FAQ Category: Knee

Taping has been used by many coaches, trainers, and therapists working with athletes who have ankle, knee, or shoulder pain. Taping usually stabilizes a joint and holds it in place. This takes pressure off the joint and nearby structures. It forces the muscles to respond more normally.

Studies definitely show a wide range of responses to taping. It would be very helpful if it were known who could benefit from taping rather than spending time trying out taping on a trial-and-error basis.

Pain during squatting may be caused by a problem called patellofemoral pain syndrome (PFPS). A recent study from Australia found two patient characteristics that may help predict which athletes with PFPS can benefit from knee taping.

The first is the patellar tilt test. The examiner glides the patella toward the outside of the knee, and then tries to lift the outer border of the patella up. In the normal knee, the patella should stay flat and should not lift up. Too much lift means the patella is very mobile and unstable.

The second is the angle of the tibia (lower leg bone). Bowing of the leg past five degrees seems to contribute to the problem of PFPS. Patients with these two positive tests often get immediate pain relief with taping.

The girls on your team who don’t get any pain relief from this type of taping may have some other problem that needs to be identified. Some other form of treatment may work better for them.

Patellofemoral pain syndrome (PFPS) is a fairly common condition. Girls are affected more often than boys. With the increased participation in sports, PFPS has become a bigger problem than it once was. Pain with knee motion makes it more difficult to stay active in sports.

The patella sits over the knee joint and moves up and down along a track or groove in the femur (leg bone). PFPS causes pain because of the way the patella (kneecap) tracks within the femoral groove as the knee moves.

The quadriceps muscle helps control the patella so it stays within this groove. If part of the quadriceps is weak for any reason, a muscle imbalance can occur. When this happens, the pull of the quadriceps muscle may cause the patella to move more to one side than the other. This in turn causes more pressure on the cartilage on one side than the other. In time, this pressure can damage the articular cartilage.

Taping the patella helps it stay in the groove and move up and down over the knee as it should. Many patients get immediate pain relief with this treatment technique. Taping is usually accompanied by a muscle stretching and strengthening program.

Many people have reported differences not only from airport to airport but even from time to time through the same security detector. To solve this puzzle, Dr. Robert F. Ostrum, Chief Orthopaedic Surgeon at Cooper University Hospital in Camden, New Jersey did a little research on the topic.

He found that airport metal detectors generate a brief magnetic field. When a metal object passes through the detector, the magnetic field is reversed and a sharp electrical spike sets off the alarm. Many other factors come into play as well.

For example, the more metal you have (say from multiple implants) or the larger the pieces (mass), the more likely it is that the detector will sound the alarm. The type of metal can also make a difference. Anything with iron in it or other type of metal that can be magnetized increases your chances of detection.

Detection units can also be set for higher sensitivity. So on high alert days, you are more likely to set off the alarm when you walk through the archway compared to a low-alert status.

Some of the walk-through archways only have a detection device on one side. If your implant is on the opposite side, you are less likely to set off the alarm. The handheld wand detectors are more likely to detect metal implants but these are not used routinely.

A specific diagnosis is needed before treatment can be determined. Results of treatment for this type of problem are best if the right treatment is applied.

In the case of the knee joint, X-rays should include several views. Standing upright and 45-degree knee flexion in standing are usually taken. A special lateral view (from the side) and sunrise view of the kneecap may also be taken.

X-rays show small changes in the joint space and any defects of the cartilage where it meets the bone. Bone cysts and bone spurs can also be seen on X-rays.

MRIs are helpful in locating other structures of the knee that might be damaged. Poor alignment, meniscal deficiency, and ligament instability are identified with MRI. Repair of these injuries must be done for a successful result.

A thorough examination of this type is, indeed, needed in order to plan the correct treatment for the best result.

Microfracture is a method of treating defects in knee cartilage that go clear to the bone. The surgeon drills tiny holes through the cartilage into the bone. This allows the blood from inside the bone to seep into the cartilage layer. Blood clots are formed and start a healing process.

Studies show that results after microfacture are best when the patient follows a four- to six-week postoperative program. The rehab includes protected weight bearing on that leg and continuous passive motion (CPM).

