Tag: Knee

  • 04
  • Apr
Patellar Tendinitis (Jumper’s Knee)
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Brief Outline of Patellar Tendinitis (Jumper’s Knee)

Activities that require repetitive jumping like basketball or volleyball can lead to tendinitis in the patellar (tendon) ligament, also referred to as jumper’s knee. The force placed on the tendon over time can lead to inflammation and pain. The pain is generally felt just below the knee cap.

Anatomy and Physiology of Patellar Tendinitis (Jumper’s Knee)

Patellar tendinitis affects the teno-osseous junctions of the quadriceps tendon as it attaches o the superior pole (extremity) of the patella, and the patellar (tendon) ligament as it attaches the inferior pole of the patella and the tibial tuberosity. Pain is concentrated on the patellar (tendon) ligament, but can also occur at the insertion of the patellar (tendon) ligament into the tibial tuberosity. The patellar (tendon) ligament is involved in extending the lower leg, but is also the first area to experience shock when landing from a jump. It is forced to stretch as the quadriceps to contracts to slow down the flexion of the knee. This repetitive stress can lead to minor trauma in the tendon, which will lead to inflammation. Repetitive flexing and extending of the knee also places stress on this tendon if the tendon does not travel in the required path.

Cause of Patellar Tendinitis (Jumper’s Knee)

Repetitive jumping and landing activities. Running and kicking activities. Untreated minor injury to the patellar tendon.

Signs and Symptoms of Patellar Tendinitis (Jumper’s Knee)

Pain and inflammation of the patellar tendon, especially from repetitive or eccentric knee extension activity or kneeling. Swelling and tenderness around the tendon.

Complications if Left Patellar Tendinitis (Jumper’s Knee) Unattended

As with most tendinitis, inflammation that is left untreated will cause additional irritation, which causes more inflammation, setting up a vicious cycle. This can eventually lead to a rupture of the tendon. Damage to surrounding tissue may also occur.
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  • 03
  • Apr
Subluxing Knee Cap
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Brief Outline of Subluxing Knee Cap

A subluxation or dislocation of the knee cap (patella) commonly occurs during deceleration. The knee cap slides partially out of the groove that is designed for it but does not limit mobility. Pain and swelling may accompany this condition. Athletes who has a muscle imbalance or a structural deformity, such as a high knee cap, have a higher chance of a subluxing knee cap.

Anatomy and Physiology of Subluxing Knee Cap

The patella is a small triangular sesamoid bone within the tendon of the quadriceps femoris muscle and forms the front of the knee joint. It is attached above to the quadriceps tendon, and below to the patellar (tendon) ligament, and articulates with the patellofemoral groove between the femoral condyles to form the patellofemoral joint. The patella slides over the groove when the knee flexes. If the outer muscle of the quadriceps, the vastus lateralis, is stronger than the inner muscle, the vastus medialis, this imbalance may cause an uneven pull on the knee cap forcing it out of the normal groove. In addition, the lateral femoral condyle and medial patellar bone may be bruised. This happens with forceful contractions such as planting, changing direction, or landing from a jump.

knee-subluxationCause of Subluxing Knee Cap

Strength imbalance between the outer quadriceps group and the inner group. Impact to the side of the knee cap. Twisting of the knee.

Signs and Symptoms of Subluxing Knee Cap

Feeling of pressure under the knee cap. Pain and swelling behind the knee cap. Pain when bending or straightening the knee.

Complications if Left Knee Cap Subluxation Unattended

Continued subluxations can cause small fractures in the patella, cartilage tears, and stress on the tendons. Failure to treat a subluxation could lead to chronic subluxations.

Immediate Treatment for Knee Cap Subluxation

R.I.C.E. Anti-inflammatory medication. Physiotherapy.

Rehabilitation and Prevention of Knee Cap Subluxation

During rehabilitation, activities that do not aggravate the injury should be sought, such as swimming or biking instead of running. Strengthening of the vastus medialis and stretching the vastus lateralis will help correct the muscle imbalance that may cause this condition. A brace to hold the knee cap in place may be needed when initially returning to activity. To prevent subluxations, it is important to keep the muscles surrounding the knee strong and flexible and avoid impact to the knee cap.

Long-term Prognosis for Knee Cap Subluxation

Subluxations respond well to rest, rehabilitation, and anti-inflammatory measures. Rarely surgery may be required to prevent recurring subluxations due to misalignment or loose support structures.
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  • 15
  • Nov
Knee pain sufferers often avoid treatment
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Almost half of elderly Singaporeans suffer from knee pain, according to a small local survey, but a significant proportion avoid seeking treatment, citing pain as one of the side effects of age or the cost of medical care.

