Transcription:
Common Knee Injuries

Scott Webb: Knee injuries and knee pain are common and there are lots of causes and treatment options. And joining me today to go over all things knee pain is Dr. Barry Hyman. He's an orthopedic surgeon with Montefiore St. Luke's Cornwall. This is Doc Talk presented by Montefiore St. Luke's Cornwall. I'm Scott Webb.

So doctor, thanks so much for your time. This is the first of two podcasts we're going to do. Up first in this first one here, we're going to talk about common knee injuries and the causes, treatment options, and so on. So as we get rolling here, what are the most common knee injuries that you treat?

Dr. Barry Hyman: So the first thing that happens is people can fall, that's one of the most common injuries. They land directly on their knee and they get what's called a contusion, which is a bruise. And you can have a contusion to the soft tissues or the contusion can occur to the bone. And the soft tissue injuries are quicker, but they can be painful, especially if you bleed after you do that, then that's called a hematoma or ecchymosis where it bleeds and it swells. And it could be if you fall from a more of a height and you hit it hard, it could be a contusion to the bone and that contusion to the bone, if hard enough, could be either a stress fracture or actually you can get a real fracture from that type of injury.

Scott Webb: Yeah. And I think just hearing you describe this, I think we've all had that experience, falling, you know, on one or both of our knees, and we have a sense of at least how painful that can be. I wanted to ask you also about osteoarthritis and rheumatoid arthritis? Are those common causes of knee pain as well?

Dr. Barry Hyman: People who have arthritis can also get injured. They have underlying pain in their joints and they can also get injured as well. And sometimes it's confusing when somebody who has arthritis to begin with gets injured, you don't know if the pain is from the arthritis or the pain is from the injury itself.

Scott Webb: So when we think about the knee pain, knee injuries, these issues, when folks come into the office, how are they diagnosed?

Dr. Barry Hyman: So we talked about the direct trauma. There's also a twisting type of injury too, for instance. And a lot of the diagnosis comes on the history of how somebody got injured. So a twisting injury, you could injure your meniscus, like the old clipping injury, where somebody hits you from the knee, from the side and the leg is planted and it twists, the leg goes one way and the body goes the other. Those can be ligamentous injuries. The common injury there would be the medial collateral ligament, which is the ligament in the inside. It could be your major ligament, which is your anterior cruciate ligament.

And so the diagnosis starts with the history of how somebody was injured, that helps an orthopedist like myself. Knowing the mechanism of injury often alone can push us in the clues of the type of injury. How much force was attained? Was it a mild fall from a little bit of a height or was it a force from another height? Or was it a car accident where somebody's knee went into the dashboard and their kneecap or the area by the top of the knee hit the dashboard? How much force from that? Did the airbags go off? Which obviously a lot of force. How much damage to the car? So we get clues from the history. So that's how we'd like to start, with a history. And then from there, we go to a physical exam. We examine somebody and that is also helpful quite a lot. A lot of times between the history and exam, an orthopedist sort of has a really good idea of what is going on.

Now, of course, studies are helpful, and x-ray is the most basic one. And that will tell you whether there's a fracture or not, but also will tell you whether there's underlying arthritis. But again, if somebody has arthritis to begin with, but didn't have the pain beforehand, we sort of know that pain is not from the arthritis, it's from that injury that occurred. And then obviously, an MRI is a great study to get which gives us even more information.

Scott Webb: Yeah, I see what you mean. And that's one of the things I love most about doctors is what good listeners you all are, most of you are anyway. So really listening to the patient, what happened, how did it happen, how much force, how much damage and so on. So good for us if we come to you that we have all that information for you. So when we think about the treatment options, you know, let's go through that list. As you begin to diagnose patients, what are the treatment options?

Dr. Barry Hyman: So the first thing is if somebody has a contusion and they swell up real quickly, if they can just put an ACE wrap around them, put some compression on that, then some ice, that'll help them a lot, just by getting the pressure down and not allowing it to swell so much. So that's a very basic thing. Elevation, sometimes just lifting the leg up a little bit when you're doing that compression can again get the fluid away from that area of the joint and that fluid slows things down. So that's one of the most basic treatments. Sometimes someone actually comes into our office and their knee is huge. It's swollen and it's after trauma. They can actually bleed into the joint and we can take that out in a gentle way using a needle, but we usually use cold spray and numb somebody up. And often, that helps too, but we don't do that a lot, but just as a treatment for somebody who has swelling.

Now, if it's something that's more than that, obviously if you have a fracture, enough trauma to have a fracture or a broken bone, there is non-operative treatments and operative treatments for that. And what commonly I see a lot in my practice is meniscus tears, where there's tears of the cartilage. There's two types of cartilage in the knee. There's the articular cartilage, which are the shiny stuff at the ends of the bones and all joints have that. But the knee has a cartilage called the meniscus, which is like a washer inside the knee. And unfortunately, for a lot of people, that's a common injury where they can twist and tear that. And only a small percentage of people will get better without a surgical approach without arthroscopic surgery, which is a very easy procedure generally. For a lot of people, it's only a 15-minute procedure and you just remove a little piece of that tear and then the symptoms go away.

