How knees get hurt in crashes, falls and work accidents

The knee sits at the height of the dashboard, which is why it is injured so often in a frontal crash. When a seated occupant’s bent knee is driven into the dash, the shin is pushed backward under the thigh. That force can stretch or tear the posterior cruciate ligament, crack the kneecap, or bruise the bone deep to the skin. The same impact travels up the thigh bone, so an orthopedic physician examines the hip on the same side as well — see orthopedic hip care.

Other mechanisms produce different injuries:

• Twisting on a planted foot — slipping on a wet supermarket aisle or stepping awkwardly off a truck lift gate — tends to injure the ACL and the meniscus.
• A blow to the side of the knee, common in a side-impact collision or a pedestrian strike, stresses the MCL or LCL. Our page on ACL and MCL sprains and tears covers the ligaments in detail.
• A bumper striking the leg of a pedestrian can split the flat upper surface of the shin bone, a tibial plateau fracture.
• Direct blows and repeated kneeling on tile, roofing or concrete cause a deep contusion or an inflamed bursa over the kneecap.

What the orthopedic knee exam checks

Knee pain on its own does not tell anyone which structure is injured; general information is on our knee pain page. The orthopedic exam tests the parts of the knee one at a time and compares them with your uninjured side.

• Swelling inside the joint. Fluid that collects soon after an injury can mean bleeding inside the knee, which raises concern for a ligament tear or a fracture.
• Ligament stability. Stress tests check whether the shin slides too far forward (ACL), backward (PCL) or opens on the inner or outer side (MCL, LCL).
• The meniscus. Tenderness along the joint line, catching and a knee that locks point toward a cartilage tear.
• The extensor mechanism. If you cannot lift your straightened leg off the table, the kneecap, the quadriceps tendon or the patellar tendon may be damaged.
• Nerves and circulation. Pulses at the ankle and sensation on the outer shin are checked, because the peroneal nerve wraps just below the knee and can be stretched in a side blow.

Motion is measured and recorded, often with formal range of motion testing, so later visits can be compared against the first.

X-ray first, MRI when the exam points to it

Most knee visits start with digital X-ray to rule out a fracture of the kneecap, the lower thigh bone or the tibial plateau. X-rays do not show ligaments or cartilage, so when the exam suggests a torn ligament, a meniscus tear or a bone bruise, the orthopedic physician orders an MRI. A CT scan may be ordered to map a plateau fracture. Our diagnostic imaging page explains how outside scans are scheduled, and do I need an MRI after a car accident covers when one is reasonable.

An MRI is read alongside the exam, not instead of it. Many adults have meniscus wear that predates any accident, so the physician documents which findings match your mechanism of injury and your symptoms.

What a non-surgical knee plan coordinates

After the exam and imaging you receive a written treatment plan. Depending on the injury, it may combine:

• Bracing or immobilisation — a hinged brace for a sprained collateral ligament, or a knee immobiliser while a fracture or tendon injury is being evaluated. Whether you use crutches is decided by the examining physician.
• Physical therapy to restore quadriceps control, knee motion and a normal walking pattern. Car accident physical therapy runs under the same written plan.
• Injections and pain management when swelling or pain keeps you from participating in rehabilitation.
• EMG nerve testing if you have numbness on the outer shin or toes that catch when you walk.

Work restrictions for kneeling, squatting, ladders and stairs are written specifically for your job and updated as the injury changes. How the knee responds varies with the injury, and your clinician will set expectations after examining you.

When a knee injury needs a surgical opinion

Some findings call for a surgeon’s opinion: a knee locked so it will not fully straighten, a complete ACL tear with repeated giving way, damage to more than one ligament, a displaced fracture, or a torn quadriceps or patellar tendon. A referral does not mean an operation is certain; the surgeon discusses surgical and non-surgical options with you.

Injury Recovery MD does not perform surgery. You choose your own surgeon. IRMD prepares the pre-surgical work-up documentation — the exam findings, imaging and treatment history — and provides rehabilitation afterward. If you have an operation, your operating surgeon sets the rehabilitation protocol and milestones. For background, see ACL reconstruction, meniscus surgery and the surgery overview.

