FAQ Category: Knee

A mild-to-moderate strain of the hamstring muscle usually only involves one of the several tendons of that muscle. A tiny tear occurs where the muscle and tendon blend together. This is called the musculotendinous junction.

In cases like this, nonsurgical treatment (conservative care) is advised. This consists of rest, ice, and antiinflammatory drugs. A physical therapist can help with the use of heat, electrical stimulation, stretching, and exercise.

Most soft tissues take about six weeks to heal. You can certainly play during this time if you feel up to it, but you risk reinjury and a worse situation. Complete rupture of the tendon will likely require surgery to repair it.

Return to play takes much longer after surgical treatment. The average time to return to full function or sports activity after surgery has been reported around 8.5 months.

You can return to full sports participation when the strength of the injured leg is equal to 80 per cent of the uninjured side. This is a safe measure to use for both a strain treated conservatively and for a rupture treated surgically. The therapist has several ways to test the muscle for loss or return of strength.

You may have strained or even ruptured one or more of the tendons to the hamstring muscle. The hamstring is the large muscle along the back of the thigh. It bends the knee and extends the hip.

You didn’t mention any problems with walking. Most people with a strain or complete rupture have trouble walking normally. It hurts to bend the hip and knee. They end up using a stiff-legged gait pattern to get around.

A medical exam would be a good idea. The hamstrings are deep and not easily palpated for tenderness. An ultrasound or MRI may be needed to see if anything has been seriously injured or damaged. MRI is especially helpful to identify what has happened and how serious is the injury.

Most of the time, a single tendon torn will only retract or pull away slightly. Then it reattaches itself to the other tendons. When two or three of the tendons are ruptured, they may even pull away from the bone with a small piece of bone still attached. For the best results, this type of injury requires surgical repair.

An orthopedic surgeon may be the best one to advise you. Conservative care may be all that’s needed. But if surgery is indicated, the sooner it’s done, the better the results will be. Delayed treatment can result in loss of function and strength.

Total knee replacements are usually done because a patient has severe osteoarthritis or rheumatoid arthritis of the knee, or has had a severe trauma or injury to the knee that is causing a lot of pain and difficulty with movement.

Your mother’s doctor may have looked at the amount of pain she is experiencing when she walks and how it may be limiting her life. If she can’t walk without a significant amount of pain, or has difficulty going up and down stairs, or getting in and out of chairs, this can be affecting her quality of life. If her pain is severe even when resting and she’s not responding to pain relievers, this can affect how she sleeps and even how she feels about herself.

It could be that other treatments, like physiotherapy, have also been tried but without much success.

Immobility and social isolation are big problems among our older citizens and it’s important for them to be able to maintain their independence as long as possible.

Of course, your mother’s doctor will also ensure that she is healthy enough to undergo such a surgery.

You should ask your doctor about the post-surgery routine at your hospital. There may be a patient education booklet that outlines what will be happening but there are some general things for which you can prepare.

There will be pain afterwards, as with most surgeries. Be sure to discuss with your doctor and, importantly, the nurses about how often you can take your pain medication. It is not in your best interest to try to be stoic and not take the pain medication if you need it. If the pain is bad, you will likely not move your leg enough to be able to recover quickly.

Because of the general anesthetic, you will be asked to do deep breathing and coughing; this is to make sure your lungs are clear. YOu may also be taking medications to thin your blood to prevent clots. As your doctor or nurses to explain to you about the particular drug you are taking.

If you are prescribed support hose or compression boots, be sure to use them as instructed as they will help decrease the chances of developing a blood clot. You will likely be encouraged to do gentle leg exercises and you may have a machine called a continuous passive motion (CPM) machine. Finally, you will likely be seen by a physiotherapist who will teach you how to get in and out of bed and walk safely, as well as provide you with some specific exercises to help you regain movement in your knee.

Your friend may have received the Oxford unicompartmental knee replacement surgery. The implant is actually manufactured in England (where Oxford is located) but distributed in the United States by the Biomet Company in Indiana.

This implant works very well when used in the right patient. There is a long list of patients who should not be given this implant. The four most important factors include:

Unicompartmental knee replacement (UKR) is possible today. The surgeon is able to remove the damaged joint on one side and replace it with an implant that just fits one side.

