Knee

The knee contains menisci and ligaments that support and protect the joint and are cushions between the thigh bone and lower bones on the leg, these are subject to injury.  The knee can be injured with a simple twisting motion or during an athletic event. The meniscus can be torn with a rotational injury without falling. Major ligaments, (ACL an MCL) of the knee can also be injured with a fall, twisting injury or running.  Most of these injuries can be treated with braces, physical therapy and anti-inflammatory medication. However, persistent pain or significant damage to these structures could require arthroscopic surgical repair.  The doctors at Jefferson Orthopedic Clinic are experts in arthroscopic surgery of the knee.

 

CONDITIONS

ACL Tear

The anterior cruciate ligament (ACL) works together with the other ligaments in the knee to connect the femur to the tibia and support the knee joint. A tear in the ACL is one of the most common knee injuries, causing the joint to become unstable and slide forward too much. This injury occurs most often in athletes and causes pain, swelling, tenderness and limited motion.

Bursitis

Bursitis is a painful condition that affects the small, fluid-filled sacs — called bursae — that cushion the bones, tendons and muscles near your joints. Bursitis occurs when bursae become inflamed.

The most common locations for bursitis are in the shoulder, elbow and hip. But you can also have bursitis by your knee, heel and the base of your big toe. Bursitis often occurs near joints that perform frequent repetitive motion.

Treatment typically involves resting the affected joint and protecting it from further trauma. In most cases, bursitis pain goes away within a few weeks with proper treatment, but recurrent flare-ups of bursitis are common.

Jumper’s Knee

Tendonitis in the knee joint most often affects the patellar tendon, which connects the kneecap to the shin bone and aids in the extension and strength of the knee. Patellar tendonitis occurs when the patellar tendon and surrounding tissues become inflamed and irritated as a result of overuse. This condition often develops from excessive jumping, and is sometimes referred to as “jumper’s knee”.

Patients with patellar tendonitis may experience pain in the kneecap that is worse with activity, and swelling around the knee as well.

Treatment for patellar tendonitis usually begins with conservative methods such as rest, applying ice, bracing and anti-inflammatory medications to help reduce symptoms and restore the tendon to its regular state. Surgery is rarely needed to correct this condition, and is only performed on patients with chronic tendonitis that involves a degenerative tendon.

Knee Osteoarthritis

Osteoarthritis, also known as wear-and-tear or degenerative arthritis, is the most common form of the disease, affecting millions of people in the US each year. This condition is most common in older patients whose cartilage has worn down over time, and in athletes who have worn down their cartilage from overuse and repetitive motions.

Patients with osteoarthritis may experience pain, swelling and stiffness within the joint, which tend to worsen as the condition progresses. Your doctor can diagnose this condition after evaluating your symptoms and performing an X-ray examination of the knee. Treatment for osteoarthritis initially focuses on relieving pain and other symptoms, and may include rest, physical therapy, bracing, anti-inflammatory medication and injections. More severe cases of osteoarthritis may require surgery to replace the joint. Most procedures can be performed through arthroscopy, which significantly reduces bleeding, scarring and recovery times.

Meniscal Tear

Made of cushioning cartilage, the C-shaped meniscus performs many functions in the knee: it stabilizes the joint, helps it carry weight, facilitates turning in many directions, and keeps the femur (thighbone) and tibia (shin) from rubbing together. Athletic injury (trauma) or weakened tissue associated with aging or illness (degeneration) can tear the meniscus. Movements most likely to result in a meniscal tear are twisting the knee, pivoting, cutting and rapidly decelerating. A meniscal tear may occur at the same time as an ACL tear.

Symptoms of a meniscal tear include stiffness, swelling, pain, tightness, tenderness, and fluid build-up frequently described as “water on the knee.” If a piece of the meniscus breaks off in the joint, the knee may pop, slip or lock (become stuck at a 45-degree angle until physically moved out of the position).

Patellar Femoral Pain

The patella, commonly known as the kneecap, helps increase leverage and support within the knee joint. Pain may develop in the patella as a result of overuse or injury, and often causes a fracture. Patella fractures can involve a single crack across the kneecap or a break into several pieces, and usually causes severe pain and swelling.

Surgery may be required for more intense patella fractures, and aims to repair the patella by realigning the fractured ends and holding them in place with pins, screws and wires. Part of the bone may just be removed in smaller fractures. During the healing process, the knee must be kept straight, and patients will often undergo physical therapy to help restore movement to the joint.

The patella, commonly known as the kneecap, helps increase leverage and support within the knee joint. Pain may develop in the patella as a result of overuse or injury, and often causes a fracture. Patella fractures can involve a single crack across the kneecap or a break into several pieces, and usually causes severe pain and swelling.

Surgery may be required for more intense patella fractures, and aims to repair the patella by realigning the fractured ends and holding them in place with pins, screws and wires. Part of the bone may just be removed in smaller fractures. During the healing process, the knee must be kept straight, and patients will often undergo physical therapy to help restore movement to the joint.

