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MENISCAL TEAR
The menisci (plural for meniscus) are cartilage pads, which function to cushion the compressive loads in the knee. One or both of these pads can be torn which often occurs when the lower leg is forcefully bent and twisted. Signs and symptoms include joint line pain, locking and swelling of the knee. The tear often has a bucket handle or parrot beak shape. Initial treatment should consist of rest, ice, compression and elevation. followed by conservative physical therapy management to promote healing, improve joint mechanics, range of motion, strength and return to activity. Arthroscopic surgery may be indicated for a larger tear.

ANTERIOR CRUCIATE LIGAMENT (ACL) TEARS
The cruciate (or crossing) ligament stabilizes the knee. The anterior cruciate (ACL) may completely break (rupture) when the knee is bent beyond its normal range of motion or with excessive twisting. Signs and symptoms include a 'pop' sensation with significant swelling and pain. There is a sense of instability or the knee giving away. Initial treatment includes rest, ice, elevation, and compression. Physical therapy consisting of progressive strengthening and functional exercise may facilitate recovery. If knee instability persists, surgery is indicated. The middle third of the patellar tendon, hamstrings, or cadaver ligament may be used to reconstruct the lost ligament.

ACL tears are common in teenage female athletes. Some of the best clinical/sports medicine research to date, suggests that a preventive training program can significantly reduce the risk of ACL injuries in female adolescent athletes.

POSTERIOR CRUCIATE LIGAMENT (PCL) TEARS
The posterior cruciate ligament (PCL) is stronger and less commonly injured. Motor vehicle accident, when the knee(s) forcefully impact the car dash board, is a common mechanism of injury. Initial treatment includes rest, ice, elevation, and compression. Physical therapy consisting of progressive strengthening and functional exercise may facilitate recovery.

MEDIAL COLLATERAL LIGAMENT (MCL) TEARS
MCL tears are common injuries. A forceful stress on the outside of the knee can cause a stretching and injury of the MCL. Signs and symptoms include knee pain at the inner aspect and swelling. Medial meniscal tears and ACL injury may occur with severe trauma (commonly occurs during football and soccer). Initially, rest, ice, elevation and compression is necessary
followed by bracing and rehabilitation.

ANTERIOR KNEE PAIN
The patello-femoral joint (the joint between the kneecap and the thigh bone-called the femur) is a problematic area for many. Excessive forces on the underside of the kneecap (causing painful stress on the cartilage on the underside of the kneecap), quadriceps tendinitis/tendinosis and patellar tendonitis/tendinosis are three common causes of pain in the front of the knee. Chondromalacia (softening of the cartilage) patella is also a common diagnosis for anterior knee pain.

Overuse and poor hip strength are often associated with these conditions. These conditions can be managed with physical therapy, taping/bracing of the knee and hip, and with the appropriate eccentric and hip stabilization exercises per your therapist's recommendations.

0APATELL0-FEMORAL PAIN (Commonly Called Chondromalacia Patella)
Chondromalacia meaning softening of the patellar cartilage, is a common misdiagnosis. Softening of the cartilage can only be detected by directly visualizing the cartilage during surgery. The correct diagnosis for pain and swelling originating from under the kneecap is Patello-femoral Pain.

Treatment includes pain relief with rest, ice, compression, and elevation. Swelling must be controlled. Anti-inflammatory medications, bracing, and physical therapy are often helpful. Progressive strengthening of the quadriceps is essential. Occasionally, foot orthoses may be helpful. Rarely, surgery is required to assist in realigning the kneecap by releasing the tight structures on the outside of the kneecap and reefing the inner structures.

PATELLAR TENDINITIS (Jumper's Knee)
Jumping sports (such as basketball and volleyball) put a huge load on the kneecap and attached tendons. Signs and symptoms of patellar tendonitis include pain to touch directly on the patellar tendon and occasionally, swelling. Treatment includes activity modification, and physical therapy.

Sinding-Larsen-Johansson is a specific disorder of the patellar tendon where it attaches to the base of the kneecap. In contrast, Osgood-Schlatter disease is a disorder of the tendon where it attaches at the tibial tuberosity of the leg. Both are common disorders in maturing teens. Treatment includes activity modification, phys ical therapy.

KNEE OSTEOARTHRITIS
Osteoarthritis of the knee occurs when the cartilage coverings on the end of the femur and the top of the tibia wear out. The tibia has two special cartilage pads called menisci (one is called a meniscus). This cartilage becomes flattened, bone spurs form, the joint becomes inflamed, range of motion is lost, there is ensuing weakness, pain and difficulty with walking, climbing stairs, and getting in/out of chairs. Physical therapy can help with recovery of range of motion, strength, walking skills, and pain management. Aquatic therapy (often involving a customized exercise program) can be helpful.

After total knee replacement (also called a total knee arthroplasty), physical therapy helps with recovery of range of motion, pain management, strength, balance and walking skills, and endurance. Commonly, patients say, "Why did I have this surgery? I am worse off now." You must be patient. Give yourself at least 3 months to recover.