I’ve heard that women are more likely than men to have medical complications after ACL surgery. Is this true?

The research has been mixed on this issue. Some studies have found that both genders are prone to complications from ACL surgery. Other studies show no differences between the two groups.

A recent study followed 200 patients who had this type of surgery. None of the patients, male or female, had serious complications. The authors felt that this was because the patients immediately started a swiftly progressing rehabilitation program. The program got patients up and moving quickly and emphasized straightening the knee as early as possible. The authors also tried to delay surgery until patients had maximal knee extension and the swelling was gone.

These factors may make a difference in whether patients avoid problems after ACL surgery. For the time being, it looks like gender doesn’t have an impact on surgical complications after ACL surgery.

I know that women are more prone to ACL injuries than men. Does this mean that women also have worse results from ACL surgery?

No. A recent study followed 200 patients who had ACL reconstruction. The researchers found that men and women actually had the same surgical results. There were a few minor physical differences, but in general women had the same amount of pain and physical function a few months after surgery as men did. And both groups were equally satisfied with their surgery. It seems that both men and women can expect good results from this kind of surgery.

I am a dancer who’s having ACL surgery. The doctor says I have to wear a brace for a few weeks afterward. Is it normal to have to wear a brace, and will it affect my future performance?

The brace is used to protect your knee in the early weeks after surgery. You’ll be instructed to remove the brace several times during the day to do exercises for improving knee motion and muscle tone.

As a dancer, you’ll also be concerned with getting your balance and agility back after surgery. A recent study looked at two types of postsurgical treatment for patients who had ACL surgery. Half of the patients wore casts for five weeks after surgery. The other half wore braces for the same amount of time and did exercises to improve their range of movement. After at least six months of supervised rehabilitation for agility and strength training, patients in both groups did equally well on tests of balance. The results for balance and agility were excellent.

Talk to your doctor and physical therapist about how often to take your brace off and when you can discontinue using it.

I tore my ACL playing basketball, and I’m having surgery to reconstruct the ligament. Can I expect to get my balance back?

The outlook is good. Researchers recently observed patients who had ACL surgery followed by five weeks of wearing either a cast or a brace. Patients also had six to eight months of therapy to get their agility and strength back. Three years after surgery, these patients did as well on tests of balance as people who didn’t have ACL problems. Patients who had ACL surgery had slightly slower reaction times, but in general their balance was just as good.

Ask your doctor or physical therapist about ways to manage your knee after surgery to ensure a full recovery.

I am having ACL surgery, and I want to make sure I get my ability to balance back. Any suggestions?

Researchers have shown that certain types of treatment can help restore balance after ACL surgery. They suggest rehabilitation with three components. One component is training to improve range of movement in the knee. Another is agility training to exercise and quicken the reflexes. The final component is strength training, especially of the hamstring muscles.

A recent study looked at patients who had this type of rehabilitation three times a week for at least six months after ACL surgery. Results showed that these patients were able to balance about as well as people who never had ACL problems. 

A physical therapist can suggest a training program to help you maximize your recovery after surgery. If you stick with your program, you have a good chance of getting your balance back.

What is ACL reconstruction surgery? Where does the “reconstruction” come from?

The anterior cruciate ligament–or ACL–is a major stabilizer of the knee joint. When this ligament is torn, the original, damaged tendon is removed, and the knee is reconstructed with new tissue. Typically, surgeons cut a strip from the patellar tendon (below the knee) to replace the ACL. Or they may use tissue from one of the hamstring tendons along the inside of the thigh. Screws are used to attach the new tissue in the exact location of the original tendon.

This procedure is typically successful. In a recent study of 200 patients, no significant medical complications developed from ACL reconstructions using the patellar tendon. In fact, 96 to 98 percent of patients said they would choose this surgery if they had to go back and do it again.

I tore the anterior cruciate ligament (ACL) in my knee back in high school. When my doctor went in to fix the ACL, he had to take the meniscus out because it was torn. I’m only 30 years old now, and I’m starting to feel stiffness and pain in my knee. Am I going to end up with arthritis in my knee?

Not necessarily. But people who tear the meniscus or damage the joint cartilage in an ACL injury are more likely to have problems later. This is because healthy meniscus and joint cartilage helps cushion and steady the knee. If the meniscus has to be taken out surgically, the joint tends to lose some of its stability, and the extra movement inside can take a toll on the joint.

You can take action now to reduce the chances of future problems by avoiding activities that put a lot of strain on the knee, especially sports that require cutting, jumping, and quick starts and stops. Exercises to maintain movement and strength in the knee can help ease pain and protect the joint. Be sure to talk with your doctor about other ways you can improve the health of your knee.  

