A Randomized Clinical Trial in The Journal Of Rheumatology has reported that a physiotherapy program consisting of exercise is effective at reducing pain and disability when combined with physician care.

References
Van Baar MF, Dekker J, Oostendorp RA. The Effectiveness of Exercise Therapy in Patients with Osteoarthritis of the Hip or Knee: A Randomized Clinical Trial. The Journal of Rheumatology. 1998; 25:2432-2439.

The ACL is located deep within the knee. It is one of the ligaments which attaches the upper bone (femur) to the lower bone (tibia). The ACL’s main function is to prevent the tibia from sliding forward on the femur or the femur from sliding back on the tibia. It is also responsible for preventing hyperextension of the knee. Injury to this ligament is frequently seen in sports such as rugby, football, soccer, hockey, and skiing.

There are three degrees of injury. A grade I injury is painful but improves relatively quickly and there is no actual tearing of the ligament. A grade II injury results in tearing of some fibres of the ligament but it will most likely respond well to a physiotherapy program of strengthening, proprioceptive training, and modalities. Athletes are generally back to their sport in 6-8 weeks. A grade III tear is a total disruption of the ligament. Often, there is little pain and people often report having heard a "pop" at the time of impact followed by swelling in a short period of time. The role of physiotherapy at this level is to reduce swelling, regain range of motion, retrain muscles, and improve proprioception. Surgery is often necessary if the athlete wants to return to his sport. Rehabilitation is ongoing after surgery and the individual can usually return to his full pre-injury level of activities in six months.

References
West Vancouver Sports and Orthopedic Physiotherapy

Injuries that involve twisting actions, hyperextension, or hyperbending of the knee sometimes damage meniscal cartilage in the joint. There are two menisci in each knee. They are crescent-shaped rings of fibrocartilage that attach to the inside (medial) and outside (lateral) of the top of the tibia (lower leg bone). Their main function is to provide cushioning and support for the bottom end of the femur (upper leg bone).

When the knee joint is subjected to a twisting, hyperextending, or hyperbending force, the menisci will bend and twist with the force. However, if the force exceeds the ability of the cartilage to compensate, the meniscus will tear. The signs and symptoms of meniscal tearing are swelling throughout the knee joint, an inability to fully straighten and/or bend the knee, clicking and/or locking of the knee, pain with weightbearing, and point tenderness to touch along the knee joint line. However, tenderness on palpation is not present in all meniscal injuries.

The degree and location of the tear greatly influences healing time. The tear may be located deep within the knee on the inner portion of the cartilage which, unfortunately, has a poor blood supply and therefore leads to a longer healing time.

The goals of physiotherapy in the initial stage of injury is to reduce swelling, decrease pain, and increase the range of motion. As the pain and swelling decrease, strengthening and proprioception training of the joint can begin.

Meniscal injuries that do not respond to conventional physiotherapy treatment often need surgery, however, a good exercise program and proper care of the injury are nevertheless necessary.

References
West Vancouver Sports and Orthopedic Physiotherapy Clinic

Patellar tendonitis or jumper’s knee is an overuse condition which affects the knees of many athletes. It is commonly found in sports which require explosive movement such as basketball and other jumping sports. Activities like running, walking, or bicycling may also lead to patellar tendonitis.
The quadriceps muscle attaches to the kneecap (patella) and the patellar tendon is a band of connective tissue which connects the patella to the shinbone (tibia). When the quadriceps contracts, it affects the tension of the tendon and will cause the knee to straighten or extend pulling the patella up at the same time. Pain occurs in this tendon with repetitive loading and unloading of the patellar tendon which creates stress on the tendon and causes inflammation. Contributing factors include improper biomechanics such as excessive pronation, worn out shoes not supporting the foot, poor quadriceps strength or flexibility, and excessive training.

Symptoms may include pain, tenderness and swelling around the patellar tendon, pain with bending or straightening the knee, and pain with jumping, running or walking.

Early intervention is important to prevent a chronic condition. In the acute stage, place ice on the knee for 15 minutes 2-3x/day. Rest the knee and avoid any painful activities. See your physiotherapist for proper assessment, treatment to reduce the pain and swelling, stretching and strengthening exercises, and advice on modifying activities and the use of bracing.

References
West Vancouver Sports and Orthopedic Physiotherapy Clinic

Osgood-Schlatter is an overuse syndrome which causes pain and swelling beneath the knee joint at the bump called the tibial tuberosity. It occurs in young athletes who are extremely active in their rapid growing years (ages 9-15) and will affect boys more than girls. The pain will get worse with activity and better with rest. Osgood-Schlatter is a common and temporary condition which can affect one or both knees. There will be a swollen, warm and tender bony bump below the kneecap. The bump will be painful to touch and painful with kneeling, jumping, climbing stairs, running, squatting, or performing any activity which bends or fully extends the leg.

The pain comes from the repeated pulling of the kneecap (patellar) tendon. During growth periods, the bones will grow more rapidly than the muscles. In the knee, the quadriceps will become tightened and repetitive activity will cause excessive pulling of the patellar tendon on the tibial tuberosity. The tendon will become inflamed or may tear away taking a piece of the bone with it.

During the acute stage of inflammation, it is important to rest the knee and avoid activities which cause any pain. If your knee is swollen, apply ice for 15 minutes 2-3x/day, elevate the leg and place your knee on a pillow. Ignoring the pain and continuing with activities will make treating the injury much more difficult and may cause recurrence later in life. Healing may take 6-18 months. During this time, sporting activities may not need to be stopped but should be modified. Continued use of ice after any activities is very important to reduce inflammation and pain. See your physiotherapist for proper assessment, advice on appropriate level of activity and use of a knee brace, and specific stretching and strengthening exercises. A well designed rehabilitation program will allow faster return to activities and will prevent further recurrence.

References
West Vancouver Sports and Orthopedic Physiotherapy Clinic