Knee Sports Injuries

Three bones make up the anatomy of the knee: the femur (thighbone), the tibia (shinbone) and the patella (kneecap). On the end of the femur and tibia and on the underside of the patella there is a very smooth and firm covering of cartilage that provides cushioning and a smooth surface for the bones to glide on.  This type of hard smooth cartilage is called hyaline cartilage. 

In addition to the cartilage on the ends of the bones (hyaline cartilage) there are two pieces of soft rubbery c-shaped cartilage between the femur and tibia called the menisci. Each meniscus provides additional cushioning between the two bones, but also provides added stability. They function similarly to tire wedges or wheel cocks that prevent cars from rolling down a hill. 

There are four main knee ligaments, tough bands of tissue, that connect the thighbone and shinbone. They are the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the lateral collateral ligament (LCL) and the medial collateral ligament (MCL). The ACL crosses in front of the PCL in the center of the knee behind the kneecap. The ACL prevents the shinbone (tibia) from moving too far forward in relation to the thighbone (femur) and the PCL prevents the tibia from moving too far backwards relative to the femur. The LCL is on the outside of the knee, while the MCL is on the inside  of the knee. These collateral ligaments prevent excessive sideways motion of your knees. 

The ligaments help connect the bones in the knee and keep the knee stable when you move. Accompanying the ligaments are sets of tendons connecting the leg muscles to the knee bones that help you move your knee.  

Along the outside of the knee joint are several flat sacs called bursae. Each bursa provides a smooth gliding surface between the bones, muscles and tendons around the joint during activity. 

Anterior cruciate ligament (ACL) injuries, including ACL sprains and ACL tears, are some of the most common ligament injuries in the knee. Approximately 100,000 injuries to the ACL occur each year in the United States.  The ACL is vulnerable to injury during activities involving jumps, pivots or sudden stops and in contact sports like football. Female athletes are at significantly higher risk due to multiple factors. ACL injuries also increase the chance of developing osteoarthritis later in life.

A torn ACL often happens suddenly. There might be a popping sensation when the ACL is injured, with symptoms following immediately after the injury happens. It is rare that an athlete will feel very little pain or have little swelling. Signs you have sprained or torn your ACL include:  

• Severe knee pain that keeps you from continuing activities
• Swelling within a few hours
• Loss of range of motion
• Instability, or feeling like the knee will give out 

To determine whether you have a partial ACL tear or a full ACL tear, your doctor has specialized physical examination tests to check your ACL. A skilled Sports Medicine doctor can be close to 95% certain if your ACL is torn or not with a physical exam. 

Sometimes there is too much pain or swelling after your injury, so your doctor may ask you to come back a week or two later to re-examine your knee after some of the swelling has gone away. If the exam suggests an ACL tear or if there is concern regarding other structures in the knee such as the meniscus, your Sports Medicine doctor may order an MRI. An ACL injury is a very serious injury and will take several months to a year to recover enough for full athletic activity.  

All ACL injuries require diligent physical therapy regardless of whether or not surgery is needed. Most athletes who have torn their ACL will be recommended to discuss surgical options with an Orthopedic doctor.

Athletes who have recovered from the initial trauma and pain of the injury and those who have done some physical therapy prior to surgery do much better in the long run. Less serious ACL sprains may not need surgery, but still require rest and physical therapy and frequently a knee brace.

Injuries don’t happen as often to the posterior cruciate ligament (PCL) as they do to the ACL, but it can be strained or torn by a sudden blow or fall onto a bent knee during contact sports. PCL tears and PCL sprains also don’t cause as much pain, instability or damage to the knee as a torn ACL, but recovery may keep you sidelined for several weeks or months. It also increases your risk of developing arthritis later on. 

A torn PCL does not usually cause a popping or snapping sound when the injury occurs. Instead, PCL sprain symptoms and PCL tear symptoms include: 

• Pain that could cause a limp or difficulty walking
• Swelling within a few hours
• Instability, or feeling like the knee will give out  

The type of treatment your doctor suggests may depend on how much instability the PCL injury is causing. Unlike ACL tears, a majority of PCL tears can be treated without surgery. All PCL injuries initially require rest, ice, and medication for pain relief. Most PCL injuries including tears require knee bracing and some require crutches for a period of time. If the PCL tear occurred with injuries to other knee structures such as the ACL or MCL, or if there is significant instability despite bracing and good physical therapy, surgery may be needed. 

