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Treatment is generally conservative with rest, ice, and specific exercises being recommended. Simple pain killers may be used if required such as acetaminophen (paracetamol) or ibuprofen. Typically symptoms resolve as the growth plate closes. Physiotherapy is generally recommended once the initial symptoms have improved to prevent recurrence. Surgery may rarely be used in those who have stopped growing yet still have symptoms.
Non-septic prepatellar bursitis can be treated with rest, the application of ice to the affected area, and anti-inflammatory drugs, particularly ibuprofen. Elevation of the affected leg during rest may also expedite the recovery process. Severe cases may require fine-needle aspiration of the bursa fluid, sometimes coupled with cortisone injections. However, some studies have shown that steroid injections may not be an effective treatment option. After the bursitis has been treated, rehabilitative exercise may help improve joint mechanics and reduce chronic pain.
Opinions vary as to which treatment options are most effective for septic prepatellar bursitis. McAfee and Smith recommend a course of oral antibiotics, usually oxacillin sodium or cephradine, and assert that surgery and drainage are unnecessary. Wilson-MacDonald argues that oral antibiotics are "inadequate", and recommends intravenous antibiotics for managing the infection. Some authors suggest surgical irrigation of the bursa by means of a subcutaneous tube. Others suggest that bursectomy may be necessary for intractable cases; the operation is an outpatient procedure that can be performed in less than half an hour.
Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat PFPS, however there is only very limited evidence that they are effective. NSAIDs may reduce pain in the short term, overall however, after three months pain is not improved. There is no evidence that one type of NSAID is superior to another in PFPS, and therefore some authors have recommended that the NSAID with fewest side effects and which is cheapest should be used.
Glycosaminoglycan polysulfate (GAGPS) inhibits proteolytic enzymes and increases synthesis and degree of polymerization of hyaluronic acid in synovial fluid. There is contradictory evidence that it is effective in PFPS.
Presently, treatments make it possible for quicker recovery. If the tear is not serious, physical therapy, compression, elevation and icing the knee can heal the meniscus. More serious tears may require surgical procedures. Surgery, however, does not appear to be better than non surgical care.
One of the main ways to prevent OSD is to check the participant's flexibility in their quadriceps and hamstrings. Lack of flexibility in these muscles can be direct risk indicator for OSD. Muscles can shorten, which can cause pain but this is not permanent. Stretches can help reduce shortening of the muscles. The main stretches for prevention of OSD focus on the hamstrings and quadriceps.
As patellofemoral pain syndrome is the most common cause of anterior knee pain in the outpatient, a variety of treatments for patellofemoral pain syndrome are implemented. Most patients with patellofemoral pain syndrome respond well to conservative therapy.
Initial treatment may include physical therapy, bracing, anti-inflammatory drugs, or corticosteroid injections to increase flexibility, endurance, and strength.
Exercises can strengthen the muscles around the knee, especially the quadriceps. Stronger and bigger muscles will protect the meniscus cartilage by absorbing a part of the weight. The patient may be given paracetamol or anti-inflammatory medications.
For patients with non-surgical treatment, physical therapy program is designed to reduce symptoms of pain and swelling at the affected joint. This type of rehabilitation focuses on maintenance of full range of motion and functional progression without aggravating the symptoms. Physical therapists can utilize modalities such as electric stimulation, cold therapy and ultrasonography, etc.
Recently, accelerated rehabilitation programs have been used and show to be as successful as the conservative program. The program reduces the time the patient spends using crutches and allows weight bearing activities. The less conservative approach allows the patient to apply a small amount of stress and prevent range of motion losses. It is likely that a patient with a peripheral tear may pursue the accelerated program and a patient with a larger tear will use the conservative program.
Two types of treatment options are typically available:
- Surgery
- Conservative treatment (rehabilitation and physical therapy)
Surgery may impede normal growth of structures in the knee, so doctors generally do not recommend knee operations for young people who are still growing. There are also risks of complications, such as an adverse reaction to anesthesia or an infection.
When designing a rehabilitation program, clinicians consider associated injuries such as chipped bones or soft tissue tears. Clinicians take into account the person's age, activity level, and time needed to return to work and/or athletics. Doctors generally only recommend surgery when other structures in the knee have sustained severe damage, or specifically when there is:
- Concurrent osteochondral injury
- Continued gross instability
- Palpable disruption of the medial patellofemoral ligament and the vastus medialis obliquus
- High-level athletic demands coupled with mechanical risk factors and an initial injury mechanism not related to contact
Supplements like glucosamine and NSAIDs can be used to minimize bothersome symptoms.
