Knees at risk for many types of injuries

Last week, we learned how to prevent knee injuries, but the reality is even the most seasoned, fit and well-trained athlete can wind up with an injury. Monday sports pages often have at least one story about another football player out with a knee injury.

Dr. Terry Orr gave a talk last January to locals about knee injuries. He works for Tahoe Fracture & Orthopedic Medical Clinic and is a doctor for the U.S. Men's Alpine Ski Team. Olympian Daron Rahlves of Truckee was one of his patients.

Orr said one out of every 1,000 skiers will hurt their knee. Considering Heavenly has had 1 million skiers on its slopes each of the past couple of years, that's a lot of people limping around just on the South Shore. And of those injuries, Orr said about one-third are ACL (anterior cruciate ligament) injuries.

More people are getting their ACLs reconstructed compared with when Orr first came to Tahoe in 1988. At that time, about 95 percent of ACL injuries were repaired and 5 percent reconstructed. It's the opposite now, because people want to remain active.

ACL injuries usually occur when part of the leg stays still and the rest of the body keeps moving. A Vermont research group recently did a study on ACL injury patterns that drew a common thread among skiers. When the hips are below the knees and the person is falling backward, it's a recipe for ligament damage.

Because of the knee's complexity, the number of structures involved, the amount of use it gets over a lifetime and the range of injuries and diseases that can cause knee pain, the signs and symptoms of knee problems can vary widely.

Acute knee pain is severe pain that comes on suddenly and often is the result of injury. Some of the more common knee injuries and their symptoms include:

-- Ligament injuries. Ligaments connect bones to bones. Your knee contains four ligaments - tough bands of tissue that connect your thigh bone (femur) to your lower leg bones (tibia and fibula). You have two collateral ligaments - one on the inside (medial collateral ligament) and one on the outside (lateral collateral ligament) on each knee.

A tear in one of these ligaments usually is the result of a fall or contact trauma, especially in sports like football, and is likely to cause immediate pain in the injured area. The discomfort, which can range from mild to severe, usually is worse when walking or bending your knee. If the collateral ligament on the inside of your knee sprains or tears, you may feel a ripping sensation.

The other two ligaments are inside your knee and cross each other as they stretch diagonally from the bottom of your thigh bone to the top of your shin bone (tibia). The posterior cruciate ligament (PCL) connects to the back of your shin bone, and the anterior cruciate ligament (ACL) connects near the front of your shinbone.

If you tear the ACL, either partially or completely, you're likely to know it right away. You may feel or hear a pop in your knee and have intense pain and immediate swelling. When you try to put weight on your injured leg, your knee may "buckle," or at least feel as if it might give way. In most cases, you'll have to stop all activity, either because the pain is too severe or because your knee isn't stable enough to support your weight.

PCL tears aren't usually as dramatic or painful. Most often, you'll experience pain and swelling in the space behind your knee (popliteal fossa) and a feeling of instability, as if your knee might give way.

-- Tendon injuries. Tendinitis is irritation and inflammation of one or more tendons - the thick, fibrous cords that attach muscles to bone or muscle to muscle. Athletes - especially runners, skiers and cyclists - are prone to develop inflammation in the patellar tendon, which connects the quadriceps muscle on the front of the thigh to the larger lower leg bone (tibia). Tendinitis can occur in one or both knees and often causes pain and swelling at the front of your knee and just below your kneecap. The discomfort usually isn't constant but tends to occur when you jump, run, squat or climb stairs. The quadriceps or patellar tendons also may rupture, either partially or completely. In that case, the pain is likely to be most intense when you try to extend your knee. If the tendon is completely ruptured, you won't be able to extend or straighten your knee at all.

-- Meniscus injuries. The meniscus is a C-shaped cartilage that curves within your knee joint. Meniscus injuries involve tears in the cartilage, which can occur in various places and configurations. For example, the cartilage may tear lengthwise or from the inside to the outside rim of the meniscus (radial tear). Although you may not notice small tears, in most cases, you'll have pain and mild to moderate swelling that develops over 24 to 48 hours. Occasionally, a lengthwise tear flips into the knee joint instead of staying around the joint's edge, an injury called a bucket-handle tear. A flap of the torn cartilage can interfere with knee movement and cause your knee joint to lock so that you can't straighten it completely. Meniscal injuries that cause locking of your knee should be surgically treated. Meniscal tears that don't cause locking, including those of a degenerative nature, usually can be managed nonsurgically.

Other knee-related injuries are bursitis, loose body, dislocated kneecap, Osgood-Schlatter disease, iliotibial band syndrome, hyper-extended knee, septic arthritis, rheumatoid arthritis, osteoarthritis, gout, chondromalacia of the patella, and patellofemoral pain.

Ice always is a good first treatment for an injury. It will reduce the swelling and sometimes the pain. Surgery is not always the answer, but X-rays and MRIs are best for diagnosing the true problem.

When you're ready for prevention and rehabilitation techniques, call me.

- Rhonda Beckham is a nationally certified personal trainer, with teaching certificates in Pilates and kickboxing.