FAQ Category: Knee

The surgeon uses an arthroscope to look inside the knee joint without making any large incisions to actually open up the knee. After the arthroscopic examination, the remains of the torn ligament are usually cleared away.

Then, donor tissue is taken from a point near the knee to use as a replacement. Usually, a tendon just below the knee or along the inside edge of the knee is used. The surgeon prepares the donor tissue by shaping it and stitching it to get just the right amount of tension for its new use.

Using a special drill, the surgeon makes a tunnel through the shinbone (the tibia) in the lower leg. The donor tissue is passed through this tunnel and screwed or stapled in its new location. The knee is then tested by putting stress on the graft and making sure it is set at a tension that allows movement and relaxation of the joint.

The skin is closed. A dressing is applied to the wound, and a cold compress is placed around the knee to reduce swelling. Unless there are some unusual complications, patients go home the same day.

Biofeedback is a treatment used by physical therapists to help patients see what muscles they are using and how they are using them. There are different kinds of biofeedback. For example, holding a tiny thermometer in the hand can record skin temperature. By thinking about breathing and imagining a warm place, it is possible to increase the blood flow to the fingers. This increases the temperature of the skin, and the thermometer records the increase on a computer screen.

Likewise, muscle activity can be measured with electrodes placed on the skin. These record the electrical impulses of the muscles when they contract. By watching signals on the computer screen or hearing signals, it is possible to increase or decrease muscle contractions. This form of biofeedback is called electromyographic biofeedback.

Biofeedback treatment is used to help people improve their ability to control their own muscles. Once the electrodes are in place, the therapist will teach the patient how to contract and hold one muscle while relaxing another. When the muscles function properly, the patella moves normally, and pain is reduced or eliminated.

Chondromalacia, or patellofemoral pain syndrome, occurs when the cartilage on the back of the kneecap (patella) becomes cracked and worn. The rough surface “catches” on the bones underneath, causing painful symptoms. The exact cause of this problem is unknown. Anything that pulls the patella off the center of the knee can be part of the problem.

The muscle in front of the thigh (quadriceps) is supposed to help hold the patella in the middle. Pain or injury can lead to a loss of control in this muscle. As a result, the patella gets off track. This is a major cause of chondromalacia of the patella.

Exercises to strengthen the quadriceps and other measures to help the patella track normally can help. Two-thirds of all patients with this problem have an overall positive result with this kind of program.

I have been diagnosed with chondromalacia of the knee. What is this?

Chondromalacia, sometimes referred to as “patellofemoral pain syndrome,” is a common problem in young adults. When the kneecap (patella) moves up and down, it usually follows a track that runs along the bones underneath. If the patella is not in the center, it starts to move off the track. This can cause wear and tear of the cartilage behind the knee. The back of the patella becomes rough and catches on the bone. This produces a crunching sound called crepitus. When this happens, pain, aching, and muscle weakness can develop.

Q-angle–or quadriceps angle–is the angle between the quadriceps muscle (front of the thigh) and the patellar tendon (just below the kneecap). This angle can be determined using X-rays. More often, it is measured by placing the person flat on a table with the hips, knees, and feet in a neutral position. A line is drawn from the pelvic bone to the middle of the kneecap. A second line is drawn from the middle of the kneecap through the large bump on the shin (called the tibial tubercle). The angle formed by the crossing of these two lines is called the Q-angle.

Normally, the Q-angle is between 13 and 18 degrees when measured this way. Boys and men usually have smaller angles than girls and women. With a larger than normal Q-angle, the kneecap (patella) moves up and down over the knee joint in such a way that it can cause wear and tear of the cartilage. This causes crepitus, or the crunching feeling people describe when straightening the knee.

Ask your doctor about seeing a physical therapist. Using taping techniques, shoe inserts (orthotics), or muscle strengthening exercises, the therapist may be able to help your daughter learn how to keep the patella in the middle.  These measures can help reduce pain, swelling, and the crepitus sensation.

Certain movements place a large strain on the ligaments of the knee. These include stopping suddenly, or planting the foot on the ground and turning in a different direction. Soccer players are especially prone to injury of the anterior cruciate ligament (ACL) in the knee.

The hamstring muscles behind the thigh help protect the knee. How fast the hamstrings contract in response to sudden movements may help prevent injury to the knee. Quick response is a major principle of injury prevention for any athlete out on the field.

A total body response including the upper body, hip, knee, and ankle is also important for soccer players. A training program should include strength and balance training for these areas.

A new program for the prevention of ACL tears in soccer players has been published. It includes training the mechanisms in the knee and ankle to give these joints a sense of where they are and how they are moving. This training involves the use of a balance training board or disk.

The athlete is required to “balance” the board–or move it without losing balance. This action improves the body’s reaction time out on the field. This can help prevent knee injuries. Ask your trainer about this type of program if you aren’t already doing it.

When the anterior cruciate ligament (ACL) is strained, it becomes weak or “deficient” in holding the knee together. Without good ACL strength, the knee can be easily reinjured. This could happen while you are riding or during other activities.

Exercises on a special training disk retrain the ankle and knee to respond to quick movements. Stopping suddenly or changing directions quickly are examples of these types of movements. Balancing on the board or moving the board in many directions without losing your balance is important. This kind of activity improves the joint’s sense of direction and position.

Usually eight weeks of exercises on an exercise disk for 15 minutes each day are recommended. This is based on a series of studies done on athletes with ACL injuries. When you have finished your home program, the therapist can measure your strength and balance. This will help you decide if any further rehabilitation is necessary.

Your definition of “tolerate” may be different from your doctor’s. Just because you can grin and bear the pain doesn’t mean your joint is able to tolerate the extra pressure when you’re up and about. You may need to ease up on your activity level, limit the amount of exercise you’re doing, and possibly use a cane or walker for a while. If you’re doing too much and your joint can’t tolerate it, you may end up with more pain and swelling. Use these symptoms as guides to what the joint can handle.

