The Knee Center

Anterior cruciate ligament (ACL) injuries

The ACL is one of the ligaments in the knee joint that connects the thighbone (femur) with the shin bone (tibia). Injuries to the ACL are generally associated with a specific injury event. Symptoms of an ACL injury include pain and swelling on the outside and back of the knee, and instability or limited movement in the knee joint. Treatment depends on many factors by may include physical therapy, bracing, and in some cases, surgery.

Arthritis

Arthritis is painful inflammation and stiffness of the joints, which can be caused by many types of degenerative or inflammatory conditions. There are many types of arthritis, including osteoarthritis, rheumatoid, post-traumatic, septic, and gout. Arthritis symptoms often include swelling, tenderness, sharp pain, stiffness, and sometimes fever and chills.

Knee arthritis is one of the most common disabling locations for arthritis. It is managed initially with activity modifications, gait aids such as a cane, stretching and strengthening exercises to build up the supportive musculature, anti-inflammatory medications, Tylenol, and injections. When these options fail to provide relief, surgery may be indicated.

Bursitis

Bursitis is painful inflammation of the bursae, the fluid-filled sacs that reduce friction between bones, tendons, and muscles. It can be caused by an injury, infection or other condition. Pain may be accompanied by swelling, tenderness or loss of movement.

Chondromalacia

The ends of the bones in a joint are covered with articular cartilage. In the normal process of aging, this cartilage in the knee begins to soften and break down. As the cartilage deteriorates, the bones of the knee joint begin to rub together, causing damage and discomfort. Symptoms include pain, swelling, and stiffness in the knee joint. It is best managed by weight management, functional strengthening, and in some cases, surgery.

Knee fracture

A knee fracture is a break in the bones of the knee joint. This typically happens as a result of trauma, such as a fall, or forceful blow. The kneecap (patella), lower thigh bone (femur), or the upper shin bone (tibia) may be affected in a knee fracture. Symptoms include severe pain, tenderness, and swelling, accompanied by deformity of the knee joint and inability to walk or put weight on the injured leg. Treatment initially is ice and immobilization. Once we determine the extent of the fracture, treatment may be surgical or nonsurgical.

Iliotibial (IT) band syndrome

The iliotibial band is a group of fibrous tissues that runs down the outside of the thigh, providing stability to the knee and hip. It is a long stretch of tissue that crosses 2 joints, so irritation at either the hip or the knee can easily be transmitted. IT band syndrome causes the fibers to tighten, causing the band to rub against the bone when the knee is bent. Symptoms include pain on the outside of the knee or hip that improves with stretching or rest.

Ligament injuries & tears

The knee joint has four ligaments (anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL)). These ligaments are tough, flexible fibers that link the bones together providing stability and controlling movement. Injuries to these ligaments may occur during sporting activities or with trauma, such as an abrupt twist or direct blow to the knee. Symptoms include pain, swelling, and a pop at the moment of injury. It may be difficult to put weight on the affected leg, and the knee joint may feel loose and unstable. Many of these can be diagnosed by history and physical exam, but xrays and an MRI are also warranted to evaluate the extent of the injury

Meniscus tears

Menisci are c-shaped discs of cartilage located between the bones of the knee joint. In each knee there are 2 menisci, medial and lateral. Meniscus tears can happen suddenly as the knee ages or may be related to a twisting-type injury. Knees with arthritis will likely have degenerative, or age-related, meniscus tears. If there is a clear injury, the tear is often associated with swelling. Treatment is based on symptoms and the nature of the tear. Most degenerative tears are managed with rest, activity modifications, injections, and time. Many traumatic tears in younger patients are considered for surgery.

Osgood-Schlatter disease

Osgood-Schlatter disease is a common cause of knee pain in growing adolescents. It is inflammation of the area just below the knee where the tendon from the kneecap (patellar tendon) attaches to the shinbone (tibia). It commonly begins during growth spurts. Because running and jumping activities place additional stress on the knee, young athletes are at increased risk; however, it can present even in sedentary adolescents.

