Knee Injuries

The knees are usually injured in vehicle accidents due to direct impact against the dashboard, lower half of the steering wheel, driver or passenger side door, or center console. Another mechanism of injury is “bracing” or “jamming” the knee by fully extending the leg while your foot is against the floorboard.

Bruising of the knee, while temporarily very painful, usually resolves with ice packs and anti-inflammatory medications (over-the-counter Aleve or Ibuprofen). However, more serious injuries often occur. These include tears of the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL). The word “cruciate” means “cross”, and these are a pair of ligaments that crisscross each other and are attached to the femur (thigh bone) and tibia (shin bone). The purpose of these ligaments is to stop forward or backward shifting of the femur on the tibia. A strain will usually heal with ice, anti-inflammatories and strapping/bracing. A tear, however, almost always requires surgery. Even if this is able to be performed arthroscopically, recovery usually takes up to one year, and a significant amount of postoperative rehabilitation to attain.

Meniscal tears are also common. There is a medial (or inside) meniscus (cartilage), and a lateral (or outside) meniscus. These essentially act as “shock absorbers” between the femur and the tibia. They are kidney bean shaped and flat. They are often injured if there is a twisting force through the knee. A torn meniscus rarely heals on its own, as it has a poor blood supply. Arthroscopic repair is a relatively minor procedure compared to an ACL or PCL repair. Recovery is normally complete within two to three months. Much less significant injuries are straining of the medial or lateral collateral ligaments. These are ligaments on the inside and the outside of the knee that prevent sideways bending of the knee. These generally will heal with ice, anti-inflammatories, and physical therapy strapping. We will often use laser therapy to accelerate healing.

Other injuries to the knees include fractures, often of the tibial plateau (the area that is closest to the femur). This normally heals well with immobilization in a cast. Strain of the iliotibial band (tight ligamentous tissue on the outside of the thigh that begins around  the hip and ends around the outside of the knee) can occur. The lateral cutaneous femoral nerve, which weaves between the iliotibial band fibers, can also be injured at the same time. This normally responds extremely well to physical therapy including nerve release techniques. The fibula, which is the very thin bone on the outside of the shin, joins the tibia just before the knee joint. It is not uncommon for this joint to “jam”. The fibular nerve wraps around this part of the fibula and can also be injured at the same time. These injuries respond very effectively to physical therapy and nerve release techniques.

Generally, knee injuries respond well to a combination of conservative therapy (ice and anti-inflammatories), various forms of physical therapy, immobilization, and surgery if necessary. If surgery is needed, the length of recovery is significantly increased.

A Better Way to Get Better,
Adrian Lewis
Adrian Lewis, MD