Knee

Home /  Specialties /  Knee

Conditions

Posterior Cruciate Ligament (PCL) Injury

The four ligaments that stabilize the knee are:

  • The anterior cruciate
  • The posterior cruciate(PCL)
  • the lateral ligaments
  • medial collateral ligaments

The PCL has been described as one of the main stabilizers of the knee. It is broader and stronger than the ACL. It connects the femur (thigh bone) to the tibia (shin bone). Its function is to prevent the posterior translation of the tibia relative to the femur.

It has been reported that there is only a 2% incidence of isolated PCL tears. PCL injury commonly occurs in sports such as football, soccer, basketball, and skiing. A forceful hyperextention of the knee or a direct blow just below the knee cap will disrupt the PCL and cause knee pain and PCL Injury. For example, the football player who is tackled with a direct hit to the knee will hyperextend the limb and sustain a PCL Injury. The basketball player who lands on the court directly on a bent knee will tear his PCL resulting in knee pain. A thorough evaluation by a sports medicine specialist is needed to assess the extent of the ligament injury and the appropriate treatment options. Both examples frequently lead to knee pain which often requires knee surgery.

Medial Collateral Ligament (MCL) Injury

The medial collateral ligament (MCL) is one of four ligaments that are critical to the stability of the knee joint. A ligament is made of tough fibrous material and functions to control excessive motion by limiting joint mobility. The four major stabilizing ligaments of the knee are the anterior and posterior cruciate ligaments (ACL and PCL, respectively), and the medial and lateral collateral ligaments (MCL and LCL, respectively).

The MCL spans the distance from the end of the femur (thigh bone) to the top of the tibia (shin bone) and is on the inside of the knee joint. The medial collateral ligament resists widening of the inside of the joint, or prevents "opening-up" of the knee.

Grade I MCL Tear

This is an incomplete tear of the MCL. The tendon is still in continuity, and the symptoms are usually minimal. Patients usually complain of pain with pressure on the MCL, and may be able to return to their sport very quickly. Most athletes miss 2-4 weeks of play.

Grade II MCL Tear

Grade II injuries are also considered incomplete tears of the MCL. These patients may complain of instability when attempting to cut or pivot. The pain and swelling is more significant, and usually a period of 4-6 weeks of rest is necessary.

Grade III MCL Tear

A grade III injury is a complete tear of the MCL. Patients have significant pain and swelling, and often have difficulty bending the knee. Instability, or giving out, is a common finding with grade III MCL tears. A knee brace or a knee immobilizer is usually needed for comfort, and healing may take 6 weeks or longer.

Meniscal Tear

The meniscus is a very important shock absorber of the knee made of a very strong substance called fibrocartilage. It protects the cartilage of the joint, keeping it from wearing out and causing early arthritis. A large percentage of our body weight is distributed through the meniscus as we walk, run, and jump. The meniscus adds to the stability of the knee joint by helping the shape of the femur or thigh bone conform to the tibia or leg bone. The meniscus also plays a role in the nourishment of the joint cartilage that covers the bones in the joint.

Symptoms

An acute meniscal tear may be heard as a "pop" and felt as a tear or rip in the knee. Many are followed within a few minutes to hours by swelling of the knee as a result of blood accumulation. Some do not result in much swelling and some present themselves in a less acute fashion. Patients with meniscal tears often describe a popping or catching in their knee. Some actually can feel something out of place. In the most dramatic situations the knee will actually lock, preventing the patient from fully extending or straightening the knee -- or occasionally from flexing or bending it. The pain or discomfort is usually along the joint line or where the femur and tibia bone come together. It often starts out relatively painful; then with time, much (if not all) of the pain disappears except with certain activities. Some patients will have the tear become asymptomatic (no symptoms) for a time, especially if their activity level decreases significantly.

Causes

Several events can cause the meniscus to become damaged. It can tear or rip from force, pinching it between the femur and the tibia. Most frequently this is a twisting-type force and is relatively common in sports-related knee injuries. Occasionally it is associated with a ligament rupture. It does not always require a major fall or twist to cause a meniscal tear. Some occur with nothing more than getting up from a squatting position. Certain meniscal tears occur gradually over a long period of time. In older patients these may represent so-called degenerative meniscal tears and may not be symptomatic. The location of the tear within the meniscus may determine the type of treatment which is most appropriate.