In most cases, rest, anti-inflammatory medication, and stretching/strengthening exercises will relieve pain and allow a return to daily activities.

Osteochondritis dissecans

Osteochondritis dissecans occurs when the blood supply to part of the cartilage or bone in the knee (or other joints) is lost. That portion of cartilage or bone can develop small cracks or even break off entirely. In some cases, the fragment of bone or cartilage may lodge itself in between the bones of the joint, making movement difficult or impossible. Symptoms include pain, swelling, tenderness, and grinding or locking in the knee joint.

Infected knee replacement

If your knee replacement becomes infected, surgery may be necessary to correct the problem. Infections, though rare (<2%), are caused by bacteria traveling through the bloodstream. A systemic illness or traumatic dental work can sometimes be the culprit.

Symptoms of an infection include fever, chills, redness or swelling of the knee, and drainage from the surgery site. If you suspect that your knee may have an infection, you should consult your orthopedic surgeon for evaluation.

Failed knee replacement

Failure of a replacement knee joint can be caused by many factors, but the symptoms often include pain, swelling, instability, and stiffness. The knee components are a combination of metal and plastic, and in time, the parts can wear out. If you are concerned that you knee may no longer be working properly, you should see a joint replacement specialist for an evaluation. In some cases, knee revision surgery may be necessary to correct the problem.

Tendonitis

Tendonitis is inflammation of the tendons, the tissue that connects muscle to bone. Tendonitis is caused by overuse (repetitive motion) or sudden injury. Tendonitis symptoms include pain in the tendon area, swelling, and loss of motion.

Patellar tendonitis is inflammation in the patellar tendon that often results from repetitive impact. It is also referred to as “jumper’s knee”. Rest, immobilization, anti-inflammatory medications, and physical therapy are the mainstays of treatment.

Quadriceps/Patellar tendon tears involve partial or complete disruption of the complex that powers knee extension. In most circumstances, if the muscles cannot power the knee to extend after an injury, surgery is recommended to restore the connection.

In the late 1970s and early 1980s, arthroscopic surgery became popular, especially in the sports world, as fiber-optic technology enabled surgeons to see inside the body using a small telescope, called an “arthroscope,” which projects an image to a television monitor. Thanks to ongoing improvements made by technology leaders like Smith & Nephew, arthroscopic surgery is now accessible to more people than just professional athletes. In fact, active patients all over the world have experienced the benefits of minimally invasive surgical procedures.

Arthroscopy may be used for a variety of knee joint conditions, including a torn meniscus, loose pieces of broken cartilage in the joint, a torn or damaged anterior or posterior cruciate ligament (ACL/PCL), an inflamed or damaged synovium (the lining of the joint), or a malalignment of the patella(knee cap).

Through an incision the width of a straw tip, your surgeon is able to insert a scope, which allows him or her to inspect your joint and locate the source of your pain. The scope can also help identify tears or other damage that may have been missed by an X-ray or MRI. Your surgeon will then make one or more small incisions to accommodate the instruments used to repair the knee. These instruments can shave, trim, cut, stitch, or smooth the damaged areas.

Arthroscopic knee surgery is often performed in an outpatient surgery center, which means no overnight hospital stay is required. Patients report to the surgical center in the morning, undergo the procedure, and -following a recovery period under the care of medical professionals – return home later in the day.

Postoperative care

After surgery, you will be transported to the recovery room for close observation of your vital signs and circulation. You may remain in the recovery room for a few hours.

When you leave the hospital, your knee will be covered with a bandage, and you may be instructed to walk with the assistance of crutches. You also may be instructed to ice or elevate your knee.

Your surgeon will likely provide further details regarding postoperative care for your specific procedure.

Rehabilitation

Steps for rehabilitation following a meniscus repair or an ACL procedure vary from physician to physician. To learn what activities will be involved in your own rehabilitation, consult your orthopedic specialist.

