Knee Injuries
Coronavirus / COVID-19 update
During the COVID-19 risk period, wherever possible we’ll be reducing face-to-face appointments and helping you manage your injury remotely. This means that, in accordance with the British Orthopaedic Association guidelines, your individual treatment and follow up plan may be different to what happens under normal conditions. An orthopaedic consultant or a member of the orthopaedic team will always review your notes and x-ray and decide if a face-to-face follow up is necessary.
If we haven’t asked to see you for a follow up, but you still feel you’d like to see someone, you can book an open appointment at any time in the six months after your injury. Please call 01736 758892 to make an appointment.
Advice for a new knee injury
- rest your leg
- elevate it above hip level
- apply a cold pack regularly
- use crutches for walking or a support bandage
- Protect
- Rest
- Ice
- Compression
- Elevate
- Rehabilitation
Medication
The Emergency Department (ED) or a Minor Injury Unit (MIU) may have prescribed you with some pain relief. Take these as instructed to help manage the pain.
If you do not feel that this medication is helping, talk to your GP about an alternative option.
Cold packs
Ice is a great natural anaesthetic that helps relieve pain and controls swelling. Apply ice packs or a bag of frozen peas wrapped in a wet thin towel to your knee for up to 15 minutes every few hours.
- Do not place ice in direct contact with the skin.
- Do not leave the ice pack on for more than 20 minutes at a time in one hour.
Rest and elevation
It’s normal to experience swelling after your injury. Elevation reduces swelling, which in turn relieves pain and speeds up your healing. Keep your knee elevated as much as possible during the first 24 to 72 hours.
Raise your leg on a stool or cushions above the level of your hip to elevate it as much as possible.
Smoking
Medical evidence suggests that smoking prolongs fracture healing time. In extreme cases it can stop healing altogether. Stopping smoking during the healing phase of a fracture will help ensure optimal recovery from this injury.
For advice on stopping smoking and local support available, please discuss this with your GP or go to the NHS Smoke Free website.
Care plans for your knee injury
Your diagnosis should have been made by an orthopaedic consultant or one of the team working under the supervision of the consultant team. The information in these care plans is to help you understand your diagnosis and is not exhaustive. Your consultant may give you a different, personalised care plan based on your injury and whether you need imaging (x-ray, CT scan, MRI or an ultrasound) or an operation.
Patella dislocation
What is your injury?
A patella dislocation is when your kneecap slides out of joint. You will have a T-scope brace or a patella stabilising brace to help manage this injury.
Healing
This injury will take up to 12 weeks to heal, but this may differ depending on your individual circumstances.
Follow up
A knee specialist will call you for a follow up after your injury. This usually takes place after around two weeks. They will tell you about the next stage of your rehabilitation. Please make sure we have your up-to-date contact details.
If you feel you’d like to see someone at any time in the six months after your injury, you can book an open appointment by calling 01736 758892.
Please call the Fracture Clinic on 01872 253091 if:
- you’re unable to follow this rehabilitation plan
- you have any questions
- you’re struggling with your brace
- you experience pain or symptoms other than at the site of the original injury or surrounding area.
Wearing your knee brace
To protect your knee, you must wear the brace fitted by the Emergency Department (ED) or Minor Injuries Unit (MIU). Your brace is called a T-scope. We will set your brace at 0 to 90 degrees range of movement.
If this is the first time you have dislocated your knee cap, you need to wear the brace for 6 weeks. Put your full weight through your leg as you’re able.
You must wear your knee brace during the day and night for 6 weeks. Only take it off to wash or use a cold pack. You must keep your knee straight and put the brace back on when you finish washing or using your cold pack.
This video tells you how to fit your T-scope brace.
If this is not the first time you have dislocated your knee cap
Please use your patella stabilisation brace again. Put as much weight through your leg as you can. We’ll tell you when you no longer need the brace.
Walking
You can put weight through your leg. You may find it easier to use crutches in the early stages.
Exercises
It’s important to start exercises as soon as possible. Follow the instructions and pictures below.
Do each of these exercises 3 to 4 times a day. Start straight away. Do not push into pain.
Ankle exercises
Point your foot up and down. Repeat this 10 times.
Static quadricep exercises
Rest with your leg supported and straight. Gently tense the muscles in your thigh and try to straighten your knee further.
Hold for 5 seconds and repeat 7 to 10 times.
