Knee Injuries
Knee injuries - Most common injuries are listed below. Accurate diagnosis and treatment of acute injury is necessary to ensure the best chance of a successful return to normal activity or sports. The most common knee problem I see is not an actual injury but pain in or around the knee cap. This is frequently successfuly resolved. Treatment usually consists of FSM microcurrent, soft tissue therapy ( Active Release Technique and Trigger Point Therapy) Sports Massage, Dry Needling, Kinesio Taping. Also trying to determine the underlying cause and help the patient correct this.
- Meniscal injury
- Medial collateral ligament (MCL) injury
- Anterior cruciate ligament (ACL) injury
- Posterior cruciate ligament (PCL) injury
- Lateral collateral ligament (LCL) injury
- Articular cartilage damage
- Fracture of the patella (kneecap)
- Patella dislocation (kneecap)
- Patella tendon rupture
- Fat pad impingement
- Fracture of the tibial plateau
- Superior tibiofibular joint injury
- Ruptured hamstring tendon
- Patellofemoral syndrome (anterior knee pain, runner’s knee)
- Patellar tendinopathy (jumper’s knee)
- Synovial plica
- Osgood-Schlatter’s disease
- Sinding-Larsen–Johansson syndrome
- Quadriceps tendinopathy
- Pre-patellar bursitis (housemaid’s knee)
- Iliotibial band friction syndrome (ITBFS)
- Biceps femoris tendinopathy
- Pes anserinus tendinopathy
- Pellegrini-Stieda syndrome
- Popliteus tendinopathy
- Gastrocnemius tendinopathy
- Baker’s cyst
Meniscal Injury
What is it?
A meniscal injury refers to damage to one of the two C-shaped cartilages which separate the bones in the
knee joint. These cartilages act as shock absorbers within the knee to assist in cushioning forces.
How does it happen?
The menisci in the knee are most commonly injured when the knee is twisted. This often occurs when
changing directions quickly whilst the foot is fixed on the ground. It may also occur if a fellow competitor hits
your knee causing it to twist or buckle.
How does it feel?
The first sensation felt when a meniscus is injured is pain within the knee joint. This may be associated with
a sensation of something tearing. Depending on the severity of the injury, the knee may swell and you may
have difficulty walking due to pain. Swelling may be immediate or occur over a period of hours. The knee
may also feel weak and ‘unstable’, and may produce clicking noises, lock or give way.
What should you do?
To limit the severity of this injury it is advised you stop your activity immediately and start initial treatment.
The most important time in the treatment of any injury is the first 24–48 hours. Swelling is a necessary step
in the healing process; however, too much swelling can delay healing and cause further tissue damage. To
control the amount of swelling and limit the degree of damage to the knee, the RICE regime should be
commenced (Rest, Ice, Compression, Elevation). This will help to reduce blood flow to the injured area,
thereby reducing the extent of swelling and tissue damage.
Rest involves ceasing your activity or sport, and limiting the amount of weight you put through your leg.
Crutches may be required if you are having difficulty walking.
Ice should be applied to the injured site for 15–20 minutes every 1–2 hours. Ideally, it should be applied
using crushed ice wrapped in a moist cloth or towel.
Compression involves the application of a firm elastic bandage around your knee. It should be firm but not
tight enough to cause pain.
Elevation involves lying with your knee resting comfortably on a chair or pillows so that it is above the level
of your heart. You should continue the RICE regime until you consult a sports medicine professional,
preferably within two days of the initial injury.
What shouldn’t you do?
Following injury to a meniscus, you shouldn’t undertake activities which increase blood flow to the injured
area. These include hot showers, heat rubs, the consumption of alcohol and excessive activity. These may
increase the bleeding and swelling within the knee and potentially prolong your recovery.
Could there be any long-term effects?
Because the menisci in the knee have a poor blood supply, when they are injured they are unable to heal by
themselves. As such, they can result in ongoing problems, depending on the severity of the injury. These
problems include persistent knee swelling, clicking, locking and giving way. To limit these ongoing problems
surgery is often performed to remove the damaged portion of the meniscus. Recovery from surgery normally
takes a number of weeks. In some situations, this may be prolonged if, at the time of the injury, other
structures within the knee were also injured.
Management
The assistance of a sports medicine professional is important in the treatment of a meniscal injury. Initially
they can assist in determining which tissues have been damaged and the extent of this damage. From this,
they will be able to determine the most appropriate treatment. This may involve surgery, activity
modification, and strengthening and stretching exercises
Medial collateral ligament (MCL) injury
What is it?
A medial collateral ligament injury refers to a sprain (tear) in the ligament which runs down and supports the
inner aspect of the knee joint.
How does it happen?
The medial collateral ligament is injured when it is overstretched (sprained). This commonly occurs when an
opponent or team-mate falls across the outside of your knee when your foot is fixed on the ground. This
causes the knee to bend inwards, overstretching and injuring the medial collateral ligament.
How does it feel?
The first sensation felt when the medial collateral ligament is injured is pain along the inner aspect of the
knee. There may also be an audible snap, crack or tear. Depending on the severity of the injury, the knee
may swell and you may have difficulty walking due to pain. Swelling may be immediate or occur over a
period of hours. The knee may also feel weak and ‘unstable’.
What should you do?
To limit the severity of this injury it is advised you stop your activity immediately and start initial treatment.
The most important time in the treatment of any injury is the first 24–48 hours. Swelling is a necessary step
in the healing process; however, too much swelling can delay healing and cause further tissue damage. To
control the amount of swelling and limit the degree of damage to the knee, the RICE regime should be
commenced (Rest, Ice, Compression, Elevation). This will help to reduce blood flow to the injured area,
thereby reducing the extent of swelling and tissue damage.
Rest involves ceasing your activity or sport, and limiting the amount of weight you put through your leg.
Crutches may be required if you are having difficulty walking.
Ice should be applied to the injured site for 15–20 minutes every 1–2 hours. Ideally, it should be applied
using crushed ice wrapped in a moist cloth or towel.
Compression involves the application of a firm elastic bandage around your knee. It should be firm but not
tight enough to cause pain.
Elevation involves lying with your knee resting comfortably on a chair or pillows so that it is above the level
of your heart. You should continue the RICE regime until you consult a sports medicine professional,
preferably within two days of the initial injury.
What shouldn’t you do?
Following injury to the medial collateral ligament, you shouldn’t undertake activities which increase blood
flow to the injured area. These include hot showers, heat rubs, the consumption of alcohol and excessive
activity. These may increase the bleeding and swelling around the injured ligament and potentially prolong
your recovery.
Could there be any long-term effects?
Most medial collateral ligament injuries heal without complication within a matter of weeks. However, a
proportion of injuries can result in longer-term effects depending on the severity of the injury and extent of
damage. When the medial collateral ligament is injured, it is not uncommon to also injure other ligaments
which support the knee and surrounding structures. Injury to these structures may prolong your recovery.
Similarly, recovery may be delayed if the injury is not appropriately diagnosed and managed. This may
result in a poorly healed ligament which is susceptible to reinjury when you return to sport.
Management
The assistance of a sports medicine professional is important in the treatment of a medial collateral ligament
injury. Initially, they can determine which tissues have been damaged and the extent of this damage.
Imaging techniques such as an X-ray, ultrasound or CT scan may be used to confirm the diagnosis. Your
sports medicine professional will then determine how long the injury should to take to heal. In addition,
sports medicine professionals can use a number of treatment techniques to assist in reducing the pain and
swelling and enhance the healing of the injured structures. This will facilitate your return to activity and sport
and limit possible long-term effects. You will be provided and supervised with a rehabilitation program, which
will progress you through a series of exercises designed to limit both long-term effects and reduce your
chance of reinjury. A sports medicine professional will also be able to advise you on other preventive
measures such as the use of strapping tape or knee braces.
Anterior cruciate ligament (ACL) injury
What is it?
An anterior cruciate ligament or ‘ACL’ injury refers to a tear in one of the cruciate ligaments inside the knee
joint.