All information provided on this website is for information purposes only. Every patient’s case is unique and each patient should follow his or her doctor’s specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

Ligaments are tough, nonstretchable fibers that hold your bones together. A tear to the anterior cruciate ligament (ACL) of your knee joint is among the most common sport-related injuries. The ACL connects the thighbone (the femur) to the shinbone (the tibia) and acts to prevent your thighbone from moving too far forward over the knee joint. This ligament also helps stabilize the shinbone from rotating out of the knee joint.

CAUSE & SYMPTOMS

The ACL can tear when it’s stretched beyond its normal range. This typically happens by sudden twisting movements, slowing down from running, or landing from a jump. Injury to the ACL can result from a direct blow to the knee, or from non-contact injuries such as making a sudden stop or landing on an extended leg. At the time of injury, you may hear an audible popping sound, and the knee will give way. Shortly after the injury, the knee will become swollen and walking will be very difficult. The swelling and pain will subside after the first few days.

A different injury to the knee to be aware of is a Meniscus Tear. A meniscal tear can also occur simultaneously with injury to other ligaments of the knee (in particular, the anterior cruciate ligament which helps to connect the upper and lower leg bones).

REPAIR FOR AN ACL TEAR

Immobilize the knee

Following the acute injury you should use a knee immobilizer and crutches until you regain good muscular control of the leg. Extended use of the knee immobilizer should be limited to avoid quadriceps atrophy. You are encouraged to bear as much weight on the leg as is comfortable.

Control Pain and Swelling

Crushed ice or an Aircast knee Cryocuff along with nonsteroidal anti-inflammatory medications such as Advil, Nuprin, Motrin, Ibuprofen, Aleve (2 tablets twice a day) are used to help control pain and swelling. The nonsteroidal anti-inflammatory medications are continued for 7 – 10 days following the acute injury.

Consult a Specialist

In most cases, your ProSports physician will be able to diagnose and ACL injury with direct examination. In the likelihood that there may be additional injury to the joint, or if the swelling makes diagnosis difficult, your physician may conduct an MRI or arthroscope the fully evaluate the injury to the knee.

Because the ACL is not capable of healing itself (ligaments, unlike muscles, do not have their own blood supply), it can only be reconstructed (that is, replaced) surgically — it cannot simply be repaired. Less active people may choose to treat a torn ligament nonsurgically with a rehabilitation program focusing on muscle strengthening and lifestyle changes. Surgical reconstruction, however, may help many people recover full function after an ACL tear. Your doctor can discuss these different options with you and help choose what is right for you.

The decision whether or not to surgically repair the ACL depends on several factors, including the extent of the injury and the expectations of the patient. Your ProSports physician will determine the degree of the injury or injuries to the knee, and the “laxity,” or looseness, of the joint.

For younger patients with moderate to several injuries and laxity, who want to continue with a broad range of physical activities, surgery will most likely be necessary. For older patients and others with less severe injuries, who anticipate less vigorous physical activity, a rehabilitation program will be prescribed.

RECOVERY

After ACL reconstruction, performing rehabilitative exercises may gradually return full flexibility and stability to your knee. Building strength in your thigh and calf muscles to support the reconstructed knee is a primary goal of rehabilitation. You may also need to use a knee brace for a short time, and it is important not to return to full activity too soon to prevent reinjury.

ACL rehabilitation includes exercises to restore the full range of motion to the knee, followed by a program of strengthening exercises. These programs continue until the leg strength and flexibility are nearly back to normal.

If you have undergone surgery for an ACL tear, the ACL protocol contains instructions and exercises to help you recover.

ARTHROSCOPIC SURGERY TO RECONSTRUCT AN ACL

The ACL, or Anterior Cruciate Ligament, connects the front of the tibia (shinbone) to the back of the femur (thighbone). The ACL serves to prevent the shinbone from moving forward in the knee joint. Injury to the ACL can result from a direct blow to the knee, or from non-contact injuries such as making a sudden stop or landing on an extended leg.

