Knee injuries are very common in athletes who engage in cutting sports, like soccer, football, basketball, rugby and lacrosse.

One of the most common types of injury is anterior cruciate ligament (ACL) tear, damaging the tough fibrous tissue running diagonally through your knee that serves as the main restraint in keeping the shin bone in place, preventing your knee from overextending and providing side-to-side support. Other knee problems include:
  • Meniscus tear – twisting and/or awkward knee flexion that causes damage to the fibro-cartilage pad that sits between the thigh bone and shin bone
  • Kneecap dislocation – when a sudden change in direction puts your kneecap under stress or slips it to the outside of the knee
  • Lateral collateral ligament injuries – partial (sprain) or full tear of the thin ligament that runs on the outside of the knee and keeps the joint stable
  • Patellofemoral pain syndrome (front of the knee pain) – excessive shifting of the patella from sports activities that involve knee bending
  • Medial collateral ligament (MCL) injury – the most often sprained ligament in the knee occurs when the knee is forced inward with a stress or impact to the outer side of the knee
  • Posterior-lateral corner injury – trauma to the knee, a posterior lateral force directed to the inside of the knee, knee hypertension or excessive knee rotation that damages the static and dynamic stability of the posterior lateral knee
Knee injuries can result in pain, loss of function and premature arthritis. Symptoms include acute pain, inflammation and significantly reduced mobility due to stiffness or instability.

Diagnosis
Your doctor will ask questions about the injury, the history of your pain and your symptoms and perform clinical tests to measure joint laxity. He or she may order X-rays or MRI scans to verify the diagnosis if significant swelling is present or the exact structures involved are unable to be determined. The clinical measures, tests and imaging will also be used to rule out or evaluate concurrent injuries. In some cases, the knee injury may be given a specific grade to determine its severity and guide treatment planning.


Physical Therapy and Rehab

Physical Therapy and Rehabilitation

Physical Therapy and Rehabilitation

A physical therapist may work with you on a variety of strengthening, flexibility and mobility techniques, post-surgery or as an alternative to surgery. That may include:

Instrument-Assisted Soft Tissue Mobilization

In addition to applying manual muscle therapy, our physical therapists use an instrument-assisted technique to detect scar tissue and restrictions in affected areas of the body. Once detected, the instrumentation is used to break up the scar tissue.

Intramuscular Manual Therapy

Dry needling is an alternative pain relief technique that physical therapists may administer. It involves the insertion of a small, solid filament needle into a stressed muscle’s site of spasm and pain, also known as a trigger point. By doing so, the muscle relaxes and blood flow increases into the area, alleviating pain and improving motion.

Trigger points can often be the result of a different overuse injury, because muscles overcompensate for imbalances and weakness in the injured area. Inflammation and spasm develop and lead to discomfort and pain in the muscle.

Isokinetic Testing

Isokinetic testing uses computerized equipment to isolate muscle groups and test their tolerance. By doing this, our therapists and trainers can identify vulnerable areas and what positions or movements may be causing pain and soreness. This is used as part of a rehab/return-to-sport program or for assessment of the athlete at different stages.

Level Belt

The level belt was developed at Ohio State's Wexner Medical Center. An elastic strap aligned with your pelvis is worn as a phone application detects core stability and mobility. It’s initially used for assessment and then is applied as training support. As an example, a baseball pitcher needs a stable core to perform well and reduce injury to the shoulder and arm. The level belt can help the pitcher isolate pelvic mobility and strengthen the core.

Aquatic Therapy

Aquatic therapy is well-suited for early athletic rehab and for patients experiencing a great deal of pain or a weight-bearing restriction that doesn’t permit land-based rehab. Water provides the resistance for a workout and the buoyancy for low impact. Aquatic therapy helps to restore mechanics and is best suited for lower body injuries, including those of the lower back, postop knee and areas affected by arthritis.

Ask your physical therapist about our locations for aquatic therapy that offer warm water and Olympic-size pools.

Nonsurgical Treatments

Nonsurgical treatments

Nonsurgical treatments

Injection Therapy

Steroid Injections
Injections may be used to reduce joint pain and inflammation associated with knee injuries like cartilage tears, degenerative meniscus and arthritis-related issues. Steroid injection can help improve function, and for less complicated first-time injuries, can be effective as part of a nonsurgical treatment program, which may include wearing a knee brace and participating in physical therapy. Your physician may use musculoskeletal ultrasound to help guide your injection into the joint. Musculoskeletal ultrasound improves accuracy when treating you with steroid injections in the office, and it is used for deeper joints, joints with poor anatomic landmarks and joints with little to no joint space. This technique uses sound waves to create images of the joint and to identify the needle used to inject the joint helping the physician guide it to the affected area. This technique is done in the office and does not expose you to any radiation.


Natural Joint Fluid Treatment
This treatment, also known as hyaluronic acid injections, uses an injectable substance made from the building blocks of cartilage to create the type of cushioning cartilage provides. It is primarily used for arthritis of the knee. Those who respond to this treatment can experience relief for up to six months or longer, and this treatment can be repeated if pain returns.

Intramuscular Manual Therapy

Dry needling is an alternative pain relief technique that physical therapists may administer for muscle pain. It involves the insertion of a small, solid filament into a stressed muscle’s site of spasm and pain, also known as a trigger point. By doing so, the muscle relaxes and blood flow increases into the area, alleviating pain and improving motion.

Trigger points are often the result of an injury to a different part of the body, because other muscles overcompensate for imbalances and weakness in the injured area. Because of this overcompensation, muscle spasm occurs, causing discomfort and pain in the muscle.