More information
You can find out more about your patella dislocation, and see demonstrations of the exercises in this video from Brighton and Sussex University Hospitals.
Undisplaced patella fracture
What is your injury?
It’s a fracture (break in the bone) to your kneecap. Undisplaced means that the bones have not moved.
Healing
This injury will take up to 12 weeks to heal, but this may differ depending on your individual circumstances. You may experience some ongoing pain and swelling for 3 to 6 months.
Follow up
You’ll be referred to our virtual fracture clinic and we’ll tell you whether you need to come to the Fracture Clinic for a see a clinician for a face to face appointment. If you don’t need to come in, but you feel you’d like to see someone at any time in the six months after your injury, you can still book an open appointment by calling 01736 758892. After the virtual clinic, we’ll also send you a letter explaining the next step in managing your injury.
Please call the Fracture Clinic on 01872 253091 if:
- you’re unable to follow this rehabilitation plan
- you have any questions
- you’re struggling with your brace
- you experience pain or symptoms, other than at the site of the original injury or surrounding area.
Wearing your knee brace
To protect your knee, you must wear the brace fitted by the Emergency Department (ED) or Minor Injuries Unit (MIU). Your knee brace is called a T-scope.
Only remove the brace to wash your leg daily or apply a cold pack. Keep your knee straight while you wash and replace the brace afterwards.
How do I adjust my brace?
They will set your brace at 0 to 30 degrees range of movement. Keep it at this setting for two weeks.
You will then need to adjust your brace:
- 2 weeks after your injury adjust it to 0 to 60 degrees
- 4 weeks after your injury adjust it to 0 to 90 degrees
This video tells you how to adjust your T-scope brace.
Walking
You can partially walk on your leg for 6 weeks by putting about 50% of your bodyweight through your injured leg. Try standing on weighing scales and use crutches to assist you. These videos explain how to use crutches for partial weight bearing.
After 6 weeks, you can put your full bodyweight through your injured leg and gradually remove the brace and crutches. Try using one crutch until you can walk without them.
Early weight bearing (putting weight through your injured leg) helps increase the speed of healing. Try to walk as normally as possible. This will help your recovery.
Exercises
Follow the exercises below within the limits of your pain. These exercises will help the healing process.
Do each of these exercises 3 to 4 times a day. Start straight away. Do not push into pain.
Ankle exercises
Point your foot up and down. Repeat this 10 times.
Static quadricep exercises
Rest with your leg supported and straight. Gently tense the muscles in your thigh and try to straighten your knee further.
Hold for 5 seconds and repeat 7 to 10 times.
More information
You can find out more about your patella dislocation, and see demonstrations of the exercises in this video from Brighton and Sussex University Hospitals.
Mild soft tissue injury / knee sprain
What is your injury?
It’s a sprain to your knee. This can range from mild to severe. You may have been fitted with a knee support to help with initial swelling. If so, remove it at night.
Healing
Mild soft tissue knee injuries can take up to 12 weeks to heal, but this may differ depending on your individual circumstances and the severity of your injury.
Follow up
These injuries do not normally need a follow up, but we may decide you need to be referred to a physiotherapist. We’ll let you know if you do.
If you feel you’d like to see someone, you can book an open appointment at any time in the six months after your injury. Please call 01736 758892 to make an appointment.
Please call the Fracture Clinic on 01872 253091 if:
- you experience a sensation of giving way, locking or instability in your knee
- you’re unable to follow this rehabilitation plan
- you have any questions about it
- you experience pain or symptoms, other than at the site of the original injury or surrounding area.
Walking
You may walk on your leg as comfort allows. Use crutches and/or a support if you were given them at the Emergency Department (ED) or Minor Injuries Unit (MIU).
Gradually use your crutches and support less as pain and swelling eases.
Exercises
Follow the exercises below within the limits of your pain. These exercises will help the healing process.
Do each of these exercises 3 to 4 times a day. Start straight away.
Do not push into pain. Adjust your activity level until your movement returns and your pain has resolved.
Ankle exercises
Point your foot up and down. Repeat this 10 times.
Static quadricep exercises
Rest with your leg supported and straight. Gently tense the muscles in your thigh and try to straighten your knee further.
Hold for 5 seconds and repeat 7 to 10 times.
Inner range quads exercise
Place a rolled up towel or small pillow under your injured knee.
Tense your thigh muscle and try to straighten your knee. Keep the back of your knee in contact with the towel or pillow.
