A sports-related knee injury can be devastating to a young athlete hoping to play in college or a professional level. Not understanding the long-term effects of their injury and the severity of it, many rush back into activity before they are fully rehabilitated and end up with lifelong problems. It has been shown that those with severe knee osteoarthritis have higher rates of depression and that they avoid doing exercise due to fear of further damaging their knee. With the increasing number of knee injuries, and ways to treat them that have variable success rates, educating people on their treatment options is the key to helping them return to a lifestyle with minimal pain and good knee function.
Sports-related knee injuries are very common, especially among physically active individuals. At some point in our lives, it has been estimated that 10-15% of all sports injuries involve the knee. Knee injuries have increased due to the increasing number of people involved in sports and recreation activities, more awareness, which is followed by more injuries, and more kids and young adults involved in organized sports. The most commonly affected group are people from the ages of 15-45 and it has been found that the male gender is more vulnerable to knee injury than women. Since the knee is a weight-bearing joint, it is very prone to injury because of the large forces exerted upon it.
Overview of sports-related knee injuries
Meniscus injuries are another common cause of knee pain. The meniscus is a rubbery, C-shaped disc that cushions the knee. Each knee has two menisci. They can be torn if a person changes direction quickly while running, especially if the foot is planted. They are often torn playing aggressive sports and are a common injury in athletes. A torn meniscus will cause pain and swelling in the knee. If a small piece of the meniscus breaks free and enters the joint space, the knee will fail to straighten, and it will be impossible to put any weight on it. Left untreated, a meniscus tear can lead to joint instability and early onset of osteoarthritis.
Anterior cruciate ligament (ACL) injuries are among the most common sports-related knee injuries. They are common in sports such as football, basketball, soccer, and skiing. The ACL is the ligament that stabilizes the knee. It prevents the tibia from sliding out in front of the femur, as well as providing rotational stability to the knee. The ACL can be sprained or torn. The higher grade of tear, the more unstable the knee will become. If left untreated, it is possible for the person to develop osteoarthritis because the cartilage will continue to wear. Symptoms of an ACL injury are swelling, pain, instability, and loss of range of motion. It is quite common to feel a “pop” sound at the time of the injury.
Importance of seeking treatment from knee pain specialists in Singapore
Sports-related knee injuries are usually some of the most complex musculoskeletal injuries. The sports activities are generally strenuous and the knee has to absorb forces on it, sometimes going up to six times body weight, depending on the activity. Athletes and non-athletes alike are susceptible to knee pain and injuries due to the knee sustaining wear and tear as time progresses. Injury is more likely as the knee ages, and untreated knee injuries can lead to further damage of the knee. The harder an athlete pushes, the more likely an injury to the knee is going to occur. It is very crucial that all knee injuries are given a thorough assessment and diagnosis to prevent further damage or discomfort in the knee. So regardless of how trivial an injury may seem, a thorough examination by a knee pain specialist is recommended. With the advancements in medicine today, a specialist is able to take a whole array of tools to diagnose the cause of knee pain. These include: medical history, physical examination, x-rays, and MRIs. A treatment plan can then be formulated once an accurate diagnosis is determined. Oftentimes the R.I.C.E regimen (rest, ice, compression, elevation) is enough to treat minor knee injuries. However, the road to recovery can be a long and frustrating process. Step one to prevention and treatment of knee pain is understanding the function of the structure of the knee, common causes of knee pain, and effective prevention and treatment. Today, knee pain sufferers, athletes, and non-athletes can take advantage of a plethora of knee information resources and services. From the family doctor to the medical specialist, there are many services available that can offer varying levels of help. These can include internet websites, hotlines, doctor’s offices, written materials, and medical specialists. Remember, it is always important to strive to maintain knee health so that it may be possible to enjoy an active lifestyle free from knee pain and injuries.