Symptoms

Frequently a tear in the ACL will result in an audible popping sound, and the knee will give way. Shortly after the injury, the knee will become swollen and walking will be very difficult. The swelling and pain will subside after the first few days.

Diagnosis

In most cases, your ProSports physician will be able to diagnose and ACL injury with direct examination. In the likelihood that there may be additional injury to the joint, or if the swelling makes diagnosis difficult, your physician may conduct an MRI or arthroscopy to fully evaluate the injury to the knee.

Surgery or not?

The decision whether or not to surgically repair the ACL depends on several factors, including the extent of the injury and the expectations of the patient. Your ProSports physician will determine the degree of the injury or injuries to the knee, and the “laxity,” or looseness, of the joint.

For younger patients with moderate to several injuries and laxity, who want to continue with a broad range of physical activities, surgery will most likely be necessary. For older patients and others with less severe injuries, who anticipate less vigorous physical activity, a rehabilitation program will be prescribed.

PREPARING FOR SURGERY

Before proceeding with surgery the acutely injured knee should be in a quiescent state with little or no swelling, have a full range of motion, and the patient should have a normal or near normal gait pattern. One of the most common complications following ACL reconstruction is loss of motion, especially loss of extension. Studies have demonstrated that the timing of ACL surgery has a significant influence on the development of postoperative knee stiffness.

The highest incidence of knee stiffness occurs if ACL surgery is performed when the knee is swollen, painful, and has a limited range of motion.

The risk of developing a stiff knee after surgery can be significantly reduced if the surgery is delayed until the acute inflammatory phase has passed, the swelling has subsided, a normal or near normal range of motion (especially extension) has been obtained, and a normal gait pattern has been reestablished.

More important than a predetermined time before performing surgery is the condition of the knee at the time of surgery.

Control Pain and Swelling

Crushed ice or an Aircast knee Cryocuff along with nonsteroidal anti-inflammatory medications such as Advil, Nuprin, Motrin, Ibuprofen, Aleve (2 tablets twice a day) are used to help control pain and swelling. The nonsteroidal anti-inflammatory medications are continued for 7 – 10 days following the acute injury.

Restore Normal Range of Motion

You should attempt to achieve full range of motion as quickly as possible. Quadriceps isometrics exercises, straight leg raises, and range of motion exercises should be started immediately.

Development Muscle Strength

Once 100 degrees of flexion (bending) has been achieved you may begin to work on muscular strength: Mentally Prepare

• Understand what to realistically expect of the surgery
• Make arrangements with a physical therapist for post-operative rehabilitation
• Make arrangements with your place of employment.
• Make arrangements with family and/or friends to help during the post-operative rehabilitation
• Read and understand the rehabilitation phases after surgery

THE SURGERY

Before Surgery

Prior to beginning the operation and at the conclusion of the operation, a solution containing morphine or Demerol and a long acting local anesthetic Marcaine will be injected into your knee. This solution will block the pain nerve fibers and local pain receptors in your knee. Recent studies have shown that this is a safe and effective way to control pain after knee surgery. In many cases the injection will last 12 or more hours after surgery and significantly reduce the amount of pain medication that you will have to take.

During Surgery

At the time of surgery a plastic drainage tube which is connected to a vacuum container is placed in the subcutaneous tissues around your knee and into the knee joint to prevent blood from collecting.

After Surgery

Prior to leaving the operating room a Cryocuff and a knee immobilizer will be applied to your knee.

• The Cryocuff will provide cold and compression, reducing pain and swelling. This unit should be used continuously for the first 3 – 4 days after your surgery. After this time period the Cryocuff can be used as needed for comfort.
• The knee immobilizer is to be worn while walking and sleeping, otherwise it can be removed.
• After surgery, your leg will be wrapped in soft cotton bandage and a white elastic TED stocking will be applied over the cotton dressing from your toes to your groin.
• The purpose of the elastic stocking is control swelling in the leg. The TED stocking should be worn full time for the first 12 – 14 days after surgery.
• The drainage tubes are still attached to prevent blood from collecting. The drainage tubes will be removed before you leave the hospital.