Repeat 10 times. Try to hold your knee straight for 5 seconds.
Knee flexion and extension
Bend and straighten your injured leg as far as you feel comfortable. Repeat 7 to 10 times.
Seated knee flexion and extension
Bend and straighten your knee while sitting as comfort allows. Repeat 10 times.
If you can, hold your leg straight for up to 5 seconds.
More information
You can find out more about your injury, and see demonstrations of the exercises in this video from Brighton and Sussex University Hospitals.
Proximal fibula fracture
What is your injury?
It’s a break to the bone on the outside of your leg below your knee.
Sometimes this injury is associated with an ankle injury. It’s important that you tell us if you have any associated pain, swelling or bruising around your ankle.
Healing
It can take up to 12 weeks for this fracture to heal, but this may differ depending on your individual circumstances. You may experience some ongoing pain and swelling for 3 to 6 months.
Follow up
We’ll tell you if you need a further follow-up.
If you feel you’d like to see someone, you can book an open appointment at any time in the six months after your injury. Please call 01736 758892 to make an appointment.
Please call the Fracture Clinic if:
- you still have significant pain or swelling after 6 weeks
- you’re struggling to remove the boot
- you’re unable to follow this rehabilitation plan
- you have any questions about it
- you experience pain or symptoms, other than at the site of the original injury or surrounding area.
Walking
You can put weight through your leg when wearing your boot. You may find it easier to use crutches in the early stages. You will need to pace your activity until your pain and movement is better.
Try to stop using the boot and crutches as soon as you can. You should have stopped using them by 6 weeks after your injury.
Practice walking without your boot and crutches around your home first. Build up to longer walks outside.
Remove your boot to wash, dress and do your exercises.
Exercises
It’s important to start exercises as soon as possible. Follow the instructions and pictures below. Do each of these exercises 3 to 4 times a day. Start straight away. Do not push into pain.
Ankle exercises
Point your foot up and down. Repeat this 10 times.
Static quadricep exercises
Keep the leg straight and supported. Gently tense your thigh muscle and try to straighten your knee further. Hold for 10 seconds and repeat 7 to 10 times.
Inner range quads exercise
Place a rolled up towel or small pillow under your injured knee.
Tense your thigh muscle and try to straighten your knee. Keep the back of your knee in contact with the towel or pillow.
Repeat 10 times. Try to hold your knee straight for 5 seconds.
Knee flexion and extension
Sit or lie with your legs outstretched.
Bend and straighten your injured leg. Go as far as you feel comfortable.
Repeat 7 to 10 times.
Seated knee flexion and extension
Bend and straighten your knee while sitting as comfort allows. Repeat 10 times.
If you can, hold your leg straight for up to 5 seconds.
More information
You can find out more about your proximal fibula, and see demonstrations of the exercises in this video from Brighton and Sussex University Hospitals.
Tibial plateau fracture
What is your injury?
You have fractured the top of your tibia (shin bone). This area is called the tibial plateau. It’s part of your knee joint.
Healing
This injury will take up to 12 weeks to heal, but this may differ depending on your individual circumstances.
Some people with a tibial plateau fracture may need surgery.
Follow up
You’ll be referred to our virtual fracture clinic. We’ll tell you when you need to come to the Fracture Clinic for a see a clinician for a face to face appointment. After the virtual clinic, we’ll also send you a letter explaining the next step in managing your injury.
If you feel you’d like to see someone at any time in the six months after your injury, you can book an open appointment by calling 01736 758892.
Please call the Fracture Clinic on 01872 253091 if:
- you’re unable to follow this rehabilitation plan
- you have any questions about it
- you experience pain or symptoms, other than at the site of the original injury or surrounding area.
Wearing your knee brace
You will have been given a T-scope brace at the Emergency Department (ED) or Minor Injuries Unit (MIU) to help you manage your injury. You can take this off to wash and check your leg but keep your knee straight as you do it.
Keep the brace on when doing your exercises. Try to bend and straighten your knee as much as your brace allows you to and within pain limits, as shown below.
You should repeat this 10 to 15 times, 4 to 5 times a day.
How do I adjust my brace?
They will set your brace at 0 to 30 degrees range of movement. Keep it at this setting for two weeks.
You will then need to adjust your brace:
- 2 weeks after your injury adjust it to 0 to 60 degrees
- 4 weeks after your injury adjust it to 0 to 90 degrees
This video tells you how to adjust your T-scope brace.