How does it happen?
The ACL is most commonly injured when the knee is twisted. This can occur when landing from a jump,
pivoting or decelerating suddenly. Often it is surprising how relatively simple the movement or activity is
which injures the ACL. The ACL may also be torn when the knee is injured directly. This can occur, for
example, when another player falls across your knee, bending it in the wrong direction.
How does it feel?
When the ACL is torn, there is often an audible ‘pop’, ‘crack’ or feeling of something going out and then
going back in. When the ACL is completely torn, you may experience extreme pain for the first few minutes
after the injury. Even though the pain may subside quickly, you will usually be unable to continue
participating because the knee may feel ‘unstable’ or collapse when you try run and twist on the knee.
Following an ACL injury the knee frequently swells. This may occur quickly (i.e. within the first couple hours)
or overnight.
What should you?
To limit the severity of the symptoms it is advised you stop your activity immediately and start initial
treatment. The most important time in the treatment of any injury is the first 24–48 hours. Swelling is a
necessary step in the healing process; however, too much swelling can delay healing and cause further
tissue damage. To control the amount of swelling and limit the degree of damage to the knee, the RICE
regime should be commenced (Rest, Ice, Compression, Elevation). This will help to reduce blood flow to the
injured area, thereby reducing the extent of swelling and tissue damage.
Rest involves ceasing your activity or sport, and limiting the amount of weight you put through your leg.
Crutches may be required if you are having difficulty walking.
Ice should be applied to the injured site for 15–20 minutes every 1–2 hours. Ideally, it should be applied
using crushed ice wrapped in a moist cloth or towel.
Compression involves the application of a firm elastic bandage around your knee. It should be firm but not
tight enough to cause pain.
Elevation involves lying with your knee resting comfortably on a chair or pillows so that it is above the level
of your heart. You should continue the RICE regime until you consult a sports medicine professional,
preferably within two days of the initial injury.
What shouldn’t you do?
If you have or suspect you have injured your ACL, you shouldn’t continue to participate. This may cause
your knee to give way or collapse, potentially injuring other structures. In addition, you shouldn’t undertake
activities which increase blood flow to the injured knee. These include hot showers, heat rubs, the
consumption of alcohol and excessive activity. These may increase the bleeding and swelling around the
injured ligament and potentially prolong your recovery.
Could there be any long-term effects?
Unfortunately, an injury to the ACL often results in a prolonged recovery, and is the most common cause of
prolonged absence from sport. Two reasons for this are that the ACL does not heal by itself and that the
knee cannot function very well without this ligament. Surgery is usually required to repair or ‘reconstruct’ the
ACL. During surgery, tissue from another part of your body may be used to replace or reconstruct the ACL.
Following surgery, it may be more than twelve months before you return to full contact sport. This may be
prolonged if, at the time of your injury you also injured surrounding structures. Other structures that may be
injured could include the menisci, the medial collateral ligament, or cartilage lining the joint surfaces. Injury
to these structures may result in prolonged swelling and pain and a slow recovery following surgery.
Management
The assistance of a sports medicine professional is important in the treatment of an ACL injury. Initially, they
can assist in confirming your diagnosis and determine whether you need surgery. Whether you undergo
surgery or not, the sports medicine professional will also be able to assist in returning you to your job, activity
or sport. This will involve a rehabilitation program designed to assist in reducing your swelling, improve your
joint flexibility and strengthen the muscles supporting the knee joint.
Posterior cruciate ligament (PCL) injury
What is it?
A posterior cruciate ligament or ‘PCL’ injury refers to a tear in one of the cruciate ligaments inside the knee
joint.
How does it happen?
The PCL is most commonly injured when the knee is hyperextended or, in other words, bent backwards.
This can happen when you land from jumping with the knee straight or when a fellow participant hits the front
of your knee joint.
How does it feel?
The first sensation felt when the posterior cruciate ligament is injured is a deep pain within the knee or at the
back of the knee. There may also be an audible snap, crack or tear. Depending on the severity of the injury,
the knee may swell and you may have difficulty walking due to pain. Swelling may be immediate or occur
over a period of hours. The knee may also feel weak and ‘unstable’.
What should you do?
To limit the severity of the symptoms it is advised you stop your activity immediately and start initial
treatment. The most important time in the treatment of any injury is the first 24–48 hours. Swelling is a
necessary step in the healing process; however, too much swelling can delay healing and cause further
tissue damage. To control the amount of swelling and limit the degree of damage to the knee, the RICE
regime should be commenced (Rest, Ice, Compression, Elevation). This will help to reduce blood flow to the
injured area, thereby reducing the extent of swelling and tissue damage.
Rest involves ceasing your activity or sport, and limiting the amount of weight you put through your leg.
Crutches may be required if you are having difficulty walking.
Ice should be applied to the injured site for 15–20 minutes every 1–2 hours. Ideally, it should be applied
using crushed ice wrapped in a moist cloth or towel.
Compression involves the application of a firm elastic bandage around your knee. It should be firm but not
tight enough to cause pain.
Elevation involves lying with your knee resting comfortably on a chair or pillows so that it is above the level
of your heart. You should continue the RICE regime until you consult a sports medicine professional,
preferably within two days of the initial injury.
What shouldn’t you do?
If you have or suspect you have injured your PCL, you shouldn’t continue to participate. This may cause
your knee to give way or collapse, potentially injuring other structures. In addition, you shouldn’t undertake
activities which increase blood flow to the injured knee. These include hot showers, heat rubs, the
consumption of alcohol and excessive activity. These may increase the bleeding and swelling around the
injured ligament and potentially prolong your recovery.
Could there be any long-term effects?
Although PCL injuries do not heal by themselves, with a comprehensive rehabilitation program you can
usually return to sport within a matter of months. However, this may be prolonged if at the time of your
injury, you also injured surrounding structures. These include the menisci inside the knee and the cartilage
lining the joint surfaces. Injury to these structures may result in prolonged swelling and pain and a slow
recovery. In some instances when the PCL is injured, surgery may be required to repair the ligament or to
repair any damage to surrounding structures.
Management
The assistance of a sports medicine professional is important in the treatment of a PCL injury. Initially, they
can assist in confirming your diagnosis and determine whether you have injured any surrounding structures.
From this, they will be able to determine how long the injury is expected to take to heal and determine an
appropriate treatment program. This may involve a series of exercises designed to assist in reducing your
swelling, improve your joint flexibility and strengthen the muscles supporting the knee joint.
Lateral collateral ligament (LCL) injury
What is it?
A lateral collateral ligament injury refers to a tear in the ligament which runs down and supports the outer
aspect of the knee joint.
How does it happen?
The lateral collateral ligament is injured when it is overstretched (sprained). This commonly occurs when an
opponent or team-mate falls across the inside of your knee when your foot is fixed on the ground. This
causes the knee to bend outwards, overstretching and injuring the lateral collateral ligament.
How does it feel?
The first sensation felt when the lateral collateral ligament is injured is pain along the outer aspect of the
knee. There may also be an audible snap, crack or tear. Depending on the severity of the injury, the knee
may swell and you may have difficulty walking due to pain. Swelling may be immediate or occur over a
period of hours. The knee may also feel weak and ‘unstable’.
What should you do?
To limit the severity of the symptoms it is advised you stop your activity immediately and start initial
treatment. The most important time in the treatment of any injury is the first 24–48 hours. Swelling is a
necessary step in the healing process; however, too much swelling can delay healing and cause further
tissue damage. To control the amount of swelling and limit the degree of damage to the knee, the RICE
regime should be commenced (Rest, Ice, Compression, Elevation). This will help to reduce blood flow to the
injured area, thereby reducing the extent of swelling and tissue damage.
Rest involves ceasing your activity or sport, and limiting the amount of weight you put through your leg.
Crutches may be required if you are having difficulty walking.
Ice should be applied to the injured site for 15–20 minutes every 1–2 hours. Ideally, it should be applied
using crushed ice wrapped in a moist cloth or towel.
