Injuries and disorders of the knee represent one of the more common problems seen by the orthopedic surgeon. Inadequate and painful knee function can be very disabling and severely alter one's daily activities. Knee disorders may be severe enough to prevent walking, or may prohibit fine control necessary for work or sports activities. The specialists at AOKC utilize the most advanced techniques to get you back on your feet, including state of the art arthroscopic techniques.
How do the Knees Work?
The knees provide stability for the body and allow legs to bend and straighten. Both flexibility and stability are needed for standing and for motions like walking, running, crouching, and jumping.Several kinds of supporting and moving parts, including bones, cartilage, muscles, ligaments, and tendons help the knees to do their job. Any of these parts can be involved in pain or dysfunction.
What Causes Knee Problems?
There are two general kinds of knee problems: mechanical and inflammatory.
Mechanical Knee Problems: Some knee problems result from injury, such as a direct blow or sudden movements that strain the knee beyond its normal range of movement. Other problems, such as osteoarthritis, result from wear and tear.
Inflammatory Knee Problems: Inflammation that occurs in certain rheumatic diseases, such as rheumatoid arthritis and systemic lupus erythematosus, can damage the knee.
Common Knee Injuries and Problems
Arthritis
Arthritis of the knee is most often osteoarthritis. In this disease, the cartilage in the joint gradually wears away. In rheumatoid arthritis, the joint becomes inflamed and cartilage may be destroyed. Arthritis affects joints as well as supporting structures such as muscles, tendons, and ligaments.
Osteoarthritis may be caused by excess stress on the joint from deformity, repeated injury or irritation, excess weight, or heredity. Rheumatoid arthritis often affects people at an earlier age than Osteoarthritis.
Symptoms – Pain, swelling, and decrease in range of motion are common complaints. Other common symptoms are morning stiffness, joint locking, and stiffening.
Treatment – Osteoarthritis is most often treated with pain-reducing medications, such as nonsteroidal anti-inflammatory drugs. Losing weight may also help. Rheumatoid arthritis may require physical therapy and stronger medications. Joint replacement is also an option. Recently, new technological advances have been made in treating all forms of arthritis with magnetic resonance imaging.
Meniscus Injuries
The meniscus is easily injured by the force of rotating the knee while bearing weight. A partial or total tear may occur when a person quickly twists or rotates the upper leg while the foot stays still. If the tear is tiny, the meniscus stays connected to the front and back of the knee; if the tear is large, the meniscus may be left hanging by a thread of cartilage. Serious depends on location and extent of the tear.
Symptoms – Mild to severe pain at point of injury, especially when leg is straightened. Swelling is likely, and knee may click, lock, or feel weak.
Treatment – Most patients will benefit from a muscle-strengthening physical therapy regimen. For more extensive tears, arthroscopic or open surgery may be required.The meniscus may be repaired or removed and replaced with an allograft.
Ligament Injuries
1. ACL & PCL: The Anterior Cruciate Ligament (ACL) is most often stretched or torn (or both) by a sudden twisting motion. The Posterior Cruciate Ligament (PCL) is most often injured in direct impact, such as a car accident or football tackle.
Symptoms – Injury to a cruciate ligament may not cause pain. Popping and buckling are common. An MRI will accurately detect a complete tear, but arthroscopy may be the only reliable means of detecting a partial one.
Treatment – For an incomplete tear, patients will benefit from bracing and physical therapy. For a complete tear, especially in athletes and active people, surgery is recommended, with reconstruction using allografts or autografts.
2. MCL & LCL: The Medial Collateral Ligament is more often injured than the Lateral Collateral Ligament. The cause is most often a blow to the outer side of the knee that stretches and tears the ligament on the inner side of the knee. Such blows occur frequently in contact sports.
Symptoms – When a collateral ligament is injured, a pop and sideways buckle may occur. Pain and swelling are common.
Treatment – Most sprains will heal with Physical Therapy, and bracing and ice packs will help. Severely sprained or torn ligaments require surgical repair.
Tendon Injuries and Disorders
1. Tendonitis and Ruptured Tendons: These injuries may be caused by inflammation or tear. Overuse contributes to inflammation. Also, trying to break a fall may cause the quadriceps muscles to contract and tear the quadriceps tendon above the patella (kneecap) or the patellar tendon below the patella. Tendonitis of the patellar tendon is sometimes called Jumper’s Knee because in sports that require jumping, the muscle contraction and force hitting the ground after a jump strain the tendon. After repeated stress, the tendon may become inflamed or tear.
Symptoms – Repeated tenderness at the point where the patellar tendon meets the bone. Pain may be present, as well as difficulty bending, extending, and lifting the leg.
