Knee injuries: why early assessment is crucial

Written by: Mr Shahid Punwar
Edited by: Conor Lynch

Knee injuries are extremely common and it is quite unlikely that we won’t suffer some degree of a knee injury in our lifespan. In most cases, most knee injuries are not too much of a concern, but it is when we self-diagnose and leave it too late to get assessed, that complications can arise.


In our latest article, mightily experienced and skilled consultant orthopaedic surgeon, Mr Shahid Punwar, outlines and explains the most common and most severe knee injuries, before revealing how an orthopaedic surgeon will typically go about assessing one’s knee injury.

What are the most common knee injuries and which ones are the worst?

A lot of people injure their knee by just falling over or twisting it playing sport, and in many cases, this could just be a simple soft tissue injury, something that you could call a knee sprain. This could be a small tear of one of the ligaments on the side of the knee, a bruise, or a hematoma.


All of these types of injuries will usually settle by themselves with the usual treatment of RICE (Rest, Ice, Compression, Elevation). It is, though, quite difficult to tell whether you just have a sprained knee or a more serious knee injury, and that is why we would always recommend to get assessed if you are finding mobility difficult or are in pain.


Patients could also have a shock absorber tear (the menisci that sit on top of the shinbone) and if one twists their knee, the shock absorbers can be torn (either the inside or outside one). You could also properly tear a ligament (either a collateral ligament on the sides of the knees or one of the cruciate ligaments which are inside the knee, stopping the shinbone from going forwards or backwards).


You could also tear one of the muscles and, in the most serious of scenarios, you could also dislocate the knee, where more than one ligament is ripped. These injuries are normally seen quite quickly in the emergency department.


What kind of knee injury symptoms should someone look for before seeing a medical professional?

I think if you’ve got severe pain and/or swelling, difficulty standing on the leg or moving your knee fully, you may need to seek a medical professional. If you’ve got specific severe symptoms such as locking (when the knee won’t fully bend), this could be a sign of a shock absorber tear.


Also, if your knee suddenly gives way on you, it can be because of pain which inhibits the muscles and the leg just collapses, or it could be because you have torn a cruciate ligament. Normally, the anterior cruciate ligament is the most common, which should really prompt early review.


How can patients assess their injury and how will a medical professional assess it?

Patients can try putting weight on the knee, checking if they can bend it as much as the other knee. If your knee is not getting better within a few days, then you certainly need proper assessment, particularly if you can’t lift the leg up properly and you’re getting those locking and giving way symptoms.


When you do go and see a medical professional or a physiotherapist, they will carry out various tests. First, they’ll take a look at the knee. They will look for what we call an effusion (a swelling in the knee which is usually caused by blood if you have had an injury to the bone structures inside the knee).


They will also feel for the amount of swelling in the knee and then they’ll assess the movement. First, we see how much you can do for yourself, how much you can bend and straighten your knee on your own, and then they’ll try to bend and straighten it themselves.


Then, there are some special tests for the shock absorbers and the ligaments. So, for the shock absorbers, we’ll often feel the joint line of the knee to see if there is any pain, and we might twist the knee gently to see if that causes pain.


For the ligaments, we can gently try to move the shinbone away from the thigh bone in various directions, just to see if any of the ligaments around the knee are sightly loose. Based on all of that then, we will have a pretty good, solid impression of what you might have done. To determine the injury further, we will use an X-Ray and then the next stage is usually to book an MRI scan.

What can happen if a serious knee injury is not properly assesses and treated?

I really would encourage people to come in and get their proper assessment because you can make a problem that could be fixed, such as a shoch absorber tear, into one where we might have to remove a bit of cartilage rather than repair it because over the months, the cartilage may become deformed within the knee and it’s difficult to repair.


So, say you suffer the common shock absorber tear. This should be operated on within about six weeks to have a good chance of repairing it. Otherwise, you’re looking at resection. If you resect a shock absorber rather than repair it, you’re increasing the risk of wear and tear in later life.


With ligament injuries, such as the anterior cruciate ligament, you probably will not be able to return to sport, particularly if it is a pivoting sport. It certainly affects lifestyle and we commonly find that people who have an unstable knee cannot work, and they can’t do their normal activities. I think the biggest worry is worsening any damage to your knee by walking on or playing sport with a knee that has not been properly assessed.


What advice would you give to patients who may have a knee injury?

You’ve got to think to yourself and ask yourself if your knee injury is serious. If you cannot walk on the knee properly and it’s very swollen, then you need to get it assessed early. I think it’s best if medical professionals then decide whether it’s a simple knee sprain (where we can just try ice, compression, elevation and rest), or we may need to investigate further.


It is notoriously quite difficult in the first day following a knee injury to assess it properly because there is pain and swelling. So, it’s quite a good idea to get into the system early to arrange a follow-up so the knee can calm down a bit and then the medical professional can assess you and your knee after a few weeks.


If the knee is still unstable, those tests we talked about earlier are certainly easier to perform after a couple of weeks. So, you certainly want to get an early assessment and then you want to schedule a follow-up appointment after a couple of weeks. You also want to get an MRI scan (if that’s what you need) as quickly as possible.


Just be very careful about self-diagnosis. If it doesn’t get better after a couple of weeks, you need to get an urgent assessment.


Mr Shahid Punwar is an extremely well-regarded and experienced London and Beckenham-based consultant orthopaedic surgeon who specialises in sports injuries, ACL reconstruction as well as knee injuries, but to mention a few. Check out his Top Doctors profile today to schedule a consultation with him.

By Mr Shahid Punwar
Orthopaedic surgery

Mr Shah Punwar is a leading consultant orthopaedic surgeon in London who is an expert in hip and knee replacement, partial knee replacements, sports knee injuries, ACL reconstruction and meniscal surgery.

Mr Punwar graduated from the Imperial College School of Medicine London in 2001 and completed his specialist orthopaedic training in Bristol. He received his fellowship from the Royal College of Surgeons in 2012.

He specialises in both joint replacements and sports surgery as well as general orthopaedic trauma. After basic surgical training in Kent and London, Mr Punwar completed his specialist orthopaedic training on the prestigious Bristol rotation. In 2013 he undertook a year of complex hip & knee arthroplasty and sports injury training in Perth, Western Australia.

As well as a Diploma in Sports Medicine, Mr Punwar has a postgraduate certificate in medical education and publishes his research work in peer-reviewed journals.

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