Knee Injuries: Causes, Symptoms, and Treatment Options

Knee injury

Hello doctor, about four months ago while training with heavy squats, I heard a popping sound in my knee when I was squatting with a weight of around 100 kilograms.
It has been a long time since the injury, and I have seen both traditional Chinese medicine and Western medicine.
Currently, when I sit, my foot tends to turn outward, and when I exert my calf, I experience pain on the outer side of my knee and at the end of my hamstring.
I also feel pain when squatting.
Since the injury, my lower back has frequently been sore and even feels dull and painful; any incorrect posture causes significant pain.
I have had X-rays and ultrasounds of my knee, and I have also undergone physical therapy.
However, treatments like ultrasound and electrical stimulation have not shown much effect.
I would like to know what might be wrong, whether it is a ligament injury, muscle strain, or meniscus damage.
For an athlete, any pain in the knee is unacceptable.
Would it be necessary to get an MRI in this situation?

A Jie, 10~19 year old female. Ask Date: 2017/07/07

Dr. Shi Guozheng reply Orthopedics

If the symptoms have not improved, further examination is necessary.
This condition can be referred to as intra-articular knee pathology, which may involve meniscal or ligament injuries.
An MRI may be required.

Reply Date: 2017/07/07

More Info

Knee injuries can be complex and multifaceted, particularly for athletes who engage in high-impact activities like weight training and squats. Based on your description of the injury occurring during a squat with significant weight, it is possible that you may have sustained damage to various structures within the knee, including ligaments, tendons, or the meniscus.

Causes of Knee Pain
1. Ligament Injuries: The knee contains several key ligaments, including the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL). A "pop" sound during an injury often indicates a ligament tear, especially if accompanied by swelling and instability.
2. Meniscus Tears: The meniscus acts as a cushion between the femur and tibia. Sudden twisting motions, especially under load, can lead to tears. Symptoms may include pain, swelling, and difficulty bending or straightening the knee.

3. Tendon Injuries: The quadriceps and patellar tendons can also be injured during heavy lifting. Tendonitis or tears can lead to pain in the front of the knee and may be exacerbated by activities like squatting.

4. Patellofemoral Pain Syndrome: This condition arises from issues with the alignment of the kneecap, often leading to pain around the kneecap, especially during activities that put stress on the knee.

5. Referred Pain: Your mention of lower back pain could indicate that your knee injury is affecting your gait or posture, leading to compensatory movements that strain your back.

Symptoms to Monitor
- Pain Location: You mentioned pain on the outer side of the knee and the back of the thigh. This could indicate issues with the lateral structures of the knee or the hamstring muscles.

- Swelling: Persistent swelling can indicate ongoing inflammation or fluid accumulation in the joint.

- Range of Motion: Difficulty in bending or straightening the knee can suggest structural damage.

Diagnostic Options
Given that X-rays and ultrasounds have not provided a clear diagnosis, an MRI is a logical next step. MRI is particularly useful for visualizing soft tissue injuries, including ligament tears and meniscus damage. It can provide a comprehensive view of the knee's internal structures and help guide treatment decisions.

Treatment Options
1. Physical Therapy: While you have already undergone physical therapy, it may be beneficial to revisit this with a focus on strengthening the muscles around the knee, improving flexibility, and correcting any biomechanical issues. A specialized therapist can tailor a program to your specific needs.

2. Rest and Activity Modification: Avoid activities that exacerbate your pain. This may include heavy lifting or high-impact exercises until a clearer diagnosis is established.

3. Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation, but if you have allergies, discuss alternatives with your physician.

4. Surgical Options: If an MRI reveals significant damage, such as a complete ligament tear or a complex meniscus tear, surgical intervention may be necessary. This could involve arthroscopic surgery to repair or reconstruct damaged structures.

5. Knee Bracing: A brace may provide stability and support during recovery, but it should be used under the guidance of a healthcare professional to avoid dependency.

Conclusion
In summary, your knee pain could stem from various injuries, including ligament tears, meniscus damage, or tendon issues. Given the complexity of knee injuries and the lack of improvement with conservative treatments, an MRI is recommended to clarify the diagnosis. From there, a tailored treatment plan can be developed to address your specific injury and help you return to your athletic activities without pain. Always consult with a healthcare professional for personalized advice and treatment options.

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