Runner’s Knee

Runner’s knee is a common ailment affecting runners and other athletes as a result of overuse, trauma, misalignment or weak muscles and leading to pain and other symptoms. Any activity that requires frequent knee bending, including walking, biking or jumping, can result in runner’s knee, also known as patellofemoral pain syndrome.

Athletes with runner’s knee often experience pain behind or around the kneecap which may worsen while walking, kneeling, running or sitting, as well as swelling and a popping sensation in the knee. Your doctor may perform an x-ray, MRI or CT scan in addition to a complete medical evaluation in order to diagnose this condition.

For many patients, runner’s knee can be effectively healed through simple life remedies like resting, icing and elevating the knee, wearing arch supports, taking anti-inflammatory medications and performing stretching and strengthening exercises. Severe cases may require surgery to remove damaged cartilage or realign the kneecap to evenly distribute pressure. Your doctor will develop a customized treatment plan for your individual condition.

 

TREATMENTS

ACL Reconstruction

ACL reconstruction is usually not performed until several weeks after the injury, when swelling and inflammation have been reduced. The torn ligament is completely removed and replaced with a new ACL. Simply reconnecting the torn ends will not repair the ACL. Part of another ligament, usually in the knee or hamstring, is used to create a graft for the new ACL.

Knee Arthroscopy

Arthroscopy offers patients many benefits over traditional surgery, including no need to cut muscles or tendons, less bleeding, smaller incisions and shorter recovery times. However, arthroscopy is not appropriate for all patients. Your doctor will decide whether or not arthroscopy is right for you.

Some knee conditions that can often be treated through arthroscopy include meniscal tears, ACL or PCL tears, synovitis, patellar misalignment, arthritis and more. During the arthroscopy procedure, a thin tube with a camera on the end (arthroscope) is inserted into the joint, along with several tiny surgical instruments so that your surgeon can adequately visualize the area while repairing any damage that is found.

Knee Visco-supplementation
During viscosupplementation treatment for arthritis, hyaluronic acid is injected into your joint. This thick fluid may help reduce pain and swelling in your arthritic joint (most commonly, your knee).

The bones that make up your joints usually have a cap of cartilage on their ends. This cartilage helps make sure that your bones move smoothly against each other. This cartilage has a fluid coating that contains hyaluronic acid. This works like a lubricant and shock absorber in your joint.

In osteoarthritis (“wear-and-tear” arthritis), this cartilage cap breaks down. When this happens, the bones of your joint scrape together abnormally. People with osteoarthritis generally have less hyaluronic acid in their joints than they should. All of this causes symptoms like pain, stiffness, and swelling. The idea behind viscosupplementation is that replacing this hyaluronic acid may help reduce symptoms.

Your doctor may first inject a numbing medicine into the space around your knee joint and possibly drain any fluid that is causing the joint to swell. Then, they will inject hyaluronic acid into the space inside your joint.

Partial Knee Replacement

Partial knee replacement may be possible for patients with damage to one part of the joint. Doctors refer to this limited damage as a Unicompartmental knee or “Uni” knee. In a partial knee replacement, only the diseased parts of the knee are removed and replaced; the healthy portions are left untouched. Successful partial knee replacements can delay or eliminate the need for a total knee replacement. They also allow a greater range of movement than standard (non-high-flex) total knee replacements.

Benefits of partial knee replacement surgery include a smaller incision (2-3 inches), shorter hospital stay (often 24 hours or less), and faster recovery and rehabilitation.

Robotic Assisted Knee Surgery
Before the procedure, surgeons capture digital computed tomography (CT) scans of your knee. This data allows surgeons to determine where to place the knee implant.

During the procedure, the surgeon uses the robotic arm to precisely shape the surrounding bone before placing the implant. Real-time video images provide visual reinforcement, which helps surgeons navigate hard-to-see areas.

At the same time, the system uses the CT image data to create a predefined, three-dimensional “envelope” of space in which the surgeon works. The robotic arm will only operate in that predefined space, so there is no chance of an instrument slipping and injuring adjacent tissues.

Total Knee Replacement

A knee replacement is recommended for patients with arthritis and certain knee injuries or diseases that have not responded well to conservative treatments such as anti-inflammatory medications or cortisone injections. The replacement devices are designed to relieve pain caused by cartilage damage, and usually last up to 20 years in most patients.

During the knee replacement procedure, the entire joint is replaced with an artificial prosthesis. The end of the femur is replaced with a metal shell, while the end of the tibia is fitted with a plastic cup and metal stem that fit into the shell. The posterior cruciate ligament and kneecap may be replaced if needed or may be left in place. This procedure can take up to three hours to perform and usually provides immediate pain relief and a return to regular activities.

 


To learn more about our Knee Procedures & Treatments, please contact us at (504) 349-6804 today to schedule an appointment.