FAQ Category: Knee

It’s possible to repeat the surgery using graft tissue from another donor site or another donor. It’s not advised to take tissue again from the original donor area. Even up to six years later, the donor tissue doesn’t return to normal and remains thinner and weaker
than normal.

But before you borrow more trouble, let the doctor take a look at you. Maybe the damage isn’t as much as you think. Or perhaps the repaired ACL can be salvaged. If skiing is a must in your future, then a rehab program will be important for you.

It doesn’t seem to matter if the defect is sutured or not. Several studies have confirmed this finding. The area fills in with tissue and heals the same either way. Since doctors
try to keep the operation as short as possible, they may leave the gap and finish the procedure.

A recent study from Sweden reports on the long-term results of patellar tendon harvesting
for ACL repairs. They found the area where tissue is removed gets wider and thicker on either side. These changes generally go back to normal later in the healing process. The hole fills in, but doesn’t return to normal even after six years. Tissue at the donor site remains thinner and weaker than normal.

Your doctor may be able to estimate how long a wait you have in store for you. By looking at your son’s height compared to other family members and examining the bone growth plates, it’s possible to get an idea if it’s a matter of months or years.

It is best to wait to have an ACL repair until the bone growth is complete. There are some other treatment options. Doctors at the University of Texas describe “physes-sparing” ACL repairs. The physis is the growth plate at the end of the bone. An ACL repair usually drills holes through bone that may still be growing in children and some teens. Any disruption of the physis can cause permanent damage.

The physes-sparing operation passes a graft through the joint without drilling a hole in the bone. There are some problems and difficulties with this procedure. Most doctors prefer to wait until the bone has stopped growing to repair the damaged ligament.

Once you know how long you might have to wait (remember, it’s just an educated guess), then speak with the football coach about the situation. Find out what your options are before planning treatment.

See an orthopedic doctor. A simple arthroscopic surgery may be all that’s needed. The doctor looks inside the joint, finds the problem, and repairs it all in one procedure. A special tool called an arthroscope makes this all possible.

The scope is a slender device with a tiny TV camera on the end. It is placed through a small opening made in the skin and goes directly into the joint. No incision or open cut is needed. Special tools can be passed through the scope into the knee. The surgeon is able to see and work inside of the joint.

Even if you’ve been able to unlock the joint in the past, it sounds like it’s now time for diagnosis and treatment. The longer that problems are left untended, the less likely
a simple repair can be done. For example, torn cartilage in the knee can be repaired in some cases instead of having to remove the cartilage completely. Keeping the cartilage
protects the joint much longer than removing it.

Some doctors will advise surgery to all patients with a torn knee ligament. Repairing the damage early is thought to prevent problems later on. An unstable knee can lead to reinjury with more damage. Without a healthy PCL the joint can be too loose and unstable.
Uneven wear and tear on the joint can also result in early arthritic changes in the joint.

Many doctors suggest surgery for patients who have pain, instability, and loss of function. If you can’t do what you want to do or if you want to return to your preinjury level of activity, then repairing the ligament is necessary.

It’s not clear if there is a point at which you’ve waited too long. Studies report the average length of time from injury to operation is about one year. Some patients have the operation within three weeks of the original injury. Others have waited up to four years
or longer.

According to the American College of Rheumatology, doctors use the exam and X-rays to tell if you have arthritis. You must have knee pain along with at least one of the following:

It’s natural to wonder and worry when we start to see signs of change with aging or disease. Keeping active is the key to maintaining physical function. Taking longer to complete a task may be a sign of early decline in strength, balance, and motion. These three things are very important to our independence.

There are some tests of overall function. These measure several types of activities from dressing and bathing to more active forms of exercise. The presence of pain, general health, and mental attitude are also part of the picture.

If you are noticing some changes and have some concerns, see your doctor for a check-up. Early detection and prevention of problems is essential in keeping our good health for as long as possible.

