The menisci (often called cartilages) and the main joint surfaces of the knee can be made more vulnerable to injury and damage if knee control is not good enough to prevent unplanned joint movements. Meniscal function is partly to control movement of the femoral condyles into particular paths, centring them on the upper shin bone plateau. Without the guiding help the large and strong condyles can catch the edges of the menisci as they roll across the tibial plateau and so cause tears or other damage to the menisci.
Damage to the menisci can take many different patterns, including splitting, tearing and losing pieces of the edge. A split can develop along the circumference of the meniscus while both ends remain attached, a so called "bucket handle tear". Part of the meniscus can become detached in a damaging manoeuvre such as twisting and become a loose body, moving about inside the joint and jamming between the joint surfaces at times. When this occurs during weight bearing then the knee can give way, and it can make the knee difficult to straighten. The cartilage cannot heal as such as the blood supply is very poor.
Ongoing degenerative changes in the menisci mean the condyles of the femur are less controlled and this heightens the stresses which are placed across the knee between the condyles. The articular cartilage surfaces can also degenerate in response to the increased stresses and this may lead to the development of osteoarthritis. If the meniscus was troublesome in the past the usual technique, before arthroscopy developed, was to remove the entire meniscus, which commonly lead to arthritic changes later in life. Knee problems lead to medial quadriceps wasting and a lot of treatments are prescribed to counteract this.
The ranges of movement of the joint and normal accessory movements need to be restored for the medial quadriceps to respond to strengthening work. Knee extension needs to be full for the medial quadriceps to exert their full and functional force and the accessory movements contribute to the necessary play within the joint. If the full extension is not returned then the exercise to strengthen the muscles will likely be in vain. The development of modern arthroscopy techniques has allowed internal inspection of the joint and the ability to do the minimal intervention to achieve the required treatment goal.
Hundreds of millions of people in the world suffer some degree of osteoarthritis, making it the most prevalent degenerative joint condition in the world, affecting almost all the elderly in some way. It is more likely that osteoarthritis will develop if there has been damage to the joint or ligaments, surgery to the menisci or a family history. If the lateral, medial or cruciate ligaments are damaged the knee may develop unwanted extra movement and so generate excessive forces within the joint which can facilitate breakdown of the joint surfaces. The lateral stresses caused by shearing movements in the joint can be of a high level.
The knee can start to develop a grating or clicking as it ages with small degrees of degeneration and is only painful if kept in one position for excessive periods. The joint capsule can become tighter if we do not perform the strong movements any longer which stress the joint to the ends of its ranges. This can increase joint compression which increases the stresses across the joint surfaces and make the joint more likely to be injured during stressful movements. As the process continues the cartilage wears down and the underlying bone, which normally has some elasticity, becomes denser and harder.
A typical arthritic knee can exhibit enlargement, pain, heat, limited ranges of motion and swelling, crepitus on joint motion and functional disability. There can be repeated cycles of swelling and pain which worsen as the joint gradually becomes worse. There may be difficulty sleeping as a comfortable position is so difficult to find and a limitation in walking ability. The medial joint line can develop tenderness and inability to manage the other knee pressure or the joint gapping which occurs when we lie on the side, with comfort demanding a pillow between the knees. - 14130
Damage to the menisci can take many different patterns, including splitting, tearing and losing pieces of the edge. A split can develop along the circumference of the meniscus while both ends remain attached, a so called "bucket handle tear". Part of the meniscus can become detached in a damaging manoeuvre such as twisting and become a loose body, moving about inside the joint and jamming between the joint surfaces at times. When this occurs during weight bearing then the knee can give way, and it can make the knee difficult to straighten. The cartilage cannot heal as such as the blood supply is very poor.
Ongoing degenerative changes in the menisci mean the condyles of the femur are less controlled and this heightens the stresses which are placed across the knee between the condyles. The articular cartilage surfaces can also degenerate in response to the increased stresses and this may lead to the development of osteoarthritis. If the meniscus was troublesome in the past the usual technique, before arthroscopy developed, was to remove the entire meniscus, which commonly lead to arthritic changes later in life. Knee problems lead to medial quadriceps wasting and a lot of treatments are prescribed to counteract this.
The ranges of movement of the joint and normal accessory movements need to be restored for the medial quadriceps to respond to strengthening work. Knee extension needs to be full for the medial quadriceps to exert their full and functional force and the accessory movements contribute to the necessary play within the joint. If the full extension is not returned then the exercise to strengthen the muscles will likely be in vain. The development of modern arthroscopy techniques has allowed internal inspection of the joint and the ability to do the minimal intervention to achieve the required treatment goal.
Hundreds of millions of people in the world suffer some degree of osteoarthritis, making it the most prevalent degenerative joint condition in the world, affecting almost all the elderly in some way. It is more likely that osteoarthritis will develop if there has been damage to the joint or ligaments, surgery to the menisci or a family history. If the lateral, medial or cruciate ligaments are damaged the knee may develop unwanted extra movement and so generate excessive forces within the joint which can facilitate breakdown of the joint surfaces. The lateral stresses caused by shearing movements in the joint can be of a high level.
The knee can start to develop a grating or clicking as it ages with small degrees of degeneration and is only painful if kept in one position for excessive periods. The joint capsule can become tighter if we do not perform the strong movements any longer which stress the joint to the ends of its ranges. This can increase joint compression which increases the stresses across the joint surfaces and make the joint more likely to be injured during stressful movements. As the process continues the cartilage wears down and the underlying bone, which normally has some elasticity, becomes denser and harder.
A typical arthritic knee can exhibit enlargement, pain, heat, limited ranges of motion and swelling, crepitus on joint motion and functional disability. There can be repeated cycles of swelling and pain which worsen as the joint gradually becomes worse. There may be difficulty sleeping as a comfortable position is so difficult to find and a limitation in walking ability. The medial joint line can develop tenderness and inability to manage the other knee pressure or the joint gapping which occurs when we lie on the side, with comfort demanding a pillow between the knees. - 14130
About the Author:
Jonathan Blood Smyth is the Superintendent of Physiotherapists at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiotherapists in London visit his website.
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