Knee pain is common for runners and knee injuries are very common in athletes who engage in cutting sports, such as soccer, football, basketball, rugby and lacrosse.
- Anterior Cruciate Ligament (ACL) tear: damage to the fibrous tissue running diagonally through your knee that serves in the main restraint in keeping the shin bone in place, preventing your knee from overextending and providing side-to-side support
- 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
- Knee sprain: stretching or tearing of one or more of the knee ligaments
- 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, sometimes referred to as runner's knee): excessive shifting of the patella from activities that involve knee bending
- Patellar tendonitis (sometimes referred to as jumper's knee or knee tendonitis): inflammation or tearing of the tendon connecting the kneecap to the shin
- MCL sprain: the most often sprained ligament in the knee, the medial collateral ligament, 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 hyperextension or excessive knee rotation that damages the static and dynamic stability of the posterior lateral knee
Diagnosis of knee injuries
Life, and sports, puts a lot of wear and tear on your knees. For runners in particular, it may be difficult to know when to see a doctor for knee pain while running. To tell normal pain from more serious signs of injury, look out for sharp pains inside the knee or along the joint lines.
Your doctor will ask questions about the injury, the history of your knee 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 difficult to identify. 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.
Nonsurgical Treatments
When we’re considering treatment options for a knee injury, we first consider how much the pain impacts your quality of life. There are a variety of conservative treatment options that can be a suitable alternative for surgery in the short term or indefinitely.
Nonsurgical treatments for injuries of the knee
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 radiation.
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 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.
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 The Ohio State University Wexner Medical Center.
Lifestyle changes like losing excess weight can also reduce the risk of knee problems.
Surgical Treatments
Surgical treatments for ACL tears, meniscus tears and other knee conditions
ACL Reconstruction
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.
Surgical treatments for ACL tears, meniscus tears and other knee conditions
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. This work has led to earlier 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 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 define the algorithms used for cartilage restoration nationwide.
Expert care: We offer fellowship-level physician care and physical therapy. Our providers have completed up to two years of intense, specialized experiential training in the field, resulting in extensive proficiency in patient care.
Patient Success
Trey's Story
Trey is a High School wrestler who tore his LCL, due to his preventative measures and physical health he beat the odds in not needing to have surgery. Here we learn about how physical therapy helped him get back to the mat in record time.
Parker's Story
Parker is a high school athlete who plays football and basketball. After several traumatic injuries to his knee and a failed surgery at another hospital, his mom discovered David Flanigan, MD, an orthopedic surgeon at The Ohio State University Wexner Medical Center. Here, Parker and his mom tell his story and how MPFL reconstruction and Tibial Tubercle Osteotomy surgery at Ohio State has put Parker back onto the field doing what he loves most: playing football.
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