Knee

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Knee pain is one of the most common pain in the human body. It affects both the elderly, generally having a degenerative origin, and young individuals as a rule due to traumatic injuries or problems with the alignment of the patella (so-called rotulian syndromes).

Generally, knee pain (whether mild or severe) has pathological significance, that is, there is a pathology or disease that is at the origin of it.

Constant knee pain is an indication (or symptom) that something is not right. In other situations, knee pain can be caused only by a specific situation of overload of effort, such as that which occurs in a longer walk, or in climbing slopes, or carrying excessive weights or even in more intense sports training. In these cases, a period of rest or sports break may be sufficient to resolve the condition.

Gonarthrosis (Knee Arthrosis)

Which is?

Chronic and degenerative disease associated with pain and loss of knee function. Greater vigilance is needed when associated with other risk factors such as diabetes or cardiovascular disease.

What are the causes?

Gradual degradation of knee cartilage, reduced viscosity and elasticity of synovial fluid. This degradation ends up fragmenting the cartilage and the protective space between the knee bones decreases, which causes greater friction and the formation of painful bone formations known as parrot beaks.

What are the symptoms?

- Knee pain and inflammation

- Joint stiffness and swelling

- Severe pain and swelling in the morning, or at rest, or after intense physical activity

- Sensation of blockage or sagging during movements due to the interference of cartilage fragments in joint movements

Previous cruciate ligament injury

The previous cruciate ligament (ACL) has the function of being one of the main stabilizers of the knee joint. The central cruciate ligament of the knee forms with the posterior cruciate ligament. Both cruciate ligaments contribute, not only to the antero-posterior stability, but also to the rotational stability of this joint.

The previous cruciate ligament rupture is one of the most frequent injuries in sportsmen. This previous cruciate ligament injury is often referred to as "tearing of the knee ligament". A non-athlete can also “break the ligament” when performing everyday tasks, as a result of a twisting mechanism and slight knee flexion. It affects women very often, due to the specificities of their knee anatomy, hormonal differences and muscle development, namely hamstrings.

In the rupture of the previous cruciate ligament, the symptoms are very characteristic . When the athlete undergoes a rupture of the previous cruciate ligament, he usually refers to a snap and acute knee pain. A hematic joint effusion quickly sets in, and the patient finds it difficult to walk without the support of Canadians for a few days. After the acute phase, one of the main symptoms of ACL rupture is instability, with the feeling that the “knee fails”. The patient feels insecure when going up and down stairs or slopes, as well as playing sports.

Physiotherapy in the rupture of the ACL is essential for a full recovery. Some patients are asymptomatic (without symptoms) after undergoing physical therapy, thus dispensing with any surgical intervention.

Meniscus injury

The meniscus is a fibrocartilaginous structure , triangular in shape, which is located inside the knee joint covering the periphery of the tibial plates. Its anatomy is specially adapted to the function it performs: dampening shocks and transmitting loads.

The rupture of the meniscus occurs very frequently during sports, due to sprains of the knee that cause twisting movements and consequent meniscal injury.

Injury to the meniscus or meniscal injury in the sportsman results in reduced performance and, in certain sports such as football, more or less prolonged stops in his practice. Therefore, the importance of timely diagnosis and treatment of all meniscal injuries should be stressed.

In the rupture or injury of the meniscus, the main signs and symptoms are the presence of knee pain , usually located in the joint interline, accompanied by a progressive installation effusion due to inflammation of the synovial adjacent to the meniscus. In the injury of the internal or external meniscus in a basket wing, the symptoms are sometimes very disabling, resulting in a deficit of passive extension of the knee, the so-called knee block.

Physiotherapy allows a faster recovery and resumption of sports activity, usually without major limitations. It is based on anti-inflammatory therapies in the initial phase, followed by mandatory muscle strengthening and proprioceptive training.

Rotulian syndrome

Rotulian syndromes (what patients call a misaligned kneecap or kneecap out of place) are also a cause of knee pain. In extreme situations, routine instability can result in dislocation of the kneecap.

Rotulian syndromes usually affect young adults, requiring an adequate study of femuro-patellar relationships. Strengthening and rebalancing the quadriceps muscle , namely the vast internal oblique, are decisive in reducing external hyperpressure of the kneecap, but the realignment surgery of the extensor apparatus may be necessary to reduce anterior knee pain and prevent progression to kneecap arthrosis.

Knee tendonitis

Tendonitis of the knee usually causes pain in the insertion area of ​​the inflamed tendon. They are located, most frequently, in the lower pole of the patella, quadriceps insertion and in the tendons of the goose leg. They usually force the patient to take ice, anti-inflammatories and rest for very variable periods, but they generally have a good prognosis.

Knee bursitis

Knee bursitis occurs due to inflammation of the bursae or synovial pouches that exist around the knee. They usually result from long periods of placing the knees on the floor, as in certain professions or activities (housekeepers, religious, floor settler, etc ...) especially in the pre-patellar zone or pre-tibial tuberosity.

Chondromalacia

Which is?

Chronic and degenerative disease that cause abnormal softening and degradation of cartilage, also known as "runner's knee".

What are the causes?

Very associated with overuse of the knee (running or jumping sports), muscle weakness, traumatic injuries or surgery.

What are the symptoms?

- Excessive knee pain (running or jumping sports), muscle weakness, traumatic injuries or surgery.

- Pain around the kneecap with greater intensity when descending or climbing stairs - Pain when kneeling, or crouching, or with the knee bent for a long period of time

Total knee arthroplasty (TKA)

Knee arthroplasty (TKA) is the knee surgery generally used to treat knee arthrosis. The operation consists of replacing the affected joint with a metal and polyethylene implant, the so-called knee prosthesis. This is fixed to the bone using a special cement.

Knee arthrosis results from a degenerative process due to wear on the knee cartilage that occurs naturally with the evolution of age, or secondarily originated by excess weight, deviation in the knee axis or trauma with a fracture or injury to the cruciate ligaments.

TKA is in the treatment of gonarthrosis , an alternative to the already outdated, knee arthrodesis.

It is the knee surgery that has undergone the most evolution in recent years, thanks to progress in implants and better knowledge of knee biomechanics. It allows, in most cases of knee arthrosis, a marked reduction in pain and a marked improvement in the patient's quality of life.

Surgery to place a prosthesis on the knee is essential to cancel knee pain in stages of more advanced arthrosis. The success rate of this intervention is very high (more than 90% of patients preserve their prosthesis for up to 20 years).

TKA usually requires a hospital stay of only 3 or 4 days, during which the rehabilitation process begins. The recovery of the operated knee begins the day after knee replacement surgery with active mobilization and lift supported by Canadians.

The TKA presents rapid rehabilitation allowing the patient to leave the hospital with great autonomy and safety while walking.

When technically knee prostheses are well implanted and also well rehabilitated, the probability of obtaining a normal joint after TKA is high. In this sense, after discharge, the patient must immediately start an adequate rehabilitation protocol in order to achieve a full recovery.

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Objectives of a rehabilitation program:

  • Improving mobility and joint movement

  • Pain relief

  • General physical reconditioning

  • Return to work activities , daily life and sports activities  

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