Understanding the knee
The knee is the largest and most complex joint contained within the human body. Its size and number of components make it especially susceptible to a wide range of injuries. Dislocations, bone fractures, as well as ligament sprains and tears are among the common knee injuries treated by orthopedic doctors.
In some cases, Knee injuries can be treated with a combination of non-surgical techniques, bracing, and exercises aimed at strengthening the joint. Traumatic or chronic knee injuries often times require surgery.
Common Knee Injuries
Patellar (Kneecap) Fractures
A sesamoid bone is an independent bone connected only to tendons or embedded in muscle. The patella (or kneecap) is the largest sesamoid bone in your body. The kneecap sits at the front of the knee and acts as a shield for the joint that lies underneath. A patellar fracture is considered to be a serious injury that can prevent you from straightening your knee or even walk.
Some simple knee cap fractures are treated by extending the knee and immobilizing it using a cylinder cast or brace. In most cases, however, fractured pieces of bone move out of place when the knee cap injury takes place. Displaced fractures require surgery to stabilize and repair the kneecap so that normal range and function can return.
Prepatellar bursitis occurs when the bursa in front of the kneecap becomes inflamed. The bursa is a small gel-like sack of fluid that is positioned between the kneecap and the skin. It acts as padding in front of the knee. When the bursa becomes irritated, it fills with excess fluid. This swelling places pressure on the rest of the knee which results in Prepatellar bursitis whose symptoms include:
- Swelling in front of the kneecap
- Pain during activity
- Tender to the touch
There are four main ligaments in the knee joint including the anterior cruciate ligament (ACL). It runs through the knee diagonally connecting the tibia and the femur. The ACL stabilizes the knee during movement.
ACLs are one of the most frequently injured ligaments in the knee. The outlook for an ACL that has been partially torn is usually favorable and normally requires at least three months to recover and go through rehabilitation. A total ACL rupture carries a less favorable outlook and almost always requires surgery. A torn ACL ligament is usually not repaired via suture because it has been shown repaired ACLs fail over time. Therefore, a graft made of tendon is commonly used to replace the damaged ACL.
A Meniscus tear is one of the more common knee injuries treated by Orthopedic doctors. The phrase “torn cartilage in the knee” is often used by people when referring to a torn meniscus. Each knee joint contains two menisci. These rubbery pieces of cartilage provide the cushion between the thigh bone and the knee bone. They also absorb shock in the knee. Meniscus tears often happen suddenly while playing sports. Elderly people are also susceptible to meniscus tears because the cartilage weakens over time.
People often describe feeling a “pop” when a meniscus is torn. In most cases, people are still able to walk on the knee after sustaining the injury. It is also common to hear of athletes continuing to play with a meniscus tear. The knee will gradually stiffen and swell over the course of two to three days,
Symptoms of a meniscus tear are:
- Stiffness, Pain, and swelling
- Locking or catching of the knee
- The feeling the your knee is “giving”
- Loos of range of motion in the knee joint
Total Knee Replacement Procedure
In some cases, knee joints degenerate to the point where a total knee replacement (also referred to as total knee arthroplasty) is an option to restore quality of life. This procedure is used only after non-surgical methods have failed and the patient is still experiencing debilitating pain.
Degeneration of the knee joint can be caused by any number of factors but the most common is arthritis. During the procedure the infected knee joint is replaced with an artificial joint. Knee replacements are not all the same and there are different prosthesis and configurations for the various patters of degeneration and deformity.
It is common for Patients to be able stand and move the new knee joint the day after a replacement surgery. Many patients are able to walk comfortably with minimal support after about six weeks.
ACL injuries typically cause a lot of inflammation and swelling that must subside before a reconstruction can be performed. This usually requires a waiting period of about three weeks from the date of injury. Once the ends of an ACL are torn they cannot simply be reconnected and repaired. Therefore, the damaged ligament is removed and replaced by a new ACL. A graft for the new ACL is created using a section from a hamstring or knee ligament. Each individual patient’s condition will dictate the proper type of graft that is used.
A few months is required after ACL surgery for a full recovery. This is followed by a physical rehabilitation program.
Doctors use the minimally invasive arthroscopy procedure to perform a detailed examination inside the knee joint. This is usually done after some form of imaging tests (such as MRI) have been performed and the doctor needs to confirm the resulting diagnosis. A magnifying lens, fiber-optic light, and tiny camera are inserted into the knee for the examination. In some cases, the problem can then be treated using a few additional instruments which are also inserted through small incisions. Many of the common sports related injuries are can be repaired with knee arthroscopy such as ACL tears, meniscal tears, PCL tears, and knee cap misalignment.
Knee arthroscopy has several benefits over traditional surgery including:
Lower blood loss during surgery
No need for cutting Tendons or Muscles
Minimal scarring due to the smaller incisions
A quicker and less taxing rehabilitation
A shorter recovery time
Knee Rehabilitation Exercises
An exercise program is key in helping patients return to daily activities following a knee injury or surgical procedure. Adhering to a structured conditioning program will help patients return to sports and other recreational activities. Your orthopedic doctor and physical therapist will determine which exercises will best help you meet your rehabilitation goals.