Brief Outline of Subluxing Knee Cap

Subluxing Knee Cap

A subluxation or dislocation of the knee cap (patella) commonly occurs during deceleration. The knee cap slides partially out of the groove that is designed for it but does not limit mobility. Pain and swelling may accompany this condition. Athletes who have a muscle imbalance or a structural deformity, such as a high knee cap, have a higher chance of a subluxing knee cap.

Anatomy and physiology

The patella is a small triangular sesamoid bone within the tedon of the quariceps femoris muscle and forms the front of the knee joint. It is attached above to the quadriceps tendon, and below to the patellar (tendon) ligament, and articulates with the patellofemoral groove between the femoral condyles to form the patellofemoral joint. The patella slides over the groove when the knee flexes. If the outer muscle of the quadriceps, the vastus lateralis, is stronger than the inner muscle, the vastus medialis, this imbalance may cause an uneven pull on the knee cap forcing it out of the normal groove. In addition, the lateral femoral condyle and medial patellar bone may be bruised. This happens with forceful contractions such as planting, changing direction, or landing from a jump.

Cause of  Knee Cap Subluxation

Strength imbalance between the outer quadriceps group and the inner group. Impact to the side of the knee cap. Twisting of the knee.

Signs and symptoms

Feeling of pressure under the knee cap. Pain and swelling behind the knee cap. Pain when bending or straightening the knee.

Complications if left unattended

Continued subluxations can cause small fractures in the patella, cartilage tears, and stress on the tendons. Failure to treat a subluxation could lead to chronic subluxations.

Treatment

  • Anti-inflammatory medication
  • Physiotherapy

Rehabilitation and prevention

During rehabilitation, activities that do not aggravate the injury should be sought, such as swimming or biking instead of running. Strengthening of the vastus medialis and stretching the vastus medialis will help correct the muscle imbalance that may cause this condition. A brace to hold the knee cap in place may be needed when initially returning to activity. To prevent subluxations, it is important to keep the muscles surrounding the knee strong and flexible and avoid impact to the knee cap.

Long-term prognosis

Subluxations respond well to rest, rehabilitation, and anti-inflammatory measures. Rarely surgery may be required to prevent recurring subluxations due to misalignment or loose support structures.

Call (+65) 6471 2674 Now to make an appointment to treat your subluxing knee cap today.

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Brief Outline of Patellar Tendinitis

Patellar Tendinitis

Activities that require repetitive jumping like basketball or volleyball can lead to tendinitis in the patellar (tendon) ligament, also referred to as jumper’s knee. The force placed on the tendon over time can lead to inflammation and pain. The pain is generally felt just below the knee cap.

Anatomy and physiology

Patellar tendinitis affects the teno-osseous junctions of the quadriceps tendon as it attaches to the superior pole (extremity) of the patella, and the patellar (tendon) ligament as it attached to the inferior pole of the patella and the tibial tuberosity. Pain is concentrated on the patellar (tendon) ligament, but can also occur at the insertion of the patellar (tendon) ligament into the tibial tuberosity. The patellar (tendon) ligament is involved in extending the lower leg, but is also the first area to experience shock when landing from a jump. It is forced to stretch as the quadriceps contracts to slow down the flexion of the knee. This repetitive stress can lead to minor trauma in the tendon, which will lead to inflammation. Repetitive flexing and extending of the knee also places stress on this tendon if the tendon does not travel in the required path.

Cause of Patellar Tendinitis

Repetitive jumping and landing activities. Running and kicking activities. Untreated minor injury to the patellar tendon.

Signs and symptoms

Pain and inflammation of the patellar tendon, especially from repetitive or eccentric knee extension activity or kneeling. Swelling and tenderness around the tendon.

Complications if left unattended

As with most tendinitis, inflammation that is left untreated will cause addtional irritation, which causes more inflammation, setting up a vicious cycle. This can eventually lead to a rupture of the tendon. Damage to surrounding tissue may also occur.