With CPM, your leg is strapped into a machine that slowly bends and straightens your knee. You can expect to spend six to eight hours (or more) each day on CPM. Based on the results of studies done so far, some surgeons consider patients at too great a risk for failure if they don’t want to follow the expected post-op rehab program.

This program is not strenuous, just time consuming. Talk to your surgeon about your concerns and let him or her know your thoughts on the subject. More information about what to expect on a daily basis may help you in your decision-making process.

There may be a couple things you can do. Seeing a primary care physician who can manage all your health needs may be the place to start. If you have tried to lose weight without success, you may be a good candidate for bariatric surgery. Stomach stapling or bypass has helped many overweight people in danger of losing daily functions such as standing and walking.

At the same time, you may benefit from medications, exercises, or physical therapy. These are standard first-line treatments for osteoarthritis (OA). Some patients who are too young for joint replacement are trying an alternative treatment called electrical stimulation (E-stim).

With E-stim, an electric current is delivered to the knee joint through skin surface electrodes. One study from Sinai Hospital in Baltimore has been done to show that E-stim can help patients delay knee replacement up to four years. Patients who are too young, too old, or obese are the best candidates for E-stim.

If all these conservative measures fail, there are a variety of surgical procedures to consider. A partial or total joint replacement is the most invasive approach. Modern implants are much improved now and expected to last up to 15 years. Some patients have as many as four implants over their years of their lifetime.

There are many options for you to consider. Finding the right doctor to help you manage your overall health is the first step.

Several studies have been done using electrical currant to stimulate cartilage growth and repair. Surface electrodes on the skin are placed directly over the knee for eight or more hours each day.

The current is delivered by a portable, battery-operated stimulator. It’s not an overnight cure. Patients must use it everyday for at least a year (or more) to be effective. But up to 60 per cent of the patients with moderate to severe osteoarthritis (OA) who used it have success avoiding surgery.

It works by delivering a negative charge to the ions in the cartilage cells. Biochemical influences signal the cartilage to start the process of healing and repair. The patient doesn’t feel anything. The intensity of the electrical signal is kept just below a tingling sensation.

For quite some time now, orthopedic surgeons have known that repairing a torn meniscus has a better result than taking it out. Removing this cartilage in the knee can lead to faster wear and tear and osteoarthritis in the end.

There are many ways to do these repairs. The surgeon may use an open incision but it’s more likely you’ll have arthroscopic surgery instead. The arthroscope is a long thin needle that is inserted into the joint. There’s a tiny TV camera on the end to give the surgeon a visual image on a TV screen.

Arthroscopic repairs can be done all from inside, from inside-out, and from outside-in. The repair technique depends on the type, size, and location of the tear. Whatever method is used, the goal is to get a good, strong repair that won’t tear. The strength of the repair is called the fixation strength.

Fixation strength has been tested on cadaver (donor) menisci. A special machine is used to test the ultimate tension load (UTL). This is the amount of force it takes to tear a meniscus or tear the suture holding a torn meniscus in place.

Researchers are testing a new method of suturing the meniscus called the cruciate suture. Early results show a 1.6 greater strength of this method over the more standard approach using a vertical suture for long or complex tears. The type of repair and fixation strength you’ll have will depend on the method your surgeon uses for you.

Fibrillation of the meniscus is observed as fraying of the free edge of the meniscus. This can be seen on an MRI as an area of increased signal intensity at the apex of a normal meniscus.

At first the meniscus may start to soften. This is sometimes labelled as Stage I degeneration. Stage II is fibrillation or fraying of the cartilage. Fibrillation is a sign of meniscal degeneration. Usually this occurs with aging but it can also be caused by trauma.

Stage III is a more severe case of fibrillation or fragmentation. Stage IV indicates the cartilage is worn clear down to the bone.

When a torn anterior cruciate ligament (ACL) is repaired for the first time, it’s called a primary ACL reconstruction. If the reconstruction ruptures or fails, then a second operation called a revision or revision ACL reconstruction may be needed.

Reinjury and failures occur most often in athletes who return to their former level of sports activity. With more and more people participating in sports, revisions are on the rise. A study from Australia reports the number of revision ACL reconstructions has doubled in the last 10 years.

