KNEE

ACL Injury Treatment | ACL Reconstruction | Knee Surgery

ACL Injury

The ACL (anterior cruciate ligament) is one of the most commonly injured ligaments in the knee. Running diagonally through the middle of the joint, the ACL works together with three other ligaments to connect the femur (upper leg bone) to the tibia (lower leg bone). People who play sports that are likely to damage the knee — such as basketball, football, skiing and soccer — are at greatest risk for injuring the ACL. Only about 30% of ACL injuries result from direct contact with another player or object. The rest occur when the athlete decelerates while cutting, pivoting, or sidestepping; lands awkwardly; or plays recklessly. About half of ACL injuries are accompanied by damage to the meniscus, cartilage, bone or other ligaments in the knee.

Signs that you may have injured your ACL include pain, swelling and instability immediately after the injury, followed hours later by greater swelling and pain, limited motion, tenderness and an inability to walk comfortably.

ACL Reconstruction

A tear in the anterior cruciate ligament (ACL) is one of the most common knee injuries. An injury to this ligament causes the knee to become unstable and the joint to slide forward too much. ACL tears occur most often in athletes.

ACL reconstruction is usually not performed until several weeks after the injury, when swelling and inflammation have been reduced. The torn ligament is completely removed and replaced with a new ACL. Simply reconnecting the torn ends will not repair the ACL. Part of another ligament, usually from the knee or hamstring, is used to create a graft for the new ACL. Choosing the proper type of graft depends on each patient’s individual condition.

ACL surgery requires a few months for full recovery and physical rehabilitation will be needed as well. Surgery is not required for all ACL injuries. Talk to your doctor to find out if ACL reconstruction is right for you.

Bursitis

Our joints contain small, slippery sacs called bursae that help muscles and tendons slide smoothly over our bones. Bursitis is the inflammation (swelling) of one of these sacs. Overuse or constant pressure on the knee causes the bursa to fill with fluid. It then becomes irritated, gritty and rough, and can create friction in other parts of the joint as it swells.

Two common sites for bursitis in the knee are the kneecap (prepatellar bursitis) and the pes anserine (“goosefoot”) bursa, located about two inches below the knee where the shinbone meets three tendons from the hamstrings. Pes anserine bursitis often afflicts runners and other athletes as well as people with osteoarthritis (“wear and tear” arthritis), tight hamstrings, obesity, or turned-out knees or lower legs. Symptoms include pain on the inside of the knee or at the top of the shinbone that gets worse with exercise or stair-climbing. Prepatellar bursitis tends to occur in people whose jobs involve long periods of kneeling, who play sports that frequently involve falling or being struck on the knee, who have been in a car accident, or who have rheumatoid arthritis or gout. Symptoms include pain after activity and swelling and tenderness on the kneecap.

Knee Arthroscopy

Knee arthroscopy is a minimally invasive procedure that allows doctors to examine tissues inside the knee. It is often performed to confirm a diagnosis made after a physical examination and other imaging tests such as an MRI, a CT scan or X-rays.

During knee arthroscopy, a thin fiberoptic light, magnifying lens and tiny television camera are inserted into the knee, allowing your doctor to examine the joint in great detail.

For some patients, it is then possible to treat the problem using a few additional instruments inserted through small incisions around the joint. Sports injuries are often repairable with arthroscopy. Knee injuries that are frequently treated using arthroscopic techniques include meniscal tears, mild arthritis, loose bone or cartilage, ACL and PCL tears, synovitis (swelling of the joint lining) and patellar (knee cap) misalignment.

Because it is minimally invasive, knee arthroscopy offers many benefits to the patient over traditional surgery. These include:

  • No cutting of muscles or tendons
  • Less bleeding during surgery
  • Less scarring
  • Smaller incisions
  • Faster recovery and return to regular activities
  • Faster and more comfortable rehabilitation

Knee arthroscopy is not appropriate for every patient. Your doctor will discuss which options are best for you.

Knee Replacement

The knee is a hinge joint where the thigh bone (femur) and the bone of the lower leg (tibia) meet. Arthritis (particularly osteoarthritis) and certain knee injuries and diseases can damage the cartilage that normally cushions the joint, leading to pain and stiffness. A knee replacement may be recommended when more conservative treatments — such as anti-inflammatory medications and cortisone injections — fail to relieve pain or improve movement.

During a total knee replacement, the entire joint is replaced with an artificial prosthesis. The end of the femur is replaced with a metal shell. Then the end of the tibia is fitted with a plastic cup and a metal stem that fits into the shell on the femur. This reduces friction in the joint, easing pain and allowing a greater range of movement. The main ligament of the knee (the posterior cruciate ligament) may be left in place, removed or replaced with an artificial post. The kneecap may also be replaced with, or supported by, a piece of plastic. The surgery itself lasts between one-and-a-half and three hours.

After the procedure, the patient rests in a recovery room and then in a hospital room. Patients usually experience immediate relief from the joint pain suffered before the replacement. However, there will be some post-operative discomfort. Physical therapy starts right away to speed healing and to ensure that the patient enjoys full use of the joint. Therapy progresses from use of walkers and crutches to walking on stairs and slopes, with home exercises to supplement formal sessions. In addition, continuous passive motion (CPM) machines can reduce recovery time and the risk of muscle contracture without straining the joint.

Knee replacements today last about 20 years in 85-90% of well-selected patients.

Arthroscopic Knee Surgery

Arthroscopy offers patients many benefits over traditional surgery, including no need to cut muscles or tendons, less bleeding, smaller incisions and shorter recovery times. However, arthroscopy is not appropriate for all patients. Your doctor will decide whether or not arthroscopy is right for you.

Some knee conditions that can often be treated through arthroscopy include meniscal tears, ACL or PCL tears, synovitis, patellar misalignment, arthritis and more. During the arthroscopy procedure, a thin tube with a camera on the end (arthroscope) is inserted into the joint, along with several tiny surgical instruments so that your surgeon can adequately visualize the area while repairing any damage that is found.

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