Walking
You must not put any weight on your affected leg for at least 6 weeks and possibly up to 12 weeks. You can walk using crutches by putting weight through your non affected leg.
Exercises
To recover movement it’s important to start exercises as soon as possible.
Follow the instructions and pictures below.
Do each of these exercises 3 to 4 times a day.
Knee flexion and extension
Bend and straighten your injured leg as far as you feel comfortable and only as far as the brace allows. Repeat 7 to 10 times.
Strengthening exercise
Keeping the leg straight and supported, gently tense your thigh muscle and try to straighten your knee further. Hold for 10 seconds and repeat 7 to 10 times.
Using your knee braces and crutches
How to use crutches
These videos show you how to use your crutches.
What should I do with my brace and crutches when I no longer need them?
- We can not use the brace again. You should not return it to the hospital.
- You can return crutches to the Fracture Clinic or your local physiotherapy department.
Preventing complications
Caring for your wound
If you’ve had an operation on your knee, you’ll need to keep your stitches dry and clean. You should also look out for any redness or signs of swelling, bleeding or pus as these can be signs of an infection.
You can find information about how to care for your stitches, if/when they need to be removed and signs of an infection on our orthopaedic surgery page.
Blood clots and Deep Vein Thrombosis (DVT)
Because your lower limb is immobilised and you’ll be moving less than normal, you’re at higher risk of developing a blood clot or Deep Vein Thrombosis (DVT). This can be life threatening if left untreated.
Symptoms of DVT in the leg are:
- throbbing or cramping pain in 1 leg (rarely both legs), usually in the calf or thigh
- swelling in 1 leg (rarely both legs)
- warm skin around the painful area
- red or darkened skin around the painful area
- swollen veins that are hard or sore when you touch them.
These symptoms can also happen in your arm or tummy if that’s where the blood clot is.
More information about DVT
- Watch this video about how to prevent DVT
- Learn more about DVT including symptoms, who is at risk and how to treat it on the NHS website
- Find out how to reduce the risk of blood clots when you have an immobilised lower limb (PDF, 108KB).
Preventative medication for DVT
If you have been told not to put any weight through your leg, you should have been assessed in ED or MIU and told if you need to take preventative medication. If you haven’t had this conversation please call your GP for an urgent appointment.
Pressure Sores and Ulcers
Wearing a brace and not moving your limb can lead to pressure sores or ulcers. These are injuries to the skin and underlying tissue caused by prolonged pressure, rubbing or tension.
They often develop gradually, but can sometimes form in a few hours.
Signs and symptoms of a pressure sore include:
- skin discolouration – red patches for people with pale skin, purple or blue patches for people with dark skin
- discoloured patches that do not turn white when pressed
- a patch of skin that feels warm, spongy or hard
- pain or itchiness in the affected area.
Take your brace off every day to check your skin. Make sure it’s not rubbing.
More information about pressure sores and ulcers
- Watch this video about how to prevent pressure sores
- Read more about pressure sores on the NHS website
If you think you have a pressure sore or ulcer
Call the Fracture Clinic straight away on 01872 253091. For out of hours advice please call 01736 758909.
Sepsis
Sepsis (also known as blood poisoning) is a serious infection that can be life threatening. There is no one sign for sepsis so it can be hard to spot.
Call 111 immediately if you develop any of the following:
- Slurred speech or confusion
- Extreme shivering or muscle pain
- Passing no urine in a day
- Severe breathlessness
- It feels like you’re going to die
- Skin is mottled or discoloured.
Find out more about the symptoms of sepsis on the NHS website.
These videos also explain what Sepsis is and how to spot the early signs.
Living with your injury
Driving
If you have an injury to your knee, you can return to driving when you:
- are no longer using your brace or crutches
- can walk comfortably
- can perform an emergency stop pain free.
Always test your ability to drive with the ignition off and in a safe environment.
If you have a follow up appointment with us, please wait until your consultant or physiotherapist has given you clearance to drive. If you are in any doubt, do not drive until you have spoken to our team.
Work
Decisions to return to work are made on a unique basis and should be discussed with the Fracture Clinic, your GP and your employer.
You may need time off work and when you return, you may need light or amended duties. When you should return to work will depend on your profession and your injury.
You can get a fitness for work statement or a sick note from your GP.
Sport
You should not do any sports for 6 weeks.
You must avoid contact sports and heavy lifting for 12 weeks.
