FAQ Category: Knee

Knock-knee deformity is known as genu valgum in medical terms. It’s very common in children ages three to five years old. In most cases, genu valgum corrects itself by age seven to eight. Very little improvement occurs after age eight years.

If the problem stays the same or gets worse, it may be caused by loose ligaments in the knee or weak quadriceps muscles along the front of the thigh. Being overweight or obese can make the problem worse.

Children with severe genu valgum have an awkward, lurching gait. Their knees may rub together when walking. Most do not run well and have a hard time in physical activities. These children seem clumsy and tend to fall more than normal.

The best thing to do is have your granddaughter’s doctor take a look at her. Express your concerns based on your own experiences. There is some medical treatment for this problem. Most pediatricians wait until the child is at least five years old before doing anything about it.

Knock-knees or the opposite condition bowlegs must be corrected when knee joint replacements are done. If the uneven pressure isn’t changed, the new joint implant can wear unevenly just like the old joint probably did.

ometimes it’s a simple matter to realign the bones and soft tissues while putting the new joint in place. In other cases, doctors must cut bone, ligaments, and joint capsule to make it all work in balance.

As newer technology improves, surgeons are finding ways to simplify the soft tissue releases. The goal is to give the patient pain free function with a new joint that will last as long as possible. Standing up straighter is an added bonus of these new surgical methods.

It depends on several things. Have you been treated in any way yet? Anti-inflammatory drugs and conservative treatment with physical therapy may be able to get your symptoms under control and restore your motion.

Has your doctor taken X-rays and/or MRIs to see what’s going on in the joint? The condition of the joint and size of the joint space will help the doctor decide the best course of action.

Patients have more options now with the use of arthroscopic surgery. The joint can be scraped smooth of any torn cartilage or rough edges of bone. This is called debridement. Soft tissues such as the joint capsule or muscles can be released (cut)to help patients regain lost motion.

A joint replacement is an option but most doctors will try more conservative treatment first.

Flexion means “to bend” while contracture refers to the soft tissues being ‘fixed’ or ‘stuck.’ In more functional terms, a flexion contracture means your knee is flexed or bent and can’t straighten all the way.

When a joint stays in one position without moving for a long enough period of time, the tissues start to stick together. Fibrous tissue fills in between the soft tissue fibers. Loss of motion means the joint can no longer move the way it’s supposed to.

The usual result is pain and loss of function. It becomes harder and harder to climb stairs, get up and down off the floor, or even stand for long period of time.

Surgery to release or cut the contracted tissue is sometimes advised. More conservative treatment involves stretching and other exercises.

All of those options are possible. In fact, you may want to use them all one at a time. Usually the wait-and-see approach is accompanied by an exercise program to keep the muscles around your knee toned and strong. Some of the medications available control both the pain and the disease.

If the joint starts to deteriorate more, then surgery to keep the joint surfaces clean and smooth may be the next step. The doctor may put a special fluid called hyaluronan in the joint to keep the tissue from sticking together.

When the joint space narrows too much and the bone is in danger of rubbing against bone, a joint replacement will be needed. Today’s treatment approach for osteoarthritis is to save the bone and joint for as long as possible. Taking it one step at a time is a good way to accomplish this goal.

There are some studies that show patients are at greater risk for knee re-injury after anterior cruciate ligament (ACL) tears if the damage isn’t repaired. The most common injuries later are meniscus and joint cartilage tears.

If the joint cartilage is damaged, the bone underneath is unprotected. Wear and tear can cause damage to the bone. Painful arthritis can develop much later.

A recent study of over 6,000 adults confirmed these beliefs. Patients who didn’t have an ACL repair and opted for conservative care were twice as likely to injure the meniscus later and 30 percent more likely to damage the joint cartilage.

In general, children and young adults often do heal more spontaneously and faster than older adults. This is true for many illnesses and injuries. The military has a unique ability to see what works best since there are many ACL injuries in the line of duty.

Not only that, but the military has both young and older adults. According to a recent military study, there are slightly more adults who have the surgery after ACL injury (58 percent) compared to those who don’t (42 percent).

Long-term follow-up of these cases showed more re-injuries in active duty personnel who didn’t have surgery to repair the ACL. Younger adults were more likely to reinjure themselves later. The authors of the study think this may be because younger adults are more active.

All indications are that your doctor’s advice is good. The chances of reinjury are greater for young, active adults who don’t have the ACL repair.

Sometimes the term “immobilizer” and brace are used interchangeably. It may be necessary to know exactly what type of device is being called an immobilizer or a brace. A true immobilizer keeps the joint from moving at all.