Treatment

Rehabilitation and prevention

Stretching the quadriceps, hamstrings and calves will help relieve pressure on the patellar tendon. During rehabilitation it is important to identify the conditions that caused the injury in teh first place. Thorough warm-up and proper conditioning can help prevent the onset of this condition. A support strap placed below the knee may be needed at first to support the tendon during the initial return to activity. Prevention of this condition requires strong quadriceps and a good strength balance between the muscles that surround the knee.

Long-term prognosis

Complete recovery without lingering effects can be expected with good treatment. Occasionally, it may return due to a weakened tendon, especially in older athletes.

Call (+65) 64712 674 (24 Hour) for Appointment today to treat your Patellar Tendinitis Today.

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Brief Outline of Osteochondritis Dissecans

Osteochondritis dissecans (loose bodies in the joint) occurs when a fragment of bone adjacent to the articular surface of a joint is deprived of its blood supply, leading to avascular necrosis. This causes the cartilage to become brittle and a piece, or pieces, may found in several joints, this condition is most commonly assiciated with the knee and is particularly prevalent in males aged 10-20 years.

Anatomy and physiology

The bones are covered by cartilage at their ends. This cartilage protects the bones from excessive wear. If the blood supply to this area is lost due to a prior injury or other condition, the cartilage becomes hard and brittle. Impact or repetitive wear may cause it to break. If the broken pieces stay attached to the bone, there is generally no problem. When they release into the joint, the feeling of instability and a “clicking” or locking in the joint may be noticed. This causes premature wear in the joint.

Cause of Injury

Loss of blood supply to the end of the bone and attached cartilage. Impact to the joint causing a tearing or breaking of the cartilage at the bone end. Repetitive friction leading to the cartilage becoming brittle and breaking away.

Signs and symptoms

Aching, diffuse pain, and swelling, especially during activity. Stiffness with rest. Clicking, or weakness in the joint. Momentary locking if the bony fragment has displaced and id free floating within the joint.

Complications if left unattended

If left unattended, the loose bodies will continue to cause damage to the inner surface of the joint and could eventually lead to degenerative osteoarthritis. The loose bodies could also lead to tearing or “grooving” of other cartilage in the joint.

Treatment

  • Rest
  • Immobilisation
  • Anti-inflammatory medication
  • Seek medical attention

Rehabilitation and prevention

Strengthening the muscles surrounding the affected joint will help support it better during activity. Limiting the amount of time spent doing repetitive movement with the joint may also be required. Treatment of minor injuries to the joint may also help stop the chance of the blood supply being cut off. Limit activities that cause pain and gradually work back into a full schedule.

Long-term prognosis

If the broken cartilage does not release from the bone, it may repair itself. However, if it becomes lodged in the joint and the body does not dissolve it, surgery may be required. In younger athletes, a complete recovery and return to activity may be expected. In older athletes, the development of degenerative osteoarthritis is usually a by-product of this condition.

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Knee BursitisBrief Outline of Knee Bursitis

 

Bursitis can be a painful condition, especially when located in the weight bearing knee joint. Since the job of the bursa is to cushion and lubricate the joint where friction is likely to occur, inflammation will result in  pain in most weight bearing, flexion, or extension activities. The knee joint has on average fourteen busae.

Anatomy and physiology

A bursa is a sac filled with a viscid fluid. The deep bursa formed by the joint capsule at the knee, the suprapatellar bursa, is the largest bursa in the body. It is located between the femur and quadriceps femoris tendon. Three other major bursae of the knee are the subcutaneous prepatellar bursa, located between the skin and the anterior surface of the patella, the superficial infrapatellar bursa, located between the skin and the patellar (tendon) ligament, and the deep infrapatellar bursa, located between the tibial tuberosity and the patellar (tendon) ligament. Finally, the pes anserinus bursa is located at the lower inside of the knee joint where sartoris, gracillis, and semitendinosus insert as the conjoined pes anserinus tendon. The prepatellar bursa is the most commonly injured due to its superficial location. Repetitive kneeling or impact to the knee cap can damage this bursa. The infrapatellar bursae are most commonly inflamed during jumping and landing from repetitive friction of the patellar (tendon) ligament. The pes anserinus bursa is less commonly involved in injuries but can result from load bearing on the inside of the knee, as seen with improper gait or use of worn or improperly sized running shoes.

