The Knee & Related Structures in Sports Medicine

A Physical Education Guide for Identifying Injuries & Rehabilitation

There are many different knee injuries that can occur during sports but the following are common and usually caused by overtraining and are not always involving other athletes.

Knee Injuries Caused Rapid Movement Changes

Knee and related structures are prone to injury, especially in high velocity and impact sports. Many of these injuries occur as a result of quick shifts in direction or rapid deceleration which can hyperextensions, breaks and other similar outcomes. For example, when players decelerate and shift movement such as stopping on the left foot and pushing off with the same foot, injury can result. In this situation, the individual may report a popping sensation and the feeling of the knee losing stability. The injury will be marked by extreme pain over the anteromedial joint line. Joint line pain is indicative of a tear of the lining of the joint, a meniscus tear, or possible damage to the bone or cartilage. The popping sound is indicative of a ligament or cartilage tear and this would explain the sensation of instability experienced by the player. The player should be removed to continue evaluation off-court.

By National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) — Public Domain

If rapid joint effusion and tenderness present over the anteromedial joint line and in the posterior aspect of the knee, then the situation requires the Lachman test for increased pain and instability. The athlete should be removed from the court using a stretcher in order to avoid further damage to the injured knee. Off-court evaluation of this injury would be to perform a varus or valgus stress test. Place fingers directly over the joint line while applying stress across the joint. Joint line pain or a dull sound would indicate a peripheral meniscal tear. This could also be indicative of an intraarticular crepitation or cartilage damage. The determination of whether the pain is just under the fingers is important because this may indicate an injury to the joint line capsule or deep injury.

Possible structures of the knee that may also be injured include the meniscus, anterior cruciate ligament (ACL), the kneecap tendon, the lower kneecap pole, and patellar. This injury should be managed using the rest from sport, rehabilitation, and a physician’s supervision. In some cases, knee injuries such as torn ACLs may require surgery.

Bilateral Distal Patella Tendon Pain & The Difference Between Patellar Tendonitis & Osgood-Schlatter Syndrome

Osgood Schlatter Syndrome

Telling the difference between Osgood Schlatters Disease and Patellar tendonitis can be done through assessment of the symptoms of injury. The symptoms of Osgood Schlatter Syndrome include pain at the tibial tuberosity (or bony bit at the top of the shin) just below the knee. This area will become swollen or inflamed and might look visibly larger than the other leg. The tenderness and pain are worse during and after exercise. There will also be pain when contracting the quadriceps against resistance or when contracting the muscles while maintaining a straight leg.

By James Heilman, MD — Own work, CC BY-SA 3.0

Patellar Tendonitis (Jumper’s Knee)

Although similar, patellar tendonitis (jumper’s knee) injury specifically centers on the point where the tendon attaches to bone in the knee and is in the form of inflammation where the muscles tendon attaches to the upper kneecap pole or where the kneecap tendon attaches to the lower leg bone. While the injury specifically involves the attachment of the kneecap tendon to the lower kneecap pole, the term ‘jumper’s knee’ has also become applicable to injuries involving the muscles in the thigh region and lower leg muscles. This application of the injury is due to the inflammation in muscles resulting from stresses placed on the tendons and where they attach to the knee will result in awkward and irregular movements as the individual attempts to compensate for pain from the injury in the knee. Typically, jumper’s knee will not have any visible signs of inflammation or swelling which will differentiate it from Osgood Schlatter Syndrome. Jumper’s knee, unlike Osgood Schlatter Syndrome, will not improve by the use of anti-inflammatories and cryotherapy. If the pain persists beyond 14 days, then it is likely that the condition is jumper’s knee rather than Osgood Schlatter Syndrome and the athlete should see a physician and most likely receive and MRI.

Common Injuries & Treatments

Chondromalacia

Chondromalacia (patellafemoral joint dysfunction)- This injury is the result of inflammation beneath the patella. It is caused by overexertion of the knees resulting in the kneecap rubbing against one side of the knee joint which irritates the cartilage and causes pain. The treatment for this injury is the standard RICE method which is rest, ice, compression, elevation. The use of anti-inflammatory medications and light rehabilitative exercises such as swimming or stretching should be used rather than impact or weight bearing exercise.

Patellar Dislocation

Patellar dislocation- This injury is typically caused by a direct blow or sudden sharp twist of the leg resulting in the patella slipping from its normal position. This injury is accompanied by extreme and intense pain as well as effusion. There are two forms of treatment for this injury including surgery and rehabilitation. Typically, surgery is only recommended when the patient has stopped growing or if the injury is so severe that it has created damage that the body cannot mend on its own or if other areas of the knee have been injured.

Treatment with Braces

Knee bursitis- The appropriate brace for knee bursitis is a kneepad, or knee sleeve that has a pad over the patella. This will help to reduce the pain caused by bursitis and protect the kneecap from further injury.

MCL first degree sprain- Early in the recovery phase a hinged knee brace will be used to protect against stresses while the ligament heals.

ACL tear without surgical repair- Without surgery the use of the hinged knee brace will be vital for the person to use for some time. This in order to maintain stability of the leg and allow the ACL to heal without constantly placing pressure on it from certain movements.

While these injuries and treatments are not inclusive of all knee injuries, they do comprise the bulk of serious injuries. Care should be taken in these situations to not allow continued performance for risk of making the injury worse.