FAQ Category: Knee


What is the difference between an autologous chondrocyte implantation and an osteochondral allograft transplantation? I have a large cartilage tear that goes clear down to my bone and my surgeon is suggesting I have an osteochondral allograft transplantation.

An autologous chondrocyte implantation is a two-step procedure. The first portion involves harvesting cells from cartilage in your body and then growing them in a lab until there is enough for the repair site. The second step involves the actual placement of that tissue. An osteochondral allograft transplantation (OCA) is […]


I am the kind of person who gets every possible cold, flu, and virus that is going around. If there is a complication for anything — I get it. This concerns me because I am scheduled to have ACL surgery next week. I am taking extra vitamin C, avoiding sugar, and eating lots of greens in an effort to boost my immune system. Is there anything else I can do? What am I missing?

You may not be missing anything. The preventive measures you mentioned are all very important and will serve you well. According to a recent (very large) study from the Kaiser Permanent system, the overall infection rate after anterior cruciate ligament reconstruction is fairly low (0.48 per cent). That is less […]


Do you think it makes any difference whether I have a hamstring or patellar tendon graft for an ACL tear? I know that the patellar tendon graft sometimes makes it difficult to kneel after surgery. Are there any problems with the hamstring tendon graft?

The increased risk of an infection after a hamstring autograft for the reconstruction of an anterior cruciate ligament (ACL) is a potential concern. According to a recent study, the risk of infection is 8.24 times higher for someone receiving a hamstring tendon graft compared with a bone-patellar tendon-bone (BPTB) autograft. […]


What in the world caused me to develop a cruciate ligament ganglion cyst? I have never heard of such a thing before but the MRI was pretty clear as to what is the problem and why my knee has been hurting for so long.

Ganglion cysts involving the cruciate ligaments of the knee are fairly common ranging in prevalence from 0.2 per cent up to 1.9 per cent. Men are more likely to develop this type of cyst than women but the etiology (cause) is really unknown. There are several theories. One being that […]


I would like to know straight out what’s the prognosis for someone with a rare knee problem called a tibiofibular joint cyst? That’s what I have and what I’m going to get a second opinion about. But my cousin told me to check out your website first, so here I am.

Knee pain that turns out to be a proximal tibiofibular joint cyst is, indeed, fairly rare. The word proximal tells us the problem is at the knee rather than down by the ankle (since both the tibia and fibula — the bones in the lower leg — connect in both […]


What’s all the hype about preventing ACL injuries? The cross-town high school rivals are spending lots of time doing exercise programs to prevent knee injuries. We think it’s a more valuable use of time to get out there and run the plays to perfection. But I have to ask, is it really possible to get my players in better shape so they don’t crash and burn with ACL tears? Last season, we lost six key players to this problem. Please don’t mention the town where I live. Thanks.

It is estimated that one-quarter of a million ACL injuries occur each year in the United States. As you know, players can be sidelined for months (sometimes longer). This is a concern to many people at all levels from high school to professional sports. Preventing ACL injuries not only protects […]


I’m working with a group of green college freshman on our community college basketball team. I’ve been reading on the Internet that ACL injuries are on the rise but can be prevented. What can you tell me about this? I’d like to start these guys out right this year.

Researchers at the University of Michigan (Ann Arbor) have performed a systematic review and meta-analysis on ways to prevent anterior cruciate ligament (ACL) injuries. This is important because so many of today’s sports injuries affect the ACL. Players can be sidelined for months (sometimes longer). In fact, it is estimated […]


I am having a debate with my parents over whether or not my grandparents (who are both in their 80s) should have joint replacements. I see this as a huge cost to society (myself as a tax payer) with very little return. So they feel better for a few years before they die. This may sound heartless but when I saw the cost of one knee replacement (in the thousands), I couldn’t help but wonder. What’s the current thinking on this one?

With more and more adults getting knee replacements, analysts are taking a closer look at the costs versus benefits to the individual patient and to society. Society can include employers and insurance providers (payers). You are a part of “society” in this sense if you pay taxes that finance Medicare, […]


When news reports talk about indirect cost savings of surgery (like I heard one report on how knee replacements cost millions each year but save taxpayers billions), what are they referring to? I’m considering a knee replacement and I would like to save as much money as possible. Maybe this will help me.

There are three ways to evaluate the “cost” of surgical versus conservative care for knee osteoarthritis: 1) direct costs, 2) indirect costs, and 3) quality of life measures. Direct costs include any and all medical expenses for any treatment (surgical or nonsurgical) provided. Indirect costs refer to lost wages when […]


Years ago, I was in a car accident and damaged the posterior cruciate ligament of my right knee (hit it against the glove box on the passenger side). I opted NOT to have surgery but now I’m wondering if that was such a good idea because that knee is getting pain from arthritis. Is this a typical pattern with these kinds of injuries as time goes by?

You are asking about something physicians refer to as the natural history of an injury. In other words, what happens over time? In your case, the question is what is the natural history of an injury to the posterior cruciate ligament (PCL) when treatment is conservative care? Currently, surgeons are […]


Is it possible to rehab a PCL injury and still remain active? I like to golf, play tennis, and even pickup a game of basketball now and then. The knee doesn’t bother me all the time — it just seems to flare up occasionally. I don’t really want surgery but if that’s what it takes to keep on going, so be it. I’ve had this injury for quite a while now and have just been sitting on it so-to-speak without doing anything.

The posterior cruciate ligament (PCL) is one of two ligaments that criss-cross inside the knee joint to hold the two leg bones (femur and tibia) together. The second (more commonly injured) ligament is the anterior cruciate ligament (ACL). These two ligaments provide stability to the knee joint while still allowing […]


I’ve heard that if I have both knees replaced at the same time (for severe arthritis), the cost is less but the risks are higher. What can you tell me about this?

As you point out, the proposed advantages of the simultaneous bilateral knee replacements are decreased costs and shorter recovery time. Previous studies have reported more complications with simultaneous knee replacements compared with staged procedures. Problems such as gastrointestinal complications, blood clots, heart attacks, and even death can occur. A recent […]


My husband is going to have a unicompartmental knee replacement next week. I didn’t go with him to the doctor’s but he came back with a glowing report on why it should be done without cement. Does this seem like the best way to go to you? If I question my husband, he will only get angry but I’d like to know he’s really getting the right thing.

In a recent study, orthopedic surgeons from the United Kingdom proved for themselves that cementless unicompartmental knee replacements are as good (if not better) than cemented implants of the same type. They compared two groups of patients: 32 who received the cemented Oxford unicompartmental knee replacement and 30 others who […]


Can you help me sort out two things? I’ve been advised by my orthopedic surgeon to have a unicompartmental knee replacement (thing number one: should I do it?). A cementless implant will be used (instead of cement). That’s thing number two: is cementless better?

Patients most likely to receive a unicompartmental knee replacement have osteoarthritis that is painful and severe affecting the front and inner half (side closest to the other knee). This would be labeled end-stage osteoarthritis. Diagnostic examination of the knee joint would show full-thickness loss of cartilage in the medial compartment […]


I read somewhere that being young (less than 18) and female increases my risk of a re-tear of an ACL repair (which I had done about six months ago). Can you tell me why these two things are the reason for another injury? I am both female and turning 18 this year and I definitely don’t want to go through this again!

Most people who have surgery to reconstruct a ruptured anterior cruciate ligament (ACL) expect that procedure to be the only one they have done on the knee. But unfortunately, there is a group of patients who end up needing a second knee surgery — and even sometimes surgery on the […]