Confusion after total knee replacement is common, but it’s not normal. It’s definitely more common in older patients (over 85 years old), compared to younger patients. Doctors aren’t sure what causes this in some people. It may be linked to blood clots or blocked arteries from therosclerosis.

More research is needed to find out risk factors other than age. Perhaps it’s the type of anesthesia used or the drugs needed for pain control afterward. Sometimes confusion is the first sign of a problem like pneumonia or bladder infection. Confusion is a major factor in falls and injury. Make sure your father-in-law’s doctor is aware of this new symptom.

Research shows that most patients over age 90 do well after a total knee replacement (TKR). They generally have much welcomed pain relief and increased mobility. They can often walk again and even go up and down stairs without help. They live an average of five or more years after the operation.

Complications can occur during or after any operation. Older patients are at increased risk for problems. Doctors try to monitor this closely, but sometimes serious health events like heart attack, stroke, and even death occur. Operations to put in a new hip are safe and reliable for most patients in the over 90 adult group.

Maybe not! A recent study from Mayo Clinic reports good results for adults over age 90 getting their first total knee replacement (TKR). They also report on patients ages 90 to 102 who had a repair or replacement of a previous TKR.

Doctors are expecting to see more and more adults in their 90s (and older) outliving the TKR put in when they were in their 70s. Likewise, as more people live longer, first timers in need of a joint replacement may show up in their 90s.

Loss of muscle bulk (atrophy) isn’t uncommon after a knee injury or knee surgery. Muscle atrophy and a loss of muscle strength are natural consequences of using the leg less after surgery.

A recent study of 29 PCL repairs showed about half the patients recovered 90 percent of their normal muscle strength. This was measured for the quadriceps muscles (knee extensors) up to three years after the operation. Slightly more than half the patients
regained most of the size of their hamstring muscles (knee flexors).

Even after three years most of the patients had a difference in the size of their thighs. Very few could regain the full strength in the operative leg. A more aggressive training program is advised. Talk to your doctor about your concerns.

At two months after surgery, the lack of muscle bulk isn’t as worrisome as if you were two years post-op.

Pain and swelling are often limitations on motion and activity after PCL surgery. You can continue to use the RICE formula: Rest, Ice, Compression (elastic wrap) and Elevation any
time you increase your activity and experience more swelling.

The goal is to see yourself increasing what you can do everyday. If there’s increased pain and swelling, make note if it goes away faster each time. You should also see that the knee doesn’t react quite as quickly as time goes by.

Keeping up with your exercises and walking is actually the best medicine for your knee. You can use your pain and swelling as a gauge of how much you can tolerate. Work right up to those limits and slightly beyond each day.

Be sure to let your doctor know if there’s more than usual swelling and the knee is hot to the touch or if the symptoms don’t go away with rest and ice.

Reports of muscle tightness after injury are common even years later. It’s possible that scar tissue from the healing process causes this sensation. It may be that some muscle fibers get linked up with scar tissue instead of reconnecting with the aponeurosis
where they belong.

The aponeurosis is a strong sheet of fibrous connective tissue. It acts as a tendon to attach some muscles to the bone or to bind muscles together. When muscle fibers link to scar tissue instead of the aponeurosis, the muscle gets shorter. This may cause the
tightness you are having.

Research shows that structural changes in the muscle after injury remain for a long time. The same is true for any changes made during rehab. Much of rehab is focused on contracting the muscle to regain strength. This can add to the problem of muscle fiber shortening.

Not yet. Researchers at Johns Hopkins have tried using stem cells to grow into tissue that’s like cartilage. They are testing a method injecting fluid filled with stem cells into the joint. The liquid hardens into a stable gel when placed under a special light.
Stem cells inside the gel start to multiply and form new cartilage. So far only animals have been used in these studies.

In the meantime, doctors have found two other ways to get cartilage to repair itself. The first is called microfracture. Surgeons use a blunt awl (a tool for making small
holes) to poke a few tiny holes in the bone under the cartilage. This causes new tissue, mainly scar tissue, to grow and fill in the holes.