Compression involves the application of a firm elastic bandage around your knee. It should be firm but not
tight enough to cause pain.
Elevation involves lying with your knee resting comfortably on a chair or pillows so that it is above the level
of your heart. You should continue the RICE regime until you consult a sports medicine professional,
preferably within two days of the initial injury.
What shouldn’t you do?
Following injury to the lateral collateral ligament, you shouldn’t undertake activities which increase blood flow
to the injured area. These include hot showers, heat rubs, the consumption of alcohol and excessive
activity. These may increase the bleeding and swelling around the injured ligament and potentially prolong
your recovery.
Could there be any long-term effects?
Most lateral collateral ligament injuries heal without complication within a matter of weeks. However, a
proportion of injuries can result in longer-term effects, depending on the severity of the injury and extent of
damage. When the lateral collateral ligament is injured, it is not uncommon to also injure other ligaments
which support the knee and surrounding structures. Injury to these structures may prolong your recovery.
Similarly, recovery may be delayed if the injury is not appropriately diagnosed and managed. This may
result in a poorly healed ligament which is susceptible to reinjury when you return to your activity or sport.
Management
The assistance of a sports medicine professional is important in the treatment of a lateral collateral ligament
injury. Initially, they can diagnose which tissues have been damaged and the extent of this damage. From
this, a determination of how long the injury is expected to take to heal can be provided. In addition, the
sports medicine professional can use a number of treatment techniques to assist in reducing the pain and
swelling and enhance the healing of the injured structures. This will facilitate your return to exercise and
sport and limit possible long-term effects. This will be assisted by progressing you through a series of
exercises designed to both limit long-term effects and reduce your chance of reinjury upon return to sport. In
terms of the latter, a sports medicine professional will also be able to advise you on other preventive
measures such as the use of strapping tape or knee braces.
Articular cartilage damage
What is it?
Articular cartilage damage refers to an injury to the cartilage lining the joint surfaces of the bones within the
knee joint.
How does it happen?
The articular cartilage of the knee joint may be damaged in isolation following a direct injury to the knee.
This may occur when you land on your knees, compressing the kneecap against the underlying bone and
cartilage. Similarly, the articular cartilage within the knee may be damaged when any of the structures
supporting the knee joint are injured (i.e. ligaments, menisci).
How does it feel?
Damage to the articular cartilage within the knee results in pain within the knee joint. Damage occurs
frequently deep within the joint or behind the kneecap. The pain is often aggravated by activities which
compress the damaged cartilage such as weight-bearing. Similarly, damage to the articular cartilage results
in ongoing and persistent swelling within the knee.
What should you do?
If you have or suspect you have injured your articular cartilage, you should cease your activity or sport and
begin initial treatment to control any swelling. To limit the severity of the symptoms it is advised you stop
your activity immediately and start initial treatment. The most important time in the treatment of any injury is
the first 24–48 hours. Swelling is a necessary step in the healing process; however, too much swelling can
delay healing and cause further tissue damage. To control the amount of swelling and limit the degree of
damage to the knee, the RICE regime should be commenced (Rest, Ice, Compression, Elevation). This will
help to reduce blood flow to the injured area, thereby reducing the extent of swelling and tissue damage.
Rest involves ceasing your activity or sport, and limiting the amount of weight you put through your leg.
Crutches may be required if you are having difficulty walking.
Ice should be applied to the injured site for 15–20 minutes every 1–2 hours. Ideally, it should be applied
using crushed ice wrapped in a moist cloth or towel.
Compression involves the application of a firm elastic bandage around your knee. It should be firm but not
tight enough to cause pain.
Elevation involves lying with your knee resting comfortably on a chair or pillows so that it is above the level
of your heart. You should continue the RICE regime until you consult a sports medicine professional,
preferably within two days of the initial injury.
What shouldn’t you do?
If you have or suspect you have damaged your articular cartilage, you shouldn’t undertake activities which
increase blood flow to the injured area. These include hot showers, heat rubs, the consumption of alcohol
and excessive activity. These may increase the swelling within the knee and potentially prolong your
recovery.
Could there be any long-term effects?
Unfortunately, damage to the articular cartilage can result in long-term effects. Depending on the severity of
the injury, damage to the articular cartilage within the knee can result in ongoing pain and swelling, resulting
in a prolonged recovery. In addition, articular cartilage damage can result in the development of arthritis
within the joint.
Management
The assistance of a sports medicine professional is important in the treatment of articular cartilage damage.
Initially, they can assist in determining the extent of the damage. The use of imaging techniques such as X-
ray or MRI may be of benefit. In addition, this injury may require arthroscopic surgery to directly visualise the
cartilage. From this, they will be able to determine the most appropriate treatment. This may involve activity
modification, treatments to decrease pain and swelling, and strengthening and stretching exercises.
Fracture of the patella (kneecap)
What is it?
A fracture of the patella refers to a break in the kneecap bone.
How does it happen?
The kneecap is typically fractured following a direct blow to the front of the knee. It may also be fractured
with a strong contraction of the quadriceps muscle on the front of your thigh. Contraction of this muscle
places increased force on your kneecap. If these forces are great enough, your kneecap can break.
How does it feel?
The first sensation felt when the kneecap is fractured is immediate and intense pain over the front of the
knee. This pain may worsen with movement of the knee joint or tightening of the thigh muscle. The pain is
frequently strong enough to cause you to limp and, in some instances, may be so intense that you are
unable to put any weight through the injured leg at all. If the kneecap has a complete break in it, the broken
pieces of bone may move on one another. This may give the front of the knee a different appearance to
normal. An altered appearance may also result from swelling around the injury. Swelling may occur quickly
(i.e. within the first 1–2 hours) or overnight.
What should you do?
A patella fracture represents a serious knee injury. If you suspect a patella fracture it is advised you cease
your activity or sport, begin initial treatment and seek immediate medical attention. Initial treatment involves
immobilising the knee as soon as possible using splints and bandages. You may raise the injured knee
above the level of the heart once immobilised to help reduce pain and swelling.
What shouldn’t you do?
If you have or suspect you have fractured your kneecap, you shouldn’t perform any activities which may
cause the broken ends of the bone to move on one another. To achieve this, you shouldn’t use or bend the
injured leg until it has been assessed by a sports medicine professional. In addition, you should avoid any
activities which may increase blood flow to the injured area. These include hot showers, heat rubs, massage
and the consumption of alcohol. These may increase bleeding and swelling around the broken ends of bone
and potentially prolong your recovery.
Could there be any long-term effects?
Most fractures of the kneecap heal without complication in a matter of weeks. However, a proportion of
injuries can result in longer-term effects depending on the severity of the injury and extent of damage. Injury
may also occur to the cartilage lining the undersurface of the kneecap and the tissues which support the
kneecap. Injury to these structures may delay recovery. A delayed recovery may occur if the broken ends of
bone fail to join back together. In addition to prolonging your recovery, injury to the underlying cartilage can
also increase your chance of developing arthritis within the knee in later life.
Management
The assistance of a sports medicine professional is important in the treatment of a fractured kneecap.
Initially, they can assist in diagnosing the injury and the extent of the damage. Imaging techniques such as
an X-ray, CT scan or MRI may be of benefit. From this, they can estimate how long the injury is expected to
take to heal and determine an appropriate treatment program. This may involve using crutches, wearing a
splint or brace and, in some cases, surgery to hold the broken pieces of bones together. During your
recovery, the sports medicine professional will also be able to give you a series of exercises designed to
facilitate your recovery and reduce the risk of secondary injury when you return to your activity or sport.
Patella dislocation (kneecap)
What is it?
Dislocation of the patella refers to when the kneecap (patella) moves out, and stays out of its normal
position.
How does it happen?
The patella is dislocated when forces acting on the kneecap are too great for the supporting muscles and
ligaments to resist. This can occur with a direct blow to the kneecap which pushes it out to the side of the
leg. For example, when landing on your knees. Alternatively, the patella may be dislocated when the knee
is twisted such as during rapid changes in direction.
