FAQ Category: Knee

Short-term results (six months to two years) after arthroscopic surgery for mild to moderate arthritis are good. Reports show at least 75 percent (three-fourths) of all patients get better. The have less pain and more function.

After three years, only half the patients stay pain free. Those with rough cartilage behind the knee cap (a condition called chondromalacia) often have return of painful symptoms. Patients who are overweight have pain much more often than patients of normal weight.

Patients with mild degenerative changes but no arthritis who aren’t overweight have the best results with arthroscopic surgery.

If you’ve had this problem a long time, chances are you’ve lost muscle strength and maybe even coordination. Once the cartilage is repaired and the knee has been realigned, strength and motion must be restored. This will help prevent uneven wear on the joint and prevent further injuries.

It’s likely you’ll only see the therapist a couple times. Once your strength, motion, and movement have been evaluated, a program of stretching and exercise can often be done at
home or at the gym. The therapist will also check your joint position sense and balance. These are also key to keeping a healthy knee.

Patients who have had an anterior cruciate ligament tear and repair must follow the doctor’s and the therapist’s guidelines after surgery. This is to avoid forces on the healing tissue that could tear it again.

Progressive resistive exercises known as “PREs” to therapists are avoided early on in rehab. This applies to the first 30 degrees of knee flexion. A good rehab program will take into consideration your drive and need to return to bike action. There are many other parts of the body to exercise!

Strength training for the knee usually begins within the available range of motion and not beyond. This may frustrate you and cause you to “push” yourself. You may find comfort in the new findings that show overall muscle strength around the knee improves even when only a small arc of motion is exercised.

Don’t put your new tissue graft at risk. Follow your doctor and therapist’s advice carefully. In the end, you’ll be back on your bike better than ever.

Don’t despair! If you are in the early stages of anterior cruciate ligament (ACL) rehab, full motion and full strength is on its way. But the healing tissue must be protected until it has its full strength. Then you can put the knee through its paces by doing exercises that stress the ACL repair.

And there’s more good news. A recent study from Boston University showed that knee strengthening through a partial range of motion increased strength outside the target motion. In fact, it didn’t seem to matter what direction or speed the exercises were done in. Everyone in four different exercise groups got better!

In any case, make sure your therapist knows your goals and plans so that the rehab program can be geared toward your future activities.

You probably had what’s called a false-negative. In other words, the MRI didn’t show anything wrong when there really was something torn. There are several things that could cause this.

First, the level of MRI technology makes a difference. Low field scanners are used in the doctor’s office for a quick look. They are less expensive and immediately available, but not as accurate as the more traditional MRI equipment.

A false-positive can also occur if the patient moves during the MRI. It’s possible to strain a ligament and then later re-injure the knee causing a tear to occur. In such a case, the MRI taken at the time of the first injury would be negative. A true positive might be found if a second MRI instead of arthroscopy was done after the second injury.

In your case you went from an MRI to arthroscopy. This is the normal sequence of tests when trying to diagnose an injury.

Not necessarily. In the case of ligament tears of the knee, the doctor’s exam has been proven very accurate. In fact, a recent study done at the University of Kentucky showed a clinical exam was equal to MRI for ACL and cartilage tears of the knee.

From a cost point of view, 80 percent of the knees scanned by MRI end up needing arthroscopy anyway. This means the added cost of the MRI could have been avoided by doing a clinical exam and jumping right to the arthroscopy. Arthroscopic exam finds the problem and allows the doctor to repair it all at the same time.

Magnetic resonance imaging (MRI) has become the standard test for knee injuries. But you’re right about the expense. One study stated that MRI is equal in cost to a doctor’s
exam only if the cost of the MRI is less than $250.00. MRIs can cost much more than that.

The pendulum is now swinging back the other way. Studies show a doctor’s exam is just as good as an MRI . . . most of the time. This assumes the doctor is well-trained in evaluating knee injuries.

An MRI does offer some information to help the doctor direct treatment. The MRI can show where the cartilage (meniscus) or ligament (ACL) is torn and how large the tear is. This helps in deciding between rehab and surgery. This information can be very helpful with
elite athletes trying to get back on the field.

Not all girls’ sports are affected equally by knee injuries. Any activity with pivoting and jumping puts girls at increased risk for injury. This is especially true for basketball, soccer, and volleyball.

Before adolescence, girls and boys have an equal amount of ligament sprains. Girls have a higher rate right after a growth spurt. Middle school and high school aged female athletes have four to six times the number of anterior cruciate ligament (ACL) injuries compared to boys of the same age.

Untrained girls have the highest rates of ACL trauma. Since increases in growth can’t be stopped, researchers say our focus should be on training. As you head into your new coaching position, learn all you can about this key feature in preventing knee injuries.

It looks like girls may be affected more by growth spurts than boys are affected. According to a recent study muscles seem unable to adapt to changes in height, weight, and bone length in girls. The result is a loss of knee stability.

This is an important finding. Research is focused on preventing knee injuries in young female athletes like your daughter. In future studies athletes from all kinds of sports teams will be evaluated and compared. It’s possible only certain sports are involved.

It’s well-known that female athletes are at increased risk for knee injuries. This is especially true for anterior cruciate ligament (ACL) tears in the knee. The reason for this isn’t clear yet. Researchers have found a few key factors.

According to a study at the Cincinnati Children’s Sports Medicine Biodynamics Center, growth spurts may be one of these risk factors. When bones grow fast, muscles may not be able to adapt fast enough. Muscle contraction and coordination gets off kilter. The result is an unstable knee. There are altered forces during activities like jumping and landing.