The pain I feel from osteoarthritis in my knee gets worse when I’m active. Wouldn’t it be safest for me just to stay in my recliner so I don’t feel pain?

It is natural to want to avoid movements and activities that make your pain worse. Yet health experts agree that people with knee osteoarthritis can benefit from certain types of exercise. People who stop activity because they feel pain are at risk of having more problems, because avoiding activity can cause muscles and bones to weaken and joints to get stiffer. Safe exercise helps lubricate joints and keeps muscles strong. Done on a regular basis, exercise has been found to help people control pain from knee osteoarthritis. Your doctor may have you see a physical therapist to discuss the types of exercise that will be best for you.

The arthritis pain in my knee is slowly getting worse. I’ve never gotten relief with rubs or ointments, but I’m wondering about a new cream called capsaicin. What is it made of, and can it work for me?

Many types of rubs and creams may give the feeling of warmth but do little to ease the pain felt with knee osteoarthritis. Capsaicin is different. It comes from the common pepper plant and works by getting the body to release chemicals that block pain. It does more than give a feeling of warmth on the skin. Clinical studies show that capsaicin is effective in easing pain from knee osteoarthritis. Be sure to check with your doctor before using it. Also, because it causes irritation, be sure to wash your hands after rubbing it on your knee to keep from accidentally rubbing it in your eyes or on other parts of your skin.

I’ve read that people with hip and knee osteoarthritis should think about using a cane to take pressure off the leg and to help the pain go away. What should I know about purchasing and using a cane?

If your osteoarthritis is starting to cause more pain and stiffness in your hips and knees, a cane might give you some relief. A cane helps take some of the strain of walking and standing off the weight-bearing joints. Many people only need to use their canes during flare-ups.

When you are looking for a cane, choose one with a handle that feels comfortable in your hand. To size a cane, hold it by the handle, keeping your hand by your upper thigh with your elbow bent slightly. The tip of the cane should touch the ground about six inches in front and to the side of your foot.

When you use the cane, carry it on the opposite side of your sore joint. For example, if your right knee hurts, hold the cane in your left hand. When you take a step with your affected leg, move the cane forward. This allows you to put more weight on the cane and less on your sore knee or hip.

I twisted and sprained my knee badly back in high school. I read once that having a bad knee injury can cause knee arthritis later in life. If so, I’m wondering if there is anything I can do now so I don’t end up with knee arthritis.

People who have had a significant injury of the knee joint may have a greater risk for knee arthritis in later years. Prevention includes safe exercises that focus on improving and maintaining joint movement and muscle strength.

Stay active in a low-impact conditioning program, such as walking. To help reduce shock with day-to-day activities, wear supportive shoes, and consider the addition of an insole to help absorb shock. Walk on soft surfaces when possible, and avoid standing and walking for long periods on hard surfaces, such as cement. You might also consider choosing sport and recreational activities that don’t require cutting, jumping, and quick starts and stops. The time and effort you invest now to improve the health of your knee and avoid future problems are worth it.

My doctor explained that the aching and swelling in my knee is from osteoarthritis. She told me about an injection that can lessen my pain and help me get around easier. What kind of medicine is in the shot, and does it work?

Healthy joints are lubricated and cushioned by fluid inside the joint. Osteoarthritis causes the joints to become sore and stiff because the joint fluid loses its ability to lubricate and cushion.

Doctors have observed good results with a material called hyaluronin, a substance that imitates the fluid in your knee joint. The fluid is injected directly into the sore joint up to three times over a period of several weeks. Some people find that the benefits begin to wear off. When this happens, additional injections can be given every six months. 

Many patients who have had these shots report less pain and find it easier to do their activities. However, people with more advanced knee osteoarthritis don’t always benefit from the shots.

I fell and hurt my knee pretty bad back in high school. Will I be more likely to develop arthritis in my knee as I get older?

Just because you injured your knee does not mean you’ll have problems as you age. However, significant injuries to the knee and hip have been found to increase the risk of osteoarthritis in these joints. Researchers tracked 1,337 medical students over a period of nearly twenty years to see whether people with knee or hip injuries would eventually have problems with osteoarthritis. They found that a higher percentage of people with injuries of the hip or knee in the younger years ended up having arthritis in the joint they had injured. People who are at risk because of an earlier injury should consider seeking advice on ways to improve the health of their joint and to prevent problems in the future.

My doctor said that X-rays of my knee show that the cartilage is gone in my knee joint. Now that I’ve been taking glucosamine and chondroitin, my pain is better, and I feel I can do more during the day. Could the benefits I feel be coming from these supplements?