Most of the time, the medial compartment of the knee joint is the problem. That’s the side of the joint closest to the other knee. The UKR is also available for patients with lateral compartment arthritis. This is the side away from the other leg.

With the right implant, you should have excellent results. Some implants work better for certain patients. Your surgeon will review your case carefully and choose the best replacement components.

You can expect the implant to last at least 10 years. Studies show that many people still have a good fitting, long-lasting implant up to 15 years or more. Revision surgery is needed if the implant comes loose, a bearing dislocates, or arthritis progresses to the other side of the joint.

Only a small number of patients with knee OA need to see a specialist. Most often it’s to see an orthopedic surgeon for a joint replacement. In the early stages of osteoarthritis (OA), a management program is advised. Your family doctor or primary care physician is best for this.

A management program will include patient education, exercise, and sometimes, over-the-counter drugs. Prescription drugs may be needed for severe pain or major disease flare-ups. Patient education starts with giving the patient information about the condition, what to expect, and what to do.

Weight loss and exercise are the two most important steps in treating and managing OA. A physical therapist can help your father match his interests with the right kind of exercise for OA. A program of low-impact exercise combined with moderate resistance training is best.

Your family doctor will continue to follow his progress and make adjustments as needed. If a specialist is needed, he or she will direct you to the right one at the right time. Don’t hesitate to ask if and when this might be needed.

The ACL injury, or a rupture of the anterior cruciate ligament, is a common knee injury. It can happen while you are playing a contact sport like football or rugby, or as your friend found out, just by running. It can be caused by changing directions quickly or coming to a quick stop, for example. It also seems that more women can develop a ruptured ACL than men.

If a knee injury occurs, early symptoms of an ACL rupture can be a popping noise coming from the knee, severe pain, and swelling. Of course, care should be taken not to make the injury worse. You can use ice and elevate the leg to reduce swelling of the knee. If permitted an NSAID (non-steroidal anti-inflammatory drug) like ibuprofen or naproxen may help too. You should get the knee checked by a doctor to evaluate the seriousness of the injury. You may need to wear a brace or splint to keep knee movement to a minimum, and you may need physiotherapy to help your knee regain full range of motion.

Accelerated rehab following ACL reconstruction may vary from clinic to clinic. There can be differences even from surgeon to surgeon within a single clinic. The general consensus is that patients can start muscle contractions immediately after surgery.

The physical therapist will meet with you and guide you through isometric contractions of the quadriceps and hamstring muscles to start. The program progresses quickly from there.

You’ll be instructed in how to walk with crutches while putting some weight on the operated leg. You’ll be encouraged to increase weight-bearing as much as possible, and get rid of the crutches as quickly as possible. Some patients use a cane when making the transition from crutches to no crutches.

Bracing is not used in an accelerated rehab program. The focus is on getting full extension by the 14th day after surgery. You’ll be able to start jogging after six weeks. Returning to competitive sports is still at least six months away after the surgery. The knee must be stable on testing to participate.

Long-term studies of anterior cruciate ligament (ACL) repairs are beginning to filter into the literature. Some studies compare the results of the two most commonly used graft methods: patellar tendon graft (PTG) and hamstring tendon graft (HTG).

It seems the functional results are pretty good using either method. Up to 97 per cent of patients with either graft have normal or close to normal motion, strength, and function. Patients with the PTG tend to have more problems at the graft site. Since their graft is taken from the patellar tendon along the front of the knee, pain with kneeling can be a problem.

In one study from Australia, a single surgeon compared 90 patients with a PTG against 90 patients with a HTG. After 10 years, there were only a couple differences between the groups. The PTG group had more knee pain and more knee osteoarthritis. They also were more likely to rupture the other ACL. Researchers aren’t sure yet why that might happen.

The hope and expectation is that you will have just as many years with your repaired knee as with your normal knee. This is considered the ideal</i. outcome. Continued study of ACL patients into the next decade will give us better information for long-term results.

Commercially available cartilage grafts have only been on the market for the last nine or 10 years. Thanks to the research that goes on at places like the Institute for Cartilage Repair in New York, we have a much better idea how to treat these injuries.