After the anesthesia has worn off, your vital signs are stable and your pain is under control you will be discharged from the hospital.

You will not be allowed to drive a car. Prior to your discharge arrange for transportation.

Recovering from ACL Surgery

ACL rehabilitation includes exercises to restore the full range of motion to the knee, followed by a program of strengthening exercises. These programs continue until the leg strength and flexibility are nearly back to normal.

If you have undergone surgery for an ACL tear, the ACL protocol contains instructions and exercises to help you recover.

A meniscal tear is a common injury of the knee. The meniscus is a wedge-like, shock-absorbing piece of cartilage found within your knee joint. It is shaped like a C and curves inside and outside the joint to stabilize your knee. It also allows your thigh (the femur) and your shin (the tibia) bones to glide and twist over each other with movement, as well as provide cushioning support for the weight-bearing job of your legs.

There are two menisci in the knee: the lateral meniscus (on the outside) and the medial meniscus (on the inner side of the knee). Meniscus tissue does not heal. If you suspect that you have signs or symptoms of a meniscal tear, please see your doctor for further evaluation and treatment options.

CAUSES

As with most joints there are two mechanisms for injuring the meniscus: traumatic tear and degenerative.

TRAUMATIC TEAR

Injury to the meniscus often happens during sport activity, when a sudden twisting of the knee, pivoting, or deceleration causes a tear in your cartilage. A meniscal tear can also occur simultaneously with injury to other ligaments of the knee (in particular, the anterior cruciate ligament which helps to connect the upper and lower leg bones).

You may hear a popping sound at the time of injury to the meniscus, and you may still be able to bear weight and walk on the injured knee. Pain, swelling, and redness of the joint then develop over the next 12 to 24 hours. In some cases, a piece of cartilage can interfere with knee movement, and you may notice that your knee will “lock” or “pop” with attempted movement. Your doctor may choose to evaluate a possible tear with an MRI scan, a form of imaging that uses a large magnet to view changes in tissue.

DEGENERATIVE TEAR

Over time the meniscus becomes less elastic as a natural drying out of the center of the meniscus occurs. A tear can occur with minimal trauma and sometimes there is no memorable event that can be blamed for the tear.

SYMPTOMS

Think of a torn meniscus like a hang nail. Just as a hang nail is a fragment of nail that can cause pain at the site of the tear, a meniscus tear involves a fragment of cartilage that can cause pain at the site of the tear. Typically low-level swelling accompanied by stiffness and limping toccur the next dday after injury. Activities involving impact, twisting or squatting can cause pain.

Sometimes the knee will “lock” in a bent position. In this case the torn fragment acts like a wedge to prevent the joint from moving, and attempts at moving the knee can be painful.

REPAIR

Initial treatment of a meniscal tear follows basic home care management — “RICE,” which stands for Rest, Ice, Compression, and Elevation. Nonsteroidal anti-inflammatory medications (NSAIDs) are helpful to relieve pain and inflammation. This may be all that is needed for minor tears that have occurred in the outer edges of the meniscus.

In most cases, your ProSports physician will be able to diagnose a Meniscus injury with direct examination. In the likelihood that there may be additional injury to the joint, or if the swelling makes diagnosis difficult, your physician may conduct an MRI or arthroscope the fully evaluate the injury to the knee.

Surgery may be recommended for tears that are central, cause locking or instability of your knee, or for injuries that don’t heal on their own. Surgery may involve using a small, pen-sized camera (called an arthroscope) to trim torn flaps in the cartilage and repair any other damaged ligaments. Often, a brace or cast is needed after surgery, and physical therapy is an important part of recovery to relieve pain and strengthen and stabilize the muscles around your knee.