There are many possible reasons for this to happen. Technical errors during the operation are common. The tendon graft used to replace the ACL may not be put in the best place or with the right amount of tension.

Sometimes the patient’s body just doesn’t heal well. The graft may not “take.” An overactive immune reaction or lack of blood supply may result in biologic failure. In other cases the athlete reinjures the leg while playing.

Most often there isn’t one single cause of primary ACL repair failure. Usually, it’s a combination of two or more factors. And, if there are other damaged ligament structures in the knee that aren’t repaired, then the joint can become unstable. Joint instability puts more load and stress on the healing tendon repair.

You pose a good question. There may be a hereditary connection butresearchers haven’t addressed this topic directly. In a recent study from Australia, the results of 50 patients with revision ACL repairs are reported.

All 50 patients had the first ACL repair, which failed. A second (revision) operation was performed. Five of the 50 patients (10 per cent) had a failed revision surgery. The data collected from the patients showed that 16 of the 45 patients had a positive family history. That amounts to more than one-third (36 per cent) of the group.

Soft tissue such as muscles, ligaments, and fascia are made up of collagen fibers. The pattern of the collagen tissue as it forms each of these structures helps determine its strength. There are more than a dozen types of collagen fibers that determine how elastic the tissue is.

Variations in collagen length and elasticity are likely genetically determined. A positive family history of ACL injuries in your family may be the key factor here — more than luck! Participating in contact or collision sports also increases the chances of trauma and injury.

The best approach may be to report on the results of geographic studies. We know that centers and hospitals where a high number of total knee replacements (TKRs) are done have better results. The same is true for high-volume surgeons.

It may also depend on whether or not she is planning to have both the knees replaced at the same time (simultaneous) or through a staged procedure (first one, then the other).

In general, more surgeons in the northeast do simultaneous TKRs. And more high-volume surgeons are at these centers. With only one anesthesia and one hospitalization, costs are much less for the simultaneous procedure.

If your mother has no (or very low) out-of-pocket expenses, then this may not be a direct selling point for her. We all have a responsibility to keep health care costs down, so you may be able to appeal to her from this point of view.

After care and rehab are important factors in the final result of this operation. If you can provide in-home care, transportation, and social interaction, then you may want to emphasize these benefits to her as well.

Your observations are quite correct. According to a recent study of 122,385 Medicare patients, white men are more likely to have both knees replaced at the same time. And white men in a higher income bracket are more likely to do so compared to white men with a lower income.

It’s not clear if this is a case of gender bias or simply a matter of who has a caretaker at home to help out after surgery. Since people over age 65 are the most likely candidates for TKRs, and the culture is one of women as caretakers, the greater number of males having both done at the same time may not be too surprising.

It’s possible too that more women intend to have the second knee replaced but complications occur. Or once they have the first knee replaced, their function is so much better, they decide to get along without having the second one replaced.

Without specific studies to answer this particular question, it’s merely speculation at this point. Large studies such as this one can review the records but don’t interview the patients as to their intentions and factors in decision-making.

Proper shoe wear has always been touted as being important by the experts. Our experience is that good shoe wear makes good sense but some people seem to benefit more than others.

In some cases, people with worn out shoes that offer little to no support have no symptoms and no problems. Others have to replace their shoes as soon as any wear causes an uneven support base. It’s unclear why there is such a wide range of responses. Some people may just have a more sensitive sense of proprioception (sense of joint position) that signals change immediately.

In a recent study from Canada two groups of adults with knee osteoarthritis were compared wearing two different kinds of shoes. The first group had on a high-end walking shoe by New Balance. The second group had a special medical training device called Masai Barefoot Technology® (MBT®).

The MBT is designed to increase muscle activity in the foot and lower leg. The hope is that the shoe will reduce pain and improve walking ability. The results of the study showed that patients in both groups had improved pain and function. Only the groups with the MBT® showed a change in balance.

Finding a perfect shoe that works for everyone may not ever happen. But finding the right shoe for you is possible. Start with a good walking shoe and break it in gradually. You can do this by wearing it for short periods of time each day. Gradually increase your wearing and walking time.

Replace the shoes when you see signs of breakdown on the inside or outside. Don’t wait until the shoe has holes in it or shows evidence of severe wear. It’s a small price to pay for good benefits in the long-run.