Lateral Collateral Ligament (LCL) Injury

The lateral collateral ligament (LCL) is one of the four knee ligaments. It spans the distance from the end of the femur (thigh bone) to the top of the fibula (thin, outer, lower leg bone) and is on the outside of the knee. The lateral collateral ligament resists widening of the outside of the joint. A lateral collateral ligament injury happens from a direct force from the side of the knee, causing moderate to severe knee pain and ligament injury which often leads to knee surgery. It is much less frequent ligament injury than the medial collateral ligament (MCL) but commonly occurs with other ligament injury to the knee.

Knee Arthritis

Arthritis simply means an inflammation of a joint causing pain, swelling, stiffness, instability and often deformity. Severe arthritis interferes with a person’s activities and limits his or her lifestyle.

Osteoarthritis or Degenerative Joint Disease is the most common type of arthritis. Osteoarthritis is also known as "wear and tear arthritis" since the cartilage simply wears out. When cartilage wears away, bone rubs on bone causing severe pain and disability. The most frequent reason for osteoarthritis is genetic, since the durability of each individual’s cartilage is based on genetics. If your parents have arthritis, you may also get it.

Trauma can also lead to osteoarthritis. A bad fall or blow to the knee can injure the joint. If the injury does not heal properly, extra force may be placed on the joint, which over time can cause the cartilage to wear away.

Inflammatory Arthritis Swelling and heat (inflammation) of the joint lining causes a release of enzymes which soften and eventually destroy the cartilage. Rheumatoid arthritis, Lupus and psoriatic arthritis are inflammatory in nature..

Cartilage Injuries

Injury to the knee can cause damage to the articular lining cartilage in the knee joint, or sometimes to both the cartilage and the bone.

If the injury is restricted to the cartilage, it will not show up in a plain X-ray; it may be noted on an MRI. An arthroscopy (using a special instrument to look inside the joint) can thoroughly identify it.

Detached Cartilage of Bone in the Knee Joint

If a piece of cartilage or bone has become detached in the knee and the injury is not treated immediately, the loose part can 'swim around' in the joint. This means that it may occasionally get stuck, causing pain and a feeling that the knee is locked. The knee may also click and swell up. Such a condition is called a loose body in the knee.

As cartilage does not show up on an X-ray, the loose body will only be visible if it consists of bone.

Procedures

Knee Arthroscopy Surgery

Knee Arthroscopy Surgery

When is it Time to Think About Surgery?

You may need knee arthroscopy surgery if you are experiencing knee pain, limited motion, or instability of your knee. These symptoms may be caused by ligament or cartilage tears inside the knee resulting from injury or wear-and-tear on the joint. You may also be experiencing knee joint pain, clicking, snapping, swelling, or decreased motion in your knee.

About the Surgery

Knee arthroscopy surgery involves the doctor making a few small incisions around the knee after using general anesthesia to put you to sleep. The doctor can see the inner tissues of the knee on a television monitor. Many problems can be diagnosed and corrected once the arthroscope is in place.

This procedure will take approximately a half hour for the doctor to perform. You will wake up in recovery with a bulky knee wrap and an IV. Once you are awake and taking fluids, the IV will be removed and you will be allowed to go home. You will be weight bearing as tolerated and may use crutches/walker intially for support.

Preparing for Surgery

You will have pre-admission testing done before your surgery to ensure that you are healthy enough for the planned procedure. Testing may include lab work, an EKG and a chest x-ray.

Anti-inflammatory medications, aspirin, and blood-thinning medications should be discontinued one week before your surgery. These medications affect your blood clotting factors and could increase your risk for bleeding.

What to Expect After Surgery

You may walk on the knee when you are comfortable, and you should expect your knee to be swollen and weak when you first walk on it. You may also begin to bend the knee as tolerated. You should be comfortable and may be off your walking aide unless otherwise instructed by your doctor within 3 days. The bulky dressing on your knee will be removed the morning after surgery and should not be replaced.

