FAQ Category: Knee

The knee has two main ligaments that criss-cross and stretch between the femur (thigh bone) and the tibia (lower leg bone). These are the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). Working together, the two cruciate ligaments control the back-and-forth motion of the knee.

The ACL keeps the tibia from sliding too far forward in relation to the femur. The PCL keeps the tibia from sliding too far backward. They PCL also controls how much the tibia rotates externally (outward direction). Besides the ACL and PCL, there are other ligaments, cartilage, and soft tissues that surround the knee to help give it strength and stability.

There are two ways the PCL gets injured most often. The first is much like your situation — in a car accident. The force of the impact slams the passenger’s bent knees into the dashboard. This high-velocity injury pushes the tibia back underneath the femur. The shear force is enough to rupture the PCL holding the tibia in place.

A second mechanism of injury (more common with athletes) occurs when the foot is planted on the ground and the knee hyperextends. Hyperextension means the joint is as straight as it can be and then a force pushes it into even more extension, thus the term hyperextension.

Although many people seem to function fine without an intact PCL, there can be long-term problems that develop as a result of the deficient joint. Early arthritic changes are the most common problem. Knee instability is another. Instability is seen as chronic knee pain and episodes of giving way when the knee goes out from under you. Both of these problems tend to develop as people get older and experience weakening of the quadriceps muscle or degenerative changes in the other supporting structures holding the knee together.

The decision to have surgery can be complicated with many things to consider. Many surgeons advise their patients to try a more conservative approach first. A program of strengthening and conditioning often goes a long way in protecting the knee and preventing instability. Usually a three- to six-month course of nonoperative care is enough to show you if this approach can be successful.

Having a physical therapist evaluate you and set up the program is a good idea. That way the exercises and suggestions can be tailored to your specific needs. You will be able to progress through successively more difficult exercises in order to build strength, improve coordination, and develop endurance. Most of this can be done as a home exercise program. If you are still having problems at the end of that time, then it might be time to reconsider the pros and cons of surgery.

Athletes suffer their fair share of tendon problems. Most often there’s knee pain from patellar tendon disorders or ankle pain from Achilles tendinopathy. Tendinopathy is another term for any disorder affecting the tendon.

Hamstring tendinopathy is a less common but equally disabling condition. Athletes involved in sprinting and middle- to long-distance running events are affected most often. The hamstring muscle is located along the back of the thigh. This muscle helps bend the knee and extend the hip. The muscle is made up of three main parts: the semimembranosus, semitendinosus, and the biceps femoris. The semimembranosus is the specific area affected by hamstring tendinopathy.

Surgery for buttock pain coming from the upper or proximal end of the hamstring is a possible treatment option. The surgeon cuts the affected tendon and muscle and allows them to retract (pull back) away from the bone.

Then the surgeon reattaches the tendon with sutures (stitches) to another part of the hamstring muscle (usually to the biceps femoris tendon). This is a way to shield the affected tendon from ongoing mechanical stress. The goal is to give the semimembranosus a chance to heal by protecting it from overuse.

The results can be very favorable, even allowing the athlete to return to sports activity at a level equal to participation before the condition developed. In a small number of cases reported tightness and pain persisted. The affected athletes had the operation repeated a second time with good results.

Bullet removal at the time of the initial surgery is accompanied by lots and lots of irrigation of the area. The surgeon uses a saline (salt) solution to flush the area thoroughly. Much time is spent making sure all debris and possible causes of contamination are removed.

It isn’t always necessary to remove bullet fragments. Often the body works very well to wall off the area around the bullet and protect the nearbly soft tissues. Lead toxicity is more likely when bullet fragments remain in the joint synovial fluid. The lead can leak into the joint fluid which is how it enters the blood stream. So any bullet fragments in the knee joint are carefully and completely extracted.

The body will eliminate any remaining lead through the liver and kidneys. It takes about 30 days for the body to clear itself of this substance. So if symptoms of lead toxicity are going to occur, it usually isn’t right away. The patient and family are advised to watch for symptoms such as fatigue, headache, or new onset of joint pain.

