The causes of knee pain
The causes of knee pain that we often encounter may be caused by injury, degeneration, which is also called osteoarthritis, or the abnormal mechanics of the knee.
Figure - 1 Joint Deformity
Figure - 2 Joint Deformity
Figure - 3a Unicondylar Knee Replacement
Şekil - 3b Unicondylar Knee Replacement
Figure - 4a Total Knee Replacement
Figure - 4b Total Knee Replacement
The Anterior Cruciate Ligament (ACL) is an important ligament for the biomechanics of the knee that is located inside the knee joint and prevents the tibia from slipping forward or twisting inward. It mostly gets injured due to the knee twisting inward during sports activities. (Figure 1-2-3).
Depending on the severity of the injury, ACL injuries can be accompanied by meniscus, cartilage and other ligament injuries. A tearing feeling or hearing a “pop” sound in the knee at the time of injury can be experienced and expressed by the patient. Patients generally cannot continue doing sports activities and they have to consult a doctor with complaints of swelling and pain in the knee following the injury.The complaints of the patients who continue their lives without consulting a doctor are sudden instability in the knee, abnormal knee movements (the knee may feel shaky, or catches, or gives out), inability to control the knee, and a feeling of giving-way. These complaints arise especially during sports or daily activities which require stopping suddenly, or jumping or turning. When the patients who are not treated properly try to exercise, they usually suffer knee injuries over again and, meniscus, cartilage and other ligament injuries may be added to the ACL injury.
When a person suffers a knee injury, an ACL injury and, if present, other accompanying injuries will be diagnosed through a physical examination and assessment of the findings, x-rays and Magnetic Resonance (MR) images. (Figure 4).
After suffering an Anterior Cruciate Ligament injury, in the early stages of their recovery, patients should rest their knee, use crutches to reduce fluid retention, apply cold press and they should also start knee motion and muscle strengthening exercises following the recommendations of their physiotherapists. When they are able to move their knee normally and the swelling has decreased, they can decide the course of the treatment by consulting their doctors.
The treatment of Anterior Cruciate Ligament injuries can either be surgical or conservative (non-surgical). The criteria listed below are taken into account while determining the course of the treatment.
- The expectations of the patient;: For young and active people or people who expect to continue intense physical activity, surgical treatment is the first option.
- The existence of an accompanying injury: If the meniscus, cartilaginous tissue and other ligaments have been seriously injured along with the ACL, surgical treatment is recommended.
- Recurring Complaints: For patients whose complaints continue during daily activities after receiving conservative treatment, surgical treatment may be used.
The patients who will be treated with conservative (non-surgical) approach need an intense physical therapy and rehabilitation period. The exercise program prepared by their doctors and physiotherapists should be followed strictly for around six months. During this process, the patients’ complaints are monitored. If there is the feeling of instability of the knee or if the knee gives out or feels shaky, or if another injury occurs even after following the proper rehabilitation program, then surgical treatment is recommended. At the present time, surgical treatment employs arthroscopic surgery method and it uses a graft to replace the torn ligament; a new ligament is constructed using the tissues taken from the frontal part of the knee (patellar tendon) or the muscles behind the thighs (Hamstring tendons) and it is placed inside the knee. (Figure 5). Physiotherapy begins 24 hours after the surgery and the patient is allowed to walk with crutches. Crutches are used up to four to six weeks. Exercise programs begin six weeks after the surgery and the patient may start running workouts after 2.5 or 3 months. Patients, who complete their strengthening and coordination programs may be allowed to get back to sports after 6 months. People who work in an office are able to resume working after 20 days while people who work actively may start work after 3 months.