Complications and Risks of Surgery

Blood clots: Symptoms of clotting include pain, swelling, or redness of your calf or thigh. Call the office immediately if you develop any of these symptoms or go to the emergency room if it is a weekend. Go to the nearest emergency room or call 911 if you have sudden and severe shortness of breath.

Infection: Infection is rare, but can occur following surgery. You are at a higher risk for infection if you have diabetes, rheumatoid arthritis, chronic liver or kidney disease, or if you are taking steroids. Symptoms include fever or chills, drainage, redness, a foul smell or increased pain at the incision sites. Call the office immediately if any of these symptoms occur.

Anesthesia complications: Respiratory failure, shock, cardiac arrest, and death are always possible during surgery. Patients with long-term kidney, heart, liver, or lung disease are at a higher risk. Nausea and vomiting from the anesthesia are also common. Coughing, deep breathing and drinking fluids will help flush out the anesthesia gases.

Nerve damage: Damage to your surrounding knee nerves is rare but can occur. Notify your doctor if numbness or tingling around the knee joint is prolonged or worsens after surgery.

Bleeding inside the joint: Trauma to arteries or veins surrounding the knee is rare, but may occur. It is common for some bruising and discoloration to appear around the knee after surgery. Bright red blood drainage from the scope sites is not common and the doctor should be notified if this occurs.

Recovery Period

The average recovery period for knee arthroscopy surgery is about 2-3 weeks depending on the specific type of procedure you’ve had done. Most patients are back to work within a few days if their job is sedentary, and 3 weeks if they have a labor-intensive job. Activities like walking and biking are encouraged to promote knee strength and overall fitness.

You are expected to do the exercises provided in this pamphlet. Physical therapy may be ordered if you lack normal range of motion in your knee.

Post-Op Instructions
  1. Elevate your knee above your heart and apply ice for the first 48 hours to decrease swelling and facilitate the healing of your knee.
  2. Pump the ankle of the affected leg at least 3 - 4 times every hour to improve circulation and prevent blood clots. Walk every hour during the day.
  3. Continue to do your instructed exercises at home until you are seen by your doctor.
  4. Gradually begin to put weight on the affected leg. Once you can walk without pain or swelling, you do not need to use crutches unless advised by your doctor. If you experience increased pain or swelling, continue to use the crutches until you are evaluated in the office.
  5. Call your doctor immediately at 231-733-1326 if you experience excessive pain, redness, swelling, bleeding, nausea, vomiting, calf pain, fever, shortness of breath or chest pain.
  6. You may loosen the bulky dressing so that it is comfortable after you get home. You may remove the dressing completely 24 hours after surgery. You may shower, but do not take a bath or go in a pool or hot tub. Do not apply lotion or Neosporin to your incision. Your sutures will be removed at your post-op visit 7 - 10 days after surgery.
  7. Please call your doctor’s office the day after surgery to schedule your post-op visit.
Post-Op Exercises
  1. Quadriceps sets: Lie down on your back and tighten your thigh muscle by pressing your knee toward the floor. Hold for 5 - 10 seconds. Relax and repeat 10 times. Do 6 sets each day.
  2. Straight-leg raises: Lie down on your back and lift your leg 8 - 12 inches. Hold for 4 - 6 seconds and slowly lower your leg. Relax and repeat 10 times. Do 6 sets each day.
  3. Ankle range of motion: Slowly rotate your foot 360°, making each circle as large as you can. Repeat 3 - 4 times. Do 6 sets each day.
  4. Heel slides: Lie on your back and bend your knee slightly. Slowly slide your heel along the floor toward your buttocks and slide your heel as far as you can. Hold for 5 seconds and repeat.

Please follow and do these exercises daily until you are instructed to discontinue them. These exercises will help build your upper leg muscles and speed your recovery.

Total Knee Replacement Surgery

Total Knee Replacement Surgery

When is it Time to Think About Surgery?

You may need total knee replacement surgery if you are experiencing pain, stiffness or loss of motion in your knee joint. These symptoms may be caused by degenerative arthritis (osteoarthritis), rheumatoid arthritis or injured knee cartilage. When pain interferes with daily activities such as walking, climbing stairs or getting out of a chair, it’s usually time to consider having surgery.