Like other ligaments in the knee, the medial collateral ligament (MCL) and lateral collateral ligament (LCL) can be torn or sprained with a direct blow or muscle movement that impacts the side of the knee. MCL injuries are more common than LCL injuries. People who experience an MCL or LCL injury rarely feel a pop when it happens. MCL and LCL tear symptoms include:  

• Pain on the inside of the knee with an MCL injury
• Pain on the outside of the knee with an LCL injury
• Swelling on either side of the knee within a few hours
• Pain with extension of the knee 
• Needing to keep the knee slightly bent when walking

The treatments your doctor suggests for your LCL or MCL injury will depend on the injury’s severity. Most doctors might recommend ice, rest and physical therapy, as MCL or LCL injuries rarely require surgery by themselves. However, LCL injuries often involve other structures in the knee, which could make surgery necessary.

The recovery time for an MCL tear can take several weeks or months. MCL tear treatments include rest, a knee brace and rehab to strengthen and support the ligament during recovery. An LCL tear’s recovery time may take even longer, especially if other parts of the knee were also injured that require a knee brace or rehab.

A meniscal tear happens when the c-shaped cartilage cushioning the bones of the knee is torn, often with a forceful twist or rotation. Meniscus tears occur more frequently in sports that require frequent quick changes in direction like football or soccer. As we age, the meniscus experiences general wear and becomes easier to tear in older adults A knee injury that resulted in a torn meniscus can also contribute to knee osteoarthritis later in life.  

Not all meniscal tears are the same. The type, size and location of your tear affect how your doctor treats your injury. 

Meniscal tears usually happen suddenly and cause pain. Other meniscus tear symptoms include: 

Patellar bursitis, or knee bursitis, occurs when the fluid-filled bursae cushioning the front of your knee become inflamed, often from excessive kneeling or from a blow or falling directly onto your knee. Bursitis causes pain and can limit mobility.  

People whose jobs or hobbies require them to work on their knees and athletes participating in sports such as wrestling, football and volleyball are at risk of knee bursitis. 

Signs of knee bursitis tend to appear gradually and slowly worsen. Knee bursitis symptoms include:  

• Swelling in front of the kneecap
• Tenderness and warmth to the touch
• Sometimes the skin over the front of the knee can turn red
• Pain with activity, but not usually at night 

Bursitis often improves over time, especially with avoiding kneeling, scheduled topical and/or oral anti-inflammatory medications and ice. Knee surgery for bursitis is very uncommon, but your doctor may recommend it if your bursitis is severe and not alleviated by less invasive treatments or if the bursa is infected. 

Patellar tendonitis, also known as jumper’s knee, is a tendon injury in the tissue connecting the kneecap and shinbone caused by overuse.  

It is most frequent among athletes whose sports involve repetitive jumping, such as basketball or volleyball, but even people who aren’t active in sports can develop knee tendonitis from repetitive bending of the knee. Patellar tendonitis is very common in runners and sprinters as well. Having tight thigh muscles or an imbalance in quadriceps (front of the thigh) and hamstring (back of the thigh) muscles can increases your risk of developing patellar tendonitis. 

One of the most common patellar tendonitis symptoms is pain. At first, the pain below the kneecap might only be present during physical activity. However, it can eventually interfere with sports participation and affect daily movements such as climbing stairs.  

Home treatment for knee tendonitis usually involves avoiding jumping and running for a period of time, non-prescription anti-inflammatory medications and stretching the quadricep muscles. If the pain is not improving with home therapy, physical therapy is usually the most important part of treating patellar tendonitis.

Your physical therapist could suggest exercises that cause some mild soreness or discomfort when performing them. Too much pain with the therapy exercises may be detrimental, but not pushing the exercises may also prevent improvement in tendonitis. Sometimes a patellar tendon strap can allow athletes to complete their season before focusing their attention to fully recovering from a patellar tendonitis. Corticosteroid injections are generally not used to relieve patellar tendonitis pain. However, if your condition doesn’t improve, your Sports Medicine doctor may suggest injection therapies such as prolotherapy or platelet-rich plasma (PRP) therapy with continued physical therapy to encourage full recovery.

