When the knee joint is mentioned, the main joint between the load-bearing tibia-femur bones immediately comes to mind.
In fact, they constitute an important part of the knee joint.
Runners, jumpers, and cyclists are in a bent position with their knees. In athletes who load their legs, an excessive load is placed on the kneecap. This overload puts excessive strain on the cartilage and bone beneath the kneecap and causes pain. However, one does not necessarily have to be an athlete to have these findings. This type of pain is seen in a wide range of people, from housewives to office workers.
Symptoms;
- When going up and down stairs
- When kneeling
- When squatting and standing up
- Pain occurs when sitting in a bent position for a long time.
Causes;
The complex structure of the knee is very sensitive. There are many factors that affect anterior knee pain.
The relationship between the femur bone joint surface under the kneecap; Structurally, the kneecap may be everted, semi-dislocated, dislocated or high. This causes the entire load to fall on a small area of the kneecap and causes the cartilage there to rapidly deteriorate. (See; Patella (kneecap) rotation or semi-dislocation)
- Structural leg axis disorder
- Medial plica band is the thickening of the normal joint fold in the knee, causing pain when the knee is bent.
- Injury
- Excessive training or overload
- Imbalance, weakness in leg muscles
- Flat feet
Diagnosis;
If one day you start having pain in the above positions, stop doing the movement that caused it, rest, take a simple painkiller and make ice.
If it does not go away within 1-2 days and if it recurs, it is about the knee. Consult an experienced orthopedist.
The most valuable findings for diagnosis are obtained through conversation and examination.
The position in which the patient's pain increases and its duration are very valuable data.
Cinema. Feeling pain and discomfort in the knee in situations where the knee remains fixed for a long time, such as traveling to the theater, plane or bus, is called "theatre sign" and is very typical for anterior knee pain.
After doing sports for a long time. Anterior knee pain due to muscle imbalance is common in people who quit.
When examination is added, up to 90% of the diagnosis is made.
Disease history + examination prevents anterior knee pain from being confused with main joint pain.
There are many patients whose anterior knee problems are overlooked due to MRI findings in the main joints and who receive unnecessary treatment and surgery.
After the conversation and examination, various radiological examinations are required to determine the causes and severity of anterior knee pain.
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To determine the position of the kneecap, position x-rays of the kneecap at various angles and computed tomography may be requested.
MRI is often required to determine the condition of the kneecap and the cartilage underneath it and to detect other pathologies in the knee-tendons.
Treatment;
Treatment is tailored according to the cause of anterior knee pain.
In anterior knee pain originating from tendon, injury, overload-training, the RICE protocol (rest-ice-training) is the first priority. elastic bandage - keeping it up) is applied.
Then, exercise, stretching, physiotherapy, stretching, agility, strengthening and coordination exercises are performed.
These studies continue until normality returns.
>Continuing the exercises afterwards is necessary to prevent recurrences.
You should keep in touch with your doctor on this issue.
Surgical treatments are very limited.
The position of the knee cap is very limited. There is a longer and more difficult process for anterior knee pain due to the disorder.
The primary treatment is physiotherapy and exercise therapy.
A very different physiotherapy is applied here than classical physical therapy.
While the inner part of the front knee muscles are strengthened with electrotherapy and exercise, manipulation is performed to increase the mobility of the kneecap.
50-60% success is achieved with physiotherapy.
Surgical treatment in cases that do not respond to 3 months of physiotherapy. options come to the fore.
There are two basic options for surgical treatment;
1. Arthroscopic surgery;
- Surgery is performed through 2 incisions smaller than 1 cm.
- Shaving and revitalization of damaged cartilage parts can be done with arthroscopy.
- Arthroscopic or sometimes Cartilage transplants can be performed by making small incisions of 2 cm. r. (miniopen technique)
In cases where the kneecap is turned outwards or semi-dislocated, the capsule that pulls the kneecap outwards is arthroscopically cut (LATERAL RELAXATION) to correct its position. In cases where the position of the kneecap is not fully corrected, narrowing of the inner capsule can also be added.
After this type of arthroscapillary, patients can walk and go home pain-free after 4 hours. The success rate is around 80%.
2. Redirection surgery;
- In cases where arthroscopy is not successful or in cases of advanced dislocation or semi-dislocation of the kneecap, bone operations may be required to correct the anatomical defect of the kneecap.
- The most popular operation in this regard is "Fulkerson Osteotomy".
- In this operation, it is possible to shift the lower connection of the kneecap bone, the attachment point of the patellar tendon to the tibia, inwards, forwards, up or down.
- Thus, the position of the kneecap is improved and the excessive loads on the cartilage are reduced. It happens.
- There is a serious need for physical therapy after the surgery.
Prevention;
There are things to do in daily life to protect from front knee pain.
- Stay fit; Maintain your general body condition. The absence of excess weight ensures that the loads on the knees are not excessive. For this, exercise regularly. Warm up for 5 minutes before exercise. Exercise with appropriate shoes.
- Do stretching exercises; Do stretching exercises for the muscles around the knee. (see: stretching exercises in training topics)
- Increase your pace slowly; Do not suddenly increase exercise intensity excessively.
- Stay away from exercises that put excessive stress on your knees; During "leg extension" and "leg press" movements to strengthen the muscles around the knee, keep the bending angle of your knee between 0-45 degrees and the toes are facing outward. Do not do hip abduction.
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