Knee "Sprains" and Injuries

I have a torn ACL in my right knee and torn MCL in my left knee. I've spent time on the internet trying to learn more about how to manage these injuries after having "randomly" attacked the problem with limited success initially. If you're like me, hopefully, some of the information in this article will guide you in the right direction.

The odds are that if you're reading this article, like me, you're not a medical professional and are looking for some guidance as to how to treat your ailment. First and foremost, is to try to gauge how serious your injury is, and that's difficult if you haven't been treated for this particular problem before. Here are some ideas to help you put the severity of the problem in perspective.

• If you cannot put any weight on the injured leg, this is a reasonably serious injury and you should probably seek medical assistance.
• If you can walk, even though it is painful, there are a number of things you can do to promote healing. If you think you need medical assistance, do so!
• Never apply heat to a painful knee immediately after an injury -- always use ice. The regiment is (P)RICE: protect, rest, ice, compression, elevation. Reducing swelling is the main objective. Swelling limits range-of-motion and increases pain. Heat is sometimes helpful 48 hours after the injury when the swelling has subsided.
• The key to rehabilitation is to increase range-of-motion followed by strengthening. Any activity that increases pain (as opposed to discomfort) is likely to indicate that your rehab regiment is moving too quickly for your injury.
• It's difficult for an othopedist to treat a swollen knee, so if your situation is manageable, it's important to use (P)RICE immediately after the injury. A severe tear can result in swelling and blood in the knee joint and should be treated by a professional.

The knee is an amazing design. The bones of the knee, the femur and tibia, are held in place by a "matrix" of four ligaments: the anterior cruciate ligament (ACL), the medial collateral ligament (MCL), the posterior cruciate ligament (PCL), and the lateral collateral ligament (LCL). The MCL/LCL hold the knee bones in place vertically while the ACL/PCL protect against lateral and front/back movement. 

The ligaments are listed above in order of most likely injury to least likely injury. The explanation behind why ACL is the most injured and the LCL is least injured is explained in the reference and is fairly interesting.

Knee "sprains" are tears to one or more of the four ligaments (typically one). Injuries have two principal causes: physical contact (usually through contact sports) and twisting injuries caused by magnified forces on the ligaments through an unfortunate jump or movement. Tears are "graded" as grade 1, 2, or 3: grade one being 10% or fewer fibers torn to grade 3 as a complete failure of the ligament. Typical injury recovery time seems to be 2-4 weeks, but can take months to heal, if at all. [It's unclear to me at least if a grade 3 tear will ever heal on its own, but it seems unlikely.]

The key to recovery after injury or surgery is understanding how to properly strengthen the knee joint and surrounding muscles. Strong quads and hamstrings will keep the bones of the knee in place under routine circumstances while weak muscles will allow the bones to move within the joint, causing further pain and injury, setting  back your recovery time. The Leslie Hall articles at http://www.kneeguru.co.uk/KNEEnotes/node/775 are very useful and include information on identification, assessment, management, and rehab.

Interestingly, if you are willing to give up certain activities as you get older, you may or may not decide to have surgical repairs of torn ACL's or MCL's (the most common ligament failures). "Severe" sports such as soccer, football, racketball, and basketball are not options with torn ligaments, but golf and tennis are with adequate knee braces. Elastic knee braces from companies like Ace have worked very well for me after recovery and to accelerate recovery from my ACL and MCL injuries. I've found the elastic "wraps" that are now self-sticking (no metal clamps) to offer a little bit more support but both types are very helpful.

I've found what I believe to be one of the best internet sites for knee problems and would highly recommend that you visit the site. The information seems to be the most accurate and complete of any that I've found: http://www.kneeguru.co.uk/KNEEnotes/ . The amount of information is extensive, so plan to spend some time there if you have a significant knee problem.

Probably the most common cause of knee pain is the knee cap or patella. The patella "glides" vertically in the grove in the bottom of the femur as you bend your knee and over time can become worn and causes inflamation and discomfort. The patella is a bony structure that rides on top of the knee and functions as a "lever" that amplifies the quadricep muscle. Search for "Chrondromalacia patella" for knee cap problems. For a complete overview of other issues involving knee pain, check out Wikipedia: http://en.wikipedia.org/wiki/Knee_pain .

I'm due for a complete knee replacement in my right knee at some point (and probably left knee as well) but I'm finding investigation of my recovery options to be quite interesting. Since strenthening of the knee is an important predicate for knee replacement, I'm expecting that what I'm learning now to be useful for that ultimate replacement. Replacements themselves are pretty amazing technological achievements and I want to be as prepared as possible for a fully successful surgery. There are some interesting YouTube videos on knee replacements. This animation is especially helpful http://www.youtube.com/watch?v=dqtOQ2WnYBM&feature=related . Here's a good overview of knee replacement surgery with some brief glimpses of the actual surgery: http://www.youtube.com/watch?v=6gHhhwQDZQM&feature=related .