Common Types of Sports-Related Knee Injuries
There are several common types of sports-related knee injuries, and their treatment options are usually determined by the nature and severity of the injury and the level of activity of the patient. The majority of sports-related knee injuries have a traumatic onset, but they can also have degenerative and chronic causes. Traumatic injuries are usually a result of high-energy forces in motion or impact and can occur during any physical activity. Worse still, any traumatic injury has the potential to be multi-ligamentous, with associated injuries to other structures in the knee, making the diagnosis and treatment of all injured areas that much more crucial. Chronic knee pain from overuse and degenerative disorders can also sideline any athlete from their sport. It is not uncommon for traumatic injuries to have a component of chronic pain and/or to predispose a patient to degenerative changes in the knee. The most severe of the acute knee injuries is an ACL tear. This injury occurs from a sudden twisting motion or change in direction when the foot is planted on the ground. These are quite commonly reported in sports that involve sudden changes in direction or speed, and sports that involve jumping. These include soccer, basketball, and volleyball. Complete tears of the ACL often result in the inability to continue the current activity and severe swelling of the knee in the first few hours after injury. The knee will often feel unstable, and giving way is a common complaint. Combined injuries to other ligaments, particularly the medial collateral ligament, are common. This will affect the treatment options and prognosis of the injury.
Anterior cruciate ligament (ACL) tear
The ACL is one of the four main ligaments within the knee that connects the femur to the tibia. It is needed as it provides stability to the knee. It is a commonly injured ligament with approximately 1 in 3000 people sustaining an ACL injury each year. This figure is significantly greater in people who participate in sports involving twisting and turning and changing direction. ACL injuries usually occur during sports and fitness activities that involve sudden twisting or a change in direction, a sudden stop or landing a jump. Injuries can range from mild such as a small tear, to a complete tear of the ligament. A mild to moderate injury to the ACL will still give a stable knee, but a feeling of your knee giving way is often reported and there can be recurrent swelling. A complete tear of the ACL in an active person involved in moderate to high level sports will most often require surgery to allow resumption of the same sporting activities. More functional recovery that will allow return to some sports can often be achieved without surgery in elderly or low demand patients.
Meniscus tear
Meniscus tears are among the most common knee injuries. Anyone at any age can tear a meniscus. A meniscus is a piece of cartilage providing a cushion between the femur and tibia bone. The two most common ways to tear a meniscus are by twisting your knee while your foot is planted on the ground or by deep squatting. Because the blood supply to the meniscus is poor, small tears can sometimes heal on their own, given time. The fact that healing is difficult is related to the location of the injury. Due to its lack of blood supply, treatments are limited in their ability to stimulate tissue growth. In other words, only the outer edge of the meniscus has a blood supply to facilitate healing. Tears to the blood-rich outer edge of the meniscus have a better repair potential, while tears to the inner two-thirds are better treated by procedures which trim out the torn piece of meniscus. This tearing pattern explains why some meniscus injuries become arthritic while others can be asymptomatic.
Patellar tendinitis
Exercise can be continued, but it is important to offload the patellar tendon by limiting activities that require heavy use of the quadriceps, high-impact running, and jumping. Utilizing ice and anti-inflammatory medication can aid in pain relief and reduce swelling on the patellar tendon. High rate of success has been reported for extracorporeal shockwave therapy, a relatively new treatment for chronic cases of patellar tendinitis. For more aggressive treatments, the athlete should seek a proper diagnosis and gather as much information as possible on the treatment and its success rate on athletes of similar level and condition.
The treatment most commonly recommended for patellar tendinitis, right throughout the early stages and into the chronic states, is relatively the same and it is very conservative. The main objective is to rest the tendon and allow it to recover, as long as it takes. The healing process for the patellar tendon is slow due to its poor blood supply, and this is something that frustrates many athletes, often pushing them to move onto more aggressive treatment to quickly relieve the pain and get back into their sport.
