Acute Knee Injury Care: What to Do Before Surgery

Knee Injury Care Without Injections or Surgery

Many knee injuries, including ligament sprains, meniscal irritation and overuse injuries, can be managed with non-invasive care. Chiropractic Specialty Center combines chiropractic care, physiotherapy and targeted rehabilitation, based on a thorough assessment of which structure is involved. Surgery remains an option when it is needed, such as for some complete ligament ruptures or fractures, but for most knee injuries it is not the first step.

Key Considerations for Knee Injury Recovery

• Comprehensive assessment: an accurate diagnosis identifies which structure is injured and guides the plan.
• Integrated care: combining chiropractic methods with physiotherapy addresses both joint movement and the muscles that control the knee.
• Individual rehabilitation: a progressive exercise program restores strength and control and reduces the risk of re-injury.

To understand how repeated loading, alignment and muscle control affect the knee, see the knee pain causes and exercises video.

What Is the Difference Between a Sprained and a Strained Knee?

A sprain is an injury to a ligament, the fibrous tissue that connects the bones of a joint. A strain is an injury to a muscle or tendon, the rope-like extension that attaches muscle to bone. Muscles have a richer blood supply than ligaments, so muscle strains often heal faster than ligament sprains, while injuries near the tendon attachment to bone can heal as slowly as a ligament.

Which Parts of the Knee Are Commonly Injured?

The knee is a major weight-bearing joint, and injuries can involve the ligaments, tendons, muscles, cartilage (the meniscus or the smooth covering at the ends of the bones), the bones themselves (femur, tibia, fibula and patella) or the bursae. Common knee injuries include:

• Fractures and dislocations, including dislocation of the kneecap
• Bursitis (inflammation of a bursa), more on bursitis
• Tendonitis and tendon tears
• ACL injuries (anterior cruciate ligament tears)
• PCL injuries (posterior cruciate ligament tears)
• Collateral ligament injuries (medial or lateral)
• Meniscal injuries (medial or lateral meniscus tears)
• Iliotibial band injuries
• Muscle strains of the quadriceps or hamstrings

Who Injures Their Knee, and How?

Acute knee injuries can happen at any age but are most common in active people. Sports that involve running, jumping, sudden stopping and turning, such as football, basketball, volleyball, badminton and tennis, and contact sports such as rugby and martial arts, raise the risk. Overuse and overload injuries are more common still. Ligaments and cartilage are the structures most often injured.

What to Do When You Injure Your Knee

Protect the knee from twisting and from the movements that make it feel unstable. Ice for short periods can ease pain and swelling, with a cloth between the ice and the skin. Gentle movement within comfort is generally better than keeping the knee completely still, and the leg can be used as normally as pain permits. Pain-relief medication is a decision to make with your doctor, since regular anti-inflammatory use carries its own risks.

Have the knee assessed if pain continues beyond a day or two, if the pain is significant, or if you felt or heard a pop at the time of injury, because several structures in the knee can be injured together.

Surgery and Knee Injuries

Surgery has a clear role in some knee injuries, such as some complete ligament ruptures, fractures or a knee that locks. For others, trials support trying rehabilitation first. In young active adults with an acute ACL tear, a strategy of rehabilitation with optional later reconstruction produced five-year outcomes similar to early reconstruction (Frobell RB, et al. BMJ. 2013;346:f232). For degenerative meniscal tears, arthroscopic surgery has shown small benefits at best compared with non-surgical care (Thorlund JB, et al. BMJ. 2015;350:h2747). Whatever the route, rehabilitation is what restores the strength and control the knee needs, because an operation changes the structure but does not by itself rebuild function.

Prevention and Protecting the Knee

Warming up before activity, building strength around the hip and knee, and resting when tired all reduce the risk of injury. After an injury, completing rehabilitation before returning to sport matters, because returning too early is a common reason for re-injury.

Neglected Injuries and Knee Arthritis

An injured knee that never fully recovers can be more vulnerable to wear later on. For knee arthritis, exercise and manual therapy have trial support (Deyle GD, et al. Phys Ther. 2005;85(12):1301-1317), and knee replacement remains an option when conservative care no longer controls symptoms.

Most knee problems respond to a combination of non-invasive measures: managing load, temporarily avoiding aggravating activities, and exercises to strengthen the muscles that support the knee. Orthotics or supportive footwear may be suggested where the foot and gait are contributing.

When a Knee Injury Needs Urgent Medical Attention

• Inability to bear weight, an obvious deformity, or a kneecap that has dislocated needs same-day medical assessment.
• A hot, red, swollen knee with fever needs urgent medical assessment for possible infection.
• Calf pain and swelling after an injury or period of immobility should be checked urgently for a possible blood clot.
• A knee that locks and cannot be straightened should be assessed promptly.