The decision whether or not to undergo meniscus surgery depends on several factors, including the extent of the injury and the expectations of the patient. Your ProSports physician will determine the degree of the injury or injuries to the knee.

For younger patients with moderate to several injuries and laxity, who want to continue with a broad range of physical activities, surgery will most likely be necessary. For older patients and others with less severe injuries, who anticipate less vigorous physical activity, a rehabilitation program will be prescribed.

RECOVERY

Meniscus tear rehabilitation includes exercises to restore the full range of motion to the knee, followed by a program of strengthening exercises. These programs continue until the leg strength and flexibility are nearly back to normal.

If you have undergone surgery for a Meniscus tear, the Arthroscopy protocol contains instructions and exercises to help you recover.

Meniscus Surgery

Surgery may be recommended for tears that are central, cause locking or instability of your knee, or for injuries that don’t heal on their own.

The decision whether or not to undergo meniscus surgery depends on several factors, including the extent of the injury and the expectations of the patient. Your ProSports physician will determine the degree of the injury or injuries to the knee.

For younger patients with moderate to several injuries and laxity, who want to continue with a broad range of physical activities, surgery will most likely be necessary. For older patients and others with less severe injuries, who anticipate less vigorous physical activity, a rehabilitation program will be prescribed.

PREPARING FOR SURGERY

Arthroscopy surgery is performed on an outpatient basis. If you decide to have arthroscopy, you may be asked to have a complete physical with your family physician before surgery to assess your health and to rule out any conditions that could interfere with your surgery.

Before surgery, tell your orthopaedic surgeon about any medications that you are taking. You will be informed which medications you should stop taking before surgery.

Tests, such as blood samples or a cardiogram, may be ordered by your orthopaedic surgeon to help plan your procedure. Your doctor will provide you with any specific instructions prior to your surgery.

THE SURGERY

Surgery usually involves using a small, pen-sized camera (called an arthroscope) which is inserted into the knee. First the doctor will inspect the entire knee to joint to see if there are any other problems contributing to the symptoms.

Next the tear itself is inspected to determine whether it should be repaired or removed. Meniscetomy involves cutting and removing the torn portions of the meniscus. The remaining cartilage is smoothed and contoured. The meniscus is an important shock-absorbing structure in the knee, therefore, the surgeon will try to leave as much cartilage in place as possible. Most meniscus tears need to be removed.

In some cases the meniscus is repaired using a technique to sew the meniscus back together.

RECOVERING FROM MENISCUS SURGERY

Often, a brace or cast is needed after surgery, and physical therapy is an important part of recovery to relieve pain and strengthen and stabilize the muscles around your knee. Recovering from the removal of a meniscal tear is much quicker than the time needed for a repaired meniscus.

Meniscus tear rehabilitation includes exercises to restore the full range of motion to the knee, followed by a program of strengthening exercises. These programs continue until the leg strength and flexibility are nearly back to normal.

If you have undergone surgery for a Meniscus tear, the Arthroscopy protocol contains instructions and exercises to help you recover.

One of the most common causes of knee pain and loss of mobility is the wearing away of the joint’s cartilage lining. The knee can be damaged by trauma (for example, falls, sports injuries, car accidents) or through disease such as with arthritis. When this happens, the bones rub against each other, causing significant pain and swelling — a condition known as osteoarthritis. Once enough damage has occurred, the knee becomes painful and causes discomfort, limping, instability, giving way, and swelling, resulting in a decrease in the motion and function of the knee joint. In addition, without cartilage there is no shock absorption between the bones in the joint, which allows stress to build up in the bones and contributes to pain.

CAUSE & SYMPTOMS

Arthritis is the most common form of pain due to general wear and tear. The pain associated with arthritis of the knee usually develops slowly over time, although sudden onset is also possible. Pain may worsen after a period of inactivity, or in the morning. Activities such as walking or kneeling may exacerbate the pain. The knee may become swollen and stiff, and it may become difficult to straighten or bend the knee. The degree of pain and immobility may be affected by changes in the weather.