How does it feel?
The first sensation felt when the patella is dislocated is immediate and intense pain over the front of the
knee. The pain may be associated with a feeling of the knee ‘giving way’ or something ‘popping out’. This
‘popping out’ or dislocation of the patella is often visible when you compare the appearance and contours of
the injured knee to the opposite side. The knee may also swell quickly (i.e. within the first 1–2 hours).
What should you do?
A patellar dislocation is a serious injury which requires immediate medical attention. If you have or suspect
that you have dislocated your kneecap, you should cease your activity or sport and go directly to your
nearest sports medicine professional or doctor. To help with your pain and reduce and control any swelling,
you should surround the knee in ice. Ideally, this should be in the form of crushed ice wrapped in a moist
towel or cloth and applied for up to 20 minutes.
What shouldn’t you do?
If you have or suspect that you have dislocated your kneecap, the main thing you shouldn’t do is try to
‘reduce’ or relocate the kneecap back into its socket by yourself. This requires the assistance of a sports
medicine professional or a doctor. If done incorrectly, serious damage may be sustained to other structures
(nerves, bones, ligaments, cartilage) resulting in irreparable damage and/or a longer recovery time. In
addition, you shouldn’t undertake any activities which increase blood flow to the injured site. These include
hot showers, heat rubs, alcohol and massage. These will cause further swelling in the damaged tissues
resulting in a prolonged recovery.
Could there be any long-term effects?
Due to the seriousness of a patellar dislocation, there are unfortunately potential long-term effects. The most
common of these is recurrent or ongoing patellar dislocations. When the kneecap is dislocated the tissues
which support it are overstretched and, in some cases, torn. This makes the joint less stable and decreases
its ability to resist or withstand external forces. As a consequence, it dislocates much more easily. Other
long-term effects result from damage to surrounding structures when the kneecap is dislocated.
Occasionally, when the kneecap is dislocated the cartilage lining the undersurface of the patella may be
damaged. Damage to this structure can prolong your recovery and increase your chance of developing knee
arthritis.
Management
The assistance of a sports medicine professional is important in the treatment of a dislocated patella.
Initially, they can confirm that the kneecap is actually dislocated. If it is, they can relocate or ‘reduce’ the
kneecap back into its normal position. Following this, they can assess which tissues have been damaged
and the extent of this damage. This may require the use of an X-ray, CT scan, MRI or arthroscope. From
this, they can estimate how long the injury is expected to take to heal. During your recovery, the sport
medicine professional will be able to assist in reducing your pain and promoting your recovery. This may
involve wearing a brace and using crutches for the first few weeks, followed by progressing you through a
series of exercises designed to return you back to your activity or sport and reduce the risk of ongoing
dislocations. A sports medicine professional will also be able to advise you on other preventive measures
such as the use of strapping tape or knee braces.
Tendon rupture
What is it?
Patella tendon rupture refers to a complete tear of the tendon which joins the kneecap (patella) to the shin
bone (tibia).
How does it happen?
Complete tears of the patella tendon often occur when the thigh muscle (quadriceps) is forcibly contracted.
The function of the patellar tendon is to transmit forces produced by the thigh muscle to the shin bone.
Forcible contraction of this muscle can overstress the patella tendon, resulting in it breaking or completely
tearing.
How does it feel?
A complete tear of the patella tendon results in instant pain felt in the front of the knee just below the
kneecap. Associated with this may be a feeling of something tearing or snapping. Following a complete tear
of the patella tendon, you will be unable to continue your activity or sport due to profound weakness in the
thigh muscle. You may also be unable to stand on the injured leg without it collapsing or giving way.
What should you do?
A complete tear of the patellar tendon is a serious injury which requires surgical repair. Therefore, if you
have or suspect you have a complete tear of the patellar tendon, it is advised you seek the assistance of a
sports medicine professional as soon as possible (i.e. on the same day as the injury). In the meantime, you
can commence early treatment to limit the amount of bleeding and swelling within and around the torn ends
of the tendon. To control the amount of swelling the RICE regime should be commenced (Rest, Ice,
Compression, Elevation). This will help to reduce blood flow to the injured area, thereby reducing the extent
of swelling and tissue damage.
Rest involves ceasing your activity or sport, and limiting any weight you put through your leg. Crutches will
be required.
Ice should be applied to the injured site for 15–20 minutes every 1–2 hours. Ideally, it should be applied
using crushed ice wrapped in a moist cloth or towel.
Compression involves the application of a firm elastic bandage around your knee. It should be firm but not
tight enough to cause pain.
Elevation involves lying with your knee resting comfortably on a chair or pillows so that it is above the level
of your heart. You should continue the RICE regime until you consult a sports medicine professional,
preferably on the same day as the injury.
What shouldn’t you do?
Following a complete tear of the patella tendon, you shouldn’t undertake activities which increase blood flow
to the injured site and, therefore, bleeding and swelling to the area. These include hot showers, heat rubs,
the consumption of alcohol and excessive activity.
Could there be any long-term effects?
A complete tear of the patella tendon is a serious injury which does not heal by itself without appropriate
treatment. Appropriate treatment often involves surgical repair. Following surgery, the rehabilitation period
is prolonged and it may be a number of months before you can walk on the injured leg. It may be a further
number of months before your muscle flexibility and strength return to satisfactory levels to enable return to
your activity or sport. Even then there is often some residual disability.
Management
The assistance of a sports medicine professional is important in the treatment of a complete tear of the
patellar tendon. Initially, they will diagnose the problem and establish the severity of the tear. Imaging
techniques such as ultrasound or MRI may be used. From this, the sports medicine professional will be able
to determine an appropriate treatment plan. In the majority of cases this will involve surgical repair.
Following surgery, the sports medicine professional will be able to rehabilitate your tendon so that you can
return to your activity or sport. This may involve the use of soft tissue treatments such as massage and
stretching, and a progressive rehabilitation program.
Fat pad impingement
What is it?
Also known as Hoffa’s syndrome, fat pad impingement refers to when the fat pad in the front of the knee joint
gets pinched between the kneecap and the underlying leg bone.
How does it happen?
The fat pad on the front of the knee can get pinched two ways. Firstly, it can get pinched if the knee is
forcibly extended or straightened. This can occur when kicking or landing from a jump, and causes the
bottom of the kneecap to dig into the fat pad. Secondly, the fat pad may get pinched if it is enlarged or
swollen. This can occur with repetitive minor pinching, or following damage to the fat pad such as occurs
during arthroscopic surgery. This results in it bulging around the bottom of the kneecap making it more
susceptible to being pinched. When the fat pad is pinched it can become inflamed and painful.
How does it feel?
Fat pad impingement results in pain felt just beneath the kneecap. This is most commonly felt when the
knee is forcibly extended or straightened. When the impingement is due to an enlarged or swollen fat pad,
the area below the kneecap may bulge and may be firmer than on the other knee, due to the formation of
scar tissue.
What should you do?
If you have or suspect you have fat pad impingement, you should consult your nearest sports medicine
professional. In the meantime, you should avoid any activities which cause pinching of your fat pad and
make your pain worse. Icing the front of your knee will be of benefit. Ice should be applied to the injured area
for 15–20 minutes every 1–2 hours. Ideally, it should be applied using crushed ice wrapped in a moist cloth
or towel.
What shouldn’t you do?
If you have or suspect you have fat pad impingement, you shouldn’t ignore the problem. This may result in
ongoing pinching of the fat pad and ongoing pain.
Could there be any long-term effects?
Fat pad impingement does not produce any long-term effects, as long as it is properly diagnosed and
appropriately treated. If not, it can lead to prolonged pain in the region just below the kneecap and a
prolonged lay-off from your activity or sport.
Management
The assistance of a sports medicine professional is important in the treatment of fat pad impingement.
