Are you suffering from knee malalignment?

November 21, 2014

knee painThere are several factors that can affect knee joint stability which can be crucial for a healthy joint. The knee relies on 4 major ligaments to maintain the stability of your joint – the ACL (anterior cruciate ligament), PCL (posterior cruciate ligament), MCL (medial collateral ligament) and the LCL (lateral collateral ligament). In addition to the major ligaments, other components that help maintain joint stability are the shape and alignment of the bones (bow legged versus knock-kneed), the integrity of the meniscus and the intact cartilage surfaces (loss of cartilage=arthritis). Injury from direct or indirect trauma can tear or rupture one or multiple ligaments creating instability in the joint.

The most commonly injured ligament in the knee is the ACL, which usually tears from an uncontrolled deceleration. For example, football, soccer, hockey, skiing and other sports in which players are moving quickly and then forced to slow down or stop in an uncontrolled fashion can often lead to torn ACL’s. Ligaments can be repaired, usually arthroscopically, using grafts from other parts of the knee. Many patients are able to return to their previous level of function after completing the appropriate rehab program.

Your kneecap (patella) also needs to glide properly in the “knee groove” for the joint to function normally. Patella malalignment or instability can often feel like your knee cap is slipping or dislocating out of the natural groove of the knee. Sometimes, people are born with abnormal alignment or have a knee groove that is too shallow, allowing the kneecap to dislocate. In other cases, patella malalignment can also be caused by trauma or from overuse. Patellar realignment surgery brings the kneecap back into normal alignment. This can be achieved by adjusting the tension of the ligaments and muscles on either side of the patella, creating a deeper groove with an implant or by moving the bone to one side where the patella tendon attaches to the shinbone.

If your leg alignment is abnormal (varus-bowlegged or valgus-knock kneed) then a High Tibial Osteotomy can be performed. The majority of knee osteotomies are performed on the tibia. For example, someone with abnormal alignment that has there too much stress on the inside or outside of the knee can be straightened so the force is more evenly distributed across the joint. This is achieved by taking a wedge of bone out of the shinbone, straightening the leg and then fixing the shinbone in place with screws and a plate. Alternatively, a larger bone wedge can be inserted to prop up the bone, like a shim, in order to bring the leg back into normal alignment. It takes approximately 1 year for the new bone and alignment to heal but the HTO procedure can be very effective and last a long time.

Each year, more than 100,000 ACL reconstruction procedures are completed with approximately 1/3 of those having associated knee problems such as malalignment. Are you experiencing any of the symptoms of knee malalignment?

Learn more about joint pain and solutions for treatment.

 

Sources:

http://orthoinfo.aaos.org/topic.cfm?topic=A00591

http://www.aaos.org/news/aaosnow/jul09/research1.asp

http://www.fixknee.com/patella-realignment

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071355/

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14 responses to “Are you suffering from knee malalignment?”

  1. David Nguyen says:

    Hello, I just had an ACL Reconstruction 4 weeks ago. whenever I try to bend my knee, even at a small 30 degree angle, I feel like the new ligament is being really overstretched and super tight. if I do the same bending but I use my hand to push my kneecap to the left or to the right while I attempt to bend the knee, it seems like a very normal knee bend. Does it mean that I have a knee malalignment issue? I would greatly appreciate your answer on this matter. Thank You.

  2. Nice Article. A year back I was facing Knee Pain. It was getting worse and worse day by day and one of my friends recommended me to go Paley Institute. After going there I felt good and the knee pain was reduced after few weeks. I am still having some pain but can’t go at Paley Institute because I don’t live there anymore. So thanks for your wonderful solutions. Will Try it for sure and will share my experience asap.

  3. Geoffrey says:

    So I just started working a job that requires a fair bit of jogging. After a couple days I began having knee pain. I’m flat footed and can’t afford good shoes or insoles. Looking at your diagram and comparing it to my knee I think the problem is my LCL. I have a large knot where the top of my fibula should rest – it feels like a bone. Any ideas? If it is my fibula/LCL what should I do? I can’t afford to lose my job and doubt they’ll move me into a non-running position.

