Knee Injuries Prevention and Treatment

By Maureen Sangiorgio

There’s no other way to say it –

Patrick Letourneau was a sensation on the soccer field at Freedom High School. He was the Morning Call and Express Times Soccer Player of the Year, an All-State player two years in a row, the conference MVP and an All-District Team member. (Brains accompanied brawn, too, as he would go on to graduate third in his class.) In his senior year, Letourneau signed a Letter of Intent, accepting a partial scholarship to play soccer at Colgate University. But when he was in the district finals in a game against Parkland High School, his dreams almost ended in an instant.

“Pat had the ball, turned to go in another direction, and had a collision with an opposing player,” recalls his mom, Kim. “His foot went one way, his knee went another way, he heard something crack, and he went down. When I went to check on him in the locker room, it was the saddest sight I ever saw. There was my son, this big, strapping guy, sitting with his entire knee in ice, and he was crying. He felt he had worked so hard for so long and was going to let everybody down.”

Why Knees Can Be So Troublesome

The knee is the joint where the bones of the upper leg meet the bones of the lower leg, allowing hinge-like movement while providing stability and strength to support the weight of the body. Flexibility, strength and stability are needed for standing and for motions like walking, running, crouching, jumping and turning.

Patients make about 20 million visits each year to physicians’ offices because of pesky knee problems, making them the number one reason for visiting an orthopaedic surgeon, according to the American Academy of Orthopaedic Surgeons.

Several kinds of supporting and moving parts, including bones, cartilage, muscles, ligaments and tendons, help the knees do their job. Knee problems can interfere with many things, from participation in sports to simply getting up from a chair and walking. The point at which two or more bones are connected is called a joint. In all joints, the bones are kept from grinding against each other by lining called cartilage. Bones are joined to bones by strong, elastic bands of tissue called ligaments. Muscles are connected to bones by tough cords of tissue called tendons. Muscles pull on tendons to move joints. Although muscles are not technically part of a joint, they’re important because strong muscles help support and protect joints.

Common Knee Injuries

As you can see, the knee is a complex joint with many moving parts, making it susceptible to several types of injuries. Knee injuries can occur as the result of a direct blow or of sudden movements that strain the knee beyond its normal range of motion, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Problems with the hips or feet, for example, can cause you to walk awkwardly, which throws off the alignment of the knees and leads to damage. Knee problems can also be the result of a lifetime of normal wear and tear. Much like the treads on a tire, the joint simply wears out over time.

Symptoms of a knee injury include:
• A popping noise
• Knee gives out at time of injury
• Sharp, severe pain
• Cannot move the knee
• Limping and cannot put weight on the knee
• Swelling at the injury site

If you feel any of these symptoms, contact your physician immediately.

“The most common knee injury we see here in our practice is meniscal tear injuries,” says orthopaedic surgeon Dan Terpstra, D.O., at Coordinated Health. “The meniscus is a thick, rubbery cartilage that acts as a shock absorber to the knee. As you get older, the meniscus can become brittle, making it more susceptible to tearing. It’s typically caused by a twisting injury, such as stepping off a curb, or playing sports where you’re turning and twisting a lot, such as soccer, basketball and skiing.” Meniscal tear injuries are diagnosed by an MRI. “Depending on how severe the injury is, treatment ranges from rest and anti-inflammatories to cortisone injections to arthroscopy to repair the tear.”

The second most common knee injuries involve tears to the knee ligaments, such as the anterior cruciate ligaments (ACL) and medial collateral ligaments (MCL). “Most ACL injuries are caused by changing direction very quickly, slowing down when running, jumping and landing incorrectly and skiing. We see a lot of ACL cases in the Lehigh Valley because we have a lot of skiers in the area who ski at all the local ski resorts. ACL injuries are more severe and almost always require surgery to reconstruct the ligament. Recuperation time is very long and includes physical therapy. Patients can expect to return to sports within about six to eight months.”

Dr. Terpstra’s patient, Letorneau, was diagnosed with a torn ACL. Following surgery and physical therapy, he would go on to play soccer at Colgate University.

Now, if you are diagnosed with an MCL injury, you’re lucky, as most don’t require surgery. “Most MCL injuries occur when there is a direct blow to the knee, and it buckles inward,” says Dr. Terpstra. “An MRI will show how severe the injury is. If the ligament is just stretched, it should heal on its own within about two weeks. If it’s partially torn, it can take up to six weeks. But if it’s a complete tear, surgery will be required to repair the damage.”

How You Can Prevent Knee Problems

While accidents do happen, you can lower your risk of knee injury by following this advice:

Work out with weights. “One of the most common mistakes people make is jumping right in to a rigorous exercise program — or join a sporting team — without strengthening the legs,” notes Dr. Terpstra. “If you work out with weights, you can strengthen the muscles that support the knees, so when you go to make that jump shot or go skiing, you’ve conditioned the knees to take that strain. You literally have to get in shape before you try to get in shape.” Walking up and down stairs and riding a stationary bicycle are also helpful.

Stretch a LOT. “Another misconception is that you should only stretch before or after any kind of exercising,” says Dr. Terpstra. “It’s important to stretch both before and after exercising to warm up and relieve pressure on muscles, tendons and ligaments.”

Pace yourself. Avoid sudden changes in the intensity of your exercising. Gradually increase the force or duration of activity.

Go shoe shopping. Wear shoes that fit properly and are in good condition. This will help maintain balance and leg alignment when walking and running. Flat feet or overpronated feet (feet that roll inward) can cause knee problems. Ask your doctor or podiatrist about shoe inserts.

Coordinated Health is an integrated musculoskeletal healthcare delivery network with seven locations in Allentown, Bethlehem, Easton, Brodheadsville, Hazleton and East Stroudsburg.

Look for The Art of Medicine television show on Saturdays at 5:00 p.m., and Mondays at 11:00 a.m. on Channel 69.

Maureen Sangiorgio is an award-winning consumer health writer based in Macungie.