About the Surgery

Total knee replacement involves removing diseased cartilage on your knee surfaces and replacing it with smooth artificial surfaces. This is done by removing your thigh (femur) bone surface and lower leg (tibia) bone surface and replacing it with a metal and plastic implant. A plastic “button” piece is also implanted under your kneecap surface. These three components make up your new knee replacement surfaces.

Preparing for Surgery

You should be examined by your family doctor to ensure you are healthy enough for the planned surgery. You will be encouraged to stop smoking before surgery to prevent lung complications and promote healing after surgery. Pre-admission testing (lab work and EKG) and attendance at a “joint camp” will also be scheduled to further help you prepare for surgery. Anti-inflammatory medications, aspirin, and blood thinning medications should be discontinued one week before your surgery. These medications affect your blood clotting factors and could increase your risk of blood loss during surgery.

What to Expect After Surgery

You will awake in the recovery room after surgery with an IV for antibiotics and fluid replacement that will be continued for 24 hours. You may receive medication through an IV-regulated pump to control your pain.

Physical therapy will begin the day after your surgery and you will be instructed on how to walk with the use of crutches or a walker. You may also be allowed to bear weight on the affected knee.

You may be given a prescription for a blood thinner such as Coumadin, Xarelto, Lovenox, or Aspirin to take after surgery, in order to prevent blood clots during the healing process.

Complications and Risks of Surgery

Blood clots: You are encouraged to get up and move frequently as well as take your prescription blood thinner OR aspirin to help prevent clotting. Symptoms of clotting include pain, swelling or redness of your calf or thigh, and shortness of breath. Call the office immediately if you develop any of these symptoms.

Infection: Infection is rare, but can occur following surgery. You are at a higher risk for infection if you have diabetes, rheumatoid arthritis, chronic liver or kidney disease, or if you are taking steroids. Symptoms include fever or chills, drainage, redness, a foul smell or increased pain at the surgical site. Call the office immediately if any of these symptoms occur.

Blood loss: It is possible that you will need a blood transfusion following surgery. Your doctor will evaluate you daily to determine if there is a need for a transfusion.

Nerve damage: As your doctor makes his knee incision, many small skin nerves will have to regenerate. Some numbness may occur on the outside of your knee incision. This numb feeling may take months to diminish, or it may be permanent.

Anesthesia complications: Respiratory failure, shock, cardiac arrest, and death are always possible during surgery. Patients with long-term kidney, heart, liver, or lung disease are at a higher risk.

Pneumonia: Lung congestion is possible while you are recovering from surgery and are not as active. Coughing and deep breathing are encouraged to help you expand your lungs and clear any congestion.

Constipation: Bowel movements slow down with less activity and the use of pain medications. You will be encouraged to use stool softeners after you are discharged to promote regular bowel movements and prevent constipation.

Urinary tract infection: Infection to your urinary tract can occur after having surgery. Symptoms include burning and frequent urination, as well as blood in your urine. Fever and weakness may also occur. Report any of these signs to your doctor. This type of infection is a major source of joint infection and should be treated with antibiotics quickly.

Implant malfunction: There is a slight risk that the prosthesis will fail to attach to your bone causing loosening of the implant.

Recovery Period

The average recovery period for knee replacement surgery is 2-3 months. Most patients are back to work in 2 months if their job is sedentary, and 3 months if they have a labor-intensive job. Exercise such as running, skiing, or contact sports are discouraged following knee replacement surgery. Activities like swimming, walking and biking are encouraged to promote knee strength and overall fitness.

Treating and Preventing Infection

Notify your family doctor if you develop any suspected infection so you can be placed on an antibiotic to prevent the spread of infection to your knee joint. Infections such as ear infections, ingrown toenails, bladder infections, sinus infections, and sore throats should be reported immediately. Make sure all your doctors know you have had a joint replacement so you can be pre-medicated with an antibiotic before any dental work, or bladder/bowel surgery.

Knee ACL Reconstruction Surgery

Knee ACL Reconstruction Surgery

When is it Time to Think About Surgery?

You may need ACL reconstruction surgery if you are experiencing knee pain, instability, or have the inability to perform sport activities. These symptoms may be caused by your anterior cruciate ligament (ACL) being damaged or torn. This ligament keeps your shin bone (tibia) from sliding forward when stopping quickly or changing your direction. The purpose of reconstructing the ligament is to restore the strength and function of your knee as well as stabilizing the knee joint.