“Patients choosing to limp around and delay treatment can worsen their condition,” said Dr. Kevin Yip, Singapore Renowned Orthopaedic Surgeon.

The survey included 210 Singaporeans aged 50-69 years, of which 42 percent experienced knee pain, many for 5 years or more. Of the 53 percent who sought treatment, most said they consulted their general practitioner while others consulted polyclinic doctors, Chinese physicians or private specialists.

The most common self-treatment methods were pain relieving creams or oils and herbs. The most common prescribed supplements like glucosamine, and traditional Chinese medicines.

However, advanced knee pain may be the result of osteoarthritis, in which the cartilage cushion between joints bones wears away, resulting in painful bone-on-bone contact during movement.

Osteoarthritis Knee

Non-surgical treatments include non-steroidal anti-inflammatory drugs, corticosteroids or viscosupplementation with injectable materials such as hyaluronic acid that provide cushioning in the joint area to reduce pain and prolong time until surgery.

Knee surgery can still be an eventuality but 45 percent of survey respondents were unwilling to go for surgery because of the costs, the time necessary for rehabilitation and the pain involved.

The number of knee replacement surgeries per year in Singapore has more than doubled over the past decade, up from 700 in 2000 to 2,000 in 2011.

We are trying to compare the effects of hyaluronaic acid injections on osteoarthritic knees undergoing microfracture to attempt to repair some of the cartilage versus the effects of a combination of hyaluronic acid and mesenchymal stem cell injections.

There is nothing that can regenerate the cartilage, but injectable treatments do alleviate pain and may improve quality of life.
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  • 09
  • Sep
Sports Injuries of the Knee
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The incidence of sports-related injuries has been increasing steadily over the recent years. It is estimated that doctors in the Unites States treat 3.5 million sports injuries in a year and in Singapore, over 16,000 sports injuries occur every year.

Sports  injuries impact the sufferer on two fronts. In terms of sporting activity, the individual is unable to participate during the recovery phase. After recovery, the individual may not be able to return to sport at pre-injury level due to residual impairment of function. With respect to life outside of sport, time may have to be taken off work or school, depending on the severity of the injury. Difficulties may also be experienced in the performance of certain aspects of an individual’s job.

Sports injuries can be divided into acute sports injuries and overuse sports injuries. Acute sports injuries are associated, most commonly, with contact sports (eg. football or basketball) or sports involving sudden twisting or change in direction (racket sports). The onset of symptoms is sudden and treatment often involved surgery. Overuse sports injuries occur with sports of repetition (eg. running) where the same action is repeated many times over. The onset of symptoms is gradual and treatment usually involves physiotherapy and rehabilitation. In this article, we will focus on acute sports injuries of the knee.

Knee Anatomy
Sports Injuries to Knee Ligament

The primary function of ligaments is to keep movement of the knee within the desired plane and within normal limits. Disruption of any of the knee ligaments allows abnormal knee movement. This, in turn, causes damage to other structures within the knee. The usual targets of this secondary damage are cartilage and the menisci.

There are four main knee ligaments and the most commonly damaged ligament is the anterior cruciate ligament (ACL).

Sports injuries involving the ACL are most often sustained with a twisting or hyperextension injury. With an ACL tear, immediate joint swelling is seen from bleeding within the knee. There will, of course, be pain. Some patients may experience a locked knee. In this condition, a fragment of the torn ligament gets trapped in the joint and the joint cannot be fully extended because of the mechanical obstruction. At the time of injury, the meniscus may also be damaged.

Immediate treatment with RICE (rest, ice, compression and elevation) therapy is instituted and crutches can be used if necessary. With symptoms of immediate joint swelling and pain after an injury, an early consultation with a doctor is prudent to ensure that there isn’t a fracture. Early rehabilitation is started to allow weight-bearing and regain range of motion of the knee. Further rehabilitation involves the strengthening and coordination / balance training. The most common complaint of a patient with an ACL tear is an unstable knee, which buckles with rapid change in the direction of walking or running. This prevents an individual from returning to sports and risks further damage to the knee.

Because of its position within the knee joint, ACL tears do not have the ability to heal. Once the ACL is torn, the torn ends remain separate and do not heal, even if stitched together. The objective of the surgery for an ACL tear is not to repair the damage but to replace the ACL. This is referred to as reconstruction of the ACL. Reconstruction of the ACL is performed using the patient’s own tissue to replace the torn ligament. The most common tissue used are the patella tendon (tendon connecting the kneecap to the shin bone) and hamstring tendons (tendons behind the knee). The current standard of treatment of an ACL reconstruction is with arthroscopic (keyhole) surgery.

The benefits of reconstructing a torn ACL are reducing the chances of abnormal twisting of the knee and reducing the risk of secondary damage to the menisci and joint cartilage, thus reducing the likelihood of knee arthritis. This procedure also allows the patient to return to sports requiring twisting.

