What Can Be Done?

There is a lot that can be done for injured knees, from simple treatments to complicated long operations. It all depends on what is injured, how badly and what your aims and expectations are.
Options include:

• Protection using splints and knee braces
• Rehabilitation through physiotherapy and targeted exercises, combined with painkillers
• Surgical repair or ‘keyhole’ surgery (arthroscopy)

ACL Injury or rupture
Usually it is difficult to cope getting back to pivoting impact type sports such as football and rugby without a good functioning ACL. The ligament does not heal very well on its own to allow fast pivoting. Therefore, typically the ligament is reconstructed using tissue from around your knee, rather like Michael Owen when he tore his ligament playing football.
This surgery is performed once the swelling from the acute fresh injury has settled and when the range of movement has returned to nearly normal. Physiotherapy is important to help regain that movement and sometimes the knee is rested in a knee brace. An MRI scan may or may not need to be arranged.
PCL Injury
Usually the PCL can heal and surgery is not necessary. Initially a knee brace is used to support the healing, followed by physiotherapy and strengthening exercises. However some knees will still feel unstable and then surgery can become an option – rebuilding the ligament using other tissue from around the knee. Once again it can take a long time to get back to sport.
Collateral ligament injury
MCL sprains (medial ligament injury) usually heal well and do not need surgery. There are different grades of injury and simple injuries just need physio and time – perhaps 6 weeks to fully recover. More significant injuries may need a supportive brace for 4 – 6 weeks and it can take up to 3 months to get back to sport after rehabilitation. It is uncommon to need surgery. However, if the ligament is completely torn in combination with tearing the anterior cruciate ligament then surgery is more often needed.
Meniscus tear
The menisci are the C-shaped cushions in your knee. They tear by being trapped between the thigh bone and the shin bone. Small tears can settle on their own over 6 weeks or so and may not need any surgery. Some tears don’t however and continue to cause intermittent pain on the side of the knee during activity. The small torn portion can then be removed at keyhole surgery (arthroscopy). Sometimes the fragment is large enough to block the knee going straight and this is called a ‘locked knee’. If this happens then more urgent arthroscopic surgery is needed and it may be possible to repair the torn cartilage back into place. Not all tears can be repaired and it is more usual to remove the small torn fragment.
The cartilage does not have a good blood supply which is why most tears do not heal. Removing the torn part does not usually cause long term problems but it depends on how much was removed.
Patellar dislocation
There are a variety of reasons why your kneecap is more likely to dislocate, or feel like it is going to dislocate or give way, and this dictates how it can be managed. Management includes the use of a knee brace to hold the kneecap in place and physiotherapy to strengthen the surrounding muscles and ligaments. Surgery can be used to change the way the kneecap moves compared to the other structures around it.
Articular cartilage injury
The articular cartilage is the smooth layer that covers the bones in your joints and stops your bones rubbing together when you move. Cartilage can be damaged in injuries or through wear and tear, and can cause pain, swelling and giving way.
To assess the damage to your cartilage you may need to have an arthroscopy. There are then several options for treating the area of damage. This may involve removing the damaged part and tidying the area up, or using other techniques such as microfracture or cartilage transplantation.

What can I do to help my knee in the future?
There are several general things that you can do to help the knee including:

• Regular exercise including stretching to maintain a good level of fitness
• Increase leg muscle bulk through exercise
• Weight loss to limit loading of your knee
• Look after your knee (if injured) with: rest, ice, compression and leg elevation
• Wear support braces during contact sports.