Posts Tagged ‘knee’

Knee Pain, Part II.

Thursday, June 11th, 2009

Depending on the extent of the tear and location, some meniscal injuries can be treated without surgery.  Physical therapy to increase muscle strength around the joint and increase your range of motion along with anti-inflammatory medication, knee sleeves, activity modification and time are the regimen.  However, you should have significant improvement within 2-3 months if this approach is working for you.  If little or no improvement is felt, then surgery to remove the part of the meniscus is indicated.  In younger athletes, surgery is generally the better option if the meniscus can be repaired.  Repairing the meniscus can prevent further deterioration of the joint and help to prevent arthritis later in life.

Surgery for meniscus tears is an outpatient procedure which can generally be done in under an hour.  It is performed through two small poke holes in the knee.  One hole is for the arthroscope, a lighted tube connected to a television screen, which is used to visualize inside the joint.  The other hole is for the instruments which are used to either repair or trim the torn meniscus.  If the meniscus is repairable, an additional small incision on the side of the knee may be used to retrieve the sutures and protect the nerves that travel in the skin around the knee.  You are generally allowed to go home within 2-3 hours following the surgery.

Recovery from meniscal surgery varies for different people depending on the extent of other damage to the knee structures and the person’s age.  Some athletes have arthroscopic surgery and are back playing in 2-3 days; however, most people take 2-3 weeks to regain their strength and get rid of their swelling.  If the meniscus was repaired, then you will usually have to be on crutches for 4-6 weeks to allow the meniscus to heal properly.  This is a great improvement over what was the norm 15 years ago when open surgery was done through a large incision and you were out of competition for 3-6 months.

The meniscus is an important structure in the knee joint and as much of it as possible should be preserved.  The meniscus cushions the knee joint and prevents the ravages of arthritis.  Through modern surgical techniques and improved rehabilitation, a quicker return to sports or work is possible for this bothersome condition.

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Knee Pain, Part I.

Thursday, June 4th, 2009

Many of you have friends or have heard it said that they have “torn cartilage” in their knees.  They are probably not talking about the cartilage that covers the end of the bone – the articular cartilage – but rather  a tear of one of the two bushings in the knee, a meniscal tear.  These are rather common injuries in athletes and in the general population and tend to increase in frequency with increasing age of the individual.

Each knee has two of these fibrocartilaginous bushings, the medial meniscus (inside) and the lateral meniscus (outside).  These menisci act as shock absorbers in the knee and help to conform the shape of the two bones of the knee, femur (thigh bone) and tibia (shin bone) to one another.  The menisci also act in concert with the ligaments and muscles to provide stability to the knee.  The medial meniscus is attached securely to the ligaments on the back and on the inner side of the knee and because of this attachment is the more frequently torn of the two.

The menisci can be torn when there is a sudden, unexpected twisting motion to the knee.  This motion traps the meniscus between the ends of the two bones and causes a shearing action on the tissue.  This frequently happens in conjunction with ligament injuries, especially ACL tears.  As you get older your menisci becomes softer and the blood supple decreases.  This can lead to tears with little or no trauma; sometimes just a misstep will cause a tear.

When your meniscus tears you will usually feel a sharp pain on that side of the knee at the joint line.  Generally, the knee will then start to swell within a few hours.  You may find your knee locks up on you and you are unable to straighten it all the way.  This occurs because the meniscus flips into the joint and forms a mechanical block to motion.  The swelling will eventually decrease and the pain will subside with time and you may feel your knee is back to “normal”.  It might not even bother you too much when walking straight ahead; however, when trying a sharp cut or turn you may experience a return of the sharp pain.

To determine whether you have a meniscal tear, your doctor will ask you questions about how the injury occurred and then will examine your knee.  This usually involves moving the knee around if it is not too inflamed and pressing over your joint line on either side.  Sometimes as your knee is moved from bent to straight a pop can be felt as the torn meniscus moves out of the way.  X-rays are usually taken just to assure there are no broken bones or loose bodies floating around the knee.  The X-ray will not show the torn meniscus as X-rays only show bone detail and not soft tissue.  Sometimes, if there is question remaining after examination, your doctor may order an MRI to confirm the diagnosis or determine if the meniscal tear may be repaired.

In Part II we will discuss treatment options for this common knee condition….

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The Athletic Knee, Part I.

Wednesday, March 25th, 2009

You’re out playing a soccer game, a tennis match, or maybe even down hill skiing when all of a sudden you lose your balance and feel a “pop” in your knee. For a moment, the pain is excruciating, but then it becomes more tolerable. However, your knee starts to swell and it is painful to walk on. So, you are helped off the field, court, or get a sled ride down the mountain. Unfortunately, you have just joined the nearly 200,000 others who will tear their Anterior Cruciate Ligament (ACL) this year.

With a general increase in organized sports and year round training, games and tournaments, it is not surprising that the exposures and risks for ACL injuries has increased as well. If you are female athlete (especially those participating in soccer, basketball or gymnastics) your risk of injuring your ACL is 2 – 10 times greater than your male counterparts, and the numbers are growing! With the advent of Title IX legislation and the rise in opportunities for female athletic participation, a whole new number of athletes have become at risk of injury.

ANATOMY
The ACL is one of the four principle ligaments which help to stabilize the knee. The ACL is anterior or in front of the Posterior Cruciate Ligament (PCL) and crosses it from inside to outside. The other two major ligaments are the Medial Collateral Ligament (MCL) on the inside part of the knee, and the Lateral Collateral Ligament (LCL) on the outside part of the knee. The ACL functions to prevent the Tibia (shin bone) from being pulled off the Femur (thigh bone). The quadriceps (thigh) muscles in front help to extend the knee and the Hamstring muscles in back help to flex or bend the knee. The hamstrings are vital as they actively help to prevent the quads from pulling the tibia off the femur.

RISKS
The probability of tearing your ACL is increased if you are involved in a contact or collision sport that includes cutting, twisting and jumping. However, it is important to note that non-contact ACL injuries (where no one hits you) are responsible for 70% of these injuries, where direct contact accounts for only 30%. Again, female athletes have an increased incidence of non-contact ACL injuries than do male athletes (up to 10%).

GENDER DIFFERENCES
Some of the factors increasing the risk of injury to the female athlete include:

• Anatomical Structure: women tend to have wider pelvises than men and tend to be more “knock-kneed”, putting increased stresses across the knee joint.
• Muscular Activation: female athletes do not contract the hamstrings as quickly as male athletes and are unable to protect the ACL from shearing forces.
• Ligament Structure: the female ACL is smaller in diameter than the corresponding male ACL.
• Hormonal Differences: Some have even suggested a hormonal reason, however this remains relatively inconclusive.

Coming in The Athletic Knee, Part II, we will discuss the methods used to reduce the liklihood of non-contact ACL injuries to the knee….

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