There can be gastrointestinal symptoms such as abdominal pain, nausea, vomiting, and/or constipation. Some patients report difficulty with memory, shortened attention span, and even unusual behaviors. Blood tests may show a particular kind of anemia called microcytic hypochromic anemia. If the kidneys cannot excrete all of the lead, kidney failure can develop.

Your son should remain under the care of his primary physician with periodic visits to the surgeons who operated on him as well. Don’t hesitate to report any unusual or new signs or symptoms. The earlier lead toxicity is recognized, the sooner treatment can be started and the better the response.

The hamstring muscle is located along the back of the thigh. It helps bend the knee and extend the hip. That’s why overuse from running with its repetitive hip and knee motion can cause hamstring problems. Athletes involved in sprinting and middle- to long-distance running events seem to be affected most often.

The muscle is made up of three main parts: the semimembranosus, semitendinosus, and the biceps femoris. The semimembranosus is the specific area affected by hamstring tendinopathy. Tendinopathy is another term for any disorder affecting the tendon.

No one knows exactly why the semimembranosus portion of the hamstrings tendon thickens and creates this painful condition. When other areas of the hamstrings are affected, recovery is faster than when the semimembranosus is involved. Perhaps this portion of the muscle has a slower or decreased healing capacity compared to the other parts of the muscle.

The results of lab studies of hamstring tendon tissue samples have been reported. Researchers examined the affected cells look under a microscope and compared them with normal tissue samples from the same area taken from one young athlete who had been treated for a fracture of the ischial tuberosity (bone where the hamstrings attach to the pelvis).

What they saw were changes in the cell structure to suggest tendon damage but not active inflammation. This was described as rounding of the tendon cell nuclei, increased ground substance (base material making up the tendon), and disintegration of the collagen (tissue) structure.

There were no signs of extra calcium, cartilage, or bone formation within the tissue samples. There were increased blood vessels to the area indicating an attempt by the tendon to heal itself. Added fat cells were interspersed between the bundles of collagen fibers. This suggests a degenerative process within the tendon. All of these findings were helpful in understanding why the semimembranous tendon looked thickened on MRI images.

That’s a good question and one that every patient should consider. The expectation is that your implant will last 10 to 15 years with moderate activity. It’s not designed to stand the rigors of multiple marathons — and most people in need of a knee replacement aren’t in that category anyway.

But doctors may define the success or failure of an implant differently. So that’s an important thing to look at. For example, some surgeons consider the implant a success if it doesn’t fail. That sounds rather simplistic.

What it means is that if the implant doesn’t need to be removed, replaced, or revised in some fashion, then it was a success. Infection, implant loosening, and bone fracture or fracture of the implant are the most common reasons for implant revision.

But patients may use a different measuring stick. They come into the surgery with severe, disabling knee pain. That’s why they wanted a new knee. They expect to come out of it pain free and able to engage in some of their former activities — or at least be more active. That may mean being able to walk unrestricted, ride a bike, go on a hike, dance, swing a golf club, or hit a few games of tennis.

What many people find is that they still experience mild-to-moderate levels of pain. A small number of folks report severe pain. Only about one-third of the patients providing information on pain in studies conducted are actually pain free.

More and more younger adults (younger than 60 years old) are getting total knee replacements (TKRs). Severe, disabling pain from degenerative joint disease is the main reason given for this type of surgery. And early reports indicate great success so far — a survival rate of the implant that was 82.2 percent for the first 15 years.

But some experts have called that survival rate into question. There is some evidence that those statistics may not represent the whole picture. Dr. Andrew J. Price and associates conducted a study with much less favorable outcomes. The reason for the difference is the type of measurement used to define success.

Most surgeons use revision as the end-point of the implant’s life. Infection and loosening are the usual reasons an implant must be revised, removed, or replaced. But that’s a surgeon’s idea of failure. Patients are more likely to use pain as a gauge of success vs. failure.

And the results of Dr. Price’s study showed that most patients report at least moderate pain in the years following knee joint replacement. They aren’t pain free after all. Using revision OR pain as a criteria for the endpoint in implant survival, the rates fell to less than 60 per cent.