Exercise has really been shown over and over to be most effective for mild to moderate osteoarthritis. A walking program is used by many people because it is easy to do and doesn’t require special equipment. A good pair of walking shoes and comfortable clothing are all you need.

Many communities offer walking clubs for those who don’t want to walk alone. Groups may meet at the local mall each day. Some combine walking and hiking for those who prefer an outdoor experience.

If walking isn’t possible but you have access to a pool, then consider a pool therapy program. The warmth and buoyancy of the water offer gravity-free exercise for painful joints.

Strengthening exercises for the quadriceps muscle may be helpful, too. The quadriceps muscle is the large four-part muscle along the front of the thigh. Resistive training exercises to improve strength have been shown effective.

Finally, some experts advise a good diet with adequate hydration. Clear liquids (especially water) may help lubricate joints.

Joint replacements are designed to restore a smooth joint surface for patients with bone spurs and loss of joint cartilage from athritis. The soft tissues around the knee can be adjusted to improve joint alignment.

This may or may not change the Q-angle, which is the angle of pull of the quadriceps muscle on the patella or kneecap. The goal is to reduce uneven load on the joint so it will last longer.

Joint replacement for excessive Q-angle is not a current feature of treatment. Stretching, strengthening, and supporting the local muscles will help to decrease pressure at the kneecap from an excessive Q-angle.

Implant sizes have been developed based on “average” measures of joint depth and width. There is a range of sizes available to help the surgeon match the implant to the patient. Measurements are often taken from cadaver knees. This allows for more accurate measurements from inside out.

Men tend to have broader ends on the bottom of the femur (thighbone) as it forms the upper half of the knee joint. Larger implant sizes are adjusted to match this feature in men.

Implants with a narrower width are better suited for many women. Some consideration has been given to matching the implant to the Q-angle of the knee. The Q-angle is formed by the position of the quadriceps muscle and connected patellar tendon as it inserts into the front of the knee. It is the angle of the quadricep muscle’s pull on the kneecap.

The Q-angle tends to be larger in women compared with men. But many women who have osteoarthritis and need a total knee replacement are overweight. These women have a reduced Q-angle because of a large thigh. In these cases, one of the many implants already available work best.

At this point, the extra cost of developing a gender-specific implant may not be needed. Money aimed at improving women’s health and fitness may be better spent. Such an approach may help prevent obesity, arthritis, and the need for joint replacement.

Improved implant design and survivorship (how long it lasts) have made it possible for younger adults to have a joint replacement. There’s also a unicompartmental replacement that only replaces half of the joint.

The unicompartmental knee arthroplasty (UKA) is gaining in popularity for younger, more active adults with knee osteoarthritis.

Surgeons who prefer the UKA say that results are similar to results for a total knee replacement (TKR). The advantages of the UKA include faster recovery with a shorter hospital stay. This means lower costs.

Studies also show better range of motion with a UKA. Improved motion with less pain makes it possible for these patients to resume sports and recreational activities.

Knee implants for osteoarthritis can be unilateral (one-sided). More often a total knee replacement (TKR) is done. Survivorship refers to how long the knee replacement lasts without problems.

If the implant fails for any reason or has to be removed, then survivorship has ended. There are many reasons why an implant may fail. The most common causes of failure are infection, pain, loosening, and dislocation.

Five-year survivorship is considered short- to mid-term in length. An implant that lasts 10 or 15 years (or longer) has good long-term survivorship. Most implants are expected to survive or last at least that long.

MRI is still the best way to confirm a diagnosis of meniscal tear in the knee. Studies show that doctors can use MRI results to determine if the tear can be repaired.

The MRI shows the exact location of the tear. Where the tear is located tells the surgeon how much blood supply is available. A good blood supply is needed to help the cartilage repair itself.

The closer the tear is to the junction where the meniscus meets the synovium, the better the chance for healing. The synovium is the inner lining of the knee joint, which contains the synovial fluid used to lubricate the joint.

The MRI also shows if there are degenerative changes in the meniscus. These types of tears are less likely to heal and require removal rather than repair. So even if the physician’s exam was positive for a meniscal tear, the MRI is an important diagnostic test. The surgeon will use this information in planning all aspects of your care and recovery.