FAQ Category: Knee

If these two injuries happened ten years ago, most doctors would repair the ACL and remove the damaged portion of the meniscus. Since then, studies have shown that it is usually better to fix the torn ACL and repair the meniscus whenever possible. When part or all of the protective pad of cartilage is removed (the meniscus), the knee suffers extra wear and tear. This can lead to joint damage years later. In fact, long-term studies have shown that even removing part of the meniscus can cause arthritis later.

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.

There are several possible causes of pain behind the knee. A recent injury can cause pain from a ligament tear. Sometimes a small structure in the knee such as a bursa or plica can become inflamed and cause pain.

You may be describing a condition called patellofemoral pain syndrome (PFPS). This occurs when the kneecap is slightly off center as it slides up and down over the joint. This kind of tracking misalignment can cause the cartilage behind the knee to become torn or frayed.

PFPS is often characterized by pain when descending stairs. There may also be pain when trying to bend at the knee in a partial squat. An orthopedic physician or physical therapist can examine you and determine the cause of your symptoms.

Patellar taping is a fairly new treatment option for patellofemoral pain syndrome (pain behind the kneecap). The tape helps the kneecap to stay in its proper place as it moves up and down with knee motion. It also helps unload the force or pressure on the kneecap that contributes to pain. Many people find that, with the tape in place, they can do most activities without pain.

Recent research has shown that continued pain after taping may mean the taping was not done properly. Pay close attention to the specific taping done on those days when the tape reduces pain. Compare this to the taping method used on days when the pain continues despite taping.

If this doesn’t help, contact the physical therapist or physician who showed you the taping method. Very likely, the cause of the problem can be quickly and easily identified and corrected.

Taping the kneecap in place is a relatively new approach to this problem. Research has clearly shown that this method reduces more than 90 percent of knee pain in over half of all people. Other studies have shown that taping improves the way the kneecap moves or “tracks” over the joint.

Once the pain has been reduced, the way you walk and move is restored to a more normal pattern. The muscles around the knee do not change with this treatment, so a program of specific exercises is still required. A physical therapist can help you learn how to move and stand to improve this problem. Such a program would also include specific exercises to help the muscles regain strength and function.

Rehabilitation requires a slow pace. After repairing the meniscus, doctors usually limit how much weight you can place on your foot and the amount of bend in the knee for at least six weeks. Patients are often able to resume normal activity by three months. Athletes in cutting and pivoting sports may need four to six months before resuming their sport.

Most connective tissue (such as the meniscus) takes a year to 18 months for full healing to occur. By one year, everything generally seems fine and there is no evidence of continued healing. Symptoms of any kind that are present for more than one year are not likely to go away on their own. This situation represents failure of repair. Further surgery may be needed to stabilize the meniscus.

A recent study looked at the effects of a stretching regimen on range of movement in the thigh. The participants did a supervised stretching program four times a week for two weeks. They warmed up for a few minutes and did 10 squats. Then they did two sets of stretches on each leg, for a total of 80 seconds per leg. They did the same stretches each time.

After the two-week program, thigh stretches felt less intense. However, there were no significant changes in range of movement.

It may be that the stretching program was not rigorous enough to improve range of movement. Interestingly, when participants were told to stretch until the feeling was as intense as it had been before the stretching program, range of movement increased 15 degrees. These results suggest that stretching can and does improve range of movement. Be careful to avoid stretching too forcefully, though. A physical therapist can design a good stretching program to help you get the maximum benefit.

It’s true that injuries are fairly common among distance runners. Up to 57 percent of recreational runners get injured over the course of a year. Most of these injuries (up to 75 percent) are from overuse.

A recent study identified gender and foot posture as risk factors for medial tibial stress syndrome (MTSS), commonly known as shin splints. In a group of 125 high school cross-country runners, 12 percent showed signs of MTSS. Injured runners were overwhelmingly female. They also tended to be pronators.

How do you know if you’re a pronator? A doctor or sports trainer can do tests to find out. If pronating seems to be a problem in your case, you may want to look into orthotics. These shoe inserts can be designed to support your feet against pronation as you run. Preventive measures like these can improve your chances of avoiding overuse injuries for the long run.

A recent study looked at 125 high school distance runners. Fifteen of them (12 percent) developed medial tibial stress syndrome (MTSS), which is often lumped with shin splints.

Runners with MTSS were overwhelmingly girls (13 of 15 injured runners). They also showed a more pronated foot posture than noninjured runners.