An immobilizer may be used after ACL repair to keep the knee fully extended for the first few weeks after surgery. Some doctors think this kind of immobilization is needed to prevent loss of knee extension. The immobilizer can be removed and usually is taken off
during physical therapy every day.

Braces usually have a metal hinge joint that allows the knee to bend and straighten. It keeps the joint stable and protects the healing ligament from too much strain or load during activity. In some braces, the joint can be set to allow some, but not all motion.

Anterior cruciate ligament (ACL) injuries are commonly reported at all three military academies (West Point, Naval Academy, Air Force Academy). The cadets and midshipmen are all required to join in sports and military activities all year long. No one is exempt.

Everyone must meet a high level of physical fitness to get in any of these schools. And they must keep up this level of fitness throughout their training. Likewise, any cadet suffering an ACL injury is expected to return to the same high level of physical activity after knee surgery.

It may be best not to second guess your son’s decision based on this one injury. It could have happened anywhere.

There are different kinds of braces and uses after ACL repair. Bracing is different from the immobilizers used in the first few weeks of post-operative recovery. Some (rehabilitative) braces are used for eight to 10 weeks after the operation. The patient can then switch to a functional brace used during twisting or torquing activities.

Many studies have been done to show that bracing doesn’t make a difference after ACL repair. Patients have the same long-term results with or without bracing. There’s no difference in motion, strength, or endurance. The number of reinjuries later is the same with or without bracing.

Despite these findings, many patients still wear a brace for up to a year after ACL repair. This may give patients an increased sense of confidence or safety, but doesn’t appear to make any real difference in function or protection.

Not at all. You may have just done a bit too much or progressed your exercises too fast. Once your arthritic symptoms are under control, try again. Start at a very slow pace with only a few repetitions of each exercise. Wait a day to see how you feel. Most people don’t know they’ve done too much while they are exercising. It’s not until 24 to 36 hours later that the body shows signs of distress from overdoing it.

Give some thought to the kind of exercise you are doing. Arthritic knees do respond well to the right kind of movement and exercise. Using a stationary bike is a good idea. This keeps the knee in a straight plane of motion without any twisting motions. It keeps the joint moving through its range of motion without the weight of your body putting a load on it.

An aquatics program is also ideal. If you have one in your area, this is an excellent way to exercise while “unloading” or taking the pressure off the joint. In the pool, the effects of gravity are eliminated. At the same time, the joint is supported by the buoyancy and warmth of the water.

If none of these options work for you, see your doctor or a physical therapist. They are trained to find out what exercise is best for each individual based on their age, weight, overall health, and level of fitness.

Studies show muscles can heal but it’s a slow process with a high rate of re-injury. The
formation of scar tissue seems to slow up the recovery process of injured muscle.

Fibrous scar tissue forms when the body sends too much growth factor to the injured
muscle. Some growth factor is needed to stimulate new cell growth. These new cells fill
in the damaged area.

Too much of the growth factor TGF-beta leads to too much fibrosis. Fibrous scar tissue
prevents full recovery of the injured muscle resulting in a loss of motion. Physical
therapy can help in some cases. The use of deep heat, friction massage, and stretching
may help restore flexibility. A program if resistance training can help restore full
strength.

Teasing this kind of information out of the literature can be difficult. Other variables must also be considered such as age and level of activity. Treatment of the torn ACL has also changed over the last 20 years, affecting the results for both men and women.

In general, more ACL tears are repaired surgically early on. Early ACL repair allows young patients (especially athletes) to return to full activities.

Several studies have been done looking at the rate of reinjury in two groups of patients: those who have an ACL repair and those who don’t. The consensus at this time is that gender isn’t a factor in reinjury.

It looks like age is more of a predictive factor. The younger, active patients who don’t have ACL repair reinjure the knee later. Meniscus and joint cartilage are damaged most often. If you have access to a medical or public library, check out these two articles for more information:

Warren R. Dunn, MD, MPH et al., The Effect of Anterior Cruciate Ligament Reconstruction on the Risk of Knee Reinjury. In The American Journal of Sports Medicine. December
2004. Vol. 32. No. 8. Pp. 1906-1914.

Barber-Westin SD, et al. A Rigorous Comparison Between the Sexes of Results and Complications After Anterior Cruciate Ligament Reconstruction. In Arthroscopy. Vol. 12. Pp. 462-469, 1996.

Not yet. Sumarin is used primarily to treat African sleeping sickness. It works by causing the parasites to lose energy,which causes their death. Suramin is also used to stop the growth of bladder cancer by stopping blood flow to the tumor.

Recently it was discovered to work as an antifibrotic agent, which means it prevents scar tissue from forming. It may be helpful in promoting faster muscle healing after injury.