Initially, they can assist in diagnosing the problem and its severity. From this, the sports medicine
professional will be able to determine an appropriate treatment plan. This may involve activity modification,
regular icing, the taking of anti-inflammatory medications and taping of the knee.
Fracture of the tibial plateau
What is it?
A fracture of the tibial plateau refers to a break in the top of the shin bone (tibia) just below where it joins with
the thigh bone to form the knee joint.
How does it happen?
The tibial plateau may be fractured following a direct blow to the knee joint or as a result of a compressive
force going through the knee. The latter may occur when forces are transmitted up the leg following a fall
from a height or when the knee is bent in the wrong direction.
How does it feel?
The first sensation experienced when the tibial plateau is fractured is immediate and intense pain within the
knee joint. This pain is often made worse by movement of the knee and is frequently strong enough to
prevent you from putting any weight through the injured leg. The knee may also swell quickly following injury
(i.e. within the first 1–2 hours).
What should you do?
A fracture of the tibial plateau represents a serious knee injury. If you suspect a tibial plateau fracture it is
advised you cease your activity or sport, begin initial treatment and seek immediate medical attention. Initial
treatment involves immobilising the knee as soon as possible using splints and bandages. Once the knee is
immobilised, you may raise it above the level of the heart to help reduce pain and swelling.
What shouldn’t you do?
If you have or suspect you have fractured your tibial plateau, you shouldn’t perform any activities which
cause excessive movement of the injured leg until it has been assessed by a sports medicine professional.
In addition, you should avoid any activities which may increase blood flow to the injured area. These include
hot showers, heat rubs, massage and the consumption of alcohol. These may increase bleeding and
swelling around the broken bone and potentially prolong your recovery.
Could there be any long-term effects?
Many tibial plateau fractures heal without complication within a matter of weeks. However, a proportion of
injuries can result in longer-term effects, depending on the severity of the injury and extent of damage.
When the tibial plateau is broken, a number of structures close to the bone may also be injured. These
include the cartilage lining the knee joint and the ligaments which support the knee. Injury to these
structures may delay your recovery. In addition to prolonging your recovery, injury to the underlying cartilage
can also increase your chance of developing arthritis within the knee.
Management
The assistance of a sports medicine professional is important in the treatment of a tibial plateau fracture.
Initially, they can assist in diagnosing the injury and the extent of the damage. This may require the use of
an X-ray to visualise the bone. From this, they will be able to estimate how long the injury is expected to
take to heal and determine an appropriate treatment program. This may involve using crutches, wearing a
splint or brace and, in some cases, surgery to hold the broken pieces of bones together. When your bone
has healed sufficiently, the sports medicine professional will be able give you a series of exercises designed
to facilitate your recovery and reduce the risk of other injuries when you return to activity or sport.
Superior tibiofibular joint injury
What is it?
The superior tibiofibular joint is the joint between the shin bone (tibia) and the smaller bone in the leg (fibula)
where they meet just below the knee joint. A superior tibiofibular joint injury refers to when this joint and its
supporting structures are damaged.
How does it happen?
An injury to the superior tibiofibular joint may result from direct trauma to the joint. This can occur when the
outside of the leg is kicked just below the knee joint. Similarly, the joint may be injured when the leg is
rotated or twisted. This can occur when pivoting or cutting from side-to-side and is often coupled with an
injury to either the ankle or knee.
How does it feel?
A superior tibiofibular joint injury results in pain felt just below the outside of the knee. This is usually brought
on by activities which require rotation of the leg. For example, pivoting or cutting from side-to-side.
What should you do?
If you have or suspect you have injured your superior tibiofibular joint, you should cease your activity or sport
and begin initial treatment to control any swelling and to limit the severity of the symptoms. The most
important time in the treatment of any injury is the first 24–48 hours. Swelling is a necessary step in the
healing process; however, too much swelling can delay healing and cause further tissue damage. To control
the amount of swelling and limit the degree of damage to the superior tibiofibular joint, the RICE regime
should be commenced (Rest, Ice, Compression, Elevation). This will help to reduce blood flow to the injured
area, thereby, reducing the extent of swelling and tissue damage.
Rest involves ceasing your activity or sport, and limiting the amount of weight you put through your leg.
Crutches may be required if you are having difficulty walking.
Ice should be applied to the injured site for 15–20 minutes every 1–2 hours. Ideally, it should be applied
using crushed ice wrapped in a moist cloth or towel.
Compression involves the application of a firm elastic bandage around your knee and leg. It should be firm
but not tight enough to cause pain.
Elevation involves lying with your knee and leg resting comfortably on a chair or pillows so that it is above
the level of your heart. You should continue the RICE regime until you consult a sports medicine
professional, preferably within two days of the initial injury.
What shouldn’t you do?
Following an injury to the superior tibiofibular joint, you shouldn’t undertake activities which increase blood
flow to the injured area. These include hot showers, heat rubs, the consumption of alcohol and excessive
activity. These may increase the bleeding and swelling within the injured structures and potentially prolong
your recovery.
Could there be any long-term effects?
An injury to the superior tibiofibular joint usually gets better within a couple of weeks and does not produce
any long-term effects, as long as it is properly diagnosed and appropriately treated. If not, it can lead to
prolonged pain in the region just below the outside of the knee and a prolonged lay-off from your activity or
sport.
Management
The assistance of a sports medicine professional is important in the treatment of a superior tibiofibular joint
injury. Initially, they can assist in diagnosing the problem and its severity. From this, the sports medicine
professional will be able to determine an appropriate treatment plan. This may involve activity modification,
regular icing, electrotherapy treatment, and stretching and strengthening exercises.
Ruptured hamstring tendon
What is it?
A rupture of a hamstring tendon refers to a complete tear within one of the hamstring tendons on the back of
the thigh.
How does it happen?
A complete tear of a hamstring tendon often occurs when the hamstring muscle group on the back of the
thigh is forcibly contracted. The function of the hamstring tendons is to transmit forces produced by the
hamstring muscle group to the leg bone. Forcible contraction of this group of muscles can overstress a
hamstring tendon, resulting in it completely tearing. This most frequently occurs during sprinting.
How does it feel?
A complete tear of a hamstring tendon results in instant pain felt behind the knee in the lower part of the
back of the thigh. Associated with this may be a feeling of something tearing or snapping and a feeling of
weakness in the hamstring muscle group.
What should you do?
A complete tear of a hamstring tendon is a serious injury which often requires surgical repair. Therefore, if
you have or suspect a complete tear of a hamstring tendon it is advised you seek the assistance of a sports
medicine professional as soon as possible (i.e. on the same day as the injury). In the meantime, you can
commence early treatment to limit the amount of bleeding and swelling within and around the torn ends of
the tendon. This should involve the RICE regime (Rest, Ice, Compression, Elevation).
Rest involves ceasing your activity or sport, and limiting the amount of weight you put through your leg.
Crutches may be required if you are having difficulty walking.
Ice should be applied to the injured site for 15–20 minutes every 1–2 hours. Ideally, it should be applied
using crushed ice wrapped in a moist cloth or towel.
Compression involves the application of a firm elastic bandage around your knee and thigh. It should be
firm but not tight enough to cause pain.
Elevation involves lying with your knee and thigh resting comfortably on a chair or pillows so that it is above
the level of your heart. You should continue the RICE regime until you consult a sports medicine
professional, preferably on the same day as the injury.
What shouldn’t you do?
Following a complete tear of a hamstring tendon, you shouldn’t undertake activities which increase blood
flow to the injured site and, therefore, bleeding and swelling in the area. These include hot showers, heat
rubs, the consumption of alcohol and excessive activity.
Could there be any long-term effects?
A complete tear of a hamstring tendon is a serious injury which does not heal by itself without appropriate
treatment. Appropriate treatment often involves surgical repair. Following surgery, the rehabilitation period
is prolonged and it may be a number of weeks before you can walk on the injured leg. It may be a further
number of weeks before your muscle flexibility and strength return to satisfactory levels to enable return to
your activity or sport.