The researchers concluded that sex and foot posture predict which runners get MTSS 76 percent of the time. This model is still under investigation. Still, it wouldn’t hurt to look out for girls and pronators, who seem to be at higher risk for these kinds of injuries. Orthotics may provide a means of early prevention for these runners.

Unfortunately, no. Patients who show limited bending in the knee before joint replacement surgery often have difficulty getting the knee to bend fully afterward.

There are ways you can improve your chances of avoiding a stiff knee after surgery. Get as much information as you can about how the surgery is done, what you can expect from surgery, and what exercises and rehabilitation you’ll be doing after surgery. Patients who follow their doctors’ advice and comply with a comprehensive rehabilitation program after surgery improve their chances of getting optimal surgical results.

First, learn as much as you can before having surgery. Find out what happens during surgery, and what to expect from the procedure. Gather information about what you’ll need to do after surgery to avoid a stiff knee.

Second, be sure to follow the advice of your doctor and physical therapist about exercises and therapy after surgery. Patients who are consistent with a comprehensive rehabilitation program tend to avoid the complications of a stiff new knee joint.

If you’re not getting improved knee movement after aggressive physical therapy and the splint, your doctor may recommend a procedure called manipulation under anesthesia. This involves a forceful stretch of the knee while you’re asleep from anesthesia. This treatment is designed to break up scar tissue and improve knee motion. Patients usually resume physical therapy after manipulation.

If you still don’t have better movement in your knee, additional surgery may be suggested. Choices include surgery using an arthroscope to remove scar tissue followed by a forcefull stretch of the knee. Less commonly, surgeons may need to revise or replace the parts of the prosthesis.

Your active participation in rehabilitation is an important factor that sometimes minimizes stiffness in a new knee joint. But there may be other reasons why your knee is still stiff.

Some people have a tendency to form a lot of scar tissue after an injury or surgery. When this happens after total knee replacement, the added scar tissue can produce stiffness in the knee. Likewise, people who go into surgery without much bend in the knee commonly have problems getting full knee bend after surgery.

Bear in mind that not all problems of stiffness are due to patient factors. Errors in the way the surgery is done can affect whether the knee is stiff after surgery. Improper alignment in the parts of the new prosthesis can lead to tightness in the hinge-action of the joint. Other technical errors during surgery can also contribute to tightness. Complications can result after surgery if there’s infection or if the prosthesis has become loose or broken.

Be sure to discuss your concerns with your doctor.

This depends on the type of surgery you’ll need and the recommendations of your doctor. As a general rule, patients are instructed to use crutches or a walker when standing or walking for at least six weeks. This limits the weight patients bear on the operated leg. For debridement surgeries, doctors often allow patients to start out by putting a comfortable amount of weight down. But if an allograft surgery (using donated tissue) is done to restore the bone and cartilage, patients may have to avoid bearing much weight on that side for up to four months.

In a recent study of this relatively new procedure, about a third of the transplants tore within three years after surgery. Most tears were due to some sort of trauma. These torn transplant had to be partly or totally removed.

Researchers think the transplants may be prone to tear because the transplanted meniscus doesn’t develop as many cells compared to a normal meniscus. And the cells that are present don’t produce as many nutrients. Heavy and repeated strains put the transplanted tissue at an even greater risk of tearing. Until more is known about the long-term results of this procedure, it’s a good idea to strictly follow your surgeon’s recommendations.

Plan on getting up and moving the same day or the day after surgery. You’ll be using crutches or a walker to get started. Usually you can discard the walking aid in two to four weeks, depending on how fast your thigh strength returns and the swelling goes down. Don’t expect to return immediately to the activities that resulted in your injury. 

Returning to sports activities really depends on the treatment plan set up by your doctor and physical therapist. It also depends on your progress in rehabilitation after surgery. Treatment protocols after ACL surgery are generally designed to take between four and six months. Be sure to ask your doctor if you have questions about the activities you’d like to do.

Some doctors prescribe up to 12 physical therapy visits before scheduling ACL surgery. Doing some physical therapy first can help prepare you for the surgery. The visits help by getting control of the swelling, restoring knee movement, and improving knee stability. Getting the swelling down before surgery may keep scar tissue from developing after surgery. Improving knee movement and joint stability before surgery can also affect your progress after surgery. Your physical therapist can use the visits before surgery to answer your questions. He or she can train you to use crutches, and go over the exercises you’ll do after surgery.

Hard to say. Doctors really don’t know why this happens to some people. Some think it could have to do with genetics. Others believe it could be from a previous knee injury. People who have endocrine imbalances are also prone to this condition. Finally, experts believe it can show up in later life if there was a problem during the time when the growth plate in the knee bones was changing from cartilage into bone.