Doctors may put a needle inside the knee joint or into the bursa sac in front of and below the kneecap to find where the fluid is coming from. The needle can then be used to draw the fluid out. However, if the problem that is causing the extra fluid is not corrected, the fluid will probably come back. Unless there is an infection in the knee, there is no danger in leaving the fluid there because the body will gradually absorb it.

This usually describes pre-patellar bursitis. This is when fluid builds up in the bursa sac that lies in front of and below the kneecap. The front of the knee may look like a goose egg.

There are also conditions when the knee joint itself fills with fluid. A joint capsule encloses the bones of the knee joint. When the capsule fills with fluid, it may give the appearance of “water on the knee.” This can happen with problems like arthritis or infection.

An injury to the structures inside the knee can cause bleeding and swelling to fill the inside of the joint. In these instances, there will be fullness in the tissues of the knee, rather than simply a goose-egg appearance in the front of the knee.

Until recently, giving you guidance would be mere guesswork. Now we can say that your safest bet is to avoid any activities that cause a lot of impact on the knee, such as heavy jumping, lunging, and fast starts and stops. Research also shows that jogging and downhill walking put too much stress on the joint. Cycling and level walking are safer choices because the forces that happen during these activities are more evenly spread over the surface of the joint. Exercising in a pool is a good idea, too, because the water’s buoyancy allows you to move and exercise more easily, and there is less pressure on the joint.

Osteochondritis dessicans (OCD) of the knee is when a piece of bone just under the joint cartilage is injured and dies. The piece of bone and the cartilage above it may actually separate from the joint. When this happens, the fragment can float around inside the joint. Because it floats free, the fragment can get stuck in the joint, causing the knee to pop, click, or even lock up. 

Let swelling and pain be your guides. Pain is an indicator that something isn’t right. You may feel some discomfort with your exercises, but it should be “reasonable” discomfort. If you end up feeling a lot of pain that lasts more than one hour after exercise, you’re probably overdoing it. If you have pain with exercise or activity, you need to make some changes. Reduce the intensity, time, or repetitions of your exercise or activity. If you see swelling around your knee late in the day, this could also be a sign that you are overdoing it.

There aren’t any major nerves that pass by the area you’ve described. The feelings of weakness you have may be from a condition called “muscle inhibition.” When there is pain or swelling around a joint, the muscles in the area may shut down; that is, they become “inhibited.” The condition starts to improve once the pain and swelling are taken care of. If the problem continues, physical therapy treatments using muscle stimulators and exercise may be needed to get the muscles working correctly.

It is questionable whether you merely tore your medial collateral ligament (MCL) when you were first hurt. Had you only injured the MCL, chances are it would have scarred down and not given you much trouble.

From what you describe, it is more likely that you also stretched or tore the anterior cruciate ligament (ACL). In either case, you might not be a candidate for ligament surgery given your age. Instead, a surgeon specialist will probably want to have you use a brace and do exercise treatments. If these aren’t helpful, surgery might be a last resort. 

Age is one factor your surgeon will consider. So is activity. Your surgeon may treat you as he or she would a younger patient, given your level of activity.

If the tear is small and doesn’t cause swelling, you may be safe to exercise. But exercise probably won’t fix the tear. This is because joint cartilage does not have its own supply of blood and lymph vessels. This means the cartilage is not able to heal on its own. If the tear goes all the way down to the bone, you may not require surgery. But again, your knee will probably not get better as a result of doing exercise.

It’s best to choose exercises like swimming or biking, to keep from forcefully jarring the joint and putting extra pressure on the unprotected portion of bone below the tear. If the cartilage and the bone below it have become unstable or dislodged, exercise will make things worse, meaning surgery will probably be recommended.

Some of the muscles that support the knee attach at the hip. Like other muscles that are closer to the center or “core” of the body, these muscles give stability to joints. The muscles help put your joints in the right position, and they steady the joints while you squat, walk, or jump. Core muscles form a stable platform, letting you move your leg and foot with precision. If these muscles are weak, your knee will lose some of its control, keeping it from working at its best. 

The new arrows are “bioabsorbable,” which means the body will eventually absorb or dissolve this material. Minor complications are very common with the use of the arrows.? As many as one-third of all cases may develop symptoms of knee pain and tenderness, skin irritation, and bruising.

Studies have shown that many of the symptoms associated with the use of these arrows are temporary. Most of the problems take care of themselves within the first year. Further surgery is required only occasionally.

Most ACL injuries occur when the knee is perfectly straight or slightly bent. This type of injury can happen when a player is running, jumping, or standing still. In soccer, the ACL is most likely to be injured when a player is running and changing directions quickly, stopping suddenly, or twisting the body over the foot. Jumping and landing on the foot with the knee twisted can also cause problems.

New technology has allowed researchers to measure the strain placed on the ACL. One important discovery has been that stopping suddenly (rapid deceleration) puts a high level of strain on the ACL. This occurs when the foot makes contact with the ground and the leg is at its straightest. Doctors and physical therapists are working together to develop an exercise program that will prevent these types of injuries.

After many years of treating meniscal tears, doctors have determined who can rehab the injury and who should have surgery. The doctor will look at where the tear is located, the length of the tear, the stability of your knee, and the condition of the other knee structures. Certain conditions must be operated on. For example, tears that are longer than 10 millimeters require surgery.

Most orthopedic doctors are willing to try rehab first. Usually, a program of exercises is prescribed by a physical therapist. If after rehabilitation the knee “locks up,” preventing any motion and causing severe pain or swelling, surgery is advised. Likewise, reinjury of the same knee will probably call for surgery.