  4. My brother tore his ACL while playing basketball last week. He is concerned about his future in sports, and is looking into what treatments are available to him. I didn’t realize that ligaments can be repaired by grafting from other parts of the knee, and many patients are able to make a full recovery after rehab. That’s an incredible treatment that my brother will enjoy hearing about.

  5. Brian says:

    Hello I have been off work for going on six months-I step at work and twisted my right knee, had a sharp stabbing pain in my knee and ended up working on it for four more days. Couldn’t take the pain anymore so I went to an Orthopedic surgeon, got an MRI on it and had two tears in the meniscus. Knee scope was done on it and then therapy. Still have pain in right knee and left knee. Before all that happen I had Quad tightness in both legs. First doctor is saying I will need a total knee replacement eventually. Went to another doctor to get a second Opinion and he showed me on the X ray’s that my knee caps are way out of Aline ( to the out side of my leg ). The Doctor told me that they can Surgically realign them. I am 57 years old and walking like I am 90 year old going down stairs hurts really bad. My question is will this re aligned will this make my knees feel better? Thanks for your thoughts.

  6. Amie says:

    Hello! I have had 3 knee surgeries. Two arthroscopic when I was a teen. The third was done about 6 years ago, I don’t know the name of the surgery but the Dr pulled ligaments from my lower leg up to my knee cap to stop it from “giving out”. My knee hasn’t gave out since that surgery but the last 8 months I am unable to take long walks, jump, run.. etc. My knee is on constant pain and there are times I can feel it shifting over but I completely stop what I am doing, bandage it up and use my crutches. I’m lost as what to do from here. I’m tired of living with chronic pain in my knee. Is there any advice you could give me? Thank you!
    I ever mentioned this but I was 32 when I had my last surgery.

    • arthrosurface says:

      Hi Amie, We sent you an email a few weeks ago with additional information. Please let us know if you did not receive it.

  7. Susie says:

    I had ACL reconstruction in 1989. It was from a gymnastics injury. This is the same knee that has Osgood-Schlatter disease. I got that at 12 or 13 and doctors said I would outgrow the pain which I did. Now it’s just a giant bump. After the acl repair (all on right leg) I had a hard time with rehab. I never really got the full range of motion back. Still I continued to workout at gyms as instensly as I could and nothing ever really bothered it. Sometimes it would ache or some of the meniscus tore but nothing the doctors ever felt they needed to fix. Cut to 2017 and I’m now completely in love with Crossfit. I have taken time off trying to figure out why I have so much knee pain that won’t go away. It got so bad that I couldn’t walk up stairs, stand for a long period of time, wear any shoes with a heel and forget about squatting. I was losing range of motion in both knees. During My first break, I did lots of yoga. It seemed to help but when I went back. To working out, it didn’t take long for the pain to come back. It’s more of a stiffness than anything else. Now I am back again after a 10 month break. I did nothing at all for 5 of those months (not helpful) and then got back to yoga, went to the doc and am now in PT. The doc said I had patellafemoral malalignment syndrome. He said nothing about surgery. Just said I have to bcareful with doing too much. He recommended PT for me for 6 months and one day a month. So not very consistent. They do give me exercises to do at home and at the gym. And I do them but I just don’t believe it’s going to work. I have only been back for 2 weeks and I already feel the knees tightening up. I have some stretching and mashing for the quads and glutes that I can do but this really isn’t a good sign. Is surgery really the best option if none of this PT stuff helps. I am getting so anxious about it because I finally found my sport that I lioe and I plan to do it until I reach 100. Seriously! If there’s no sure way to get rid of the pain and stiffness, I’m not sure what I will do.

  8. Jennifer Smith says:

    I injured my knee, but do not have the necessary health insurance to see a proper doctor. My feet were planted strongly in a sandy area and I was tackled from the left side. My tibia stayed still but the rest of my body went to the right causing my knee to slide to completely to the right. It was excruciating. Now, it feels as though my knee is in a bind and my tibia is not centered like before. When I push my to the right while pushing my tibia to the left, my lower leg shifts slightly to the left and it relieves most of the bind that my knee feels like it is in. What could have happened and what should I do? I know the obvious answer is to go the doctor, but that is out of the question as of now. Please help

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