Cause of Knee Bursitis

Repetitive presssure of trauma to the bursa. Repetitive friction between the bursa and tendon or bone.

Signs and symptoms

Pain and tenderness. Mild swelling, due to relapse of the fluid in the bursal sac. Pain and stiffness when kneeling or walking downstairs.

Complications if left unattended

If a bursa is allowed to rupture and release its fluid, the natural cushioning will be lost. The build-up of fluid will cause loss of mobility in the joint as well.

Treatment

  • Injection
  • Anti-inflammatory medication
  • Shockwave
  • Physiotherapy

Rehabilitation and prevention

Strengthening the muscles around the knee will help to support the joint, and increasing flexibility also will relieve some of the pressure exerted by the tendons upon the bursa. Frequent rests when required to be in a kneeling or crouching position also help to prevent this condition. Identifying any underlying problems, such as improper equipment or form is important during rehabilitation to prevent it from recurring.

Long-term prognosis

Bursitis is seldom a long-term concern if treated properly. Occasionally draining of the fluid from the joint is necessary.

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Brief Outline of Meniscus Tear

The menisci are discs of fibrocartilage that cushion the knee joint. Tearing of the menisci can occur with forceful twisting of the knee, or may accompany other injuries such as ligament sprains. The unhappy triad is when a blow to the lateral side of the knee causes tearing of the medial collateral ligament, the anterior cruciate ligament, and the menisci.

Knee Meniscus Tear

Anatomy and physiology

Knee Structure

The menisci is actually composed of two parts, the medial and lateral meniscus. The medial meniscus rests on the medial plateau of the tibia and the lateral meniscus rests on the lateral plateau. Each meniscus is C-shaped and provides cushioning and protection for the ends of the femur and tibia, acting as a shock absorber. The menisci help to distribute the weight evenly through the joint. Forceful twisting of the knee, especially if bent, can cause tearing of the menisci. This is often seen in sports that require a planting of the foot to quickly change direction. The medial meniscus is injured much more frequently that the lateral meniscus, mainly due to it being more securely attached to the tibia, and, therefore, less mobile.

Cause of Meniscus Tear

Forceful twisting of the knee joint, most commonly seen when the knee is also bent. May accompany ligament strains as well.

Signs and symptoms

Pain in the knee joint. Some swelling may be noted. Catching, or locking, in the joint.

Complications if left unattended

The loose bodies and jagged edges of a meniscal tear can cause premature wear on the cartilage at the ends of the bones and under the patella. This can lead to arthritic conditions and a fluid build-up in the knee joint.

Meniscus Tear Type

Treatment

  • Anti-inflammatory medication
  • Surgery may be needed to repair the torn meniscus

Rehabilitation and prevention

After repair of a meniscal tear, it is important to strengthen the muscles surrounding the knee to prevent the injury from happening again. Strong quadriceps and hamstring help support the knee and prevent the twisting that might cause a tear. The muscles should be stretched regularly as well since tight muscles can also cause problems in the knee. After repair of a meniscus tear, weight bearing should be encouraged as tolerable, but as with any restart of activity it should be done gradually.

Long-term prognosis

A tear to a meniscus usually requires arthroscopic surgery to repair. The surgery requires removal of the torn edges of the meniscus but leaves the main body of the meniscus intact. Therefore, most meniscus tears heal fully with no long-term limitations.

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