Dr. Price points out that revision (for any reason, not just infection or loosening) and pain are just two variables that can be used as an end-point in determining success versus failure of implants. There are others as well. For example, function such as walking, going up or down stairs, getting up and down off the floor, and even running could be used as measures of outcome in younger patients.

More study is needed to gather data on younger patients getting total knee replacements. Using only one measure of outcomes (revision) may not provide all the necessary information needed to determine the success rate of total knee replacements in this age group. This means the current reported outcomes of total knee replacements in younger patients may be too optimistic.

Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur). A joint surface damaged by OCD doesn’t heal naturally. OCD mostly affects the femoral condyles of the knee. The femoral condyle is the rounded end of the lower thighbone, or femur.

Each knee has two femoral condyles, referred to as the medial femoral condyle (on the inside of the knee) and the lateral femoral condyle (on the outside). Like most joint surfaces, the femoral condyles are covered in articular cartilage. Articular cartilage is a smooth, rubbery covering that allows the bones of a joint to slide smoothly against one another.

The problem occurs where the cartilage of the knee attaches to the bone underneath. The area of bone just under the cartilage surface is injured, leading to damage to the blood vessels of the bone. Without blood flow, the area of damaged bone actually dies. This area of dead bone can be seen on an X-ray and is sometimes referred to as the osteochondritis lesion.

The lesions usually occur in the part of the joint that holds most of the body’s weight. This means that the problem area is under constant stress and doesn’t get time to heal. It also means that the lesions cause pain and problems when walking and putting weight on the knee. It is more common for the lesions to occur on the medial femoral condyle, because the inside of the knee bears more weight.

With a mild lesion, patients are treated conservatively (nonoperative approach). It sounds like that’s the course your son is on. Keeping weight off the damaged area helps keep blood flowing to the area and prevents further wear and tear of an already torn area. But repair and recovery can take weeks to months. Many athletes aren’t patient enough to wait it out but they must do so for a good result.

The surgeon will follow your son at regular intervals. X-rays will show the progress of healing and give you a better timeline to expect. Avoidance of sports activity and strict immobilization with non weight-bearing is absolutely essential for a good result.

You have asked the very same question that has come to light recently in a study from Poland. When surgeons are reconstructing the anterior cruciate ligament (ACL) of the knee, they often see damage to the joint surface. The area affected is called the articular cartilage. This is the cartilage that covers the joint and makes it possible for the two sides of the joint to slide and glide smoothly across each other.

There is a question about whether or not surgeons should go ahead and repair these cartilage (chondral) lesions. Does it make a difference in the results of the ACL repair? Maybe it doesn’t matter and it’s best to leave these defects alone. We just don’t know yet which approach is best.

In this study, surgeons compared results between two groups of ACL patients: those with a chondral defect and those without. The patients with just an ACL rupture but no chondral damage were considered the control group. Patients in the two groups were matched by age, sex, and type of chondral injury. In terms of the cartilage injury, each patient had one defect rated as a grade 3 or 4 — that’s moderate-to-severe.

Everyone in both groups was treated the same way. First they saw a physical therapist for a preoperative program of rehabilitation. Then, the surgeon reconstructed the ruptured ligament using a bone-tendon-bone graft. This means they took a piece of tendon from some other area of the leg and used it to replace the damaged ACL. Then everyone went back to rehab after surgery. They all completed the same program of exercises. The cartilage lesion was not repaired and no special measures were taken to rehab differently because of the chondral lesion.

Everyone was followed for 10 to 15 years to see what the long-term differences might be between the two groups. The authors were unable to see a measurable difference between the two groups. The location of the lesion didn’t seem to change anyones’ function after surgery.

X-ray findings weren’t significantly different between the two groups. And tests of function using the International Knee Documentation Committee (IKDC) scores showed no major differences from one group to the other.

They concluded that deep cartilage defects that occur along with ACL rupture can be left alone. Treating them or not treating them does not give better results. And these lesions don’t seem to contribute to further joint damage or degeneration.

The authors did say they would like to see more studies in this area before throwing the towel in on chondral lesions. It’s possible that some other (as yet unidentified) factor is important in the treatment decision about chondral lesions. Perhaps if we found a better way to treat the chondral lesions, the results would be improved.