Once dry needling resets the tone of muscle, your physical therapist works on correcting strength and mobility deficits in the muscle, which allows healing and prevents injury.

  • Results can be immediate or take up to 72 hours
  • One to five treatments is the expected course
  • Rehab exercises are part of the treatment


Lifestyle Modification

Depending upon the type of knee problem you have, we may suggest lifestyle changes to help reduce the pain and stress on your knees. Your exercise prescription might include low- or no-impact exercises such as swimming or biking, avoiding activities with running and/or twisting and adding moves to improve the strength of your quadriceps. It is also believed that strengthening your hamstrings and gluteals is important to knee health as well. This is part of a current research study at Ohio State's Wexner Medical Center.


Lifestyle changes like losing excess weight can also reduce the risk of knee problems.

Surgical Treatments

Surgical treatments

Surgical treatments

ACL Reconstruction

The anterior cruciate ligament (ACL) attaches the shinbone to the thigh bone. Tearing this ligament is common among athletes, especially those engaged in cutting sports like soccer, football, basketball, rugby and lacrosse. ACL reconstruction is usually required and seems to provide the greatest long-term solution for many athletes.

In ACL reconstruction, a new ligament is built from a graft that is provided from a donor or from the patient. Surgery is often performed four to six weeks after the ACL tear. This gives time for a preoperative home exercise program or physical therapy to work on quadriceps activation and strength, full knee range of motion and swelling reduction. The procedure lasts about one and a half hours, and patients usually are on their way home two hours after surgery.

Arthroscopy

Arthroscopy involves inserting a telescopic device fitted with a camera into the affected knee area. Your physician will make the appropriate repairs, removing inflammation, loose bone or cartilage. This procedure is often used as part of anterior cruciate ligament (ACL) reconstruction. Depending on the extent of the repair, the procedure usually takes less than an hour.

Microfracture Surgery

Knee microfracture surgery repairs significant acute damage to small areas of knee cartilage. An arthroscope (tubular instrument with an affixed camera) is inserted into an incision made in the knee. Small holes (microfractures) are made in the bone near the damaged cartilage. Cells from your bones are released through the microfractures and create new fibrocartilage.

You will need crutches to keep the weight off your knee for six to eight weeks, which will help the new cartilage grow.

Meniscus Surgery

The meniscus is padding between the tibia and femur that can tear as a result of an injury and is a common complication in ACL tears. Depending on the type of tear, the meniscus may be repaired through surgery. Surgical removal of the torn section (partial meniscectomy) or the entire meniscus (total meniscectomy) may be necessary in severe cases.

Kneecap Dislocation Surgery

A direct blow to the kneecap (patella) in contact sports or pivoting injury to the knee are often the causes of a kneecap moving out of place (dislocation). Initial dislocations can often be corrected by wearing a brace for a few weeks and following up with physical therapy. Imaging is often needed to see if a cartilage lesion occurred with the dislocation.

In repeat cases where ligament damage occurs, medial patella femoral ligament (MPFL) reconstruction may be necessary. MPFL reconstruction rebuilds the ligament, using a graft from the femur to the kneecap to help prevent further dislocations.

Osteochondral Autograft

Osteochondral autograft replaces injured cartilage and underlying damaged bone using your own tissue. It is common for knee repair but can be used to repair other joints as well. In this procedure, the injured cartilage and underlying bone are removed. An autograft (replacement cartilage and bone from another part of the patient or knee) is then substituted.

The injured area can usually bear weight within four to six weeks. Activity is gradually increased. Athletes can typically return to sports in about six to nine months.

Autologous Chondrocyte Implantation

Autologous chondrocyte implantation (ACI) provides pain relief from larger areas of cartilage damage and cartilage injuries. ACI is a three-stage procedure:

Stage 1: Cells are taken from another part of the patient’s knee.
Stage 2: The cells are grown in vitro for about four to six weeks.
Stage 3: The cells are reintroduced into the affected area in the knee under a patch, ultimately forming new cartilage.

Crutches are needed for at least six weeks and up to three months, depending on the condition and other factors of the individual patient. Ongoing rehabilitation is required and essential for cartilage growth, patient mobility and strength.

Why Ohio State?

Why choose The Ohio State University Wexner Medical Center for treatment of sports-related knee injuries?

Innovative diagnostics: The diagnostic advancements achieved in our Biomechanics Lab in identifying the movement patterns associated with ACL injury are recognized internationally and have led to early detection, more effective treatment and even prevention.

Nationally recognized leadership: We host an annual symposium that draws attendees from across the country to present the latest knowledge-based findings on ACL injury.

Leading-edge treatments: We offer a full spectrum of cartilage restoration treatments, including options not offered elsewhere in central Ohio. Our team is also helping to define the algorithms used for cartilage restoration nationwide.

Expert care: We offer fellowship-level physician care and physical therapy. That means our providers have completed up to two years of intense, specialized experiential training in the field, which translates to extensive proficiency in patient care.

A Closer Look at Sports-Related Knee Injuries

Cartilage Restoration

Dr. Dave Flanigan explains how Ohio State's doctors determine the best personalized solution for each individual.

ACL Leadership

Christopher Kaeding, MD discusses Ohio State's internationally recognized research and work in ACL prevention, treatment and rehabilitation.

Patellofemoral Pain

Dr. Bob Magnussen, discusses patellofemoral pain and injuries, with common treatments and prognosis after injury.

Our Doctors