An effective rehabilitation program reduces the chances of reinjury and of other knee-related problems such as patellofemoral pain syndrome and osteoarthritis. Rehabilitation focuses on maintaining strength and range of motion to reduce pain and maintain the health of the muscles and tissues around the knee joint.
Early stages may be treated conservatively using the R.I.C.E methods.
1. Rest
2. Ice
3. Compression
4. Elevation
Exercises involving eccentric muscle contractions of the quadriceps on a decline board are strongly supported by extant literature. A physical therapist may also recommend specific exercises and stretches to strengthen the muscles and tendons, eg. cycling or swimming. Use of a strap for jumper's knee and suspension inlays for shoes may also reduce the problems.
Should this fail, autologous blood injection, or platelet-rich plasma injection may be performed and is typically successful though not as successful as high volume saline injection (Crisp "et al."). Uncommonly it may require surgery to remove myxoid degeneration in the tendon. This is reserved for patients with debilitating pain for 6–12 months despite conservative measures. Novel treatment modalities targeting the abnormal blood vessel growth which occurs in the condition are currently being investigated.
New research shows that knee operations in most cases have no better effects than exercise programs, and that most knee operations thus can be avoided.
The term for non-surgical treatment for ACL rupture is "conservative management", and it often includes physical therapy and using a knee brace. Instability associated with ACL deficiency increases the risk of other knee injuries such as a torn meniscus, so sports with cutting and twisting motions are problematic and surgery is often recommended in those circumstances.
Patients who have suffered an ACL injury should be evaluated for other injuries that often occur in combination with an ACL tear and include cartilage/meniscus injuries, bone bruises, PCL tears, posterolateral injuries and collateral ligament injuries. When a combination injury occurs, surgical treatment is usually advised.
In the absence of cartilage damage, pain at the front of the knee due to overuse can be managed with a combination of RICE (rest, ice, compression, elevation), anti-inflammatory medications, and physiotherapy.
Usually chondromalacia develops without swelling or bruising and most individuals benefit from rest and adherence to an appropriate physical therapy program. Allowing inflammation to subside while avoiding irritating activities for several weeks is followed by a gradual resumption. Cross-training activities such as swimming, strokes other than the breaststroke, can help to maintain general fitness and body composition. This is beneficial until a physical therapy program emphasizing strengthening and flexibility of the hip and thigh muscles can be undertaken. Use of nonsteroidal anti-inflammatory medication is also helpful to minimize the swelling amplifying patellar pain. Treatment with surgery is declining in popularity due to positive non-surgical outcomes and the relative ineffectiveness of surgical intervention.
Treatment generally includes the following:
- Sometimes pharmacologic therapy for initial disease treatment
- Physical therapy
- Occupational therapy
- Use of appropriate assistive devices such as orthoses
- Surgical treatment
Treatment of medial knee injuries varies depending on location and classification of the injuries. The consensus of many studies is that isolated grade I, II, and III injuries are usually well suited to non-operative treatment protocols. Acute grade III injuries with concomitant multiligament injuries or knee dislocation involving medial side injury should undergo surgical treatment. Chronic grade III injuries should also undergo surgical treatment if the patient is experiencing rotational instability or side-to-side instability.
Plica syndrome treatment focuses on decreasing inflammation of the synovial capsule. A nonsteroidal anti-inflammatory drug (NSAID) is often used in conjunction with therapeutic exercise and modalities. Iontophoresis and phonophoresis have been utilized successfully against inflammation of the plica and synovial capsule. Failing these, surgical removal of the plica of the affected knee may be necessary.
Treatment of the unhappy triad usually requires surgery. An ACL surgery is common and the meniscus can be treated during the surgery as well. The MCL is rehabilitated through time and immobilization. Physical therapy after the surgery and the use of a knee brace help speed up the healing process.
A typical surgery for a blown knee includes:
- Patellar tendon autograft (An autograft is a graft that comes from the patient)
- Hamstring tendon autograft
- Quadriceps tendon autograft
- Allograft (taken from a cadaver) patellar tendon, Achilles tendon, semitendinosus, gracilis, or posterior tibialis tendon
The goal of reconstruction surgery is to prevent instability and restore the function of the torn ligament, creating a stable knee. There are certain factors that the patient must consider when deciding for or against surgery.