If no other treatments are being done at the same time, you are most likely getting results from the supplements. The benefits you report are similar to what others are saying, and there’s evidence that these supplements can help with osteoarthritis of the knee. However, since they are relatively new, there hasn’t been a lot of research done on them yet. Also, most of the studies that have been done tested them over a short time period, about four to six weeks. Some of the methods used to test them give exaggerated estimates of how beneficial these supplements really are. And because manufacturers have sponsored most of the scientific studies on these products, it’s possible that some of the reported benefits might be inflated. There is enough evidence, however, to show that these supplements are safe, offer some benefits, and certainly have a role in treating knee osteoarthritis. 

I had knee surgery for a torn anterior cruciate ligament (ACL) last year. Is it true that if you tear this ligament you end up getting osteoarthritis in the knee?

Had you asked this question ten years ago, the answer would have been a confident “yes.” With today’s advancement in surgical and rehabilitation procedures, the answer isn’t so simple. It depends on if there is damage of the meniscus or joint cartilage at the time of ACL surgery. If so, the chances are pretty good of having more symptoms and possible signs of osteoarthritis in the knee with the passage of time. People with a straightforward ACL reconstruction, meaning there’s no damage to the meniscus or cartilage, are less likely to end up with osteoarthritis in the knee. A recent study showed that 97 percent of the people with healthy meniscus and cartilage at the time of ACL surgery returned to high-level sports, showed no signs of osteoarthritis, and had no increase in symptoms up to 15 years after their surgery.  

One of the ligaments inside my knee was injured in a recent football game. I’m wondering about the knee bones. My biology teacher said ligaments are attached to bones. Do the bones get hurt, too?

Good job thinking it through! In fact, bones are often bruised when the ligaments that attach to them get torn. These “bruises” can’t be seen on an X-ray. They can be seen with MRI scans. A bone bruise is like a small fracture of the bone. Most bruises will go away completely. But it’s still unclear what the bone injury will mean in the long term.

Scientists are concerned that the initial bone injury eventually causes the bone to become less resilient–less “bouncy.” With the shock absorbers down, the cartilage that covers the knee joint ends up taking more force. This can take a toll on the joint surfaces, and may lead to arthritic changes in the knee joint.

I recently had my right ACL repaired. My orthopedist said everything looked great. If my rehab continues to go well, does this mean I won’t have problems in the future?

Unfortunately, there is no way to predict the long term outcome for you. Sometimes, people who tear a knee ligament also bruise the knee bone. This damage may or may not go away completely. Even though the ACL may have been repaired successfully, the joint may still become arthritic if the bone damage doesn’t completely resolve. This is because the initial bone bruise can cause the bone underneath the cartilage to harden. The joint loses its ability to absorb shock, so the cartilage takes the brunt of the forces on the joint. Scientists are working to figure out how to predict and prevent these kinds of problems.

My dad had his knee operated on, and now, 15 years later, it’s starting to hurt. He hasn’t done anything to hurt it again that he can think of. Otherwise he’s in pretty good shape. Is the pain coming from his initial problem, or is this something new?

A previous knee injury or surgery can affect the health of the knee later on in life. A past leg or knee fracture, a ligament tear, or a meniscal injury can each cause abnormal movement and alignment in the knee joint, leading to wear and tear on the joint surfaces. Over the years, this can begin to take a toll on the knee joint, and may explain why your dad is feeling pain now.

I have osteoarthritis in my knees. I have been trying to loose weight because my doctor told me it could help relieve some of the pain. But whenever I go for a walk, my knees hurt even more. It feels like I’m making the problem worse, so I have stopped exercising altogether. I’m worried that I will keep gaining weight if I don’t exercise. Any suggestions?

This is a “catch-22” situation. It is nearly impossible for most people to loose weight without exercising. Weight gain, in turn, can worsen arthritis pain in the lower body due to the added pressure on the knee joints. You need to find activities that you can tolerate. Walking is great for most, but not all, patients with knee arthritis. You might try water aerobics, bicycling, or yoga instead. You may also want to work with a physical therapist who can help you ease into an exercise program that is right for you.

What can be done to keep my leg muscles from shrinking after knee surgery?

A new technique called vascular occlusion has been found to help reduce the amount of muscle wasting that follows surgery. This technique involves applying five minutes of squeezing pressure to the thigh muscles several times a day in the first week or two after surgery. A large blood pressure cuff can be used to put the squeeze on the thigh. The pressure triggers the muscle to produce enzymes and hormones that actually promote muscle development.

Vascular occlusion by itself will not completely stop muscle wasting. But it can slow the process down. Low-intensity resistance exercises, such as straightening the leg over a pillow, or straight leg raises can also help reduce muscle shrinkage.