Damage to the articular cartilage is fairly common with ACL tears. This is especially true in young, active athletes. Most of the lesions occur on the femoral condyle (bottom knob of the femur or thigh bone). Cartilage doesn’t have a very good blood supply so it doesn’t heal well. And we don’t have very good treatments yet to encourage proper healing.

There are probably more unanswered questions about cartilage injuries than answered questions. The size of the defect doesn’t seem to make a difference. According to some studies, the long-term effects are the same in patients with mild versus severe injuries.

The location within the joint articular cartilage doesn’t seem to matter either. But even when the lesions occurred on other locations than the femoral condyle, the final results after weren’t any different than for patients with femoral lesions.

Differences in knee function as measured by the International Knee Documentation Committee (IKDC) test didn’t show up based on location of the chondral lesions. X-rays didn’t really show any signs of knee joint degeneration but this may be because of the young age of the patients and the fact that signs of joint degeneration don’t appear until there is quite a bit of damage.

The jury is still out on whether or not to routinely repair chondral (cartilage) defects when doing a reconstruction surgery on the anterior cruciate ligament (ACL). There is plenty of evidence to support your surgeon’s recommendation. Each patient must be considered individually. A decision is made based on patient age, activity level, and type of injuries. The surgeon can review any pros and cons for your particular case.

Sometimes (like in your case) osteoarthritis of the knee only affects one side of the joint. When that happens, it’s called unicompartmental knee arthritis. Although either side of the joint can be involved, the medial joint (side closest to the other knee) is affected most often.

Surgical treatment for this problem could be with a tibial osteotomy. During this procedure, the surgeon removes a pie- or wedge-shaped piece of bone. The osteotomy may be an opening wedge tibial osteotomy or a closing wedge.

The difference is in the direction of the pie-shape. Open wedge is used to create distance between the two sides of the bone. The result is to shift the weight away from the side of the osteotomy. Closed wedge collapses the two edges of bone, thus shifting the weight toward the side of the osteotomy.

There are pros and cons with either technique. The goal is to shift the mechanical weight-bearing load away from the medial joint line and move the weight distribution more toward the middle of the joint. The intended result is to decrease joint pain and improve function.

The technique has been improved over the years, making it possible to preserve bone in younger, active adults. Later, you might be a good candidate for a unicompartmental knee replacement. Loss of correction and delayed bone healing are two concerns after tibial osteotomy surgery. You’ll want to ask your surgeon about your chances for any complications as well as what to expect in terms of recovery of motion and function.

The osteotomy procedure is most often used for patients who have osteoarthritis in only one side of their knee joint. The operation helps realign the knee joint and shifts the weight off the load bearing side. This operation may increase the life span of the joint and prolong the time before a knee replacement surgery becomes necessary.

There are two methods to realign the knee joint. One involves taking out a wedge of bone; the other involves adding a wedge of bone. In a closing wedge osteotomy, the surgeon cuts though the tibia (lower leg bone) on the lateral side (side of the leg away from the other leg). A pie-shape or wedge of bone is removed. Pins or a metal plate and pins are used to close the open edges back together.

In an opening wedge osteotomy, the surgeon cuts though the tibia on the medial side (side closest to the other knee) and opens a wedge, adding a bit of bone graft to hold the wedge open. The bone graft is usually taken from pelvis bone, through an incision in the side of your hip. The bone graft is held in position with a metal plate or pins.

In either procedure, care is taken to protect the nerves and blood vessels that travel across the knee joint. The surgeon uses either X-rays or a fluoroscope, a special kind of X-ray machine that casts images on a fluorescent screen, to make sure the wedge is the right size and is placed correctly.

The way the medical system works, yes, your husband has the right to refuse the antibiotics. However, the surgeon also has the right to refuse to do the surgery then because he may feel that by not taking the antibiotics, your husband is putting himself at a very high risk of developing an infection in the knee.

Knee replacement surgeries can result in deep infections that cause delayed healing, pain, and may possibly end up causing permanent damage. And, revisions of knee replacements do as well but to make it worse, their infection rate is higher. One way to reduce the risk of infection is to give antibiotics before the surgery and then after for a few days, up to a week.