Treatment of posterolateral corner injuries varies with the location and grade of severity of the injuries. Patients with grade I and II (partial) injuries to the posterolateral corner can usually be managed conservatively. Studies have reported that patients with grade III (complete) injuries do poorly with conservative management and typically will require surgical intervention followed by rehabilitation.
If surgery is decided upon, either because obvious instability interferes with activities of daily living, or because the knee is subject to repeated, severe, provocative maneuvers, such as the case of the competitive athlete involved in cutting and rapid deceleration etc., then several issues need to be decided upon.
- Timing. Immediate repair is usually avoided and initial swelling and inflammatory reaction allowed to subside.
- Choice of graft material, autograft or allograft.
- Choice of anterior cruciate ligament augmentation, patellar tendon or hamstring tendon.
These issues are fully explored in ACL Reconstruction.
It is possible to prevent the onset of prepatellar bursitis, or prevent the symptoms from worsening, by avoiding trauma to the knee or frequent kneeling. Protective knee pads can also help prevent prepatellar bursitis for those whose professions require frequent kneeling and for athletes who play contact sports, such as American football, basketball, and wrestling.
Undisplaced fracture can usually be treated by casting. Even some displaced fractures can be treated with casting as long as a person can straighten their leg without help. Typically the leg is immobilized in a straight position for the first three weeks and then increasing degrees of bending are allowed.
Until recently, there was no specific treatment for osteitis pubis. To treat the pain and inflammation caused by osteitis pubis, antiinflammatory medication, stretching, and strengthening of the stabilizing muscles are often prescribed. In Argentina, Topol et al. have studied the use of glucose and lidocaine injections ("prolotherapy", or regenerative injection therapy) in an attempt to restart the healing process and generate new connective tissue in 72 athletes with chronic groin/abdominal pain who had failed a conservative treatment trial. The treatment consisted of monthly injections to ligament attachments on the pubis. Their pain had lasted an average of 11 months, ranging from 3–60 months. The average number of treatments received was 3, ranging from 1–6. Their pain improved by 82%. Six athletes did not improve, and the remaining 66 returned to unrestricted sport in an average of 3 months.
Surgical intervention - such as wedge resection of the pubis symphysis - is sometimes attempted in severe cases, but its success rate is not high, and the surgery itself may lead to later pelvic problems.
The Australian Football League has taken some steps to reduce the incidence of osteitis pubis, in particular recommending that clubs restrict the amount of bodybuilding which young players are required to carry out, and in general reducing the physical demands on players before their bodies mature.
Osteitis pubis, if not treated early and correctly, can more often than not end a sporting individuals career, or give them an uncertain playing future.
Although surgery has a role in repairing traumatic injuries and broken bones, surgeries such as arthroscopic lavage do not provide significant or lasting improvements to either pain or function to people with degenerative knee pain, and therefore should almost never be performed. Degenerative knee pain is pain caused by wear and tear, such as osteoarthritis or a meniscal tear. Effective treatments for degenerative knee pain include physical therapy exercises, pain-reducing drugs such as ibuprofen, knee replacement surgery, and weight loss in people who are overweight.
Conservative treatment relies on immobilizing the knee in full extension to allow the stretched or torn ligaments to heal. It is imperative that the patient keep the knee immobilized and not bear weight on the joint for 3 to 4 weeks to allow sufficient time for the structures to heal. Following immobilization, the patient can begin exercises to improve range of motion and begin bearing weight on crutches only. The crutches can be discontinued when the patient can walk without limping. Quadriceps strengthening exercises are allowed, but no isolated hamstring exercises should be attempted for 6 – 10 weeks following the injury. If after 10 weeks, pain or instability continue, the patient should be reevaluated for surgical treatment.
It is possible for the PCL to heal on its own without surgery when it is in Grades I and II. PCL injuries that are diagnosed in these categories can have their recovery times reduced by performing certain rehabilitative exercises. Fernandez and Pugh(2012) found that following a PCL grade II diagnosis, a treatment that spanned over the course of 8 weeks consisting of chiropractic lumbopelvic manipulation, physiotherapy, and implementing an exercise program that emphasized in eccentric muscle contraction (lunges, 1-leg squats, and trunk stabilization) which proved to be an effective way to recover from the PCL injury. For Grades III and IV, operative surgery is recommended or is usually needed. Grafts is the method when addressing PCL injuries that are in need of operative surgery. With grafts, there are different methods such as the tibial inlay or tunnel method.
Treatment may be with or without surgery, depending on the type of fracture.