Even at a minimum, it takes at least 14 days to process tissue after harvest. The allograft is tested right away for bacterial contamination. It is also tested for hepatitis and HIV. It will be tested again for bacterial content just before transplantation into a live patient.

A recent study from the Institute compared the results of fresh allografts to frozen grafts. The fresh tissue was implanted within 30 days of harvest. The stored tissue was 30 days old or older.

The older graft tissue actually had better results. The graft maintained its thickness while filling in the open defect very nicely. Most of the patients had a smooth intersection between the graft and native host (the patient’s own) cartilage.

For now it looks like the standard length of storage time (several weeks) can extend up to and beyond 30 days. Most research is needed in this area to determine the optimal time for harvest and implantation.

Damage to the cartilage of this type is fairly common among young, active athletes. The cartilage doesn’t have much ability to heal on its own so without surgery, pain and joint degeneration are likely.

There are a number of different ways to treat full-thickness cartilage defects. Besides cartilage transplantation, holes can be drilled into the cartilage to stimulate healing. This operation is called microfracture.

Sometimes the patient is able to donate his or her own cells. Live cartilage cells are removed and multiplied in a laboratory setting. Then the new cells are implanted in the damaged area. This is called autologous chondrocyte implantation.

The rehab program for any of these procedures is similar. Some of the specifics may vary from center to center. Some surgeons may have their own preferred protocols. According to the Institute for Cartilage Repair at Cornell Medical College in New York, you can expect up to a year-long recovery time.

Following surgery, all patients at the Institute use a device called continuous passive motion (CPM). The leg is placed in the CPM unit and gently moved through the full range of motion for hours at a time. Most patients use this at night.

During the day, their patients are placed in a hinged knee brace for at least eight weeks (usually longer). They are allowed to touch their toe to the ground for stability and balance when walking.

After eight weeks, patients are switched into a special brace that unloads the joint. This brace is used for another four months. A program of exercise supervised by a physical therapist begins at the end of two weeks after surgery. Therapy continues until the patient regains a strength and motion. By this time the patient is usually walking normally again with good motor control.

From time to time, patients report uneven results with steroid injections. There’s been some question about whether the results are based on the type of steroid used. Some doctors questioned if maybe one type of steroid worked better than another.

A recent study comparing two commonly used steroids showed no difference between them. Patients with knee arthritis or shoulder rotator cuff problems received either methylprednisolone or betamethasone. The steroid was mixed with lidocaine (a type of novocaine).

The authors of the study suggest that immediate pain relief is obtained with steroid injections when the injection is done correctly. The correct placement of the needle into the joint is important.

Typically patients experience immediate pain relief. This is a sign that the placement was correct. There is often a slight increase in pain about three days after the injection. The pain subsides and by the end of three weeks, patients report overall improved pain.

Side effects of steroid injections are minimal. Too many injections can cause the joint cartilage to break down. This is very unlikely in someone having a single injection.

Sometimes patients report a brief increase in pain a couple days after the injection. This is a common response that will go away and long-term pain relief will occur.

Specific studies of patients with diabetes haven’t been reported. A recent report comparing the use of two different kinds of steroid injections was published. The only adverse effect mentioned was an increase in blood sugar values right after the injection.

If you are used to tracking your glucose levels, then just monitor yourself after the injection. You should be able to adjust diet and exercise levels to correct for any unusual spikes or sudden drops in glucose levels.

The answer to your question may depend on what kind of action you have in mind. Are you thinking of returning to recreational sports activities? Or are you a competitive athlete ready to get back into the game? And what kind of sports or activities are you interested in returning to?

The answer to these questions may direct you. There is a series of hop tests physical therapists use to gauge how ready patients are to return to sports. Sometimes only one or two tests are used, but there are four tests altogether that might help you find out your own readiness level.

The first test is a single hop for distance test. You hop and land on the involved leg going as far forward as you can. The distance hopped is measured. The second test is a timed hop test. You hop and land on the involved leg as fast as you can to the end of a six-meter long line.

The third test is the triple-hop for distance test. In three hops, you go as far forward as you can, always landing on the same leg. The fourth and final test is the crossover test. While hopping forward three times, you alternate which side of a line you land on.

