Knee Care

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What Causes Knee Pain?The knee is the largest joint in the body. It has many moving parts, such as bones, cartilage, muscles, ligaments and tendons. Anyone of these parts can suffer from disease or injury causing pain in the knee. Though the most common disease to cause knee pain is arthritis, a number of injuries can lead to knee pain and with the increasing number of aging adults, overuse injuries are becoming more common.

Diseases that cause knee pain
Osteoarthritis is the number one disease that causes knee pain. Osteoarthritis wears away the cartilage in the knee and eventually affects the adjacent bones. Osteoarthritis most typically affects adults over age 50. Younger people can be prone to osteoarthritis if it runs in the family, or if they had a previous injury that triggers the onset of osteoarthritis. Osteoarthritis treatments include:

  • medicines to reduce pain, such as aspirin and acetaminophen
  • medicines to reduce swelling and inflammation, such as ibuprofen and non-steroidal anti-inflammatory drugs (NSAIDs)
  • exercises to improve movement and strength
  • weight loss
  • knee replacement surgery

Rheumatoid arthritis is another cause of pain in the knee, but it affects a much smaller portion of the population. This autoimmune disease causes the body to attack the membranes that line the joints. This results in inflammation and damage to the bone, tendons and ligaments of the knee. Rheumatoid arthritis treatments include:

  • physical therapy
  • medications
  • knee replacement surgery

Injury
Your knee plays an essential role in everyday life and supports the weight of your body, allowing you to walk, run, stoop, bend and jump. Pain in the knee can result from a direct blow, falling, twisting or over-extension. There are many parts of the knee, and each can contribute to knee pain.

Cartilage Injuries
Chondromalacia occurs when the cartilage of the kneecap softens. This can be caused by injury, overuse, or muscle weakness, or if parts of the knee are out of alignment. The meniscus is a C-shaped piece of cartilage that acts like a pad between the femur (thigh bone) and tibia (shin bone). It is easily injured if the knee is twisted while bearing weight.

Symptoms

Generally, when you injure a meniscus, you feel some pain, particularly when the knee is straightened. The knee pain may be mild to severe and includes swelling. Although symptoms of meniscus injury may disappear on their own, if they persist or reoccur, treatment is recommended.

Treatment

  • exercises to strengthen muscles
  • electrical stimulation to strengthen muscles
  • surgery for severe injuries

Ligament Injuries
Ligament injuries are known as sprains. Two commonly injured ligaments in the knee are the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). The ACL is most often stretched or torn by a sudden twisting motion. The PCL is usually injured by a direct impact, such as in an automobile accident or football tackle. If a ligament is the cause of your knee pain, you may hear a popping sound, and the leg may buckle when you try to stand on it.

Treatment

  • ice packs immediately after the injury to reduce swelling
  • exercises to strengthen muscles
  • a brace
  • surgery for more severe injuries

Tendon Injuries
The three main types of tendon injuries and disorders are:

  • tendinitis and ruptured tendons
  • Osgood-Schlatter disease
  • iliotibial band syndrome

People with tendinitis describe the knee pain as tenderness at the point where the patellar tendon meets the bone. A complete rupture of a tendon is not only painful, but also makes it difficult for a person to bend, extend, or lift the leg.

Treatment

  • rest
  • ice
  • elevation
  • medicines such as aspirin or ibuprofen to relieve pain and reduce swelling
  • limiting sports activity
  • exercise to stretch and strengthen
  • a cast, if there is a partial tear
  • surgery for complete tears or very severe injuries

Is surgery right for my knee pain?
If you have a serious knee injury, surgery may be the preferred option to repair the damage and prevent your pain. You and your doctor will discuss your knee pain and evaluate your options. Often, total knee replacement is the answer for persistent pain, and when the limited range of motion in their knee joint severely affects your quality of life.

Weiss Orthopedic Surgeons are specialists in knee pain and are experts in knee repair. Knee surgery patients who stay in the hospital after surgery recover on an award-winning, dedicated orthopedic unit, Joint University, where the focus is on maximizing recovery through education, early mobility, and patient experience.

Types of surgery for knee pain include:

  • arthroscopic surgery
  • open surgery
  • knee resurfacing implants
  • total knee replacement

Some conditions treated by Weiss orthopedic specialists include:

  • Femur Fractures
  • ACL Reconstruction
  • Torn Meniscus
  • Arthrofibrosis
  • Bursitis

Arthroscopy

A common tool in treating orthopedic injuries is Arthroscopy. Arthroscopy is a minimally-invasive diagnostic and treatment procedure used for conditions of a joint. Originally, Arthroscopy was a diagnostic tool only, used primarily for planning a standard open surgery. However, because of the development of new instruments and advanced surgical techniques, many conditions can also be treated with arthroscopic surgery alone.

Arthroscopy uses a small fiber optic scope inserted through a small incision in the skin to see inside a joint. It has two purposes: diagnostic and surgical. First, it is a diagnostic tool, allowing surgeons to view joint problems without major surgery. During arthroscopy, the surgeon makes small incisions in the joint and inserts a camera the size of a pencil. This allows the surgeon to evaluate any knee damage. Depending on the problem found, surgeons may use arthroscopy to perform surgery by inserting small instruments through additional incisions to repair damage, such as a torn meniscus or a torn ligament.