This type of approach isn’t the misuse of antibiotics that you’ve been reading about. Doctors have been giving antibiotics for years to patients who will be having surgery and to them after, even if they don’t have an infection. This is because they’ve learned that this prevents certain infections from happening in the majority of cases. Even dentists do this for certain patients. If a patient has had a certain type of heart problem or surgery, he or she usually takes a few doses of antibiotics before seeing the dentist, in case any bacteria gets into the body through the dental work.

Hamstring injuries are fairly common in athletes or others participating in recreational sports. The injury can be fairly debilitating for a competitive athlete, requiring at least two weeks (and as much as six weeks) rest for recovery. And even with proper care, the recurrence rate for reinjury is fairly high.

There’s evidence that at least one-third of injured professional or amateur athletes older than 18 will reinjure themselves within the same season. The rate is much higher (60 to 70 per cent) for recurrence in future seasons.

Management of hamstring injuries usually centers on treating the acute injury and taking a look at risk factors. If any of those risk factors for injury can be modified, treatment should be directed toward doing so. This might be stretching and flexibility exercises for tight hamstrings or muscle retraining for muscle imbalances or muscle weakness.

It turns out the biggest risk factor for hamstring injury really is a previous hamstring strain. Athletes with at least one previous hamstring injury were two to six times more likely to have another similar (or worse) hamstring injury.

And most of those second injuries occurred soon after the first injury (within eight weeks’ time). But it’s not safe to say that if you have an initial injury and it’s been eight weeks without a second injury, that you won’t reinjure yourself. Many athletes suffer a reinjury even a year (or more) later.

The most success has been seen with functional rehab including progressive agility drills and trunk stabilization (core training) exercises. In the interest of your future sports participation, it might be wise to follow your coach’s advice. Use this time to restore normal movement and balance of the hamstring and quadriceps muscles. Participate in a functional rehab program that will prepare you for full return-to-sport at the end of your bench time. See it as an investment in your future sports career.

Athletes often ask about the use of knee bracing to prevent knee injuries or to prevent re-injury. There’s a lot of debate about this idea.

Some experts have expressed concern that bracing will cause the leg muscles to weaken and atrophy. Others think bracing will compromise speed and agility. Players often feel as though the brace gives them the support and protection they need to be able to play their best. But others complain that the brace holds them back and hampers their performance.

What’s the real truth about prophylactic (preventive) bracing? There isn’t much evidence from high-quality studies yet to guide us. What has been published so far shows that injury rates are lower for players at risk for medial collateral ligament (MCL) injury who wear a protective knee brace during practices and games.

While providing protection for the knee, the brace doesn’t really seem to limit function. That information should help put players’ fears to rest that their performance is negatively affected by the brace.

The next question seems to be: what kind of bracing should be used? Can an athlete using a prefab (off-the-shelf) garden-variety knee brace get the same kind of protection as someone wearing a more specifically designed type of brace? One study of eight commercially available knee braces showed a 20 to 30 per cent increase in knee stiffness and reduction of strain on the ligaments.

But another study reported decreased blood flow and oxygen to the muscles and joint in athletes wearing a brace to protect and prevent knee injuries. A study done on military recruits at West Point playing intramural tackle football showed fewer knee injuries in the cadets who were wearing a knee brace. Injuries were far fewer for players at risk of medial collateral ligament injuries (e.g., linebackers and tight ends).

Overall, it looks like there may be some benefit to wearing a knee brace to prevent medial collateral ligament injuries (the most commonly injured knee ligament). More studies are really needed to confirm this and prove that there are no limitations to knee function while wearing the brace.

More and more, folks are finding out that it takes longer to recover from injuries and surgeries than they necessarily have insurance coverage for. And in the case of anterior cruciate ligamentreconstruction, that’s not surprising because it can take months to regain full motion, strength, and proprioception (joint position awareness).

If you have any kinesiophobia (fear of movement and/or reinjury), it can take longer than that. So what is the optimal length of time for rehab after ACL reconstruction? What impairments (physical problems, loss of function) are present to keep the athlete from returning to sports full speed ahead?

