DESERT ORTHOPEDICS

Knee

Knee conditions are a common orthopedic complaint and include both acute and chronic injuries. Common symptoms include pain, swelling and instability. Acute injuries can range from minor strains to ligamentous cartilage or meniscal damage. Chronic conditions include arthritis and musculoskeletal imbalances. At Desert Orthopedics our goal is to get you back to activity, work or play.

The knee is the largest joint in the body. Nearly normal knee function is needed to perform routine everyday activities. The knee is made up of the lower end of the thigh bone (femur), which rotates on the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. Large ligaments attach to the femur and tibia to provide stability. The long thigh muscles give the knee strength.

The joint surfaces where these three bones touch are covered with articular cartilage, a smooth substance that cushions the bones and enables them to move easily.

All remaining surfaces of the knee are covered by a thin, smooth tissue liner called the synovial membrane. This membrane releases a special fluid that lubricates the knee which reduces friction to nearly zero in a healthy knee.

Normally, all of these components work in harmony. But disease or injury can disrupt this harmony, resulting in pain, muscle weakness, and less function.

ACL INJURIES

When you twist your knee or fall on it, you can tear a stabilizing ligament that connects your thighbone to the shinbone. An anterior cruciate ligament (ACL) unravels like a braided rope when it’s torn and does not heal on its own. Fortunately, reconstruction surgery can help many people recover their full function after an ACL tear.

Ligaments are tough, non-stretchable fibers that hold your bones together. The cruciate ligaments in your knee joints crisscross to give you stability on your feet. People often tear the ACL by changing direction rapidly, slowing down from running or landing from a jump. Young people (age 15-25) who participate in basketball and other sports that require pivoting are especially vulnerable. You might hear a popping noise when your ACL tears. Your knee gives out and soon begins to hurt and swell.

First treatment includes rest, ice compression and elevation (RICE) plus a brace to immobilize the knee, crutches and pain relievers. Get to your doctor right away to evaluate your condition.

ACL Evaluation

Your doctor may conduct physical tests and take X-rays to determine the extent of damage to your ACL. Most of the time, you need reconstruction surgery. Your doctor replaces the damaged ACL with strong, healthy tissue taken from another area near your knee. A strip of tendon from under your kneecap (patellar tendon) or hamstring may be used. Your doctor threads the tissue through the inside of your knee joint and secures the ends to your thighbone and shinbone.

In a few cases when the ACL is torn cleanly from the bone it can be repaired. Less active people may be treated nonsurgically with a program of muscle strengthening.

ACL Outcomes

Successful ACL reconstruction surgery tightens your knee and restores its stability. It also helps you avoid further injury and get back to playing sports. In the U.S., doctors see more than 95,000 ACL tears each year and perform about 50,000 ligament reconstructions. The surgeries are successful about 85-92 percent of the time.

After ACL reconstruction, you’ll need to do rehabilitation exercises to gradually return your knee to full flexibility and stability. Building strength in your thigh and calf muscles helps support the reconstructed structure. You may need to use a knee brace for awhile and will probably have to stay out of sports for about 6 months after the surgery.

One of the most commonly injured parts of the knee, the meniscus is a wedge-like rubbery cushion where the major bones of your leg connect. Meniscal cartilage curves like the letter "C" at the inside and outside of each knee. A strong stabilizing tissue, the meniscus helps the knee joint carry weight, glide and turn in many directions. It also keeps your femur (thighbone) and tibia (shinbone) from grinding against each other.

MENISCUS INJURIES

Football players and others in contact sports may tear the meniscus by twisting the knee, pivoting, cutting or decelerating. In athletes, meniscal tears often happen in combination with other injuries such as a torn ACL (anterior cruciate ligament). Older people can injure the meniscus without any trauma as the cartilage weakens and wears thin over time, setting the stage for a degenerative tear.

Signs and Symptoms of Meniscus Tears

You might experience a "popping" sensation when you tear the meniscus. Most people can still walk on the injured knee and many athletes keep playing. When symptoms of inflammation set in, your knee feels painful and tight. For several days you have:

-Stiffness and swelling 

-Tenderness in the joint line.

-Collection of fluid ("water on the knee").

Without treatment, a fragment of the meniscus may loosen and drift into the joint, causing it to slip, pop or lock—your knee gets stuck, often at a 45-degree angle, until you manually move or otherwise manipulate it. If you think you have a meniscal tear, see your doctor right away for diagnosis and individualized treatment.

Diagnosis of Meniscus Tears

Be sure to tell us exactly what happened and when. We may conduct physical testing to evaluate the extent of your meniscal tear. We may need X-rays to rule out osteoarthritis or other possible causes of your knee pain. We may use a magnetic resonance imaging scan to get a better look at the soft tissues of your knee joint. Your doctor may also use a miniature telescope (arthroscope) to see into your knee joint, especially if your knee locks.

Menisci tear in a number of different ways:

-Young athletes often get longitudinal or "bucket handle" tears if the femur and tibia trap the meniscus when the knee turns.

-Less commonly, young athletes get a combination of tears called radial or "parrot beak" in which the meniscus splits in two directions due to repetitive stress activities such as running.

-In older people, cartilage degeneration that starts at the inner edge causes a horizontal tear as it works its way back.

Non-Surgical Meniscus Treatment

Initial treatment of a meniscal tear follows the basic RICE formula: rest, ice, compression and elevation, combined with nonsteroidal anti-inflammatory medications for pain. If your knee is stable and does not lock, this conservative treatment may be all you need. Blood vessels feed the outer edges of the meniscus, giving that part the potential to heal on its own. Small tears on the outer edges often heal themselves with rest.

Surgical Meniscus Treatment

If your meniscal tear does not heal on its own and your knee becomes painful, stiff or locked, you may need surgical repair. Depending upon the type of tear, whether you also have an injured ACL, your age and other factors, your doctor may use an arthroscope to trim off damaged pieces of cartilage.

A cast or brace immobilizes your knee after surgery. You must complete a course of rehabilitation exercises before gradually resuming your activity.