It is important to seek medical attention at the early stages of the injury to reduce the change of secondary damage.

Sports Injuries to Meniscus

A meniscus is a piece of specialist cartilage shaped like the letter “C”. There are two menisci in each knee. They serve to absorb shock transmitted through the knee and to protect more fragile cartilage covering the surfaces of the knee joint.

A meniscus can be torn with a twisting or impact injury. There is associated knee swelling, which may be of a more gradual nature than in an ACL tear, together with pain. There may also be locking of the knee.

Meniscus Tear

Surgery for a meniscus tear is performed arthroscopically (keyhole surgery). During the procedure, the meniscus is either repaired or debrided (torn fragments removed and remaining meniscus smoothed down). The decision whether to repair or debride is made based on the location, size and configuration of the tear.

The aim of the meniscal surgery is to obtain a stable meniscus, which will not displace into the joint to cause locking. To restore the normal configuration or smoothen out the damaged surfaces also reduces the risk of further damage and consequent arthritis.

Although the occurrence of acute sports injury of the knee is increasing, treatment outcomes are good and many patients do return to playing their chose sport. It is important to seek medical attention at the early stages of the injury to reduce the chance of secondary damage. With early treatment and arthroscopic (minimally-invasive, keyhole) surgery, when needed, the down-time from sports and daily activities can be minimised.

Do

  • Seek early medical attention after an acute sports injury of the knee (especially if associated with swelling)

Don’t

  • Neglect a locked knee. This requires urgent attention to “unlock” it. Walking on a locked knee will result in irreversible cartilage damage of the knee.
  • Ignore an unstable knee. Frequent twisting of an unstable knee may cause meniscal or cartilage injuries.

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  • 26
  • Aug
Synvisc – Pure and Simple
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Relieves joint pain & improves mobility to put the spring back in your step and choices back into your life!

Synvisc (sodium hyaluronate) is a treatment to provide relief from the pain of osteoarthritis (OA). Now you have an alternative to the use of pain killers such as nonsteroidal anti-inflammatory drugs (NSAIDs) or steroids.

Given by your doctor, this proven treatment reduces joint pain and improves joint mobility allowing you to resume some of the activities you once enjoyed.

Synvisc Benefits: Lubricates, cushions and protects the joint

Synvisc renews more efficient lubrication and cushioning absent from the synovial fluid of an arthritic joint. It helps to restore essential properties of the synovial fluid.

Synvisc helps to lubricate, cushion and protect the joint, bringing relief that lasts up to 6 months, from one simple injection.

Synvisc is a simple procedure

The procedure is called visco-supplementation – a simple procedure done by an orthopaedic surgeon. Your doctor injects Synvisc directly into the joint where it combines with the synovial fluid.

For many patients, relief occurs after a few days and optimum results shortly, thereafter. Unlike other treatments that may require up to five injection, Synvisc only requires a single injection.

Synvisc – Pure and Simple. Helps you get back in the game!
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Important benefits of having Synvisc treatment

Patients can look forward to some of Synvisc advantages:

  • Significant pain reduction from osteoarthritis
  • Enhanced joint mobility and joint protection
  • Long term relief achieved with one single injection
  • Resumption of many activities you once enjoyed

Synvisc is made from a natural product

Synvisc is a highly purified, clear fluid made from a natural substance called sodium hyaluronate, which has been used in medicine for over 20 years. Synvisc has been specially formulated for single injection therapy. Your doctor can give you Synvisc by injection directly into the joint to relieve the pain of osteoarthritis at that site.

Synvisc added benefits of local treatment

  • Synvisc avoids the side effects often seen with traditional systemic osteoarthritis treatments
  • Synvisc injected into the joint at that site of discomfort restores the viscosity of the synovial fluid

Discuss Synvisc with your doctor

You and your doctor can decide if Synvisc is right for you. Ask for more information about the benefits of this pure and simple way to relieve osteoarthritis pain and enhance joint function.

How the knee joint moves

To understand how this new treatment – Synvisc works, it is important to first understand how the knee joint moves.
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Osteoarthritis Knee

The knee joint is formed where the thigh bone, called the femur, meets the shin bone, called the tibia. That joint is covered by the kneecap or patella and is secured by muscle, tendons and ligaments, which allow the knee to bend and straighten.

The surfaces where the two bones touch are covered with a tough substance called cartilage. The space called the synovium inside the knee contains synovial fluid that helps to cushion the weight supported by the knee joint and also lubricates the bones – working like grease on a squeaky hinge.

In osteoarthritis, the synovial fluid loses its ability to lubricate ans cushion the joint effectively. As a result, the cartilage can be destroyed. The unprotected bones then rub together causing pain.
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