As experts in the field of sports medicine and rehab, these are the questions physical therapists are asking. They would like to be able to formulate some guidelines for athletes to follow when entering a rehab program after their ACL reconstruction.

In a recent study from the University of Florida, several well-known therapists in this area found that pain intensity and fear-avoidance behaviors associated with kinesiophobia were holding patients back from full return-to-sports. They hope to continue studying this problem in order to identify who might need some help in this area right from the start.

In the meantime, when situations like this one come up, patients must be aware that they still have some important options. First, you can document your need for ongoing therapy and submit it to your insurance company. With a letter of support from the surgeon and your therapist, you may be able to get an extension on your coverage.

If that is denied, you can still make arrangements with the therapist for a payment plan that suits your budget. Combining a home program with an exercise program at the clinic can help extend the time between sessions with the therapist but still give you the supervision you need.

The unicompartmental knee arthroplasty (UKA) was designed to replace half the joint when only one side was worn away and arthritic. In its early days there were high rates of failure and revision surgeries. Today, studies show excellent medium-to-long-term results. There are fewer reoperations, less joint degeneration, and more evenly balanced knees. Plus patients have an increased chance to remain active (or increase activity level).

Improved surgical techniques have been demonstrated. In the early days of UKAs, it was easy to overcorrect a knee deformity and end up with a failed surgery. Getting the right patient, using the most appropriate implant for that individual, and maintaining proper limb alignment are now understood to be a necessary part of the equation for success.

Correct limb alignment refers to the fact that it can be very easy to insert the implant with too much rotation or tilt to one side or another. The surgery can be done with an open incision, which gives the surgeon a better view of the joint and easier time of aligning the implant.

Or it can be done as a minimally invasive procedure with just a three-inch incision. It’s harder for the surgeon to see what he or she is doing with minimally invasive surgery. But the fact that it can be done successfully with less disruption of the surrounding muscles makes the minimally invasive approach very attractive. The stay in the hospital is shorter and the cost is less.

Third, changes have been made in the implant design that have improved results. The polyethylene (plastic) platform that the implant sits on is thinner than it used to be. Finding the right balance of thickness has been a challenge that is yet to be overcome completely. The surgeon aims for correction of any deformities but tries to ere on the side of undercorrection instead of overcorrection.

The slope (or curvature) of the implant has been changed over the years. Surgeons were able to see that an increased slope led to a higher rate of implant loosening. And they’ve discovered that the slope makes a difference when the ACL isn’t present or is damaged. In such cases, an implant with a neutral slope is selected.

Different types of implants have been developed. Some sit right on top of the bone. These are called resurfacing designs. Others require a portion of the bone surface to be removed to make an inset design for the implant.

There’s also the fixed-bearing versus the mobile-bearing implant. This feature describes how much the implant pieces move and rotate against each other. The mobile-bearing unit seems to be winning out. It has a larger area of contact to spread out the load resulting in lower wear rates. Mobile-bearing units are more difficult to get the right balance of knee flexion and extension. This requires a perfect soft-tissue balance to achieve.

So you can see, there have been many improvements that might warrant consideration of this approach. You can rely on your surgeon for his or her best recommendations for you and your particular situation. Not all people are good candidates for this approach. Some people really do need a total knee replacement right off the bat.

Anterior cruciate ligament (ACL) tears are among the most common sports injuries — especially for females. With over 200,000 ACL injuries every year just in the United States alone, data on recovery is providing us with some clues as to why some athletes return to full play and others don’t.

In fact, we now know that up to half of all athletes who have ACL reconstruction don’t return to the same sports they participated in before surgery. And if they do, they function at a reduced level compared with their preinjury performance.

Why does this happen? Could your daughter be one of those athletes who never quite get back into the game? Studies show there may be several factors here. The first is the possibility that athletes are discharged from physical therapy too soon. Impairments such as loss of motion, strength, and proprioception (joint position sense) may not be restored enough to achieve full function again.

