Winning the battle of wounded knee: Treated easily if caught early



21:01 GMT, 13 October 2012

A knee injury is usually a result of a sporting mishap. Actor Brad Pitt injured one of his while skiing – and was pictured on red carpets earlier this year using a rather rakish walking cane.

Tennis star Rafael Nadal had to bow out of the Olympics due to a similar complaint.

But you can just as easily do damage while running for the bus, getting out of the bath – or by dancing, as comedian James Corden discovered while appearing in the hit musical One Man, Two Guvnors on Broadway.

Support act: Brad Pitt, with Angelina Jolie, recently needed a cane due to a knee injury suffered while skiing

Support act: Brad Pitt, with Angelina Jolie, recently needed a cane due to a knee injury suffered while skiing

He ultimately needed surgery. As an orthopaedic surgeon, I know all too well just how serious such a procedure can be.

Fortunately, the majority of knee injuries can be treated easily as long as they are caught in time. Here is my guide to warning signs.

SYMPTOMS: Tenderness over the knee, which is worse when walking

DIAGNOSIS: Knee sprain. This is the most common knee injury. It is a sprain of the muscles or ligaments surrounding the knee. It happens when a ligament or muscle has been overstretched, rather than torn.

TREATMENT: Painkillers, rest and applying ice. Special support bandages compress the injury, prevent swelling, reduce pain and speed recovery, so are more useful than they may appear.

Rehabilitation, either gently on your own or under the guidance of a physiotherapist, can quickly return you to normal activity. These injuries will generally heal themselves and rarely have lasting consequences.

SYMPTOMS: Pain and bruising worsening over a week, often following a fall.

DIAGNOSIS: Bone contusion (bone bruising). The bones of the knee are near to the skin, so there’s little tissue to cushion them from impacts.

When we fall, the bones take all the shock and – if they don’t break – they bruise. This is visible on an MRI scan, but the mainstay of a diagnosis is a good examination.

TREATMENT: Treatments include ice, painkillers and a return to activity to stop the knee becoming stiff.


The knee is formed of three parts: the
medial (inside), the lateral (outside) and the patellofemoral (the
joint between the knee cap and thigh bone).

Inside these compartments are cartilage pads (menisci), which act as human shock absorbers.

How it works - and how it goes wrong

Four main ligaments support the knee. The medial and lateral ligaments prop up either side of the joint.

the anterior cruciate ligament prevents the shin bone from sliding away
from the thigh bone, while the posterior cruciate ligament stops it
sliding backwards.

There are
also numerous stabilising muscles that allow it to bend, straighten
and deliver strength from the lower leg to the ground.

SYMPTOMS: Severe pain, limited movement, some swelling, feeling of catching or clicking

DIAGNOSIS: Meniscal Tear (damage to the cartilage pads). These are very common injuries, usually caused by changing direction suddenly when running. The cartilage pads are squashed between the end of the thigh bone and the top of the shin bone, causing a tear to develop. The pain often settles down but patients usually complain of intermittent severe sharp pain from the knee, often accompanied by swelling.

TREATMENT: These injuries can be effectively managed with painkillers, rest and a splint or support bandage, but physiotherapy is critical to a good recovery.

If locking or giving way occurs, then surgery is usually needed, in the form of an arthroscopy (keyhole surgery) to trim the damaged cartilage. Recovery is normally quick, especially with physiotherapy.

SYMPTOMS: Unable to walk, dramatic swelling, bruising and severe pain

DIAGNOSIS: Fracture (broken bone). These are serious and significant injuries to the knee. They commonly occur with falls but can happen in contact sports such as rugby or football. DON’T try to soldier on. These hairline breaks pose a range of potential complications and should always be seen by A&E staff – the wrong diagnosis can have lasting consequences – and need X-rays and frequently a CT scan.

TREATMENT: Some of these injuries can be treated with a plaster cast, but many require an operation to reconnect the bones using plates and screws. Rehabilitation can take several months with the guidance of a physiotherapist.

SYMPTOMS: Pain at the front of the knee, swelling and increasing pain when bending the joint

DIAGNOSIS: Pre-patellar bursitis (water on the knee). This is caused by inflammation of a bag of fluid, called the bursa, that lies between the kneecap and the skin. It normally acts as a lubricant to stop the kneecap catching the underside of the skin as it moves. It becomes inflamed when irritated by kneeling for long periods.

TREATMENT: Rest and anti-inflammatory medicines such as ibuprofen. Splints and compression bandages are useful to support movement during recovery.

SYMPTOMS: Dramatic swelling and bruising, inability to bear weight on leg.

DIAGNOSIS: Complete tears of muscles or ligaments. If you have any of these symptoms, you should visit your local A&E department.

TREATMENT: An MRI scan will be needed to see exactly what has been injured – and how bad the damage is. Treatment will be dictated by this.

Many injuries can be managed using splints and rehabilitation with a physiotherapist. However, surgery is commonly needed to fix torn ligaments (and sometimes muscles) and return them to normal function. Rehabilitation can take up to a year.