A physical therapist can give you these tests and score them to help you see how strong you are. If you want to just do the actions on your own (without proper scoring), it may help you get a sense for how far along you are in the recovery process.

Loss of balance, inability to complete the task, or muscle soreness afterwards are signs that your rehab program is not completed yet.

Blood clots called deep venous thrombosis (DVT) can be a serious complication. It’s important to try and reduce or eliminate as many risk factors as possible. You may want to ask your surgeon to review your personal risk factors with you.

Risk factors you can do something about are called modifiable risk factors. Things you can’t change about yourself are nonmodifiablerisks. For example, age over 75 is a nonmodifiable risk factor.

Most of the risk factors for DVT are nonmodifiable. Other nonmodifiable risk factors include previous history of blood clots, cancer, or immobility. History of blood clots includes you or anyone in your immediate family.

Having hip or knee surgery increases your risk dramatically. Less powerful risk factors include being overweight, having varicose veins, and pregnancy.

Your doctor can conduct a screening test for DVT risk factors. A simple test of adding risks up can help predict your risk. Each risk is given a point value. After adding up your points, your risk can be judged as low, moderate, or high.

Many studies have shown it is important to find ways to measure results of treatment. Using the same test before and after treatment can help identify improvements (or decline) in function.

The hop test, although seemingly very simple and easy for some patients, is really a very good way to measure outcomes. It is practical because it really measures performance. It’s easy and inexpensive to do, and it doesn’t take very long to complete.

In general, hopping as a skill requires neuromuscular control, strength, and confidence. Balance and knee stability are also required. Patients who can’t complete the hop test(s) are more likely to have problems later on with other knee injuries.

There are several different hop tests that can be given. Combining them together gives a good idea of your speed and ability to go faster or slower. These kinds of activities help predict how ready you are to return to sports that require cutting, changing directions, and change in speed.

All in all, the hop test is a good measure of dynamic knee stability. Therapists can use it to progress patients through their rehab program. Hop tests can also be used to decide when to discharge patients and when to allow return to sports play.

You are not alone in your response to this type of surgery. Studies show that a number of patients do not attempt jumping or squatting activities after knee surgery. This is true despite the fact that they have good range of motion and near normal muscle strength in the operated leg.

Fear if reinjury may be part of the problem. But there may be other factors to overcome as well. For example, a natural decrease in activity level over time may leave that leg weaker, less stable, and not fully rehabilitated.

You should schedule a follow-up visit with your surgeon. Talk to him or her about your situation. See if a short course of rehab with a physical therapist might be appropriate to get you over the hump.

The postoperative program for patients after an anterior cruciate ligament (ACL) repair may vary depending on a number of factors. First, different surgeons have different protocols for their patients.

Second, every surgery can be different. The amount of weight you can put through the operated leg and the exercises you do may depend on the type of graft used or the type of fixation method used to hold the graft in place.

It may also depend on any other surgical procedures carried out during the ACL repair. For example, if the meniscus (cartilage inside the joint) was torn, it may have to be repaired or shaved smooth.

Patients who have both the ACL and a meniscal repair are often only allowed to bear partial weight the first few weeks after surgery. The use of crutches and a brace may also vary from patient to patient based on these same considerations.

And finally, rehab with different therapists can sometimes result in different programs. If the knee is unstable or there are other problems, the therapist may advise a more cautious, less aggressive rehab program.

Clearly, females have a higher incidence of anterior cruciate ligament (ACL) tears. The reasons for this may be multifactorial and not just one cause. For example, differences in male versus female anatomy may be a big part of the problem. The width of the pelvis and the angle at the knee are just a couple things to consider.

Training techniques and training schedules may also be a factor. As a coach, you may have more to say about this variable than things you can’t change like body type or hormone levels.

Monthly fluctuations of hormones can affect ligaments. Exactly how the collagen fibers are affected hasn’t been shown yet. It’s possible the fibers relax more during certain times of the month, making them more vulnerable to injury. There is an actual hormone called relaxin designed to relax soft tissues during pregnancy and birth. It’s possible that levels of relaxin rise and fall with the menstrual cycle.

There are no specific guidelines at this time to put into action. More research is needed because studies have not consistently shown the same results when hormone levels have been tested in athletes.