Measuring neuromuscular control isn’t part of the standard sports physical exam. At best the doctor may measure joint motion and test for ligament laxity.

Right now there’s no practical way to screen for athletes at risk for ACL injury. As more studies are done, doctors, athletic trainers, and physical therapists may find an accurate and reliable screening test.

The medical diagnosis for obesity is based on body mass index or BMI. The BMI is equal to a person’s weight divided by height. The calculations are done in metric. There’s a web site that will help you find out your BMI easily: http://nhlbisupport.com/bmi/bmicalc.htm.

Anyone with a BMI less than (or equal to) 27 is within normal limits (not overweight). Between 27 and 30 is overweight. Between 30 and 40 is obese. Over 40 is
morbidly obese. Morbid is a word used to describe disease. Morbid obesity has been linked to many diseases such as diabetes, heart attacks, and strokes.

Stomach or gastric stapling (bypass) is becoming more popular as a treatment for morbid obesity. Many of the patients having this operation have been unable to lose weight successfully in any way. Not everyone is eligible for this surgery.

Your wife will need to have a doctor examine her and evaluate her potential for weight loss with this kind of treatment. It may be a good option. With weight loss there can be relief from painful knee symptoms when the stress and pressure of added weight is removed from the joint.

Sometimes a joint implant only needs to be revised, not replaced completely. The plastic lining may be removed and replaced. Or perhaps only one side of the joint is loose. Waiting too long can lead to uneven stresses and strains on the joint. More damage than good is done in such cases.

A few guidelines may help you when deciding when to go ahead with a joint revision. Watch for:

The rising cost of health care has taken “simple” out of almost every picture today. Obesity is linked with degenerative disease of the hips and knees. A high body weight is also linked to a poor result after the joints are replaced.

A recent study at The Good Samaritan Hospital in Baltimore, Maryland compared total knee replacements (TKRs) in obese and nonobese adults. The patients all got the same joint implant (one that has been used successfully for many years).

Results were reviewed after five years. Being overweight had a negative impact on the success rate of TKRs. More implants failed in the obese group than in the nonobese group. Obese patients with failed implants had lower satisfaction rates.

There are improved medical treatments for obesity today. Encourage your brother-in-law to see his doctor and find out what are his options. He may be able to at least improve his health before his knees wear out and he faces the risks of surgery.

It’s possible but you’ll need someone to look at it for you. Make a follow-up appointment with whoever made or fitted the orthotics for you. You may be slightly over-corrected or something may have worn down on the orthotic to change your foot and ankle position from where it was to start.

It’s also possible the shoes need to be replaced. Don’t make any changes until your situation can be re-checked. Once the foot is in good alignment then the kneecap can track properly and knee pain goes away. New symptoms can crop up if there is a separate problem anywhere from toes to hip. A follow-up or second evaluation may be needed to check this out.

Not necessarily, but if you do purchase a new pair, you should do so BEFORE the insert is made. Custom-made shoe inserts called orthotics are fit to your foot and ankle and
to the shoe. Off the shelf, pre-fab models are more forgiving and don’t fit as well.

When looking for a shoe that works well with an orthotic watch for the following:

You can, but you’ll need to check with your doctor first and then get some help starting an exercise program of this kind.

A decision of this kind depends on the type of joint replacement you have and how long you’ve had it. The implant must be well healed with good motion. The doctor will check for infections, loose parts, and uneven wear.

If everything checks out okay, then a physical therapist will measure motion and test your strength to find your starting weight for resistance. The leg without a joint replacement can be used to test “normal,” unless you have pain and weakness from arthritis or other problems on that side, too.

Once you are able to match strength, force, and motion on both sides, then the program can be advanced for both legs. The therapist will direct the frequency, duration, and intensity of your program for best results.

It might be time for a follow-up visit with your doctor or therapist. Tests of motion, strength, balance, and coordination can guide you. Patients exercising on their own can still show major weakness even years after a total knee replacement. This can put you at
risk for falls and other injuries.

Every person is different and has his or her own unique needs for rehab after joint replacement. A closer look at what you’re doing and how you doing can lead to an answer to your question.

It’s likely that some form of exercise will be advised. Regular exercise and physical activity has been shown to keep joints healthy, even joints already affected by arthritis. Make it worth your while to exercise. Find out what’s best for you in this phase of your recovery.

Studies show this is typical, but it’s not normal. Many adults have only half the muscle and leg power they need to be active and fully functioning.

Research shows this weakness is probably present long before the joint is replaced. It’s likely the result of months and years of adapting to the pain and limits from arthritis.

A standard exercise program after total knee replacement (TKR) may not be enough. Scientists are looking for the best mix of exercises and activities to fully restore the entire limb after TKR.

Older adults do get “out of shape” as the pain of arthritis slows them down. Deconditioning and loss of balance leave a person feeling uncertain of his or her ability to do a task or activity.

Walking, going up and down stairs, and getting up from a seated position without using the hands are three measures used to assess function. These tasks can be affected by knee pain, loss of muscle strength, decreased endurance, or a loss of motion.

The arthritis can contribute to one or all of these losses. An exam is needed to find out for sure the cause of your mother-in-law’s problems. A medical exam can help rule out other important causes of this downward decline.

For years doctors have used X-rays to help diagnose osteoarthritis (OA). Recently, researchers have started to call this practice into question. An X-ray reading of the joint may not be valid in predicting pain and function. In other words, the joint looks
fine but the pain is very limiting all the same.

More and more doctors are using MRIs to find OA. MRIs can image cartilage and soft tissues. The more the doctor knows about the soft tissues involved, the more direct and specific treatment can be.

Ask your doctor about having an MRI. You may be a good candidate.