And sports that contribute to this type of knee injury often require motions such as cutting, pivoting, or jumping. Sometimes the athlete is afraid of reinjuring him or herself. They stop moving in ways that they think might cause pain or reinjury. This response to their first injury is called kinesiophobia.

Pain intensity and fear avoidance behaviors can lead to a difference between what patients think they can do and what they can really do. This shows up when test results are compared with what the patient reported being able to do. For example, by self-report, they will say they can’t hop on that leg or perform leg presses because they don’t have enough strength in that leg. But when a physical therapist tests their motion and strength, they perform better than expected.

In these cases, patient’s perception of their pain intensity and fear of movement limit function. Fear-avoidance behaviors of this type are commonly reported in studies on back pain. Fear-avoidance is considered a psychologic variable. The concept has been less well studied in knee injuries such as after ACL surgery.

Identifying the problem (whatever it turns out to be) and focusing some attention in overcoming any barriers to recovery may require some outside help. If these two areas (pain intensity and fear-avoidance behaviors) are holding her back, she may be a good candidate for some sessions with a physical therapist. The therapist can assess what’s going on and help her get back on target. If she’s just lost her drive and motivation, then that may be a different story requiring a different approach.

From your description, it sounds like you may have just experienced a grade I or II (mild) injury to the medial collateral ligament (MCL). Taking a step wrong or moving in just a way that causes a sudden, sharp pain along the inside (medial side) of the knee can result in a strain to the MCL.

The MCL is made up of several layers of fibers. Some fibers are parallel. Others angle down from the lower end of the femur (thigh bone) to the upper part of the tibia (lower leg bone). The ligament is made up of multiple layers of fibers that cross the knee joint. It protects the knee from injury along the inside edge when a force is applied to the outside or lateral edge of the joint.

MCL injuries are among the most common knee ligament injuries. Most of the injuries to the MCL occur when the knee is slightly bent or flexed. Most of the time, people don’t even bother going to the doctor for this. They just take it easy for a few days until the pain goes away.

Being overweight does put you at increased risk for complications and problems linked with having ligamentous damage to the knee. If this is a re-injury of a previous injury, there may be added ligament, cartilage, or other soft tissue injuries. Combined injuries challenge treatment and recovery.

But before you jump to any conclusions, it may be best to get a proper diagnosis. Even if surgery is not indicated, a clear idea of what’s wrong can help guide conservative (nonoperative) treatment. You may be a good candidate for a rehab program. A physical therapist will guide you through joint range-of-motion and strengthening exercises.

You will also be shown how to work on retraining the knee’s proprioception. Proprioception refers to the joint’s sense of its own position. With proper training, it’s possible to restore your knee’s ability to recognize and respond to even tiny movements. Improving proprioception can also help prevent future reinjuries.

Losing weight is still important as well. Though difficult for many people, every effort should be made to take weight off slowly and steadily. Weight loss reduces the stress on joints — especially the hips and knees, but also the ankles and feet. It can go a long way to preventing future injuries, uneven wear and tear on the joints, and osteoarthritis.

Gender may be a factor in how patients respond after anterior cruciate ligament (ACL) surgery. But there are other important factors at play here. Age, level of strength and activity, and body weight can make a difference. Younger age, higher level of function, and body mass index (BMI) close to normal are all helpful in getting a positive result. For example, if your wife is younger and more athletically active before surgery, these factors could help explain the difference.

Time between injury and date of surgery is also important. You mentioned your surgeries were only two weeks apart, but how long between the dates of injuries? Longer delays can turn an acute injury into a chronic one with more damage to the soft tissues and cartilage and greater instability. Recovery is also more complicated with longer delays.

And remember, people do recover after surgery and progress through rehab at different rates. Hopefully, things will smooth out and you’ll both have good long-term results.

A recent study of the long-term results after anterior cruciate ligament (ACL) show that even a loss of three to five degrees of knee extension can make a big difference. That loss alters the biomechanics of the joint. Uneven wear and tear can lead to arthritic changes in the knee. This effect is more pronounced when the meniscus or articular (joint) cartilage is damaged.

The experts agree that patients who want the best long-term results should persist with their efforts to gain full motion, strength, and stability. It may take a little extra time and effort but the end results will be worth it.