Treatment – Rest, Ice, Compression, Elevation. Anti-inflammatory medicines also help. For complete tears, surgery is required to reattach the ends of the tendon. For partial tears, only a cast may be applied without surgery. Physical Therapy restores strength.
2. Osgood-Schlatter Disease: Caused by repetitive stress or tension on part of the growth area of the upper tibia (the apophysis). May also be associated with an injury in which the tendon is stretched so much that it tears away from the tibia and takes a fragment of the bone with it. Commonly occurs in younger people.
Symptoms – Pain just below the knee that worsens with activity and is relieved by rest. A bony bump below the kneecap may occur.
Treatment – Rest, Ice, Compression, Elevation. Limitation in vigorous sports may be advised and bracing or use of knee pads may be recommended.
3. Iliotibial Band Syndrome: This is usually an overuse syndrome which causes inflammation, although it may be caused by direct injury to the knee.
Symptoms – Aching or burning at the sides ofthe knee during activity. Pain may also localize at the side of the knee or radiate up the side of the thigh. The patient may feel a snap when bending the knee and there is usually no swelling.
Treatment – Rest, Ice, Compression, Elevation. In rare cases where the syndrome does not resolve, surgery is necessary to split the tendon so it isn’t stretched so tightly over the bone.
More about Arthroscopic Surgery
What is knee arthroscopy? Knee arthroscopy is an operative procedure which allows the surgeon to look directly inside the knee. Using small incisions, the arthroscope is inserted into the knee, and images are transmitted by a camera to a T.V. monitor. This produces an actual picture of the interior of the knee.
How is arthroscopy used? Knee arthroscopy is used basically in three ways. The first is diagnostic arthroscopy, that is, to look inside the knee to make a diagnosis. The second is operative arthroscopy, actually performing a surgical procedure with the arthroscope and small instruments. Finally, the arthroscope may be used in combination with extensive surgery as part of a reconstructive procedure.
What are the advantages of arthroscopic surgery? With the use of the arthroscope, many types of procedures can be done without having to make large incisions into the knee. As a result, arthroscopic procedures can usually be done as an outpatient, (the patient goes home the same day as the surgery). Without large incisions, the surgery is less painful and the recovery is much quicker.
What types of problems can arthroscopy help? The most common use of arthroscopy involves treatment of meniscal lesions. The menisci are “cartilage” structures within the knee which can tear and cause pain or restrict motion.
The arthroscope is also used to remove “loose bodies”, which are pieces of bone and/or cartilage which are free within the knee. “Loose bodies” may arise from injury or degenerative changes within the knee.
Certain patella, (“kneecap”) problems are also treated with the arthroscope. These include chondromalacia, which is a roughness or irregularity under the patella, producing pain. In addition, some types of patella alignment problems can also be treated with arthroscopic surgery, either alone or in combination with more extensive surgery.
Ligaments are structures that attach bones together, and are major components of the knee joint. The arthroscope can be used to diagnose injuries to ligaments inside the knee. In some cases, arthroscopic surgery is an important component of ligament reconstructive surgery.
Other applications of the arthroscope include the treatment of certain fractures, arthritis, infections, and diseases that involve the knee joint lining.
Is arthroscopic surgery limited to the knee? Although arthroscopy was first used for knee problems, refined techniques and improved instruments have expanded the uses of arthroscopy. Today, other joints are being arthroscoped with increasing frequency, including the shoulder, ankle, wrist, and elbow.
What are the limitations of arthroscopy? Arthroscopy has many uses, but it is not the perfect solution for every condition. Successful use of the arthroscope involves selecting the right patient with the right problem for arthroscopic treatment. In addition, full recovery includes a period of healing followed by rehabilitation.
Overall, arthroscopic knee surgery has produced a major advancement in the treatment of knee injuries and knee disorders. As an out-patient procedure, with decreased recovery time, many patients are able to resume work and sports activities in a short period of time. In today's active and demanding society, the arthroscope is an invaluable tool in diagnosing and treating knee disorders.
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"I cannot thank you enough these last few months for all the attention you have given me and for all the care of my knees. I have told everyone that the Athletic Orthopedics & Knee Center is the best of the best! I am forever grateful as I know without everyone's help, I would never have been able to walk again! Thank you for everything!"
Sincerely,
Diane M., 13 August 2007
This content of this page is intended for educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment for any medical condition. Never disregard professional medical advice or delay in seeking it. If you think you may have a medical emergency, call 911 immediately. If you are suffering from any type of knee injury, please call the specialists at AOKC to schedule an appointment today!