The second is autologous chondrocyte implantation. Normal, healthy cartilage cells are taken out of the knee. They are sent to a special lab where more cells are grown from
the original cells. The new batch of cells are put into the joint surface where the damage is located.

Osteoarthritis (OA) is staged according to how much damage has occurred in the joint and how much joint space is left. X-rays are used most often to stage OA. In advanced stages of OA, there is a complete loss of joint space.

The femur (thigh bone) and the tibia (lower leg bone) have no cushion between them. When you use the knee, the bones slide across each other without any protection or lubrication. We call this bone-on-bone.

Most likely you had your knee injected with a product called hyaluronic acid (HA).
This thick liquid helps restore the knee’s natural lubrication. There are many types of HA on the market.

The two major kinds are cross-linked and noncross-linked. Studies show the
cross-linked HA can result in a minor adverse reaction. The increase in local pain and swelling doesn’t last long. Researchers don’t think it damages the knee either.

This type of reaction may be what happened in your case. There are other causes of the local symptoms you’ve described. Make sure your doctor knows about these changes. The doctor may be able to treat the problem early on and prevent more damage to the joint.

Hyaluronic acid (HA) can be injected into the knee to restore the joint’s ability to move and glide easily. The knee already has some of its own HA. By injecting more, the
HA already in the joint improves the flow of the synovial fluid. Injected HA also helps keep the naturally present HA from breaking down.

Overall, studies show that HA is both safe and effective. It seems to work better for younger patients (under 65 years) and for patients with only mild to moderate disease. Patients with severe osteoarthritis may not have any natural lubrication left in the
joint. It seems without some HA, the injection doesn’t work as well.

Hamstring injuries are common among athletes at all levels from amateur to professional. Once the hamstring muscle has been torn, it’s more likely to tear again. Some athletes report five or six injuries on the same side.

Researchers at the Monash University Department of Physiology in Australia studied this problem. They found when injured hamstring muscles heal the optimum length of the muscle
needed for contraction changes. The muscle that was injured now operates at a shorter length. This can lead to microscopic damage from certain types of muscle action. These contractions are called eccentric contractions.

The answer to your problem may be to focus on eccentric activity. Instead of exercises to tighten up the hamstrings, it may be better to exercise while slowly lengthening the muscle. The eccentric contractions can shift the optimal angle toward a longer length in the hamstrings muscle.

An athletic trainer or physical therapist can help you with this type of rehab program.

Your doctor may have some ideas to suggest. Be sure and check with him or her. It may depend on what method was used to save the cartilage the first time.

Some doctors will go ahead and remove the damaged cartilage. The reason they try to save the cartilage is to prevent osteoarthritis later. A second salvage procedure is sometimes possible. If one method didn’t work, perhaps a different operation will help.

There are several ways to do this. The doctor may shave away a layer of damaged cartilage or drill holes through it. These operations help stimulate new tissue to grow in and around the damaged cartilage.

Researchers are working on cartilage transplants and synthetic (man-made) replacements. If you have to have the damaged cartilage removed, there may be new treatments available later before arthritis occurs.

The bursa is a fluid-filled sac placed between two structures to help cushion friction during movement. Usually it’s located between a tendon and the bone. The bursa cushions the tendon as it moves over the bone. Sometimes there’s a bursa between two ligaments.

In bursitis the bursa gets inflamed. The patient has pain mostly on movement. The most common cause is repeated motion. Arthritis, infection, and injury can also cause bursitis. Bursitis occurs more often with aging as the bursa becomes thinner and dried out.

Problems with bursitis occur in the feet, hips, knees, shoulder, and elbows. There are several bursae around the knee joint. Kneeling is a common cause of one type of knee bursitis. This is sometimes called housemaid’s knee. Another type of bursitis occurs most often in people who install carpet, but anyone can get bursitis of the knee.