The onset of patellar tendinitis is slow and it will gradually worsen if the excessive movement causing the injury is not abstained. At first, the athlete will feel pain only during the warm-up of an event, which will go away and seem to not affect performance. As it gets worse, the pain will persist throughout the entire event and eventually inhibit the athlete’s ability to compete. If no measures are taken to alleviate the situation, the patellar tendinitis can become a chronic and ongoing injury. This means the athlete will have periods when the pain will go away, but returning to the same activities that caused the injury previously will bring it back.
Patellar tendinitis is one of the most common issues that a professional or amateur athlete will have to face at some point. Caused by repetitive trauma to the patellar tendon, it is an injury that occurs frequently in sports which require excessive running and jumping. Patellar tendinitis is likely to be very frustrating for athletes since it is a persistent type of injury that is very difficult to get rid of.
Knee bursitis
In severe cases, the bursitis may be aspirated. However, this is becoming less common as it increases the risk of infection. If all other methods fail, surgical removal of the bursa can be considered, but this is often a last resort due to the risk of damage to the superficial nerves and possible infection.
Diagnosis is made by a clinical examination of the knee, possibly involving the removal of fluid from the bursa if it is very swollen. X-ray and scan results will help to rule out any other conditions of the knee. Treatment involves the PRICE principles for the first 24-48 hours and the use of anti-inflammatory medication. A hinged knee brace may be useful for patients, and crutches may be required if the knee is very painful. Rehabilitation often involves physiotherapy to stretch and strengthen the muscles surrounding the knee and to correct any internal knee derangement.
Goosefoot bursitis is the most common type of bursitis. It is commonly associated with a medial ligament strain or a medial meniscus tear. This can lead to an increase in pressure on the inside of the knee, resulting in bursal trauma. This presentation of bursitis is commonly mistaken for an internal knee derangement, as the symptoms of both an internal derangement and goosefoot bursitis can be very similar.
Suprapatellar bursitis results from direct trauma to the midsection of the front of the knee or from a high force impact on the knee. This kind of impact can result in a quadriceps tendon injury with bursal involvement.
Prepatellar bursitis is commonly referred to as “housemaid’s knee.” This is because the bursa can become inflamed after direct trauma or prolonged pressure (as caused by frequent kneeling). This type of bursitis occurs most commonly in plumbers and carpet layers. Acute prepatellar bursitis can cause the bursa to fill with blood and the skin to become discolored.
Knee bursitis is an inflammatory condition of the knee that results in swelling, pain, and increased warmth. There are three types of knee bursitis: goosefoot (anserine) bursitis, suprapatellar bursitis, and prepatellar bursitis. Each of these forms of bursitis affects a specific part of the knee, but they all have similar symptoms. The severity of the symptoms can depend on the extent of the trauma to the bursa.
Treatment Options for Sports-Related Knee Injuries
For patients with localized articular cartilage defects which have failed non-operative management, the ACI procedure is indicated to fill the chondral defect with new hyaline-like cartilage. This is a 2-stage keyhole surgery procedure which involves harvesting cells that are in the body that can grow to replace the damaged cartilage.
Most sports-related knee injuries are partial tears, which can be isolated to one part of the joint. Following examination, an appropriate treatment plan will be advised. The initial treatment for any soft tissue injury consists of RICE (Rest, Ice, Compression, Elevation). The aim is to reduce pain and inflammation. This is complemented by a non-steroidal anti-inflammatory tablet. The use of a walking aid, such as a stick or crutches, helps to protect the knee and avoid any further damage. A physiotherapy program will be advised. The duration will depend on the nature and severity of the injury. A supervised physiotherapy program involves a set of specific exercises that are aimed at regaining the strength and movement in the knee. This begins with muscle strengthening exercises and gradually progresses to more complex exercises and drills. An appropriate brace may be indicated to affect the behavior of the knee. This decreases the load of stress onto the knee and thus alleviates pain and disease progression. These may be custom-made to fit the knee. A post-treatment rehabilitation program is aimed at enabling the individual to return to the pre-injury activity or sport. This often involves positioning specific sports trainers. Success of the rehabilitation program depends on the consideration of the nature and severity of the injury and the compliance and motivation of the patient to complete the given exercises.
