Knee Pain and Injuries
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Knee pain is a common symptom in people of all ages and fitness levels and is one of the most common reasons you might see an orthopedic specialist. It sometimes begins as mild discomfort and gets worse over time, or it may start suddenly after an acute injury. Knee injuries can cause pain, loss of function, and premature arthritis in patients. Common knee-related symptoms may include:
- A feeling that your knee "gives way"
- Pain with activity such as walking
- Inability to squat or kneel
- Trouble sitting for a long period of time due to pain
Meniscus repair
The meniscus is two cartilage areas known as your knee’s "shock absorbers," helping to cushion the knee joint and keep it stable. Sometimes, a torn meniscus happens during activity or direct contact sports. As we age, the risk for a degenerative meniscal tear increases, as the knee cartilage can weaken over time. People who have experienced a meniscus tear often describe feeling a "pop" during the injury. Other common symptoms include pain, stiffness, swelling, a "catching" feeling in your knee and reduced range of motion. Like other knee injuries, if conservative treatments are unsuccessful in improving the pain and stability of your knee, surgery may be needed. Our orthopedic surgeons are highly skilled in performing repairs to the meniscus to help you restore your active lifestyle.
ACL reconstruction or repair
The anterior cruciate ligament (ACL) is located toward the front of the knee and is the most commonly injured ligament. The ACL can be injured during a sudden twisting motion – when the feet stay planted one way, but the knees turn the other way. Skiing, basketball and football are sports that have a higher risk of ACL injuries. If physical therapy or other treatments haven’t improved your pain and the stability of your knee, surgery may be needed. The goal of ACL surgery is to restore the function and stability of your knee so that you can become active again, and it aims to prevent future knee injuries. Our orthopedic surgeons are highly skilled in performing this procedure. Early medical treatment for knee ligament injury may include rest, elevation, ice to reduce swelling, compression from an elastic bandage or brace, or over-the-counter anti-inflammatory medicine.
Knee arthroscopy
Arthroscopy gives our orthopedics doctors a clear view of the inside of the knee to help them diagnose and treat your injury. During the procedure, your physician may repair or remove any damaged areas, helping to relieve your knee pain. Arthroscopy is a common outpatient surgical procedure and is very effective in treating knee problems. In fact, more than four million knee arthroscopies are performed each year.
Knee replacement
If the knee joint is severely damaged, surgery could be an option. This common procedure helps restore mobility, while reducing pain. You could be a candidate for a MAKOplasty partial knee resurfacing or a total joint replacement.
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In the knee joint, there is a layer of smooth cartilage on the lower end of the femur (thigh bone), the upper end of the tibia (shin bone) and the undersurface of the kneecap (patella). This cartilage serves as a cushion and allows for smooth motion of the knee. Arthritis is a wearing away of this smooth cartilage. Eventually it wears down the bone. Rubbing of bone against bone causes discomfort, swelling and stiffness.
A total knee replacement is really a cartilage replacement with an artificial surface. An artificial substitute for the cartilage is inserted on the end of the bones. This creates a new smooth cushion and a functioning joint that does not hurt.
Sometimes your surgeon determines that only part of the cartilage needs to be replaced. These are called unicondylar replacements or patella-femoral replacements.
90-95 percent of patients achieve good to excellent results with relief of discomfort and significantly increased activity and mobility.
Your orthopedic surgeon will decide if you are a candidate for the surgery. This will be based on your history, exam, x-rays and response to conservative treatment. The decision will then be yours.
Age is not a problem if you are in reasonable health and have the desire to continue living a productive, active life. You may be asked to see your personal physician for his/her opinion about your general health and readiness for surgery.
We expect most knees to last more than 10-20 years. However, there is no guarantee, and 10-20 percent may not last that long. A second replacement may be necessary.
The most common reason for failure is loosening of the artificial surface from the bone.
Most surgeries go well, without any complications. Infection and blood clots are two serious complications that concern us the most. To avoid these complications, we use antibiotics and blood thinners. We also take special precautions in the operating room to reduce risk of infections. The chances of this happening in your lifetime are one percent or less.
You will have discomfort following the surgery, but we will keep you comfortable with appropriate medication. The care team will monitor your level of discomfort frequently and treat you as ordered by your surgeon. We will discuss what pain interventions have worked for you in the past, and work with your surgeon to develop an individualized pain management plan.
We reserve approximately three hours for surgery and recovery time. Some of this time is taken by the operating room staff to prepare for the surgery. Individual recovery times may vary.
You may have a general anesthetic, which will put you to sleep. Some patients prefer to have a spinal or epidural anesthetic, which numbs your legs only and does not require you to be asleep. The choice is between you, your surgeon and the anesthesiologist.
Your orthopedic surgeon will do the surgery. An assistant often helps during the surgery.
Yes. You should follow the exercises listed in your NoteBook as instructed during your preoperative total knee class. Exercises should begin as soon as possible.
Every effort is made to control blood loss during surgery. However, you may need blood replacement and there are many choices to consider. If you have concerns, speak with your surgeon.
The frequency of follow-up visits will depend on your surgeon and your progress. Many patients are seen at six weeks, twelve weeks, and then yearly.
Yes. You will be using a walker or crutches. A therapist will discuss your needs and help you decide what equipment you may need. The care team is available to assist you in getting your equipment arrangements made.
Most patients are able to go home directly after discharge. Some may transfer to another facility. The care team will help you with this decision and make the necessary arrangements. You should check with your insurance company to see if you have benefits.
The first several days or weeks, depending on your progress, you may need someone to assist you with meal preparation, etc. If you need home services or outpatient therapy after discharge, the care team will arrange for services to meet your needs. Family members or friends may need to be available to help you, initially.
Preparing ahead of time, before your surgery, can make your discharge to home easier. Having the laundry done, house cleaned, yard work completed, clean linens put on the bed, and frozen meals available may reduce the need for extra help.
Your surgeon will discuss these needs with you before you leave the Bone and Joint Center.
Several options are usually available to you. Initially, you may arrange to have someone stay with you, with visits from home health services if ordered by your surgeon. Or you may consider a short stay at another facility following your hospital stay. The social worker is available to assist you if you have concerns.
Getting “back to normal” will depend somewhat on your progress, but consult your surgeon for advice on your activity. The ability to drive, for instance, depends on whether surgery was on your right leg or your left leg, and the type of car you have. The time it takes, and whether you my return to work, and other activities, will be a decision between you and your surgeon. Much depends on your job, the activities you wish to resume, and your progress after surgery.
You will likely be encouraged to participate in low impact activities such as walking, dancing, golf, hiking, swimming, bowling and gardening.
High-impact activities, such as running, singles tennis and basketball are not recommended. Injury-prone sports such as downhill skiing are also dangerous for the new joint. Be sure to discuss any specific activities with your surgeon.
Yes. You may have a small area of numbness to the outside of the scar which may last a year or more and is not serious. Kneeling may be uncomfortable for a year or more. Some patients notice some clicking when they move their knee. This is the result of the artificial surfaces coming together and is not serious.