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1. Meniscal injury

A meniscal injury refers to damage to the cartilage which separate the bones in the knee joint. The menisci in the knee are most commonly injured when the knee is twisted. This often occurs when changing directions quickly whilst the foot is fixed on the ground. The first sensation felt when a meniscus is injured is pain within the knee joint. This may be associated with a sensation of something tearing. Depending on the severity of the injury, the knee may swell and you may have difficulty walking due to pain. Swelling may be immediate or occur over a period of hours. The knee may also feel weak and ‘unstable’, and may produce clicking noises, lock or give way.

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2. Medial collateral ligament (MCL) injury

A medial collateral ligament injury refers to a sprain (tear) in the ligament which runs down and supports the inner aspect of the knee joint. The medial collateral ligament is injured when it is overstretched (sprained). The first sensation felt when the medial collateral ligament is injured is pain along the inner aspect of the knee. There may also be an audible snap, crack or tear. Depending on the severity of the injury, the knee may swell and you may have difficulty walking due to pain. Swelling may be immediate or occur over a period of hours. The knee may also feel weak and ‘unstable’.

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3. Patella dislocation (kneecap)

Dislocation of the patella refers to when the kneecap (patella) moves out, and stays out of its normal position. The patella is dislocated when forces acting on the kneecap are too great for the supporting muscles and ligaments to resist. This can occur with a direct blow to the kneecap which pushes it out to the side of the leg. For example, when landing on your knees. Alternatively, the patella may be dislocated when the knee is twisted such as during rapid changes in direction.

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4. Fat pad impingement

Also known as Hoffa’s syndrome, fat pad impingement refers to when the fat pad in the front of the knee joint gets pinched between the kneecap and the underlying leg bone. The fat pad on the front of the knee can get pinched two ways. Firstly, it can get pinched if the knee is forcibly extended or straightened. This can occur when kicking or landing from a jump, and causes the bottom of the kneecap to dig into the fat pad. Secondly, the fat pad may get pinched if it is enlarged or swollen. This can occur with repetitive minor pinching, or following damage to the fat pad such as occurs during arthroscopic surgery. This results in it bulging around the bottom of the kneecap making it more susceptible to being pinched. When the fat pad is pinched it can become inflamed and painful.

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5. Patellar tendinopathy (jumper’s knee)

Often referred to as ‘jumper’s knee’, patellar tendinopathy refers to inflammation within the tendon which lies just below the knee-cap (patella). Patellar tendinopathy is a common injury in sports predominantly involving jumping and landing, and results from overuse of the patellar tendon. The function of the patellar tendon is to transmit forces produced by the large thigh muscle (quadriceps) to the shin bone (tibia) to produce movement of the knee joint. Repetitive use of the quadriceps muscle and, therefore, the patellar tendon can lead to microscopic tears within the substance of the tendon. Gradual degeneration of the tendon may occur as a result. Factors which may contribute to patellar tendinopathy include a recent change in training (including frequency, duration, intensity, training surfaces), reduced rest times, biomechanical abnormalities, and decreased muscle flexibility. These factors can lead to increased stress on the patellar tendon, microtears and subsequent tendinopathy.

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6. Osgood-Schlatter’s disease

Osgood-Schlatter’s disease refers to an injury to the bone growth plate in the shin bone (tibia) just below the kneecap, which occurs in younger athletes. It is more a condition than disease. The large muscle on the front of the thigh (quadriceps) attaches to the shin bone via the patellar tendon. The function of this tendon is to transmit forces produced by the thigh muscle to the shin to support and move the knee joint. In children, the portion of the shin bone into which the patellar tendon inserts is separated from the bulk of the shin bone by a growth plate. This growth plate enables bone growth to occur. However, it also represents a site of weakness in the bone. Forcible and repeated contraction of the thigh muscle can injure the growth plate. This commonly occurs in sports which involve running and jumping and occurs during a period of rapid growth. During rapid growth, the thigh muscle and patellar tendon become tighter as the bones grow. This leads to increased pulling of the thigh muscle and patellar tendon on the shin bone and growth plate.

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7. Sinding-Larsen–Johansson syndrome

Sinding-Larsen–Johansson disease refers to an injury to the bone growth plate at the bottom of the kneecap which occurs in younger athletes. The large muscle on the front of the thigh (quadriceps) attaches to the kneecap which, in turn, is attached to the shin bone (tibia) via the patellar tendon. The function of this tendon is to transmit forces produced by the thigh muscle from the kneecap to the shin to support and move the knee joint. In children, the portion of the kneecap from which the patellar tendon originates is separated from the bulk of the kneecap by a growth plate. This growth plate enables bone growth to occur. However, it also represents a site of weakness in the bone. Forcible and repeated contraction of the thigh muscle can injure the growth plate. This commonly occurs in sports which involve running and jumping and occurs during a period of rapid growth. During rapid growth, the thigh muscle and patellar tendon become tighter as the bones grow. This leads to increased pulling of the patellar tendon on the kneecap and growth plate.

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8. Pre-patellar bursitis (housemaid’s knee)

Also known as ‘housemaid’s knee’, pre-patellar bursitis refers to inflammation and swelling of the bursa located between the kneecap (patella) and overlying skin. A bursa is a fluid- filled sac which allows adjacent tissues to slide over one another without friction. Pre- patellar bursitis occurs when the pre-patellar bursa is damaged or irritated. This can occur following either a single injury or a series of injuries to the bursa. A direct blow or fall onto the knee can damage blood vessels within the pre-patellar bursa causing bleeding. The blood in the bursa causes an inflammatory response, resulting in the swelling of the bursa and subsequent bursitis. Similarly, pre-patellar bursitis may result from repeated minor trauma to the bursa. This can occur with repeated kneeling. This increases wear and tear on the bursa causing microtrauma which, over time, can result in bursal thickening, inflammation and bursitis.

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9. Iliotibial band friction syndrome (ITBFS)

The iliotibial band is a band of strong connective tissue which runs from the pelvic bone (ilium) down the outside of the thigh to the top of the shin bone (tibia). Iliotibial band friction syndrome is a condition which describes the rubbing of this band of tissue as it passes over a bony bump on the outside of the knee joint. Iliotibial band friction syndrome is an overuse injury. When the knee is bent and straightened the iliotibial band slides over a bony bump on the outside of the knee. When this is performed repeatedly or when the band is excessively tight, wear and tear of the band can develop as it flicks over the bony bump. To heal this damage, the body commences an inflammatory response. This can cause pain at the site of the injury.

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10. Baker’s cyst

Baker’s cyst refers to a persistent swelling which develops in the back of the knee. A Baker’s cyst most commonly develops following an injury to a structure within the knee joint. When this injury is left untreated it can result in ongoing swelling. This swelling can develop into a Baker’s cyst behind the knee.

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