Non-surgical treatment approaches
In the acute situation, when pain, swelling or both are severe, the primary aim is to control the effusion. This may be achieved by simple methods including rest, ice, compression, and elevation. Alternatively, the application of ice and elevation of the limb may be combined with aspiration of the haemarthrosis, which in some patients gives immediate symptom relief. The use of continuous cryotherapy has been shown to reduce knee pain in patients with acute injury or knee surgery. A study comparing the use of continuous-flow cold therapy with that of intermittent ice packs following arthroscopic knee surgery showed significantly less knee pain in the continuous cryotherapy group. The use of non-steroidal anti-inflammatory drugs (NSAIDs) is widely accepted in the treatment of musculoskeletal injuries. Their action in reducing pain and swelling may allow earlier progression to functional rehabilitation. Oral and topical forms have been shown to be equally effective. However, the use of NSAIDs in the treatment of ligament injuries is controversial, as there is some evidence to suggest that they may inhibit ligament healing. In contrast, there is strong evidence supporting the use of bracing and functional rehabilitation for the treatment of ligament injuries. The objective of functional rehabilitation is the return of normal joint motion, restoration of muscle strength, and early return to activities of daily living. Evidence supports bracing and functional rehabilitation as effective treatments for acute ACL injuries. A functional brace has been shown to improve subjective knee function, compared to hinge bracing and early ACL reconstruction. In cases of knee ligament sprains or tears, a program of physical therapy is highly effective and the majority of patients will recover without the need for surgical intervention. High-grade strains and tears may require prolonged rehabilitation, yet surgery is not indicated if the symptoms can be satisfactorily controlled. In patients with MCL tears, functional rehabilitation has been shown to be as effective for medial joint stability, compared to immobilization in a knee brace. However, due to the high level of variability in the nature of MCL injuries, the need for surgical reconstruction will be assessed on a case-by-case basis.
Surgical treatment options
Different surgical techniques are indicated based on the specific injury and the expected demands of the patient during activities that range from low risk to high risk for further knee injury. An individual who sustains a knee injury that results in recurrent giving way and an ACL tear with an associated meniscus tear while planting and cutting on the soccer field may require a more complex and involved surgical procedure than an individual who sustains an isolated ACL tear while playing a different sport. Again, all surgical decisions should be made with the full knowledge of the potential risks and benefits for the specific procedure to be performed.
Athletes whose lives are derailed by a knee injury are often willing to do whatever it takes to return to their sport as quickly as possible. When an athlete or the athlete’s parents and physician elect to perform surgery on a knee with an old, torn ACL, the decision is often made with the hope that surgery will allow the athlete to return to his or her previous level of activity with the fewest possible long-term complications. This is often a reasonable choice when the characteristics of the injury and the expected post-operative knee function are compared with the outcomes and functional limitations associated with nonsurgical treatment.
Choosing a Knee Pain Specialist in Singapore
It is important to note that these are costly machines, and not all clinics will have them. Instead, the patient may be referred to an external imaging centre. This is usually less convenient and may prolong the period until treatment can commence. The availability of treatment technologies is also essential. The more severe a knee injury is, the more likely that surgery will be required.
An important aspect of a knee pain specialist’s clinic is the availability of advanced diagnostic and treatment technologies. These technologies provide a variety of benefits to patients. Advanced diagnostic technologies such as ultrasound and direct digital x-rays provide greater accuracy and early detection of the injury. The earlier an injury is diagnosed, the sooner treatment can commence. These help to identify the correct cause of the pain more quickly. MRIs are essential for some soft tissue injuries. This technology provides superior images for a more accurate diagnosis. This is particularly useful for knee injuries, where MRIs are commonly used to examine the various ligaments. Generally, a more accurate diagnosis leads to a more effective treatment. In the case of MRIs, no effective treatment can be done until the diagnosis is confirmed.
