This month our body part of the month is the knee and so we’ve asked our knee specialist, Alex Manos, to tell us about to tell us about two elements of the knee and their common injuries:
Anterior Cruciate Ligament (ACL)
The ACL is one of the four main ligaments of the knee, stabilising the knee both in a forward and back and rotational movement.
Injury to this ligament is common in sports such as skiing, football, rugby and any other sport involving twisting and turning. More often than not, in contact sport, the injury actually happens without contact and occurs when an individual turns direction and the knee twists. The person usually hears a 'pop' and feels a sensation as if something has been torn.
The knee usually swells up quickly and becomes difficult to move and weightbear. Early diagnosis is key and the best route is to see a physiotherapist, sports doctor or knee consultant who will organise an MRI to look at the damage. Once it has been confirmed, there are two options: conservative or surgical management. The preference is usually surgery but factors such as age, fitness level, future goals and patient choice of course are taken into account. Either way, rehabilitation is absolutely necessary.
During surgery, the ACL is replaced with either a tendon from the patella or the hamstring, or sometimes an allogarft (graft from a donor cadaver) is taken. The rehabilitation following surgery can take anywhere from 6 months to a year depending on the extent of the damage and also how well the patient adheres to the rehabilitation program given by the physiotherapist. The goal, where possible, is to return the individual back to the previous level of function. This requires a very systematic approach and goal setting to ensure all markers are met in a safe and progressive manner. The knee needs to be strong and stable and function as it did prior to the injury in order to allow for a return to sport.
Iliotibial Band (ITB)
The ITB is a thick band of tendinous fascia which attaches to a muscle on the outside of the hip called the Tensor of Fascia Latae, a muscle which pulls the hip up and out.
ITB Friction Syndrome (ITBFS/runner’s knee)
ITBFS or runner’s knee as it’s often referred to is a condition which gives pain on the outside of the knee, the lateral side. It is mainly prevalent in runners hence the name but can also occur in cyclists and other sports. We still don't know exactly what causes it but we do know that friction between the ITB tendon and the knee joint causes irritation and inflammation of the bursae (a fluid filled sack) which sits between these two structures. The onset of pain is usually very specific. In running, for example, an individual usually has a distance or time when they can pin point the onset of pain. Once it kicks in, if acute and severe, the runner can't continue. It is described as a sharp stabbing pain on the outside of the knee. There may be local swelling but knee joint itself if not swollen. People find walking downstairs and also just bending the knee - particularly in the 0-45 degrees range - painful.
The injury is atraumatic, there is no tear so there is nothing to heal, but the inflammation has to settle. Usually within a couple days the knee feels ok again and there is no issue in day to day life until the aggravating activity is taken up again. Therefore we say that the injury is biomechanical or overuse in nature. The factors which could be contributing to it can be broken down into two categories: extrinsic and intrinsic.
Extrinsic factors are things like training loads, recent changes in training, training surfaces/hills, footwear and changing fitness levels. There is often a link between one of these and the onset of ITBFS, often a sudden increase in running load.
Intrinsic factors look at what is going on within the body, areas of tightness or weakness, imbalances, running styles or other areas apart from the knee which could be contributing.
A detailed examination of both by a specialised physiotherapist will be able to determine which factors need to be addressed and corrected. Advice, combined with manual therapy and rehabilitative exercises can be very beneficial in overcoming this problem. In recalcitrant cases, a corticosteroid injection can also provide benefit.
Is your knee giving you trouble? Call us on 02030 12 12 22 to book an appointment with one of our knee specialist physios.
Words by Alex Manos.