Knee Conditions

Anatomy of the Knee

The knee is one of the most complex and largest joints in the body. As a hinge joint, the knee facilitates flexion and extension of the leg, as well as weight-bearing and motion. The knee consists of bones, cartilage, and an extensive network of ligaments and muscles. Three bones make up the knee joint, namely the femur (thighbone), the tibia (shinbone), and the patella (kneecap).

Due to the high level of stress that the knee bears from day-to-day activities, it is susceptible to injury. A number of factors lead to knee conditions, including ageing, injury and disease.

How are Knee Conditions Diagnosed?

The orthopaedic specialist will first perform a physical examination of the affected area, looking out for signs and symptoms of pain, swelling, discoloration, deformity, as well as range of motion. They will also evaluate your activity history as well as the lead-up to the pain or injury in question.

Finally, in order to confirm the diagnosis, they may perform some imaging tests, which include:

• X-ray – This helps to determine the location and extent of the bone and cartilage damage

• CT Scan – This provides detailed images of the bones from different angles

• MRI – Using radio waves and a powerful magnet, an MRI creates 3D images of the inside of the knee to assess any damage or disease in the surrounding ligament or muscle

• Arthroscopy – This procedure involves inserting a thin and flexible scope, attached to a light and camera, in order to inspect (and sometimes treat) the affected joint.

Common Types of Knee Conditions and Symptoms

Common types of knee conditions include:

• Ligament Injury – Knee ligament injuries in Singapore can occur as a result of trauma such as car accidents or sports injuries. The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) are the most commonly injured knee ligaments due to overextension or torn tissues that contribute to knee pain when running or twisting the legs. A knee ligament tear may result in a popping sound in the knee, pain, swelling, and instability in the knee joint.
  
  A knee injury can be moderate (if there is just minor ligament fibre stretching or tearing, such as a low-grade sprain) or severe (if there is a complete ligament fibre rupture). Patients suffering from a ligament injury may feel pain even while at rest. This pain may worsen when bending, walking, or putting weight on the knee.

• Meniscus Injury – The meniscus is a small, tough, C-shaped, rubbery cartilage that acts as a shock absorber in the knee joint. The knee joint has two menisci that help stabilise it and protect it from damage. An injury to the meniscus occurs when one of the menisci in the knee is torn. Injuries to the meniscus can be characterised by a popping sensation, pain, swelling, and the inability to bend or straighten the leg.
  
  Athletes involved in contact sports are at risk of a meniscus tear due to the sudden twisting or turning motions of their legs. A meniscus injury can also happen as a result of arthritis or ageing, due to the meniscus degenerating and becoming more prone to injury.

• Cartilage Injury – The articular cartilage acts as a shock absorber for the bones and enables them to move smoothly against one another. However, it may become damaged when there is excessive strain on the joints, which may be caused by sudden twisting, wear and tear, or poor alignment of the joints. An injury to the cartilage may result in a locking, cracking, or popping sensation when bending, pain and tenderness, and limited mobility.

• Patellar Instability – Patellar instability refers to the movement of the patella (kneecap) outside the groove at the end of the femur (thigh bone). In a healthy knee, the femoral groove, a V-shaped notch on the kneecap, glides up and down when the knee is bent or straightened. However, patients with patellar instability have an unstable kneecap that does not track properly in the groove. The instability of the patella is often accompanied by pain and swelling, in addition to the appearance of a noticeable deformity.

• Tendinopathies & Fractures – The term "tendinopathy" is used by knee doctors to describe a variety of overuse injuries of the tendon. It occurs when the tendon has been repeatedly strained until tiny tears have developed. Athletes who play sports like basketball, volleyball, tennis, and football, have a higher risk of sustaining tendinopathy injuries. Common signs and symptoms include painful joint movement, crackling or grating sensations, swelling, and redness.

• Knee Arthritis – Arthritis is a disease where one or more joints become inflamed or swollen. It can affect any joint in the body, with the knee being one of the most commonly affected joint. Older adults, as well as people who have had knee injuries in the past that did not heal properly, are more prone to developing knee arthritis. Patients usually experience pain, swelling, and stiffness in the knee joint that can significantly hinder their daily life, even warranting a possible knee replacement.

When Should One See a Knee Specialist?

As knee injuries can affect one’s mobility and comfort, and become more complicated to treat the longer treatment is delayed (and the condition worsens), it is important to seek medical attention from a knee specialist as early as possible. Signs and symptoms to look out for include:

• Instability while walking or standing
• Severe knee pain
• Deformity in the leg or knee
• Unable to fully extend or flex the knee
• Stiffness or discomfort in the knee
• A popping noise at the time your knee was injured
• Sudden swelling of the knee

The doctor will be able to properly diagnose your condition and come up with a targeted and effective treatment plan.

