Oh, the Iron Knee Trivia Quiz

Answer: An autoimmune disease

Your immune system fights infection. An autoimmune disease is one that mistakenly attacks healthy cells in the body. In the case of rheumatoid arthritis (RA) it is an attack on the synovium, which is a sticky membrane that coats and protects your joints. If left unchecked it has the potential to destroy both cartilage and bone. Sadly this is not a disease that afflicts when you get older; it will attack the young with equal vigour. The symptoms of RA include swelling and redness in the affected area and the joint may even be hot to the touch. Treatment will vary from patient to patient. If drugs are prescribed, it is likely that the doctor will test the disease with less potent solutions such as intra-articular injections or non-steroid anti-inflammatory drugs (NSAIDS). Should these lose their effectiveness this may be scaled up to a course of disease modifying anti-rheumatics (DMARDS). Sufferers can help themselves by performing exercises that will strengthen the muscles that support the knee or, if they are overweight, take on-board a weight reduction programme to reduce stress on the knees.

Osteoarthritis is caused by the gradual wearing of cartilage. Reactive arthritis is brought on by infection and gout is a condition whereby uric acid gets into the joint.

Answer: Chondromalacia

When I first saw the name I pronounced it as Condo-in-Majorca. Its actual pronunciation is Kon-Dro-Mah-Lay-she-ah.

This is a young adult's injury that can stem from overuse of the joint, some form of weakness within the knee or a plain old solid "whack" to the knee that either knocks the patella out of alignment or tears off a bit of cartilage. The knee-cap will then start to rub against the lower end of the thigh bone instead of gliding smoothly across it. This is a common injury in both runners and cyclists. Sufferers will feel a dull pain around the knee cap, which will become more pronounced when they try to take on a flight of stairs or negotiate some form of incline. Treatment usually starts with some low-impact exercises to strengthen particular muscles, the key one being the inner part of the quadriceps. Should the injury not respond to this, doctors may consider arthroscopic surgery.

Answer: True

Injuries to ligaments are graded on their severity:

Grade 1 sprains - mild damage to the ligament, slight stretching but the knee remains stable.
Grade 2 sprains - the ligament is stretched to the point where it is loose. This is often described as a partial tear.
Grade 3 sprains - this is a complete tear, the ligament has been split in two and the knee has lost stability.

The cruciates are part of the structures that provide stability for your knees. There are two in each knee - the anterior (at the front of the knee) and the posterior (at the back). The anterior is the most prone to injury as it is the first part of the knee to deal with sudden twisting motions. Too much force can stretch the cruciate, tear it or both. An injury to the posterior cruciate usually comes from some savage impact, e.g. a motor vehicle accident. A cruciate injury weakens your stability and there's a strong chance your leg may buckle when you try to stand on it. Treatment will involve R.I.C.E. (Rest, Ice, Compression, Elevation) to start with and seeing your doctor for a full diagnosis. If the tear is not severe you are likely to be prescribed a brace for support and an exercise programme to strengthen key muscles. A complete tear is likely to require surgery. Once again, the key to a complete recovery from this is a quality exercise programme that you stick to. This won't be easy and your rehabilitation could take anywhere from four to six months.

Answer: The medial collateral ligament

The medial collateral ligament (MCL) is on the inside of your knee. Generally the way the MCL is damaged is from an impact to the outside of the knee pushing it medially i.e. inwards. Of the four knee ligaments (two collaterals and two cruciates) the MCL has proven to be the most common that health workers need to deal with.

In sporting circles an impact on the knee is likely to be on the outside pushing in (medially); (i) it is more exposed than the inside of the knee (ii) turning the outside toward your opponent is a common defensive manoeuvre and (iii) it is also a protective strategy to keep (say) the ball further from your opponent. An injury to these ligaments may result in a popping noise, it is likely that your leg will buckle and fail to support you and it almost goes without saying that there will be pain and swelling. See your doctor as the injury will need a thorough examination. Mild strains can be resolved with exercise, some bracing and regular applications of ice to reduce the swelling. If you've severely strained or torn the ligament there's a fair chance that you will need surgery to repair it.

