles. A knee brace may also be warranted. If the ACL is completely torn, surgery may be indicated. The torn ends of the ligament may be reattached or completely reconstructed with a graft.

Medial Collateral Ligament
Most sprains of the collateral ligaments will heal if the patient follows a prescribed exercise program, including R.I.C.E. and bracing.

Osteoarthritis
Most often osteoarthritis of the knee is treated with analgesics such as aspirin or acetaminophen, and anti-inflammatories, such as ibuprofen (Motrin, Nuprin, Advil). Exercises may be warranted to strengthen the knee, as well as encourage weight loss.

Knee Tendon Injuries
Tendonitis is typically treated with R.I.C.E. and ibuprofen to relieve pain and decrease inflammation and swelling. If the tendon is completely ruptured, surgery is necessary to reattach the tendon.

Iliotibial Band Syndrome
Usually, iliotibial band syndrome eases with reduced activity. Strengthening and stretching exercises can also alleviate the IT band pain.
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If you act sanctimonious I will just list out your logical fallacies until you get pissed off and spew blasphemous remarks.
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