Scott Webb: Yeah, it's interesting. I just hosted one recently and had someone like yourself on, similar area of expertise and he was talking about, "Well, you know, the meniscus is sort of the shock absorber of the knee, and when there's an issue, we can just go in there and trim some out." And I sort of joked with him how sort of easily and freely doctors speak about things like that. When we patients here are like, "You're going to go into my knee and you're going to trim some of my meniscus?" You know, but for you, that's probably just all in a day's work, right?

Dr. Barry Hyman: If you do hundreds a year, it sort of is. But I like to sort of talk about it with somebody like whose nail, like you sort of do something and the nail peels off a little bit. It's really painful. You take a nail clipper and you just take off that nail and the pain goes away and you're fine. It's as simple as that, because the knee joint is very tight. Also, I use like a door jam. If you put a piece of paper in the door and try to shut it, it doesn't shut. But all you have to do is take a little piece of paper out and the door shuts. And so it's a very little piece of meniscus that can actually get in the way that can cause a lot of trouble and a lot of pain. And removing that little piece sometimes helps, although these can be repaired sometimes. Sometimes people will have a tear that can be repaired, then that's a different situation, but the more common one is one that can't be repaired because it doesn't have the right blood supply to heal.

Scott Webb: All right, doctor. So when we think about knee pain, knee injuries, I'm sure that you see folks or other types of injuries, other types of pain in their lower extremities, lower parts of their legs. So maybe let's go through some of those.

Dr. Barry Hyman: So one of the most common ones is kneecap pain and we call that patellofemoral pain, because us doctors like using Latin terms to make us sound important. But in general, knee cap pain is very common. And a lot of people get it and a minor injury can sort of cause dysfunction to the quadriceps around the knee and that can cause a misalignment. The way the knee works is that the quadriceps, which is the major muscle goes to the patella, which then goes to the patellar tendon, which is below the patella and then attaches to the bone on the tibia. And then you've got four muscles in the quadriceps keeping the kneecap sitting nicely in that groove. And if you ever look at a bodybuilder, that big muscle on the inside is the vastus medialis muscle, that's the strongest of the four and that tends to keep the kneecap centered, whereas the attachment is a little bit more what we call lateral, a little more to the outside, and that tends to want to push the kneecap in the wrong way. So if anybody has any problem to the knee and the knees get weak, that tends to push the kneecap on the outside laterally. And so one of the treatments is easy, it's strengthen the quadriceps, strengthen the muscles, then that pulls it back in and a lot of time the pain goes away. There's bracing that often helps people. But those are two common things that can help people, bracing and knee strengthening, That can make a big difference for kneecap pain.

Now, we talked about the quadriceps muscle and the patellar tendon with the types of injuries that people can have, people can actually tear those and rupture those. And that's a big problem and often those require surgery.

Scott Webb: You know, doctor, my daughter is a basketball player and I worry a lot about her legs and her knees and hamstrings and all of these things. And so when we think about knee injuries, the most common knee injuries, especially maybe for athletes, maybe you can talk a little bit about how all these things go together. Thinking of that song, "The thing is connected to the..." and so on. So all these things are connected, right? And they help to make things like our knees and ankles and hips and all these things work. But when something happens to, you know, our hamstrings, let's say for an example, how does that affect our knees?

Dr. Barry Hyman: People can injure their hamstrings or a gastroc muscle. Those are the main muscles around the knee. We also have on the other side, the quadriceps. But that's a very common injury you see in sports. Maybe rounding first base, you just slide into the second base and you can pull a hamstring. And those injuries can be quite debilitating, especially if they're not taken care of right away. You can have mild ones, where they just pull or tear a few muscle fibers and you can have ones where the whole muscles get torn off. You can have it at the tendon attachment or you can have it in the muscle itself, that's a common injury.

And the treatment is important. Teach people the six-week disabled list in baseball. It means that when you get this type of injury, you're out for six weeks. It's not like, "I'm feeling better in two weeks, coach. Let me go back." They know from experience that it's going to take about six weeks for something like this to heal and maybe longer, and people need to rest it for a period of time. They can do some stretching of the muscles a little bit during that time. And then as you start to get better, start some early strengthening as long as there's no pain. But that can be quite a debilitating injury, however, even worse so if you don't rest it enough and start to go back before it's healed, then you're even out for longer.

Scott Webb: And this has been really educational today, doctor. And as I mentioned, we're going to speak again about the swollen knee, but as we wrap up here, what are your final thoughts, takeaways about knee pain, knee injuries, and how you can help folks?

Dr. Barry Hyman: Well, I think that the major thing is people like myself, an orthopedic surgeon, really have experience to try to know the difference between what the pain is from. And sometimes it's very complex, even for us. So if it hasn't gotten better within a short period of time, it's a very reasonable option to go see an orthopedist and let them help you with finding a solution to the problem.

Scott Webb: Yeah, that's perfect. You know, reach out to your primary and maybe get a referral. See an orthopedist. That's perfect. So again, thanks for your time today. I'll talk to you soon and you stay well.

Dr. Barry Hyman: Thank you very much.

Scott Webb: And visit montefiore.slc.org for more information. And if you found this podcast to be helpful, please be sure to share it on your social channels and be sure to check out all the other Doc Talk episodes. This has been Doc Talk, the podcast from Montefiore St. Luke's Cornwall Hospital. I'm Scott Webb. Stay well.