Studies on Sumarin for its use in muscle injuries have been done on rabbits and mice. The next step is to test Sumarin on large animals. If it’s safe and effective in large animals then clinical trials will begin in humans. Approval for children will occur much later after the drug has been proven safe and effective in adults.

As we all know, there are many changes that occur with aging. Overall posture starts to change. We aren’t as stable in the upright position as we once were. Around the knee the
quadriceps muscle strength is less. Aging often brings arthritic changes that affect the knee.

At the same time there is a reduced amount of joint position sense. Position sense (knowing where the joint is in space) is called proprioception. Scientists aren’t sure what comes first, the arthritis or the decreased proprioception.

It’s even possible that arthritic and disc changes in the neck can lead to changes in knee proprioception. One study has shown that patients with pressure on the spinal cord
in the neck have altered knee proprioception. Another study confirms that patients with arthritis in one knee have decreased joint position sense in the other knee.

More study is needed to sort these factors out. In the meantime, make an appointment with your family doctor. It might be a good idea to rule out anything more serious going on
and get a baseline. You may just need a conditioning or strengthening program.

Patellofemoral pain syndrome (PFPS) usually presents as pain in the front of the knee or around the patella (kneecap). Pain often gets worse with activities that load the patellofemoral joint such as stair climbing, squatting, or hill running.

Many doctors suggest using over-the-counter arch supports as the first step. Custom-molded orthotics are saved for patients who aren’t helped by ready-to-wear supports.

The job of the orthotic is to limit how much the arch falls. Keeping the foot in the middle or neutral position will limit lower leg motion. The result is a decrease in the abnormal motion behind the patella. Some think custom-made orthotics, rather than off-
the-shelf models, give the best pain relief.

However, a recent study of orthotics use in PFPS showed it didn’t matter what kind of natural foot position or orthotic is used. The muscles responded the same in all cases. It’s possible that just stimulating the bottom of the foot is all that’s needed. More studies are needed to find out for sure.

Research on PFPS is ongoing. This condition causes knee pain when the patella (kneecap) doesn’t track up and down correctly during knee movement. Foot position is a key factor in this problem. The angle of the knee changes when the arch of the foot is dropped down (flat foot). The same thing happens if the arch of the foot is too high.

Even small changes in foot position can affect the way the muscles contract. The quadriceps (thigh) muscle is a key player in PFPS. If one side of the muscle contracts more than the other, the patella is pulled in that direction. When each part of the quadriceps muscle contracts in balance, the patella stays in the middle.

A recent study at the showed that orthotics can make a difference in muscle activity. Orthotics are shoe inserts that help put the foot in a better position. Treatment to address foot position and muscle activity may help PFPS the most.

Patellofemoral refers to the kneecap (patella) as it moves over the femur (thigh bone). The patella moves up and down along a specially designed track of cartilage and bone. This holds it in place and gives the knee smooth motion.

Improper foot position can get the patella off track causing painful knee symptoms. Orthotics work by altering muscle function and by changing foot position, which also alters muscle function. Orthotics slip inside a shoe and hold the foot in a neutral
position. The idea is to correct abnormal leg alignment and restore proper mechanics. With the foot in the right position, the patella can track normally.

Recently scientists found out orthotics also change the way leg muscles contract. They think nerve sensors in the bottom of the feet respond to the orthotic. Messages are sent to the quadriceps (thigh) and gluteus medius (hip) muscles. PFPS is less when these two muscles are in balance.

Sometimes the forces and load on the knee are uneven. Only one side or the other of the joint gets worn down. Arthritis affecting only the medial (inside) or lateral (outside)
edge of the joint can be treated with a unicompartmental knee replacement (UKR).

With a UKR, the other parts of the knee and knee ligaments are mostly untouched by the
operation. Knee motion is nearly normal after this surgery.

The first criterion for UKR is unilateral arthritis. Since a total knee replacement is not advised in young or middle-aged patients, the UKR is a possible choice for this
patient group.

At the present time, the knee ligaments must be stable before a UKR can be implanted. You may be a candidate for UKR if you have both unilateral joint disease and intact
ligaments.

Knee motion is more than just bending and straightening. The two main bones that form the
knee (femur and tibia) also glide, slide, tilt, and rotate. The combination of all these
motions is called kinematics.

Studies show major changes in knee kinematics after a total knee replacement. There may
be several reasons for this. One is the change in the shape of the bony surface of the knee that occurs when the implant is put in place. Another is the loss of the cruciate knee ligaments that criss-cross inside the joint to hold it together. Sometimes one or
both of these ligaments are cut to insert the implant.

Finally, the way nerves and muscles work together can be altered when other diseases or conditions are present. This can include Parkinson’s, multiple sclerosis, the results of a stroke, and many others.