Treatments of Knee Conditions

Knee joint pain treatments vary based on the type and severity of the knee condition. Some knee injury treatments in Singapore include:

• RICE Method – For mild to moderate cases, resting for a few days, icing affected areas, compressing with an elastic bandage and elevating when sitting or lying down may be an effective (if not initial) knee joint pain treatment. This helps reduce swelling, relieve pain, and facilitate the healing of strains, sprains, and other minor ligament injuries.

• Medications – Swollen knee treatments in Singapore, among other knee conditions treated, include the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, which must be prescribed by a knee doctor. These medicines can help manage pain and inflammation in conditions like osteoarthritis or tendonitis.

• Injections – Knee pain treatment involves injecting medications such as corticosteroids and lubricants directly into the knee joint to alleviate inflammation and pain commonly caused by osteoarthritis.

• Physiotherapy – Physiotherapy is an important part of the treatment and recovery process for all knee conditions. It involves a customised exercise programme to strengthen the muscles around the knee, improve flexibility, and enhance joint stability. This is beneficial for various knee conditions, including arthritis, tendonitis, and post-surgery rehabilitation.

• Total and Partial Knee Replacement – A Singapore knee surgeon may recommend surgery such as total or partial knee replacement as a form of knee injury treatment for serious cases like severe osteoarthritis or joint damage. With a partial knee replacement, a knee surgeon replaces only the most damaged part of the knee with plastic and metal components. Meanwhile, a total knee cap replacement in Singapore replaces the damaged bones and cartilage on the kneecap with artificial joints that are made from metal alloys or high-grade plastic.

• Robotic Surgery – With the help of advanced knee replacement technology, knee doctors in Singapore are able to perform knee surgery with the assistance of a robotic surgical system, which is significantly more precise.

• Meniscus Surgery – This surgery is performed to repair a torn meniscus. Meniscus surgeries are usually done through an arthroscopic surgery where two to three incisions are made in the knee to insert an arthroscope and other specialised surgical tools.

• ACL Surgery – Doctors usually recommend ACL surgery for patients who are young or are playing sports, so as to restore knee stability and prevent further damage; plus, young people tend to have a better recovery potential. This procedure involves the reconstruction of the ACL by removing the damaged ligament and replacing it with a graft to restore stability to the knee joint.

• Arthroscopic Knee Surgery – This minimally invasive procedure provides less pain and a faster recovery as compared to a traditional open surgery. It involves the use of a small camera (arthroscope) and other specialised surgical tools to access, examine and treat the joint with precision.

How Can Knee Conditions Be Prevented?

While not all knee conditions can be prevented, one can lower their risk of developing them by following these tips:

• Maintain a Healthy Weight – Excess body weight puts additional pressure on the knees, increasing the risk of knee conditions, like osteoarthritis. A balanced diet and regular exercise can help maintain a healthy weight.

• Warm-Up and Stretch – Warm-up exercises and stretches help prepare the body for the actual workout, thereby reducing the risk of injuries.

• Use Proper Footwear – Wear proper shoes that have sufficient cushioning and support (for the particular sport) to lower the risk of injuries.

• Practising Good Posture – Maintaining good posture while sitting, standing, and walking can help distribute weight evenly across your knees and prevent injuries.

What Should I Consider When Choosing a Knee Specialist?

Choosing the right knee specialist is crucial for the proper diagnosis, treatment, and management of knee conditions. Here are some things to consider:

• Specialisation – Find an orthopaedic doctor who has a specialised focus in the knee. This will give you greater peace of mind that they are knowledgeable of your condition, as well as the treatments and aftercare needed.

• Experience – Consider the experience of the knee specialist, particularly the number of years they have been practising and the volume of knee-related cases they have handled. You may also consider any leadership or teaching positions that they may have held.

• Credentials – Take a look at the credentials and qualifications of the doctor – ensure they are certified by the Ministry of Health (Singapore) and/or have relevant professional memberships.

• Reviews and Recommendations – Read reviews from other patients to give you valuable insights on the doctor’s reputation and patient satisfaction. You may also seek recommendations from family members, friends, or your general practitioner (GP) for referrals.

The International Orthopaedic Clinic provides comprehensive orthopaedic care and effective knee pain treatment in Singapore to help patients regain normal function of their knees and improve their quality of life.

FAQs