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KNEE

Knee Anatomy

The bones of the knee are the femur (thigh bone), tibia (shin bone) and patella (kneecap). view 

Knee Fracture

Knee fractures may involve the lower end of the thigh bone (femur), upper end of the shin bone (tibia), the kneecap (patella), or any combination of the three. view

Leg Fractures

The main bone in the leg (tibia) breaks into two or more pieces depending on how bad the injury. view 

Knee Dislocation

Knee dislocations are true orthopedic emergencies. In addition to the knee joint being out of place, the nerves and blood vessels that supply the leg are at risk for injury and can threaten the viability. view 

Leg Compartment Syndrome

Leg compartment syndrome occurs when the pressure within the front, back, or outer leg compartments rises above the blood pressure needed for the heart to pump blood to the thigh. view 

Knee Ligament Injury

A knee ligament injury can be a sprain in which a ligament around the knee gets stretched or the ligament can be partially or completely torn. view 

Knee Meniscus Tear

The menisci are two C-shaped cartilage disks that sit between the thigh bone (femur) and the shin bone (tibia) and provide stability, support, and cushioning for the knee. view

Patellofemoral Syndrome

Patellofemoral syndrome encompasses a spectrum of conditions that can involve the kneecap (patella), quadriceps muscle group, iliotibial band (ITB), hamstrings, as well as the thigh bone (femur) and shin bone (tibia). view

Knee Arthritis

Knee arthritis is the loss of the cartilage cushion in the joint contact surfaces that normally allows for smooth, pain-free gliding during knee range of motion.  view

Knee Tendon Disorders

The common tendon disorders about the knee include bursitis, tendonitis, quadriceps, and patellar tendon tears. view

Stiff Joints: Stiff Knee

Stiff knee, also referred to as arthrofibrosis, is a condition that is associated with moderate to severe pain with knee motion. view

Knee Infection

The knee is one of the most well-perfused (good blood supply) areas of the human body and because of this ample blood supply to the knee, circulating white blood cells offer excellent protection against infection. view

KNEE LIGAMENT INJURY

Pathology

A knee ligament injury can be a sprain in which a ligament around the knee gets stretched or the ligament can be partially or completely torn. These injuries can be caused by one specific injury, such as a fall or while playing sports, or by repetitive micro-trauma over time, often referred to as overuse injuries. When a knee ligament injury occurs, there can be pain, weakness, difficulty walking or playing sports, bruising, swelling, and feelings of instability. Since each ligament in the knee provides stability in a certain direction, the patient will have instability or increased movement of the knee in certain directions, based on which ligament(s) has been injured. A physical exam is important to find out which ligament has been injured, whether the injury is partial or complete, and whether any other structures, such as the menisci, have been injured. X-rays will show any fractures, dislocations, or any evidence of arthritis. An MRI may be necessary to better image the ligaments, tendons, cartilage surfaces, and menisci to determine the extent of any injury to these structures.

 

Treatment

If the medial collateral ligament (MCL), lateral collateral ligament (LCL), or posterior cruciate ligament (PCL) has been injured, treatment will often start with non-operative treatment measures as long as these ligaments have not been completely torn.

The most common symptomatic treatment used for all types of soft tissue injuries has three approaches:

  1. R.I.C.E. treatment,
  2. Anti-inflammatory treatment
  3. Controlled early motion and therapy.

The acronym RICE stands for Rest, ice, compression and elevation. Rest is usually done for 24-48 hours, and can include the use of slings, splints or other types of immobilizers unless otherwise advised by a physician. Ice is used for no more than 20-30 minutes at a time, three to four times per day. Ice is best applied by using an ice slush which transmits the effects of the cold sensation best and can be made by crushing ice and mixing it with water and then placing it in a zip lock plastic bag. The ice bag should not be placed in direct contact with the skin but instead should have a layer between the skin and ice bag like a towel to prevent the skin from freezing. The ice should be applied for no more than 20-30 minutes to avoid skin freezing as can occur if you fall asleep with an ice pack on your limb. Ice functions by causing the arteries to narrow the size of their lumen which in turn decreases swelling and the pain from swelling.

Compression is the wrapping of a body part to further assist in minimizing swelling and is used in conjunction with elevation. The best way to do a compressive wrapping is by having the compression have multiple layers that provide a cushion effect. The compression should be wrapped without causing the constriction of the blood supply which is recognized by increasing pain to the body part wrapped. Other signs of a tight compressive dressing are the cold sensation of the wrapped limb, blue discoloration of the body part, or change in color from the natural skin color. Elevation of an injured body part is best done by elevating the limb to the level of the heart. If elevation is lower than this, the effects of gravity on the veins, will increase vein pressure and cause the blood in these veins to have difficulty traveling back to the heart and result in limb swelling.

The use of anti-inflammatory medication helps treat the pain, swelling, and inflammation that occurs after injury is imparted on a limb. Examples of anti-inflammatories includes aspirin products, Ibuprofen (Motrin® and Advil®), Naproxen (Aleve® and Naprosyn®), Mobic®, Indocin®, Arthrotec®, and Celebrex® to name a few. All of these medications have side effects and should be taken with this knowledge in mind. Prescriptions should be discussed with your pharmacist and physician.

Controlled early motion and therapy to the involved limb decreases the effects of prolonged immobilization which includes stiffness, muscle atrophy, weakness and a longer return to the pre-injury state. The type of therapy recommended will depend on the tissue type injured and the severity of this injury. Consult your surgeon for the best advice.

When the MCL, LCL, PCL, or anterior cruciate ligament (ACL) has been completely torn, or more than one of these ligaments have been injured, surgery is often required. Surgery allows for either the repair or reconstruction of these ligaments to provide the stability required for normal knee motion and function. Because ACL injuries, even if considered partial tears, are often symptomatic and act more like complete tears, surgery is often recommended to reconstruct the ligament and provide the necessary stability for patients to return to heir desired activities.

When knee ligaments are reconstructed, they can be reconstructed with tendons taken from other parts of the patient’s body (autograft) or with tendons from a cadaver (allograft). Different tendons from around the knee of the patient’s body can be used for knee ligament reconstruction. Your surgeon will be able to discuss the pros and cons of each graft choice, and will choose the proper graft for the specific surgery based on factors such as: the patient’s age, activity level, desired activities, any previous knee surgeries, any previous knee complaints, and ability/desire to follow the specific rehabilitation protocol for each specific graft choice.