Management
The assistance of a sports medicine professional is important in the treatment of a complete tear of a
hamstring tendon. Initially, they can assist in diagnosing the problem and establishing its severity. Imaging
techniques such as ultrasound or MRI may be used. From this, the sports medicine professional will be able
to determine an appropriate treatment plan. In the majority of cases this will involve surgical repair.
Following surgery, the sports medicine professional will be able to rehabilitate your tendon so that you can
return to your activity or sport. This may involve the use of soft tissue treatment such as massage and
stretching, and a progressive rehabilitation program.
Patellofemoral syndrome (anterior knee pain, runner’s knee)
What is it?
Patellofemoral syndrome refers to pain arising from the joint between the kneecap and the underlying thigh
bone. Other names for this condition include patellofemoral pain syndrome, chondromalacia and runner’s
knee.
How does it happen?
Patellofemoral syndrome most often results from overuse of the knee. When the knee is bent and
straightened, the kneecap (patella) slides up and down within a groove on the end of the thigh bone (femur).
With repeated bending and straightening, such as during activities involving walking, running, jumping and
cycling, the underneath surface of the kneecap can become irritated. This can result in pain and
occasionally swelling.
How does it feel?
The main sensation associated with patellofemoral syndrome is pain. This is felt behind and around the
kneecap. Patellofemoral syndrome is commonly aggravated by walking, running, going downstairs or sitting
for a prolonged period with a bent knee. Associated with this pain may be grinding noises heard when the
knee is bent or straightened, a sensation of the knee giving way and weakness in the knee. The knee may
also swell at times.
What should you do?
Patellofemoral syndrome frequently does not get better on its own if the cause is not addressed and you
continue your activity or sport. If you have or suspect patellofemoral syndrome, you should consult your
nearest sports medicine professional. In the meantime, you should avoid any activities which aggravate or
cause your knee pain to occur. Icing the front of your knee will be of benefit. Ice should be applied to the
injured area for 15–20 minutes every 1–2 hours. Ideally, it should be applied using crushed ice wrapped in a
moist cloth or towel.
What shouldn’t you do?
If you have or suspect you have patellofemoral syndrome, you shouldn’t ignore the problem. This may lead
to your problem getting worse such that your pain becomes more severe and is felt more frequently.
Could there be any long-term effects?
Patellofemoral syndrome does not produce any long-term effects, as long as it isproperly diagnosed and
appropriately treated. Recovery usually takes a number of weeks. During this period you can often keep
participating. In some situations recovery may be prolonged. In these cases, surgery may be required to
assist in improving the biomechanics of the kneecap and to relieve pain. This is only performed after
conservative or non-surgical treatment has failed to give relief.
Management
The assistance of a sports medicine professional is important in the treatment of patellofemoral syndrome.
Initially they can assist in diagnosing the problem and establishing the severity of the condition. From this,
the sports medicine professional will be able to determine an appropriate treatment plan. This may involve
initial activity modification, the taking of anti-inflammatory medications, soft tissue treatment such as
massage and stretching, taping or bracing of the kneecap and specific knee strengthening exercises to
improve kneecap movement (tracking). The sports medicine professional will also be able to assess and
determine why you developed patellofemoral syndrome and address this during your recovery to prevent a
re-occurrence when you return to exercise and sport.
Patellar tendinopathy (jumper’s knee)
What is it?
Often referred to as ‘jumper’s knee’, patellar tendinopathy refers to inflammation within the tendon which lies
just below the knee-cap (patella).
How does it happen?
Patellar tendinopathy is a common injury in sports predominantly involving jumping and landing, and results
from overuse of the patellar tendon. The function of the patellar tendon is to transmit forces produced by the
large thigh muscle (quadriceps) to the shin bone (tibia) to produce movement of the knee joint. Repetitive
use of the quadriceps muscle and, therefore, the patellar tendon can lead to microscopic tears within the
substance of the tendon. Gradual degeneration of the tendon may occur as a result. Factors which may
contribute to patellar tendinopathy include a recent change in training (including frequency, duration,
intensity, training surfaces), reduced rest times, biomechanical abnormalities, and decreased muscle
flexibility. These factors can lead to increased stress on the patellar tendon, microtears and subsequent
tendinopathy.
How does it feel?
Patellar tendinopathy results in pain felt just below the kneecap. This pain may be aggravated by activities
such as jumping, hopping and bounding and typically develops gradually. Initially, the tendon may only be
painful following exercise. Associated with the pain may be stiffness or tightness in region of the kneecap.
Typically, these initial signs of patellar tendinopathy are ignored as they disappear quickly with walking about
or applying heat (i.e. a hot shower) over the kneecap region. However, as you continue to exercise. the
tendinopathy progresses and the pain within the tendon becomes more intense and more frequent. In the
earlier stages, this pain during exercise may initially disappear as you warm up, only to return when you cool
down. However, as you continue to exercise the tendinopathy worsens and your pain may begin to be
present for longer periods during exercise until it is present all of the time. This may interfere with your
performance.
What should you do?
Patellar tendinopathy generally does not get better on its own if the cause is not addressed and you continue
to exercise. If you have or suspect you have patellar tendinopathy, you should consult your nearest sports
medicine professional. In the meantime you can begin initial treatment. This should consist of icing
following exercise and regular thigh stretching. Icing should consist of crushed ice wrapped in a moist towel
applied just below the kneecap for 15–20 minutes or ice in a paper cup massaged over the region just below
the kneecap until the skin is numb.
What shouldn’t you do?
If you have or suspect you have patellar tendinopathy you shouldn’t ignore the problem. Your pain may get
better as you exercise, however, the exercise you are doing may interfere with the healing process and be
causing further damage. This can lead to your injury getting worse such that your pain does not ‘warm up’
and you feel it throughout exercise. If this occurs, your recovery may be prolonged and it may take a
number of months for you to return to your activity or sport.
Could there be any long-term effects?
Patellar tendinopathy does not produce any long-term effects, as long as it is properly diagnosed and
appropriately treated. If not, it can lead to prolonged pain in the region just below the kneecap and a
prolonged lay-off from exercise and sport.
Management
The assistance of a sports medicine professional is important in the treatment of patellar tendinopathy.
Initially, they can assist in diagnosing the problem and its severity. Imaging techniques such as ultrasound
or MRI may be used. From this, the sports medicine professional will be able to determine an appropriate
treatment plan. This may involve activity modification, soft tissue treatment such as massage and stretching,
and the progression through a series of specific strengthening exercises. The sports medicine professional
will also be able to assess and determine why you developed patellar tendinopathy and address this during
your recovery to prevent a re-occurrence when you return to full activity.
Synovial plica
What is it?
The synovial membrane encloses the knee joint and acts to secrete fluid into the joint, which provides
nutrition and frictionless movement. The synovial plica refers to a fold in the synovial membrane, which can
produce knee pain when irritated.
How does it happen?
The synovial plica is found along the inside border of the kneecap. It can produce pain when it becomes
inflamed. This may occur following a direct impact to the plica or when it is overstretched.
How does it feel?
An injury to the synovial plica can produce pain along the inside border of the kneecap. This may be a sharp
pain which may be felt when you squat down. When the inside border of the kneecap is touched, a tender,
thickened band of tissue may be felt.
What should you do?
If you have or suspect your knee pain is coming from the synovial plica, you should consult your nearest
sports medicine professional. In the meantime you can begin initial treatment. Icing will be of benefit. Icing
should consist of crushed ice wrapped in a moist towel applied to the inner aspect of the kneecap for 15–20
minutes or ice in a paper cup massaged over the region until the skin is numb every 1–2 hours.
What shouldn’t you do?
If you have or suspect your knee pain is coming from the synovial plica, you shouldn’t ignore the problem.
This may lead to your injury getting worse, prolonging your recovery.
Could there be any long-term effects?
An injury to the synovial plica does not produce any long-term effects, as long as it is properly diagnosed and
appropriately treated. In some cases treatment may involve arthroscopic surgery to remove the plica. This
is a minor operation and has no long-term consequences.
