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Internal Knee Derangement in Indians: Diagnosis & Treatment Options

With inputs from Dr.Pravallika Devisetti, General Physician & Anesthesiologist

Updated on: December 2023

With inputs from Dr.Pravallika Devisetti, General Physician & Anesthesiologist

Updated on: December 2023

Reviewed by Dr Raja Indana

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Table of contents

Key Takeaway:
– Internal derangement of the knee is a group of disorders that affects the functioning of the knee joints, leading to several complications in movement and mobility of the body.
– The most common symptom of Internal Knee Derangement is knee pain and loss of flexibility in the knee joint caused by internal conditions such as ligament tear, meniscus tear or loose bone and cartilage.
– Physical trauma is the main cause of Internal Knee Derangement, Sports injury being the most common cause. Sudden jerks caused due to climbing stairs, running, lifting heavy objects and road accidents also cause internal derangement of knees.
– Internal derangement of the knee is diagnosed through physical examinations and scans such as X-Ray, MRI and CT scan.
– RICE – Rest, Ice, Compression and Elevation is the recommended course of treatment for knee joint injury.
– Post recovery, your orthopedician may also recommend physiotherapy and other exercises to rebuild strength in the knee joints.

Important parts of the knee:
– Ligaments: Ligaments are bands of tough elastic tissues around joints in the body. In the knee joint, there are 4 main ligaments – Anterior cruciate ligament(ACL), Posterior cruciate ligament(PCL), Medial collateral ligament(MCL) and Lateral collateral ligament(LCL). Ligaments help stabilize and strengthen the knee joint.
– Meniscus: Meniscus is a piece of cartilage that acts as a soft protective cushion between the thigh bone and shin bone. Each knee joint has two menisci.
– Kneecap: Medically known as the patella, the kneecap is the bone that covers the knee. It provides strength and allows mobility in the knees.
– Main joints: The Tibiofemoral or synovial joint and the Patellofemoral of plane joints are the two main joints in the knee.

Introduction:
The knee joint is one of the most important joints in the body. It is an incredibly strong joint that provides balance and strength. It is responsible for movement, flexibility, and stability of the lower half of the body. It allows the lower legs to move flexibly relative to the upper thighs. Movements such as walking, running, jogging, jumping, sitting, standing, and agile motion cannot take place without knee joints.
The knee joint is a hinge type of synovial joint consisting of three main bones – the femur, tibia, and patella or kneecap. It comprises two main joints – the tibiofemoral joint and the patellofemoral joint. Together all work in tandem to provide strength and movement to the body.
It is extremely important to maintain strong knees since a lot of our daily activities involve them. Internal derangement of the knee can happen due to several reasons. If you’re experiencing knee pain or any stiffness, you must visit an orthopedician.

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Chapter 1: What is internal derangement of the knee?

Internal derangement of the knee is a group of disorders that affects the functioning of the knee joints, leading to several complications in movement and mobility. It mainly affects the ACL ligaments and tendons of the knees. The most common causes of internal derangement of the knee include injured ligaments, loose fragments of bone or cartilage, or even a torn meniscus.

Internal derangement of the knee does not include chronic conditions such as osteoarthritis, discoid meniscus, and meniscus cysts.

Nearly 50% of adults experience knee joint pain at some point in their lives. Several people seek knee pain treatment every year.

Imaging tests such as MRI, X-ray, and CT Scan may be required for the diagnosis of knee pain
Surgery is required in some cases
Recovery time after surgery is usually around 6 months
Can occur in both men and women

Ages affected:

Less than 12 years – rare
Ages 13 to 35 years – common
Ages 36 – 59 years – quite common
Age 60 years and above – most common

Let’s further understand the causes, symptoms, diagnosis, and treatment of Internal Knee Derangement.

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Chapter 2: What are the common symptoms of Internal Knee Derangement?

The most obvious sign of Internal Knee Derangement is knee pain and loss of flexibility in the knee joint. Do you experience pain while sitting down or standing up? Do you feel like your knee is ‘giving away’ while walking or exercising? If you do, it’s an indication of Internal Knee Derangement of some kind. A good orthopedic specialist will diagnose your knee pain to find out what’s causing it.
Here are some additional symptoms of Internal Derangement of the Knee caused due to these internal conditions:

Ligament tear:
Ligament tears most commonly occur during playing sports, especially high-intensity sports such as tennis, badminton, football, and athletics. It’s a very common sports injury and several athletes experience a ligament tear at least once in their lifetime. Ligament tear of the knee is also called an ACL injury. It’s a tear or sprain in the anterior cruciate ligament(ACL), a major knee ligament responsible for balance and strength. During an ACL ligament tear, you’ll hear a sudden pop following by excruciating pain and knee inflammation. Sudden knee pain can be quite serious so it’s important to get it checked absolutely immediately. ACL ligament tear is one of the most common causes of Internal Knee Derangement, causing severe knee joint pain.
Meniscus tear:
Derangement of meniscus or Meniscus tear is also a common knee injury that occurs when you suddenly twist your knee or tear a muscle. The menisci are present in the region between the thigh bone and the shin bone, which is well protected by two pieces of cartilage. When this tears, it causes excessive pain, knee inflammation, and stiffness. It’s similar to an ACL ligament tear in terms of its symptoms and requires rest, compression with ice and elevation.
Loose bodies:
Bits of bone or cartilage may break loose due to knee injuries, accidents or wear and tear. You should meet an orthopedician and get a bone scan to get treated.