About the Surgery

ACL reconstruction surgery involves the doctor making a few small incisions around the knee as well as a 2-4 inch incision for the ligament graft placement. This is an outpatient procedure done under a general anesthesia and possibly a nerve block and takes approximately 1 ½ hours for the doctor to perform. An arthroscope camera is used to visualize the damaged ligament and surrounding cartilage which will be removed. Small tunnels are then drilled into the femur (thigh) and tibia (shin) bones and the ligament is reconstructed by taking a piece of tendon from a different part of your body (autograft) or from a cadaver donor (allograft). This graft is brought through the bone tunnels made by the doctor and secured with bioabsorbable staples or screws. Your incisions will be closed with sutures and a bulky dressing is applied.

You will awake in the recovery room with an IV and a hinged knee brace in place. Once you are awake and taking fluids the IV will be removed and you will be discharged home.

Preparing for Surgery

Pre-admission testing (lab work) will be scheduled prior to your surgery. You are encouraged to stop smoking before surgery to prevent lung complications or delayed healing. Medications such as anti-inflammatory medications, aspirin, and blood thinning medications should be stopped one week before surgery unless otherwise specified by your family doctor.

What to Expect After Surgery

You may be up walking with your hinged knee brace on and using crutches putting partial weight on the knee or as instructed by your doctor. Applying ice and elevating your knee is important for controlling pain and swelling. Begin doing your knee exercises the day following surgery. Physical therapy will be ordered during your first postop visit 7-10 days after surgery.

Complications and Risks of Surgery

Blood clots: Symptoms of a blood clot include pain, swelling, or redness of your calf or thigh. Call the office immediately if you develop any of these symptoms or go to the emergency room. If you develop sudden shortness of breath go the emergency room or call 911.

Infection: Infection is rare but can occur following surgery. You are at a higher risk for infection if you have diabetes, rheumatoid arthritis, chronic liver disease or are taking steroids. Symptoms include: fever or chills, drainage, redness, foul smell or increased pain of incision sites. Call the office immediately if any of these symptoms occur.

Anesthesia complications: Respiratory failure, shock, cardiac arrest and death are always possible during surgery. Patients with long-term kidney, liver, lung or heart disease are at higher risk. Nausea and vomiting from anesthesia can be common. Coughing, deep breathing and drinking fluids will help flush out the anesthesia gases.

Nerve damage: Damage to your surrounding knee nerves is rare but can occur. Notify your doctor if numbness or tingling around the knee joint is prolonged or worsening following surgery.

Bleeding within joint: Trauma to arteries or veins surrounding the knee is rare but may occur. It is common for some bruising and discoloration around knee following surgery. Bright red blood drainage from the scope sites is not common and the doctor should be notified if this occurs.

Recovery Period

The average recovery period for ACL reconstruction surgery is 4-6 mos. You can return to work or school when you are comfortable and you can be sedentary.

Home Instructions
  1. Elevate your knee above your heart and apply ice for the first 48 hours to decrease swelling and pain.
  2. Pump the ankle of the affected leg at least 3-4 times every hour to improve circulation and prevent blood clots. Get up and walk every hour during the day.
  3. Do the exercises provided until you are seen by your doctor.
  4. You may remove the dressing and shower 36-48 hours after surgery. Do not take a bath or go in a pool/hot tub. Do not apply lotion or Neosporin to your incision. Your sutures will be removed at your post-op visit after surgery.
  5. Please call the office the day after surgery to schedule your post-op appointment if not already made.
Post-op Exercises (with hinged knee brace on)
  1. Quadriceps sets: Lie down on your back and tighten your thigh muscle by pressing your knee toward the floor. Hold for 5-10 seconds. Relax and repeat 10 times. Do 6 sets each day.
  2. Straight-leg raises: Lie down on your back and lift your leg 8-12 inches. Hold for 4-6 seconds and slowly lower your leg. Relax and repeat 10 times. Do 6 sets each day.
  3. Ankle range of Motion: Slowly rotate your foot 360 degrees making each circle as large as you can. Repeat 3-4 times. Do 6 sets each day.

Specialists