Management
The assistance of a sports medicine professional is important in the treatment of pain arising from the
synovial plica. Initially, they can assist in diagnosing the problem and its severity. From this, the sports
medicine professional will be able to determine an appropriate treatment plan. This may involve activity
modification, soft tissue treatment such as massage and stretching, the progression through a series of
specific strengthening exercises and, in some cases, surgery.
Osgood-Schlatter’s disease
What is it?
Osgood-Schlatter’s disease refers to an injury to the bone growth plate in the shin bone (tibia) just below the
kneecap, which occurs in younger athletes. It is more a condition than disease.
How does it happen?
The large muscle on the front of the thigh (quadriceps) attaches to the shin bone via the patellar tendon.
The function of this tendon is to transmit forces produced by the thigh muscle to the shin to support and
move the knee joint. In children, the portion of the shin bone into which the patellar tendon inserts is
separated from the bulk of the shin bone by a growth plate. This growth plate enables bone growth to occur.
However, it also represents a site of weakness in the bone. Forcible and repeated contraction of the thigh
muscle can injure the growth plate. This commonly occurs in sports which involve running and jumping and
occurs during a period of rapid growth. During rapid growth, the thigh muscle and patellar tendon become
tighter as the bones grow. This leads to increased pulling of the thigh muscle and patellar tendon on the
shin bone and growth plate.
How does it feel?
Pain felt where the patellar tendon attaches to the shin bone in people with Osgood-Schlatter’s disease. The
painful site is just below the kneecap in the bony bump on the front of the shin, called the tibial tuberosity.
Pain is felt most commonly during activity or exercise. The tibial tuberosity may also be tender to touch and
swollen.
What should you do?
If your child has pain below the kneecap and you think it may be Osgood-Schlatter’s disease, you should
consult a sports medicine professional for assistance. In the meantime, you should limit their participation in
their chosen sport/s to restrict the amount of damage to the growth plate. To help with their pain and to
control any swelling you can apply ice. Ideally, this should consist of crushed ice wrapped in a moist towel
applied just below the kneecap for 15–20 minutes, every 1–2 hours.
What shouldn’t you do?
If you think your child has Osgood-Schlatter’s disease, you shouldn’t encourage them to exercise or exercise
through the pain. This may make their injury worse, prolonging their recovery.
Could there be any long-term effects?
Osgood-Schlatter’s disease does not produce any long-term effects as long as it is appropriately managed.
It is a self-limiting condition which settles when growth ceases and the tibial tuberosity fuses with the rest of
the shin bone. This may take anywhere from six months to two years to resolve. Osgood-Schlatter’s will not
interfere with your child’s growth and the only remnants may be an enlarged tibial tuberosity.
Management
The assistance of a sports medicine professional is important in the treatment of Osgood-Schlatter’s
disease. Initially, they can assist in diagnosing the injury and the extent of the damage. From this, they will
be able to determine an appropriate management plan. This may involve an initial period of rest or activity
modification, regular icing, soft tissue treatment such as massage and stretching, treatments to assist in
relieving pain, and the progression through a series of specific strengthening exercises. In addition, the
sports medicine professional will be able to advise you and your child on an appropriate time for return to
exercise and sport.
Sinding-Larsen–Johansson syndrome
What is it?
Sinding-Larsen–Johansson disease refers to an injury to the bone growth plate at the bottom of the kneecap
which occurs in younger athletes.
How does it happen?
The large muscle on the front of the thigh (quadriceps) attaches to the kneecap which, in turn, is attached to
the shin bone (tibia) via the patellar tendon. The function of this tendon is to transmit forces produced by the
thigh muscle from the kneecap to the shin to support and move the knee joint. In children, the portion of the
kneecap from which the patellar tendon originates is separated from the bulk of the kneecap by a growth
plate. This growth plate enables bone growth to occur. However, it also represents a site of weakness in
the bone. Forcible and repeated contraction of the thigh muscle can injure the growth plate. This commonly
occurs in sports which involve running and jumping and occurs during a period of rapid growth. During rapid
growth, the thigh muscle and patellar tendon become tighter as the bones grow. This leads to increased
pulling of the patellar tendon on the kneecap and growth plate.
How does it feel?
Pain is felt where the patellar tendon attaches to the kneecap in Sinding-Larsen–Johansson syndrome. This
is in the lowest portion of the kneecap. This pain is felt most commonly during activity or exercise. The
bottom of the kneecap may also be tender to touch and swollen.
What should you do?
If your child has pain at the bottom of the kneecap and you think it may be Sinding-Larsen–Johansson
syndrome you should consult a sports medicine professional for assistance. In the meantime, you should
limit their participation in their chosen sport/s to restrict the amount of damage to the growth plate. To help
with their pain and to control any swelling you can apply ice. Ideally this should consist of crushed ice
wrapped in a moist towel applied just the bottom of the kneecap for 15–20 minutes every 1–2 hours.
What shouldn’t you do?
If you think your child has Sinding-Larsen–Johansson syndrome you shouldn’t encourage them to exercise
or play sport through the pain. This may make their injury worse prolonging their recovery.
Could there be any long-term effects?
Sinding-Larsen–Johansson syndrome does not produce any long-term effects, as long as it is appropriately
managed. It is a self-limiting condition which settles when growth ceases. This may take anywhere from six
months to two years to resolve. Sinding-Larsen–Johansson syndrome will not interfere with your child’s
growth.
Management
The assistance of a sports medicine professional is important in the treatment of Sinding-Larsen–Johansson
syndrome. Initially, they can assist in diagnosing the injury and the extent of the damage. From this, they
will be able to determine an appropriate management plan. This may involve an initial period of rest or
activity modification, regular icing, soft tissue treatment such as massage and stretching, treatments to assist
in relieving pain, and the progression through a series of specific strengthening exercises. In addition, the
sports medicine professional will be able to advise you and your child on the appropriate time for return to
exercise and sport.
Quadriceps tendinopathy
What is it?
Quadriceps tendinopathy refers to inflammation within the tendon of the large quadriceps muscle on the front
of the thigh just before it attaches to the kneecap (patella).
How does it happen?
Quadriceps tendinopathy results from overuse of the quadriceps tendon. The function of the quadriceps
tendon is to transmit forces produced by the large thigh muscle (quadriceps) to the kneecap to produce
movement of the knee joint. Repetitive use of the quadriceps muscle and, therefore, the quadriceps tendon
can lead to microscopic tears within the substance of the tendon. To repair these microscopic tears, the
body commences an inflammatory response. This inflammation within the tendon is tendinopathy.
How does it feel?
Quadriceps tendinopathy results in pain felt just above the kneecap. This pain typically develops gradually
and may be aggravated by activities such as jumping, hopping and bounding. Initially, the tendon may only
be painful following exercise. Associated with the pain may be stiffness or tightness in the quadriceps muscle
and in the region of the kneecap. Typically, these initial signs of quadriceps tendinopathy are ignored as
they disappear quickly with walking about or applying heat (i.e. a hot shower) over the kneecap region.
However, as you continue to exercise, the tendinopathy progresses and the pain within the tendon becomes
more intense and more frequent. In the earlier stages, this pain during exercise may initially disappear as
you warm up, only to return when you cool down. However, as you continue to exercise, the tendinopathy
worsens and your pain may begin to be present for longer periods during exercise until it is present all of the
time. This may interfere with your performance.
What should you do?
Quadriceps tendinopathy generally does not get better on its own if the cause is not addressed and you
continue to exercise. If you have or suspect you have quadriceps tendinopathy, you should consult your
nearest sports medicine professional. In the meantime you can begin initial treatment. This should consist
of icing following participation and regular thigh stretching. Icing should consist of crushed ice wrapped in a
moist towel applied just below the knee-cap for 15–20 minutes or ice in a paper cup massaged over the
region just below the kneecap until the skin is numb every 1–2 hours.
What shouldn’t you do?