No-Fault and workers’ comp billing for knee care

If your knee was hurt in a car crash in New York, orthopedic care is billed to the No-Fault carrier; a No-Fault doctor explains how that works. The No-Fault application must be filed within 30 days of the accident — see the No-Fault 30-day deadline. You choose your own treating provider. Under workers’ comp, that choice is among providers authorized by the New York Workers’ Compensation Board, and Injury Recovery MD is one.

A knee injured on the job is billed to the employer’s carrier through a workers’ comp orthopedic doctor. In both systems IRMD bills directly, with $0 out of pocket for covered patients. If the carrier schedules an independent medical exam, your visit notes already document the exam findings and imaging.

Where to have your knee examined

Orthopedic physicians see patients at all 7 Injury Recovery MD offices: Medford (main office), Islandia, East Islip, Mineola in Nassau County, Bohemia, Smithtown and Stony Brook. Same-day and next-day appointments are often available; call (631) 560-8357 or see all locations.

For the full crash picture, read car accident orthopedic care or return to the orthopedic care overview. If the injury also involves the ankle, see foot and ankle orthopedic care.

Where to see an orthopedic physician

• Medford3243 NY-112, Bldg 1, Suite 4, Medford, NY 11763Suffolk County
• Islandia1717 Veterans Memorial Hwy, Suite 100, Islandia, NY 11749Suffolk County
• East Islip11 Carleton Ave, East Islip, NY 11730Suffolk County
• Mineola300 Old Country Rd, Suite 321, Mineola, NY 11501Nassau County
• Bohemia1690 Washington Ave, Bohemia, NY 11716Suffolk County
• Smithtown732 Smithtown Bypass, Suite 200, Smithtown, NY 11787Suffolk County
• Stony Brook2500 Nesconset Hwy, Building 10A, Stony Brook, NY 11790Suffolk County

Orthopedic physicians see patients at every Injury Recovery MD office. Intake books the office and time that suit you. Call (631) 560-8357 — answered 24/7.

Frequently asked questions

My knee hit the dashboard and only looks bruised. Should an orthopedic doctor examine it?

Yes. A dashboard strike pushes the shin backward and can injure the posterior cruciate ligament, the kneecap or the hip on the same side while the skin shows only a bruise. An orthopedic exam tests ligament stability and the kneecap, and an X-ray can check for a fracture. If you cannot take weight on the leg, or the foot is cold, pale or numb, go to an emergency department instead.

Do I need an MRI for knee pain after a car accident?

Not always. An X-ray is usually the first image because it shows fractures. An MRI is ordered when the orthopedic exam suggests a ligament tear, a meniscus tear or a bone bruise, since X-rays do not show those structures. The MRI is interpreted together with the exam, because many adults have meniscus wear that was present before the accident.

Can knee pain after a fall actually come from my hip or back?

It can. Hip joint problems and irritated lower back nerves can both send pain toward the knee. That is why an orthopedic knee exam also checks hip motion and, when symptoms suggest it, the lower back and nerve function. Numbness or tingling in the shin or foot may lead to EMG nerve testing.

Will I need knee surgery after my injury?

Nobody can say before you are examined. Many knee injuries are managed with bracing, physical therapy and pain management. A surgical opinion is recommended for specific findings, such as a knee locked so it will not straighten, a complete ligament tear with repeated giving way, or a displaced fracture. Injury Recovery MD does not operate; if surgery is discussed, you choose the surgeon.

Does No-Fault pay for orthopedic knee care after a Long Island car accident?

For covered patients, No-Fault pays for necessary medical care after a New York car crash, and Injury Recovery MD bills the carrier directly with $0 out of pocket for covered patients. The No-Fault application must be filed within 30 days of the accident. You choose your own treating provider.

If my knee needs an operation, who picks the surgeon?

You do. Injury Recovery MD provides a referral for a surgical opinion and prepares the documentation the surgeon needs, including exam findings, imaging and treatment history. After surgery, your operating surgeon sets the rehabilitation protocol, and IRMD can provide the physical therapy and follow-up care under that protocol.