The medial collateral ligament is a band like structure on the medial (inner) aspect of the knee that runs from the femur (thigh bone) to the tibia (shin bone).  Its functions to stop the knee buckling in towards the other knee when a force is applied to the lateral (outer) aspect of the knee.  If the knee is hit from the lateral aspect whilst weight bearing the ligament can be torn.   If the injury is severe there may also be an injury to the medial meniscus as the deep part of the ligament attaches to the meniscus.

Symptoms

• Pain on the medial aspect of the joint at the joint line.
• Swelling usually absent
• Inability to fully extend (straighten) leg
• Inability to flex knee (bend) knee more than 90 degrees
• Giving way of knee
• Pain aggravated when walking on uneven surface as knee has less stability
• Pain aggravated when walking when pushing off through toe on same leg

What you can do

• Apply RICE (Rest, Ice, Compression, Elevation) procedure

What we can do

• Flushing – massage technique to reduce swelling
• Deep friction massage over ligament to boost circulation and stimulate healing
• Prescription of exercises to strengthen surrounding muscles and stabilise joint

The knee contains two crescent shaped pieces of cartilage that attach on top on the tibia (shin bone), one on the medial (inner) aspect and the other on the lateral (outer aspect).  These menisci function to

• Create an enhanced fit between the femur (thigh) and (tibia) shin bone
• Act as shock absorbers
• Improve the flow of synovial fluid (joint lubricant) within the joint capsule
• Transmit force between tibia and femur

The medial meniscus is more prone to injury than the lateral as it is more firmly attached to the adjacent structures and can therefore not ‘get out of the way’ in the event of a sudden forceful impact.  The classic mode of injury occurs when the knee rotates forcefully whilst weightbearing.  The menisci may get injured in conjunction with the anterior cruciate ligament.  Injury to the meniscus typically progress as follows

• Immediate pain with difficulty in fully extending (straightening) leg
• Swelling appears within 24-48 hours
• Symptoms resolve within 2 weeks
• Recurrent mini episodes following the above sequence of events precipitated when the knee gives way whilst twisting

Meniscal damage can also result from wear and tear as we get older causing the cartilage to become rough and frayed – more common in middle and old age.

Symptoms

• Pain on the medial (inner) aspect of the joint
• Swelling (possibly warm) all around knee joint
• Reduced range of flexion (bending) possibly limited to 90 degrees
• Inability to fully straighten knee
• Clicking noise (crepitus)
• Knee giving way
• Pain aggravated by weight bearing
• Pain aggravated by walking on uneven surfaces as knee cannot fully straighten and becomes unstable

What you can do

• Apply RICE procedure
• Gentle exercise to maintain quadriceps strength
• Glucosamine supplement can be taken 1500mg/day

What we can do

• Performance of special tests (McMurrays and Appleys grind) to confirm diagnosis
• Prescription of exercise to restore full range of motion
• Prescription of exercise to maintain muscle balance around knee
• Prescription of exercise to maintain proprioception (balance)

Further treatment options

If conservative treatment fails then surgery may be necessary.

The patella (kneecap) sits in a groove formed by the femur and tibia.  Normally as the knee bends and straightens the patella glides straight up and down within the groove.  If there is an imbalance in the sideways forces acting on the patella the patella tends to get pulled laterally (outwards) as it moves up in the groove thus causing excess abrasion on the hyaline cartilage (smooth low friction covering) on the underside of the knee.  This ‘maltracking’ results in knee pain.  Maltracking can also be caused by poor alignment of the knee i.e.

• Genu valgum (knock knees)
• Large Q angle – associated with wide hips and therefore maltracking more common amongst women
• Pronating or flat feet

Affected groups

• Participation in lots of sport – especially high impact sports
• Adolescent females (large Q angle) and softer patella
• Small or and protruding patella
• Recent injury.  The muscle on the antero-medial thigh (front-inside) is called the vastus medialis oblique (VMO).  It plays an important role in pulling the knee cap medially (inwards) as the knee straightens.  This muscle wastes away very quickly with inactivity and therefore can adversely affect the tracking of the knee.
• Dislocation of patella in past

Symptoms

• Aching pain at the front of the knee beneath the patella.
• Pain along the inside border of the knee.
• Swelling – especially after activity
• Clicking on moving knee (crepitus)
• Pain aggravated by using stairs especially descending stairs
• Pain aggravated by sustained periods of sitting

What you can do

• RICE (rest, ice, compression, elevation) to reduce swelling
• Stretch ITB (iliotibial band) and muscles on lateral (outside) aspect of thigh

What we can do

• Rebalance myofascial (muscle and tendon) forces acting directly on patella by reducing tension in ITB
• Prescribing exercises to strengthen VMO
• Improve alignment of knee by
• Prescribing orthotics and reducing over-pronation in feet
• Reducing Q angle of knee where this is due to weakness in the abductors and lateral rotators of the hip