If you have or suspect you have quadriceps tendinopathy you shouldn’t ignore the problem. Your pain may
get better as you exercise; however, the exercise you are doing may be interfering with the healing process
and causing further damage. This can lead to your injury getting worse such that your pain does not ‘warm
up’ and you feel it throughout exercise or sport. If this occurs, your recovery may be prolonged and it may
take a number of months for you to return to exercise and sport.
Could there be any long-term effects?
Quadriceps tendinopathy does not produce any long-term effects, as long as it is properly diagnosed and
appropriately treated. If not, it can lead to prolonged pain in the region just above the kneecap and a
prolonged lay-off from exercise and sport.
Management
The assistance of a sports medicine professional is important in the treatment of quadriceps tendinopathy.
Initially, they can assist in diagnosing the problem and its severity. This may require the use of imaging
techniques such as ultrasound and MRI. From this, the sports medicine professional will be able to
determine an appropriate treatment plan. This may involve activity modification, soft tissue treatment such
as massage and stretching, and the progression through a series of specific strengthening exercises. The
sports medicine professional will also be able to assess and determine why you developed quadriceps
tendinopathy and address this during your recovery to prevent a re-occurrence when you return to full
activity.
Pre-patellar bursitis (housemaid’s knee)
What is it?
Also known as ‘housemaid’s knee’, pre-patellar bursitis refers to inflammation and swelling of the bursa
located between the kneecap (patella) and overlying skin. A bursa is a fluid-filled sac which allows adjacent
tissues to slide over one another without friction.
How does it happen?
Pre-patellar bursitis occurs when the pre-patellar bursa is damaged or irritated. This can occur following
either a single injury or a series of injuries to the bursa. A direct blow or fall onto the knee can damage blood
vessels within the pre-patellar bursa causing bleeding. The blood in the bursa causes an inflammatory
response, resulting in the swelling of the bursa and subsequent bursitis. Similarly, pre-patellar bursitis may
result from repeated minor trauma to the bursa. This can occur with repeated kneeling. This increases wear
and tear on the bursa causing microtrauma which, over time, can result in bursal thickening, inflammation
and bursitis.
How does it feel?
Pre-patellar bursitis causes pain and swelling in the area in front of the kneecap. The pain is most often felt
when you kneel. In terms of the swelling, it may always be present or may only occur following activity. If
the condition has been present for some time, there may also be small lumps that can be felt underneath the
skin over the kneecap. These lumps result from thickening of the bursal sac and may give you pain and the
feeling that something is floating around in front of the kneecap.
What should you do?
If you have or suspect you have pre-patellar bursitis, you should cease your activity or sport and begin initial
treatment to control any swelling. To limit the severity of the symptoms it is advised you stop your activity
immediately and start initial treatment. The most important time in the treatment of any injury is the first
24–48 hours. Swelling is a necessary step in the healing process; however, too much swelling can delay
healing and cause further tissue damage. To control the amount of swelling and limit the degree of damage
to the knee, the RICE regime should be commenced (Rest, Ice, Compression, Elevation). This will help to
reduce blood flow to the injured area, thereby reducing the extent of swelling and tissue damage.
Rest involves ceasing your activity or sport, and limiting the amount of weight you put through your leg.
Crutches may be required if you are having difficulty walking.
Ice should be applied to the injured site for 15–20 minutes every 1–2 hours. Ideally, it should be applied
using crushed ice wrapped in a moist cloth or towel.
Compression involves the application of a firm elastic bandage around your knee. It should be firm but not
tight enough to cause pain.
Elevation involves lying with your knee resting comfortably on a chair or pillows so that it is above the level
of your heart. You should continue the RICE regime until you consult a sports medicine professional,
preferably within two days of the initial injury.
What shouldn’t you do?
In the first few days following an injury to the pre-patellar bursa, you shouldn’t undertake activities which
increase blood flow to the knee. These include hot showers, heat rubs, massage, the consumption of
alcohol and excessive activity. These can prolong bleeding in the bursa, resulting in further swelling and an
extended recovery. In pre-patellar bursitis caused by repeated minor trauma, you should also avoid these
activities until you consult your nearest sports medicine professional as they can make your swelling worse.
In addition, you shouldn’t undertake any activity which involves kneeling. This will irritate the pre-patellar
bursa further, making the pain and swelling worse.
Management
The assistance of a sports medicine professional is important in the treatment of pre-patellar bursitis. In
bursitis caused by a single injury, they will able to assist in determining the extent of damage to the bursa
and whether any surrounding tissues have been injured. An estimation of how long your injury is expected to
take to heal can be provided. Sports medicine professionals can also use a number of treatment techniques
to assist in reducing the pain and swelling and enhance the healing of the injured structures. This will
facilitate your return to activity. In pre-patellar bursitis caused by repeated minor trauma, sports medicine
professionals will be able to assist in identifying the cause and how best to stimulate healing, thereby
reducing your pain and swelling. In some situations, this may involve draining the swelling in the bursa,
taking anti-inflammatory drugs or injecting a small quantity of drug directly into the bursa to stimulate healing.
Following healing, the sports medicine professional will be able to advise on how to prevent this injury from
re-occurring.
Iliotibial band friction syndrome (ITBFS)
What is it?
The iliotibial band is a band of strong connective tissue which runs from the pelvic bone (ilium) down the
outside of the thigh to the top of the shin bone (tibia). Iliotibial band friction syndrome is a condition which
describes the rubbing of this band of tissue as it passes over a bony bump on the outside of the knee joint.
How does it happen?
Iliotibial band friction syndrome is an overuse injury. When the knee is bent and straightened the iliotibial
band slides over a bony bump on the outside of the knee. When this is performed repeatedly or when the
band is excessively tight, wear and tear of the band can develop as it flicks over the bony bump. To heal this
damage, the body commences an inflammatory response. This can cause pain at the site of the injury.
How does it feel?
Iliotibial band friction syndrome results in pain felt on the outside of the knee. This pain is often aggravated
by activities which involve repeated bending and straightening of the knee, such as running. It typically
develops gradually. Initially, the pain may begin as a dull ache down the side of the knee which appears
near the end of a session and disappears when you stop. However, if you continue to exercise and cause
further rubbing of the iliotibial band, the pain may progress to become more intense and appear earlier in a
session. It may also take longer to disappear when you stop exercising.
What should you do?
Iliotibial band friction syndrome generally does not get better on its own if the cause is not addressed and
you continue to exercise. If you have or suspect you have iliotibial band friction syndrome you should
consult your nearest sports medicine professional. In the meantime you can begin initial treatment. This
should consist of icing following exercise. Icing should consist of crushed ice wrapped in a moist towel
applied for 15–20 minutes over the outside of the knee or ice in a paper cup massaged up and down the
outside of the knee until the skin is numb every 1–2 hours.
What shouldn’t you do?
If you have or suspect you have iliotibial band friction syndrome, you shouldn’t ignore the problem. This may
lead to your problem getting worse such that your pain becomes more severe and is felt more frequently.
Could there be any long-term effects?
Iliotibial band friction syndrome generally does not produce any long-term effects, as long as it is properly
diagnosed and appropriately treated. Recovery usually takes a number of weeks. During this period you
can often keep exercising, depending upon the severity of your pain. In a small number of cases recovery
may be prolonged. In these cases surgery may be required to stop the iliotibial band from rubbing and to
relieve pain. This is only performed after conservative or non-surgical treatment has failed to give relief.
Management
The assistance of a sports medicine professional is important in the treatment of iliotibial band friction
syndrome. Initially, they can assist in diagnosing the problem and establish its severity. From this, the
sports medicine professional will be able to determine an appropriate treatment plan. This may involve initial
activity modification, the taking of anti-inflammatory medications, soft tissue treatment such as massage and
stretching, and specific strengthening exercises to stop, rubbing of the iliotibial band. The sports medicine
professional will also be able to assess and determine why you developed iliotibial band friction syndrome
and address this during your recovery to prevent a re-occurrence when you return to exercise and sport.