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Knee Pain

No other joint in the human body experiences as much force as the knee.

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The knee joint joins the thigh with the leg and consists of two areas of movement: one between the femur (upper leg) and tibia (lower leg), and one between the femur and patella (kneecap). It is the largest and most complicated joint in the body. It is a pivotal hinge joint, which permits flexion and extension as well as a slight rotation (side-to-side movement). Since the knee supports nearly the entire weight of the body, it is the joint most vulnerable both to acute injury and degenerative arthritis. There are a handful of causes of knee pain commonly seen as the result of injury, such as in a car accident or serious fall.

These include:

ACL tear: The anterior cruciate ligament (“ACL”) is one of the four main ligaments in the knee. It is located deep within the knee. Its purpose is to keep the knee tight and prevent it from hyper-extending. This ligament can become torn, particularly where there is a dislocation, torsion, or hyperextension of the knee. This is the most common type of ligament tears of the knee, and is often coupled with damage to the meniscus. Surgery is often performed to treat a torn ACL, though not always a necessity if it is only a partial tear, or if the knee remains stable. Post-surgical recovery generally takes nine months.

Unfortunately, insurance companies often minimize ACL tears, usually arguing that arthroscopic surgery is “no big deal.” However, it is a big deal, as the injury is painful, the surgery can be painful, and there is extensive rehabilitation involved. Moreover, the injury may leave the person open to further complications or problems in the future. Experienced personal injury attorneys know how to properly point these facts out in order to fully compensate their clients.

MCL tear: The medial collateral ligament (“MCL”) is one of the four main ligaments in the knee. It rests along the inside of the knee, attaching the femur (thigh bone) to the fibula (small lower leg bone). The purpose of the MCL is to keep the knee from buckling inward. An MCL injury can be very painful and is often caused when landing, or on high impact, such as a car wreck or serious fall. Most commonly, and MCL tear is associated with an ACL tear as well. For a partial tear, surgery is usually not necessary, and it will generally take between 2 and 10 weeks for the injury to fully heal. For a complete tear, surgery may be necessary, particularly if there is instability of the knee.

MCL tears can be very difficult to value, as some medical literature indicates that surgery is not always effective. Insurance companies take this to mean that surgery is never necessary. Only an attorney specializing in the field of personal injury has the background to properly evaluate this type of injury and defend against such arguments.

Meniscal tear: The articular disks (joint disks) of the knee are called “menisci.” These two disks, the medial meniscus and the lateral meniscus, consist of connective tissue made up of collagen fibers. The menisci are flattened at the center of the knee joint. They serve to protect the ends of the bones from rubbing against each other, and they also aid in shock absorption. Unfortunately, they can become cracked or torn when the knee is forcefully rotated or bent. This type of injury is most often seen in the medial meniscus. The cracks or tears can cause severe pain, which is caused by the crack/tear itself, from the bones rubbing together where the menisci are torn, or from the torn section of the menisci “catching” in the knee joint. Treatment includes the use of anti-inflammatory medication, steroid injections, or even surgery.

Because meniscal tears often occur as a result of degeneration or overuse, they can be difficult to relate to an injury. However, a good doctor can often determine if it was caused by a traumatic event. Moreover, because the menisci degrade with age and use, a person may be more susceptible to injuring them than younger people (prior infirm condition). The law protects such people, as it focuses on the symptoms, and whether the symptoms were brought about by the traumatic event. An experienced personal injury attorney will improve the probability of proving that this type of injury and treatment is legally related to the traumatic event.

Patellofemoral Syndrome: This condition is also known as Retropatellar Pain Syndrome (“RPPS”), Patellar Tendinitis, and Jumper's Knee. It is an inflammation of the patellar tendon (the tendon connecting to bottom of the kneecap), which results in pain and discomfort. This condition is caused by a weakening of the cartilage under the patella (kneecap). The softened cartilage places additional stress on the patella, which results in the patella no longer gliding smoothly as it normally would. This results in pain that is worse with climbing stairs or prolonged sitting. In many cases, the kneecap appears to "pop" or shift suddenly when the leg is extended. This condition may require surgery, depending on the cause. Otherwise, rest, anti-inflammatory medication, physical therapy, or orthotics may be prescribed.

Because Patellofemoral Syndrome is most often the result of high impact sports or overuse of the knee, it can be difficult to relate to an injury. A good doctor can often determine if the symptoms were caused by a traumatic event, such as a car accident. Moreover, because the condition (but necessarily the symptoms) are often pre-existing, it leaves the person more susceptible to injury than people without the condition (prior infirm condition). Again, the law focuses on the symptoms, and whether the symptoms were brought about by the traumatic event. An experienced personal injury attorney will improve the probability of sorting these issues out.

Bursitis: Bursae are small, fluid filled sacs and synovial pockets within the knee that aid in lubricating the knee joint. The bursae of the knee are thin-walled, making them the weakest structure in the knee, and the most prone to injury. Trauma to the knee can burst or inflame the bursae, causing swelling, pain, and restricted movement. This condition is known as “bursitis.” While bursitis is not serious, it can be quite painful. Treatment includes ice, rest, anti-inflammatory medication, steroid injections, and in rare cases, surgery.

Because this condition doesn’t generally require surgery, insurance companies typically have a low value of this type of injury. They also undervalue how painful the condition really is. Only an experienced personal injury attorney knows how to defuse such arguments.

Dislocation: The knee joint, and particularly the kneecap (patella), are prone to dislocation. Such dislocations of the knee joint itself can damage surrounding tissues, including tearing of the ligaments, tendons, menisci, bursae, nerves, blood vessels, and even the muscles. Dislocation of the patella is often less severe, but can still damage the cartilage on the underside of the kneecap. Usually, after a dislocation, the injured party is evaluated for these more serious conditions that can result, and which are discussed elsewhere on this page.

Insurance companies will use the same lines of argument discussed elsewhere on this page, depending on the doctor’s diagnosis of damage caused by the dislocation. A dislocation alone is not viewed by insurance companies as serious. An experienced doctor working with an experienced personal injury attorney can greatly aid proving this type of injury.

Osteoarthritis: This condition is also known as degenerative joint disease, and is a natural consequence of aging or trauma. Osteoarthritis is a general term for the breakdown of the joints, including that of the knee. This causes people to become more susceptible to injury, thereby requiring less force to do the same damage to the spine than a younger person. This is known as a prior infirm condition, and can result in chronic inflammation and pain once a triggering event, such as a fall or car crash, causes the symptoms to occur. While this condition is often painful, it generally does not result in surgery, except in extreme cases, where a partial or total knee replacement may be required.

Osteoarthritis can cause complications in a personal injury case. Insurance companies use it as an excuse to explain the pain after the traumatic event. They argue that they shouldn’t have to pay to fix a condition that was already there. However, it is the symptoms that are the key. If the traumatic event causes the pain to present or worsen, the law says that you can recover for the new pain and treatment, including surgery. Only an experienced personal injury attorney knows how to defuse the insurance company’s arguments that are designed to confuse a jury.