The humble knee is a true orthopedic workhorse. With its combination of bone, cartilage, ligaments and fluid, it carries us through life—until something goes wrong.
“Many knee injuries are caused by fairly minor traumatic events,” says Dr. Jerome Piontek, an orthopedic surgeon at St. Luke’s Hospital. “Knee pain without a specific injury often develops as a result of wear and tear or many minor injuries over time.”
The repetitive movement of the knee through the years is enough to wear down cartilage as we age, causing pain and affecting mobility. For people who are overweight or obese, the knees bear a greater load and are at risk of breaking down sooner. However, anyone can injure a knee regardless of age, gender or activity level.
“The most common injuries are either to the bone, which are pretty rare, or injury to the soft tissues,” says Dr. Fallon Maylack, an orthopedic surgeon with SSM Orthopedics. “Ligament sprains are commonly caused by twisting or falling. We see bruises or fractures when kids fall off jungle gyms or bicycles.” One of the most common sports-related injuries is a tear in the main, stabilizing knee ligament, known as the anterior cruciate ligament or ACL.
Maylack advises seeking medical attention after a knee injury if there is significant swelling, pain when bearing weight, or pain caused by movement that doesn’t improve after a day or two.
Diagnosis often involves both external assessment and taking images of bone and soft tissues. “I always start with obtaining a full history about the injury—things like recall of the incident itself, whether the swelling occurred immediately after the event, whether the patient was able to complete the task or sporting activity, etc.,” says Dr. Adnan Cutuk, a SLUCare orthopedic surgeon. “Following a full history, I complete the knee examination and obtain an X-ray. If I suspect ligament and cartilage injury, then I obtain an MRI of the knee to gather further information.”
Treatment is highly individualized. “Even two of the same type of injury in two different patients could be treated differently, since I always consider their individual expectations, activity level, age, history of their condition, etc.,” Cutuk says. For example, a physically active patient who injures his knee while skiing or playing a recreational sport requires a different treatment approach than someone with the same type of injury who is primarily sedentary and overweight.
Many injuries simply need time to heal. Resting and elevating the knee, using ice to control swelling, and wrapping the knee in a compression bandage or brace are initial treatments. Surgery is needed to repair more serious injuries, and physical therapy is an important part of surgical recovery.
Knee injury prevention involves maintaining strength and flexibility through physical activity, as well as maintaining a healthy weight so that the knees are not unduly stressed. “Also, ‘playing to your level’ remains my personal favorite (prevention strategy),” Cutuk says. “When taking on the new sporting activity, one must recognize his or her limitations and play to his own level or ability. For example, skiing a black diamond run after not skiing for several years and without warming up increases your risk of injury, as does playing in a soccer league that tends to be significantly more competitive then one’s individual commitment to the sport.”
Maylack sums up, “It really comes down to common sense, being careful and using your head. Follow your mother’s advice, and just don’t do anything too silly.”