knee surgery

The knee is a major weight-bearing joint in the body, and its proper function is enormously important to daily mobility and activity. It is also a vulnerable joint, susceptible to a wide range of injuries. Consequently, knee pain is an extremely common complaint in orthopaedics. Restoring your normal level of knee function requires the proper diagnosis, repair and rehabilitation.

Ligament Injuries
There are four separate ligaments that stabilize the knee joint. The anterior cruciate ligament (ACL) is located in the front of the joint and prevents the tibia from sliding forward, away from the femur, or rotating during activity. The posterior cruciate ligament (PCL), located behind the ACL, keeps the tibia from sliding backward. On the sides are the medial collateral ligament (MCL) and the lateral collateral ligament (LCL), which stabilize the knee during side-to-side activity. Injuries to these ligaments usually result in sprains or tears and range in severity.

ACL tears typically present with immediate swelling, moderate pain, and impairment of normal function. Most athletes and active individuals elect ACL reconstruction surgery to restore functionality, while less active individuals may choose to live with the disability. MCL tears present as a swelling on the medial side of the knee, and are a common ski injury. Since this ligament can often heal itself, treatment is often non-surgical. PCL injuries are common in vehicular accidents in which a blow to the front of the knee forces the leg to hyperextend backwards, and this may possibly be treated with surgery — especially if more than one ligament has been torn.

Total dislocation of the knee joint, when the femur separates from the tibia due to tears in all four ligaments, may happen as a result of a motor vehicle accident or high-speed sports injury. This type of injury would require emergency surgery.

Meniscus Tears
The meniscus is a piece of cartilage located between the surfaces of the femur and tibia that aids in weight absorption and joint stabilization. There are two common types of meniscus tears: traumatic and degenerative. Traumatic tears tend to appear when the knee has been twisted or hit from the side, often occurring with sports activity. Degenerative tears are typically associated with aging. As the meniscus has become less pliant over time, its failure can result from an ordinary activity such as squatting.

Since a meniscus tear often does not heal itself, or improve over time with medication or physical therapy, treatment usually involves arthroscopic surgery.

Patellar Injury
The patella, or kneecap, forms the knee joint along with the femur and tibia. The kneecap should slide evenly up and down a groove on the end of the femur as the knee bends. If the kneecap does not track centrally within the groove, this is called patellar subluxation. This instability, often occurring in children and adolescents, can cause discomfort and pain with activity, and may result in dislocation of the patella.

>> Click link for additional information about patellofemoral knee pain, provided by the American Medical Society for Sports Medicine (AMSSM): http://amssm.org/Handouts/Patellofemoral-final.pdf

Other common knee injuries and conditions

Osteoarthritis: Also called “wear-and-tear arthritis” or “degenerative joint disease,” osteoarthritis is caused by progressive wearing away of the cartilage of the joint, and is common in older patients, those who are overweight, and those who have a family history of arthritis. Symptoms include pain, swelling, stiffness and limited range of motion. Many treatments are available for osteoarthritis.

Bursitis: One of the most common of orthopaedic problems, bursitis causes inflammation and pain with movement around joints, tendons and ligaments. It is common in individuals who must kneel for work, such as gardeners or flooring professionals. Diagnosis often does not require x-rays or MRIs, and treatment can be wide-ranging depending on the scope of the condition and if infection is present.

Diagnosis and Treatment
Since the problems associated with knee pain and injury are wide ranging, proper diagnosis is the essential first step in the road to recovery. X-ray, MRI and CT scans are commonly used in diagnosis, though often a physical exam and thorough medical history are sufficient. Many conditions may be treated with medication, braces or physical therapy; however, arthroscopic surgery is a common solution for restoration of knee function in disabling injuries and conditions.