MANUAL MINORS
Knee soft tissue injuries involve damage to structures such as ligaments, menisci, tendons, muscles, and the joint capsule. These injuries are common in physically active individuals and athletes, ranging from mild sprains to severe tears.
Soft tissue injuries can compromise knee stability, movement, and function, and appropriate management is crucial to prevent long-term complications such as instability or osteoarthritis.
Diagnosis
Diagnosing knee soft tissue injuries is based on the patient’s history (mechanism of injury), physical examination, and imaging studies. The physical examination includes specific tests to assess ligament stability, such as Lachman’s test, McMurray’s test, and Apley’s sign, among others.
Magnetic resonance imaging (MRI) is the study of choice for evaluating soft tissue injuries, allowing visualisation of ligaments, tendons, and menisci, and determining the type and severity of the injury.
Common Soft Tissue Injuries
Soft Tissue | Type of Injury | Main Symptoms | Diagnosis | Treatment |
|---|---|---|---|---|
Anterior Cruciate Ligament (ACL) | Partial or complete tear | “Pop,” instability, pain, rapid swelling | Lachman’s test, MRI | Surgery (reconstruction), physiotherapy |
Posterior Cruciate Ligament (PCL) | Tear from direct trauma | Pain, posterior instability | Posterior drawer test, MRI | Conservative or surgical depending on severity |
Medial Collateral Ligament (MCL) | Sprain or tear | Pain, medial instability | Valgus stress test, MRI | Conservative for mild, surgery for severe |
Lateral Collateral Ligament (LCL) | Tear or sprain | Lateral pain, instability | Varus stress test, MRI | Physiotherapy or surgery if severe |
Medial & Lateral Meniscus | Tear | Pain, locking, popping, swelling | McMurray’s test, Apley’s sign, MRI | Meniscus repair or partial meniscectomy |
Patellar Tendon | Tendinitis (“jumper’s knee”) or complete rupture | Anterior pain, difficulty jumping/running | Physical exam, MRI | Physiotherapy for tendinitis, surgery for rupture |
Quadriceps Tendon | Tendinitis or rupture | Pain above the patella, weakness | Physical exam, MRI | Physiotherapy for tendinitis, surgery if ruptured |
Patellar Cartilage (Chondromalacia) | Wear or softening | Anterior knee pain, worsens with stairs | Physical exam, MRI | Physiotherapy, NSAIDs, activity modification |
Muscles (Quadriceps, Hamstrings) | Strain or sprain | Localised pain, movement limitation | Physical exam, MRI | Rest, physiotherapy |
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Knee Dislocation | Complete joint displacement with visible deformity. |
Patellar Fracture | Anterior knee pain, with visible fracture on X-rays. |
Knee Osteoarthritis | Chronic pain and progressive joint stiffness, more common in older individuals. |
Prepatellar Bursitis | Localised inflammation over the patella, with superficial pain and swelling. |
Iliotibial Band Syndrome | Lateral knee pain without instability or joint locking. |
Emergency Management
In the emergency setting, the management of knee soft tissue injuries focuses on controlling pain and inflammation, as well as immobilising the joint in more severe cases. The RICE protocol (rest, ice, compression, and elevation) forms the basis of initial treatment.
NSAIDs (ibuprofen, naproxen) are also administered to alleviate pain and reduce inflammation. In cases of significant instability or suspected severe ligament tear, the knee may be temporarily immobilised with a splint until further imaging studies are performed.
Definitive Treatment
Conservative Treatment
Mild to moderate ligament, meniscus, or tendon injuries can be treated conservatively with rest, physiotherapy, and muscle strengthening. Physiotherapy is essential for restoring knee stability and mobility.
NSAIDs and heat/cold therapy: These help reduce inflammation and pain during the acute phase.
Surgical Treatment
Ligament or meniscus repair: Surgery is indicated for severe injuries or complete tears, especially in the ACL, menisci, or tendons. Arthroscopy is commonly used to repair or reconstruct damaged structures.
Ligament reconstruction: The ACL and PCL often require surgical reconstruction with grafts when fully ruptured.
Rehabilitation
Rehabilitation is critical in the treatment of soft tissue injuries. Physiotherapy programmes include muscle strengthening, stretching, and proprioception exercises to improve knee stability. Depending on the severity of the injury and the treatment, return to physical activity may take weeks to months.
Comments