Because arthroscopy uses tiny incisions, it results in less trauma, swelling, and scar tissue than conventional surgery. This means less time in the hospital and faster recovery than traditional open surgery. Problems can be diagnosed earlier and treated without serious health risks or more invasive procedures. Furthermore, because injuries are often addressed at an earlier stage, operations are more likely to be successful. Most arthroscopic surgery is performed in an outpatient setting under general anesthesia.

The following are often discovered and/or corrected during an arthroscopic procedure:

  • inflammation
  • pieces of loose bone and/or cartilage in the joint(s)
  • bone spurs
  • ligament tears
  • tendon damage
  • Carpal tunnel syndrome

Arthroscopic surgeries involve the following:

  • an anesthetic is administered and a small incision is made
  • the arthroscope is inserted through the incision
  • other incisions may be made to introduce another small grasping, probing, or cutting tools
  • light is transmitted via fiber optics at the end of the arthroscope
  • information about the interior of the joint is transmitted to a screen
  • corrective surgery, if necessary, may be performed during the initial diagnostic procedure
  • dressings or bandages may be applied to the post-operative area

Knee Replacement Surgery

When a knee is so severely damaged by disease or injury, an artificial knee replacement may be the only option. The most common condition that results in the need for knee replacement surgery is osteoarthritis, a degenerative, joint disease that affects mostly middle-aged and older adults. Osteoarthritis is characterized by the breakdown of joint cartilage and adjacent bone in the knees.

Although each procedure varies, surgery to replace a knee usually lasts about two hours. After the damaged bone and cartilage of the knee is removed, your orthopedic surgeon will place your new, artificial knee in its place.

Treatment

The prosthesis (artificial knee) is comprised of the following three components:

  • tibial component (to replace the top of the tibia or shin bone)
  • femoral component (to replace the two femoral [thighbone] condyles and the patella groove)
  • patellar component (to replace the bottom surface of the kneecap that rubs against the thighbone)

Femur Fractures

A fracture is a partial or complete break in the bone. When a fracture occurs, it is classified as either open or closed:

  • open fracture (compound fracture.) – the bone exits and is visible through the skin or a deep wound that exposes the bone through the skin
  • closed fracture (simple fracture.) – the bone is broken, but the skin is intact 

Symptoms

  • pain in the injured area
  • swelling in the injured area
  • obvious deformity in the injured area
  • difficulty using or moving the injured area in a normal manner
  • warmth, bruising, or redness in the injured area

Treatment

  • splint/cast
  • medication
  • traction
  • surgery

ACL Reconstruction

The anterior cruciate ligament (ACL) is located toward the front of the knee and is the ligament of the knee that controls rotation and forward movement of the tibia (shin bone). It is one of the most common ligaments to be injured. The ACL is often stretched and/or torn 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.

Symptoms
Often, a cruciate ligament injury does not cause pain. Instead, the person may hear a popping sound as the injury occurs, followed by the leg buckling when trying to stand on it, and swelling.

Treatments

  • medication such as ibuprofen
  • muscle-strengthening exercises
  • protective knee brace (for use during exercise)
  • ice pack application (to reduce swelling)
  • surgery

Torn Meniscus

The ends of the three bones in the knee are covered with cartilage that acts as a shock absorber. Between the bones of the knees are two crescent-shaped discs of connective tissue, called menisci, which also act as shock absorbers to cushion the lower part of the leg from the weight of the rest of the body.

Meniscus tears can occur during a rotating movement while bearing weight, such as when twisting the upper leg while the foot stays in one place during sports and other activities. Tears can be minor, with the meniscus staying connected to the knee, or major, with the meniscus, barely attached to the knee by a cartilage thread.

Symptoms

  • pain, especially when holding the knee straight
  • swelling
  • the knee may click or lock
  • the knee may feel weak 

Treatment

  • icing
  • medication such as ibuprofen
  • muscle-strengthening exercises
  • arthroscopic surgery

Arthrofibrosis

Sometimes called “stiff knee syndrome”, arthrofibrosis can occur following surgery when excessive scar tissue forms in a knee joint and surrounding soft tissue, causing a stiffening of the knee. Arthrofibrosis can break down cartilage in the joint and cause extreme pain. Pain can be treated using physical therapy and cortisone shots. At Weiss, specialists also perform complex treatments using low-dose radiation and surgery to treat arthrofibrosis.

Bursitis

A bursa is a closed, fluid-filled sac that exists to reduce friction between tissues of the body. Bursae are located near major joints such as shoulders, elbows, hips and knees. Bursitis occurs when bursae become inflamed. Two major types of bursitis exist in the hip: trochanteric bursitis and the iliopsoas bursitis.

Trochanteric bursitis causes pain on the outer portion of the hip while iliopsoas bursitis typically causes pain in the front of the hip near the groin.

Treatment options include cortisone injections, PRP injections, physical therapy or stretching. If bursitis does not resolve with these measures, arthroscopic surgery may be used to remove the painful bursa.