Dr. Diana Koelliker’s quick guide on when to, and when not to, push through the pain.
When to Stay home:
Minimal to moderate pain with minimal to moderate swelling and no feelings of instability may be managed with ice, rest and common sense.
Patients should be cautious with an injured knee and should avoid “pushing through the pain.” Ice should be applied for the first 24-48 hours and the knee should be rested. Feelings of instability frequently improve when wearing a properly fitting hinged brace, but crutches may be needed to unweight the injured knee. Non-steroidal anti-inflammatories (ibuprofen, naproxen) will provide some pain relief, but sometimes opiate pain relievers are indicated for severe pain.
When to See a Doctor:
Severe pain, inability to bear weight (stand), feelings of instability, feeling a definitive pop or tear during the injury, or marked swelling are indications that a more severe injury may have occurred.
The initial evaluation of knee injuries can happen at our clinic or a similar facility. Orthopedic referral is common as well as referral for MRI scanning. X-rays are frequently performed to evaluate the bones in the knee. CT scanning is sometimes indicated to exclude tibial plateau fractures or to find the extent of a tibial plateau fracture. X-rays and CT scanning do not show the ligaments of the knee well and the need for a MRI may still exist.
Glossary of Most Common Knee Injuries:
Medial Collateral Ligament (MCL)
The MCL is found on the inside of the knee and provides stability preventing the knee from moving medially (towards the inside). This injury is usually painful and can result in a feeling of instability. The injury can vary from a sprain of the ligament to a complete tear. If isolated, this injury may be treated with physical therapy and a stabilizing brace. There is an increased frequency of injury of the medial meniscus and ACL with complete tears of the MCL, and examination, x-rays and or MRI, and referral to an orthopedic surgeon is warranted.
Anterior Cruciate Ligament (ACL)
The ACL is deep in the joint of the knee and cannot be palpated on exam. Patients frequently report feeling a pop when this ligament is injured and the knee can feel unstable and have a tendency to “give out.” Examination of the knee can demonstrate laxity of the lower leg being pulled forward at the knee. Initial examination can be unreliable if the pain the patient is experiencing is great or the surrounding muscles are tight. If x-rays do not show a fracture, the patients with this injury can be treated with a hinged brace and referral to orthopedics for additional imaging (MRI) and treatment options. This injury frequently will require surgical correction or the knee will become chronically unstable and prone to degenerative arthritis.
There is a medial and lateral meniscus in each knee. They are located in the joint in between the surfaces of the femur and the tibia. They act as cushions to absorb shock when the knee functions. They are commonly injured and symptoms can vary due to size, location and severity of the tear. Some meniscus tears can be treated with therapy and improve over time. Other patients with tears will experience clicking or popping with flexion/extension of the knee and recurrent pain. Sometimes a meniscal injury will cause a patient’s knee to lock and they will have trouble fully extending the affected knee. Surgery for meniscus tears usually involves debridement (removal) of part of the meniscus that is interfering with proper function. In young patients with tears on the outside of the meniscus, primary repair of the meniscus is sometimes performed
Tibial plateau fractures occur when the proximal articular (beginning of the tibia at the knee joint) surface is fractured. The size and location of the fracture as well as the degree of displacement (fracture involves bone that is out of place) determine the need for surgery. Small non-displaced fractures may be allowed to heal, but larger or displaced fractures will need surgical repair. Treatment will include a brace and crutches and minimal to no weight should be placed on the fractured extremity.