If you are middle-aged or older and experiencing pain in one or both knees, you may have Osteoarthritis. This is known as a “wear and tear” form of arthritis, caused when the joint cartilage in the knee joint wears away. Osteoarthritis usually develops slowly over time, effecting mostly middle-aged and older patients.

If both knees are experiencing pain, you may have Rheumatoid Arthritis. This is an inflammatory form of arthritis that affects the joint cartilage. It usually affects both knees, and can occur at any age.

If you once suffered a knee injury and now are begining to feel joint pain, you may have Post-traumatic Arthritis – This type of arthritis is can develop after a knee injury.

PREVENTION

One of the best ways to reduce wear and tear on your knee is to lose weight. Imagine adding a 100 pound bag of sand to the trunk of a car. Think about how the car sinks lower from this added weight. Over time, the shock absorbers in your car will wear out from carrying this additional weight. Your knees are similar to the shock absorbers in your car. For each pound you lose, you save your knees 5 to 7 pounds of force. By simply losing 5 pounds you can relieve up to 35 pounds of stress on your knees!

REPAIR

Your ProSports physician will assess the tenderness, swelling and range of motion of the knee. X-rays will show if there is significant loss of joint space in the knee, indicating osteoarthritis. An MRI may be necessary to diagnose rheumatoid arthritis of the knee.

Once the knee is damaged to the point that it is painful or that it can no longer move in the way that it is intended, the patient goes to a physician to see if anything can be done to change this situation. There are things that can be done other than knee replacement for people who have problems with their knees. Whether those things are likely to be successful, depends a little bit on the specific individual circumstances.

NON-SURGICAL TREATMENT OPTIOS:

At its early stages, arthritis of the knee may be treated with a variety of non-surgical procedures:

• Minimizing activities that aggravate the arthritis, such as running, jumping and climbing stairs, and incorporating exercises such as swimming and bicycling.
• For overweight patients, a weight loss regimen may help alleviate the symptoms.
• Physical therapy exercises (including water exercises) can help strengthen the leg muscles and increase flexibility.
• Wearing a knee brace or impact-absorbing shoes may help relieve symptoms.

In addition, your ProSports physician may work with you to develop a drug program to help with your condition. This may include anti-inflammatory medications such as aspirin or ibuprofin, steroids or other medications.

SURGICAL TREATMENT OPTIONS

For advanced stage arthritis that does not respond to nonoperative treatments, your your doctor may recommend surgery. There are surgical procedures that are lesser surgical procedures than total knee replacement such as: osteotomy, arthroscopic debridement, and synovectomy. These surgical procedures should be discussed with you to determine if they are reasonable alternatives in your case. Depending on the stage of your disease or damage, total joint replacement may be the only reasonable surgical procedure. This means that basically the choice is either to proceed with a total joint replacement or simply to wait a little bit longer to see how rapidly your condition deteriorates and to try some other things including medication, limitation of activity, weight reduction, etc.

There are several different options available:

• Arthroscopic surgery allows the surgeon clean out the inside of the joint and repair the torn cartilage.
• Osteotomy cuts the femur (thighbone) or tibia (shinbone) to improve the alignment of the knee.
• Cartilage grafting replaces the damaged cartilage with healthy cartilage. This procedure is useful for patients with limited cartilage damage (due to arthritis or trauma).
• A partial or total knee replacement uses metal or plastic to replace the torn knee cartilage.

If arthritis (or injury) has damaged your knee, and different treatments for your pain haven’t helped you get through your everyday activities comfortably, you may be ready to consider knee replacement surgery.

Knee replacement has been proven over four decades to relieve severe knee pain and restore knee function in the vast majority of patients. In fact, the National Institutes of Health recently concluded that knee replacement surgery is “a safe and cost-effective treatment for alleviating pain and restoring function in patients who do not respond to non-surgical therapies.”