Answer: Inflammation

Overuse of the knees, particularly in sports that involve jumping or repetitive motions such as running and cycling, could lead to tendons being stretched and then inflamed (tendonitis) or, worse, ruptured or torn. In the event that you contract tendonitis you will find that there is soreness (usually) where the patellar tendon meets the bone.

However, should you rupture the tendon you are likely to feel intense pain and you will find it difficult to bend, extend or lift your leg. Doctors are likely to prescribe rest, ice and elevation however, if the pain is too severe, they'll throw in some pain relief medication.

A partial tear here may not necessarily mean surgery but you will most definitely have a cast applied to restrict your movement in the region. If the patellar tendon is completely torn you will need surgery. Expect to have the knee in a cast for about 4-6 weeks and you'll be getting around with the help of a pair of crutches.

Answer: True

The menisci are crescent shaped discs that slot between your tibia (shin bone) and your femur (thigh bone). They sit on the inner and outer sides of your knees and provide a buffer for the lower part of the leg against the weight and stress of the upper body.

A tear may occur here if you rotate the upper part of leg quickly while the foot is planted - basketball players are prone to this form of injury. A small tear may cause some mild discomfort for you and, depending on the amount of blood flow into the injured area your doctor may allow this injury to heal itself with the help of some ice, elevation and elastic support bandages.

A larger tear may create a flap that lodges between the femur and the tibia and this one will cause you a fair amount of grief. Treatment for this injury may involve arthroscopic surgery and the rehabilitation will contain a solid exercise programme.

Answer: 10-15 years old

Hopefully "growth area" within the question steered you in the right direction for this answer. Active young children and growing bones are an environment for a range of issues. OSD will surface, as a result of repetitive stress from games that involve a lot of running and jumping, in the area where the patellar tendon attaches to the tibia.

The good news is that this is only temporary and you will find that it will flare up after activity and back off with some rest. Doctors are likely to suggest rest and ice to be applied to the injured area and may accompany this with a suggestion that the child seeks out a slightly more moderate activity for the short term.

This should all pass once the child has ceased that particular growth spurt.

Answer: Iliotibial Band Syndrome (IBS)

It is possible that IBS can be caused by a direct knock to the knee but this is more the exception than the rule. Usually the culprit is overuse. There will be a localised ache or even a burning feeling on the side of the knee with a chance that this radiates up the side of the thigh. Some rest, stretching and specific muscle strengthening should see the condition dissipate and, eventually, go away. It is extremely rare for IBS to persist beyond this treatment regime.

Answer: False

On the contrary, just about all the symptoms of plica syndrome are so similar to many other issues that the knees can have that it is quite often misdiagnosed. The plicae are difficult to describe. First up, they are sleeves or pleats of synovial tissue, the sticky membrane that lines your joints. Now, picture a tailor putting together a shirt and into this shirt they incorporate some extra folds/pleats so that it allows the body to move more freely.

In a similar way the synovial sleeves within your joints do the same thing, i.e. allow the joint's bones to move more freely. Your knees contain four plicae.

They can become irritated from overuse and become inflamed, which will lead to a weakness in the knee and make it susceptible to locking up. Doctors will first seek to reduce the inflammation and the thickening of the plicae.

This is done through a combination of cutting back in activity, elastic support bandages, some gentle strengthening exercises and, possibly, a course of ibuprofen. If it is a little more severe it may require a cortisone injection, however, if the condition prevails for an extended period of time doctors may resort to surgery to remove the plicae.

Answer: Blood supply

OCD can occur in all joints but is more common within the knees and, to a lesser extent, the ankles and elbows. The reasons for the lack of blood supply are varied and there is some suggestion that the condition may be an inherited one. It usually occurs in adolescents and young adults but it should heal itself in its normal course. If it doesn't then there is a chance that the cartilage can separate from the bone, break off and lead to a locking of the knee. This can be quite painful. See your doctor.

WARNING: Whilst this quiz has described some courses of action that may be prescribed by a doctor they key ingredient in that sentence is "they must be prescribed by a qualified medical practitioner". Do not take this quiz as the answer to your issues, see your doctor and get yourself diagnosed properly.