Patellofemoral Pain Syndrome, also known as anterior knee pain or runner’s knee, is among the most common sports injury conditions, surfacing as a dull aching pain at the front of the knee. 

The condition is often caused by overuse in running and jumping sports, particularly among youth, with female athletes more susceptible to the injury. Contributing factors include overuse and problems with joint alignment.  

Symptoms include of patellofemoral pain syndrome include:

• Pain behind, under or around the patella, or kneecap
• Stiffness or pain
• Misalignment of the kneecap
• Pain resulting from activities that put stress on the knee joint

A Sports Medicine doctor is often able to diagnose patellofemoral pain syndrome through a first-hand examination, in which the doctor will look at placement and movement with the kneecap, along with the range of motion at the joint. 

The injury can often be traced back to a source, either wearing and irritation in the joint, or in fewer cases, as the direct result of a specific acute injury.

At times a doctor may request imaging, such as an X-ray or MRI, but these tend to be special cases in which the doctor is checking for other injuries that may be accompanying or have similar symptoms. In patients over 50, imaging may be used to confirm or rule out arthritis. In younger patients, imaging may be requested to look for signs of osteochondritis dissecans, or OCD, growth plate damage or bone tumors.

Anterior knee pain has also been connected to chondromalacia patella, which is a softening or breakdown of cartilage under the kneecap. There are no nerves in that area, so it does not directly cause joint pain, but the condition can cause inflammation of the synovium, the tissue that lines the joints, which can cause chronic pain. 

Patellofemoral pain syndrome in most cases can be treated by a Sports Medicine physician through non-invasive methods, like prescribed rest and icing — but not heat, altered exercise routines and physical therapy.

A doctor may also recommend bracing, taping or shoe inserts to help bring the joint and leg into better alignment during recovery. The underlying issue can often also be resolved by replacing worn out or unevenly worn footwear.

Whether it’s from natural wear and tear or previous injuries, many people experience osteoarthritis in the knees, or degenerative knee arthritis, as they age. Because osteoarthritis is an age-related condition, most people who get osteoarthritis are over 50 years old. Osteoarthritis can also occur in younger athletes, especially if they had a significant knee injury such as a tear of the ACL or meniscus. Running is no longer considered a risk factor for developing arthritis later in life. 

Symptoms of knee arthritis usually develop slowly and worsen with time, but sometimes knee pain can develop suddenly. Common symptoms include:  

• Aching and soreness in the knees
• Pain after prolonged standing or walking
• Stiffness with periods of prolonged sitting 
• Painful and sometimes painless joint swelling after activity
• Gradual loss of knee range of motion

Your doctor may order X-rays to determine if you have knee arthritis, because X-rays can show whether the space between your bones has narrowed. Then, your doctor may offer non-surgical knee arthritis treatment options before considering surgery. Some non-surgical remedies that bring knee joint pain relief include: 

• Weight loss (though it is the most difficult thing to do for most patients)
• Physical therapy, which is the most effective treatment for osteoarthritis of the knees
• Lower impact activities such as like walking, swimming or biking
• Prescription and non-prescription anti-inflammatory medications
• Corticosteroid injections
• Viscosupplementation (or lubricating) injections
• Bracing

Eventually, these treatments may not adequately relieve the symptoms of knee arthritis pain because knee arthritis does progress and gets worse over time. Your doctor may discuss whether knee replacement surgery is right for you.

At Sauk Prairie Healthcare, we strive to treat every person’s knee injury as a unique case to make sure they can return to the activities they enjoy without pain slowing them down. 

Our Sports Medicine doctors in Sauk Prairie, Lodi and Spring Green treat all kinds of sports injuries, including knee injuries. These doctors focus on non-invasive treatment options first and work with a team of orthopedic surgeons, rehab therapists and certified athletic trainers for complete care until you are ready to return to play. 

Your Sauk Prairie Healthcare team will follow up with you through every step of the process after you are injured, from the first appointment until you have recovered and can safely return to play.

Our Sports Medicine Physicians:
Masaru Furukawa, MD, MS
David Krey, DO
Mark Timmerman, MD

To schedule an appointment with a Sports Medicine physician, call 608-643-7677.