RECOVERY

If you have undergone Knee Replacement surgery, the Knee Replacement protocol contains instructions and exercises to help you recover.

Knee Replacement is sometimes recommended for advanced stage arthritis that does not respond to nonoperative treatments. A Partial or Total Knee Replacement is a surgical procedure which involves the replacement of worn-out parts in the knee with an artificial joint. The replacement parts are made of metal and plastic. Most of the ligaments and all of the tendons remain intact, which allows the knee to function appropriately.

CAUSES OF ARTHRITIS

The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.

Osteoarthritis. This is an age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.

Rheumatoid arthritis. This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthritis.”

Post-traumatic arthritis. This can follow a serious knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.

Knee replacement is more accurately described as knee “resurfacing” because only the surface of the bones are actually replaced. <1cm of bone is typically removed to allow the implant to “re-cap” the prepared bones surfaces.

There are four basic steps to a knee replacement procedure.

Prepare the bone.
The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.

Position the metal implants.
The removed cartilage and bone is replaced by metal components that recreate the surface of the joint. These metal parts may be cemented or “press-fit” into the bone.

Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button.

Insert a spacer. A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.

Knee replacement surgery generally takes 1½ to 3 hours in the operating room. Directly following the surgery, the patient is brought to a recovery room where vital signs are monitored. Once the patient has been stabilized, he/she can move out of the recovery room.
There are several components to the rehabilitation and recovery process. Each one is integral to the entire course of healing.

These components include:

Physical therapy. During the first several days/weeks of physical therapy, some degree of discomfort and stiffness is expected. As the therapy continues, your body will adjust to the new prosthetic, allowing it to operate as part of your leg. Even after physical therapy is concluded, the knee needs to continue being active. Walking or other mild activities are perfect to increase mobility over time. It may take 12-18 months for your muscles to fully strengthen.

Incision care. A sterile dressing will be applied in the operating room. If dry, this dressing will often remain for 1 week. Afterwards, it can be removed and covered with a dry dressing. You must keep the incision dry for the first 10-14 days. Do not soak the knee for 4 weeks after surgery.

DVT prophylaxis. Lower extremity surgery poses an increased risk for blood clots. In mobile patients, Aspirin 2x/day for 6 weeks will thin the blood enough to minimize this risk. In patients with a history of clotting, decreased mobility, or GI issues, alternatives such as Eliquis, Lovenox, Arixtra, or Coumadin will be prescribed.

Follow-up. For the first year following surgery, scheduled follow-up appointments will ensure that recovery is going as planned. We would like to see you at 2 weeks, 6 weeks, 3 months, and one year after your surgery. After that, annual visits may be expected to keep your knee in peak condition

The knee is the body’s largest joint, and the place where the femur, tibia, and patella meet to form a hinge-like joint. These bones are supported by a large complex of muscles, tendons, ligaments, and cartilage which allow the knee joint to function.

• Knee moves like a hinge, but it can also rotate and move from side to side.
• Patella is held in place by tendons and ligaments. The patellar cartilage is the thickest in the body.
• Knee Ligaments (ACL, PCL, MCL, LCL) hold the knee joint in proper position. When one or more are injured, the knee is subject to instability.
• Menisci are cushions of tissue (cartilage) that increase the contact area of the knee. Injury to the menisci commonly cause locking, catching, and pain.
• Cartilage covers the ends of the bone and provides a cushion and healthy local environment

Symptoms of knee pain depends on the type of injury and mechanism of injury. In many cases, there is no definite starting point for the pain, which also helps up determine a diagnosis. The symptoms commonly include pain with walking, pain when using stairs, instability when changing directions, swelling, stiffness, popping and catching.

We can generally diagnosis the source of your knee pain with a good history, physical exam, and X-rays. In some cases, advanced imaging such as an MRI is useful to confirm our suspicions and identify other issues that may be hidden.