When choosing a knee pain specialist in Singapore, the first thing to look out for is their qualifications. As with any medical professional you are going to seek treatment with, it is important to ensure that the knee pain specialist is adequately qualified. Most knee pain specialists will have advanced qualifications in sports medicine. They should also be registered with the Singapore Sports Council. In knee pain Singapore, relevant qualifications for knee pain specialists include graduate diplomas and masters in sports medicine and/or physiotherapy. Some knee pain specialists are part of the Royal College of UK and/or Australian College of Medicine. Those knee pain specialists are recognized and registered as specialists in their field. You can have a look at their respective clinics’ websites for a more comprehensive list of their qualifications and credentials. In addition to this, the knee pain specialist should have a proven track record in treating similar conditions to what you have. This is vital for ensuring that you receive expert care. This can be found out by simply asking the knee pain specialist.
Qualifications and expertise of knee pain specialists
Orthopaedic knee specialists will have an MBBS degree and postgraduate qualifications, including the Masters of Medicine in Orthopaedic Surgery. With these, the doctor is able to become a member or fellow of the Royal College of Surgeons. This is a basic licensing requirement to practice orthopaedic surgery. Some specialists may have general certification to practice medicine but may not specifically be orthopaedic trained. These doctors may not be as well equipped with the knowledge and expertise required to treat knee conditions compared to those who are orthopaedic trained from the start.
Leaving your knees in the hands of a specialist requires a great deal of faith in the individual’s capabilities. You cannot hand your knees to just anyone, so it is vital that one knows what the specialist is or is not capable of and whether he is suited to the patient’s needs.
Availability of advanced diagnostic and treatment technologies
Diagnosis and management of the knee joint have advanced drastically over the past 10 years. Medical technology has come a long way, including improvements in imaging modalities such as X-ray, ultrasound, MRI, and arthroscopy. New machines have been built to help treat knee problems. These include shock wave therapy, different types of knee injections, and even robots to help with unicompartmental knee replacement. With these advances, it is important for a patient to find a knee specialist who is familiar with these technologies and how to use them in order to achieve the best possible diagnosis and treatment for the patient’s problem. Access to these technologies is usually available if the knee specialist is working in a private hospital or has connections with other healthcare providers who have the required machinery. Although it is possible to get adequate treatment at a public hospital, the availability of these machines is much greater in the private sector. Thus, it is another reason why consulting a knee specialist in a private setting will be more beneficial for the patient.
A patient should select a knee specialist based on their qualifications and expertise in dealing with knee problems, the availability of advanced diagnostic and treatment technologies, and patient testimonials. It is important for a patient to be aware of what the knee specialist’s qualifications and expertise are before consulting them on their knee condition. With so many different types of healthcare providers out there today, it is essential for a patient to see a specialist and not a generalist, such as a family physician. Although a family physician may be able to diagnose the problem, they will not be as updated or skilled in treating that problem as a specialist will be. Existing evidence shows that the volume and experience of the individual surgeon have a profound effect on clinical outcomes in total knee arthroplasty. One study showed that knee arthroplasty performed by surgeons doing less than 12 per year has been significantly associated with a higher rate of septic and mechanical complications than those doing more than 12 per year.
Patient reviews and testimonials
Before finally opting for one of the knee injury specialists or knee injury doctors, an important thing that he needs to do is to ask for views or references from his friends, relatives, and acquaintances that have any sort of connections with the knee injury specialist in question. Getting feedback from those that have had firsthand experience, such as former or even current patients of the knee injury specialist, will provide beneficial information on how good the knee specialist’s reputation. With a good reputation, comes trust, and with trust, the chance of getting cured from the knee injury will increase. If possible, the patient may request a few contacts of people experienced with the knee injury specialist from the specialist himself, which in most cases will be approved. Knee specialists that have gained achievements or developments in the medical world are usually often found in some articles or newsletters relevant to their field of expertise. From this point, it may also become a consideration to opt for knee injury specialists with a good reputation from information found on the source mentioned before.