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Chapter 3: What are the common causes of Internal Knee Derangement?

Physical trauma is the main cause of Internal Knee Derangement. Sports injury is the most common cause. Sports that put high pressure on the knees such as running, football and racquet sports are the main contributors. Road traffic accidents and other injuries such as lifting heavy weights can also lead to this condition.
These are the main causes of Internal Knee Derangement:

- Strenuous physical activity: As mentioned above, high-intensity sports or work that involves standing for long hours can put a lot of pressure on the knee joints. You’ll feel a sudden pop when you have a sports injury in the knee. It is very painful at first and needs immediate attention.
- Sudden knee pain due to jerks – Especially when stopping suddenly while running
- Motor vehicle accidents
- Heavy landing on the knee joint
- Landing or jumping with too much pressure

Injuries at the gym – lifting weights that are too heavy can put pressure on your knees. If you feel your knees giving away, stop immediately. Always speak to a trainer before lifting weights
Climbing stairs and squatting also cause knee joint pain

These are some of the main causes of Internal Knee Derangement. Let’s look at how it is diagnosed and treated.

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Chapter 4: How can you diagnose and treat Internal Knee Derangement?

Diagnosis of Internal Knee Derangement:
If you’re experiencing pain or any kind of injury in the knee, please pay a visit to an orthopedician. Your doctor will first do a thorough physical examination through various twists and techniques to gauge the injury. After a physical examination, you may have to undergo certain tests to determine the exact area and extent of the damage. These include:

X-ray
CT-Scan
MRI scan
Arthroscopy (a minimally invasive surgical procedure on the joint, using an arthroscope, that is essentially an endoscope which is inserted into the knee joint through a small incision)

Note: Arthroscopy is also used as a method of treatment for this condition.

Imaging tests, especially MRI will tell you exactly what happened to your knee joint.

Treatment of Internal Knee Derangement:
After studying your condition thoroughly, your doctor will recommend a course of treatment based on the severity and underlying causes. Treatment can either be surgical or nonsurgical. Athletes usually opt for surgery because of their high-intensity lifestyles and need to get back on the field.
However, for most people, long term nonsurgical treatment methods work well.

1.RICE:
RICE abbreviated for Rest, Ice, Compression, and Elevation is the most recommended course of treatment.

Rest: The most important thing to do is rest! Keep movements to a minimum. Don’t walk unless absolutely necessary. You must give complete rest to the injury for one week.
Ice: Apply ice on your knee and leave it there for 20 min. Use an ice pack. You can easily get one online as well. Do this up to four times a day. Ice helps reduce knee inflammation.
Compression: Wrap your injured knee with an elastic bandage to hold it in place. Your doctor may also put a cast to minimize mobility. You’ll have to wear the cast for 4-6 weeks before you take it off.
Elevation: Elevate the injured leg on an inclination over a pillow and allow it to rest in that position. Try keeping the area above or at the level of your chest to minimize swelling.

2. Surgery:
Based on the severity of your condition, your doctor will decide if you need surgery or not. You may have to undergo a minimally invasive arthroscopy, wherein an endoscope which is inserted into the knee joint through a small incision. This is mainly done to repair the meniscus in the knee joint and remove loose bodies. It takes around 6-8 weeks to recover from the procedure.
If the injury is more serious, involving a torn ligament, you may have to undergo a more invasive procedure to repair the ligament. In this procedure, your surgeon will take a tendon from your hamstrings or other areas and sew it into the damaged area. Recovery is much longer and complete recovery can take up to a year.

Post recovery, your orthopedician may also recommend physiotherapy to rebuild strength in the knee joints.

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References

1. What are the symptoms of Internal Knee Derangement?
The most common symptoms include knee pain, difficulty in walking, swelling, displacement of bones and instability. They are often indicative of conditions such as ACL ligament tears, derangement of meniscus or loose bodies in and around the knee joints.

2. What causes internal knee injury?
Physical trauma is the main cause of Internal Knee Derangement. Sports injury is the most common cause. Sports that put high pressure on the knees such as running, football and racquet sports are the main contributors, causing sudden knee pain. Road traffic accidents and other injuries such as lifting heavy weights, suddenly stopping while running and climbing stairs also lead to this condition.

3. How do you treat an internal knee injury?
After studying your knee joint condition thoroughly, your doctor will recommend a course of treatment based on the severity and underlying causes. Treatment can either be surgical or nonsurgical. For most people, long term nonsurgical treatment methods work well. RICE abbreviated for Rest, Ice, Compression, and Elevation is the most recommended course of treatment. Surgery is only recommended in serious cases.

4. How do I book an appointment with an orthopedician?
You just have to download the MFine app, or log onto MFine, search for a dermatologist near you and book an appointment by filling out your details. You can teleconsult with your orthopedician online on MFine and get treated

5. Is my information secure on the MFine app?
MFine takes your privacy very seriously. At MFine, we provide the utmost confidentiality to all our patients. No information is exchanged between your doctor and anyone else.

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