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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

PATELLOFEMORAL SYNDROME

Pathology

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). Any or all of these structures around the knee and leg may be affected. The main problem in patellofemoral syndrome is that the patella does not track properly within the central groove of the femur. Normally, the patella tracks down the center of the femoral groove much like the way a fan belt works in a car. This improper tracking can be caused by too much rotation of the thigh bone (femur) or shin bone (tibia), a femoral groove that is not deep enough to keep the patella within the groove, over-pulling of the quadriceps muscles and ITB on the outside of the knee, weakness of the quadriceps muscle, an ineffective ligament on the inner side of the kneecap, or a combination of these factors. In more severe cases, the patella can actually jump out of place and may have to be put back into place in the Emergency Room.

Patients tend to have pain along the front of the knee, and often have pain with activities such as climbing/descending stairs, squatting, kneeling, sitting for a prolonged period of time, and rising from a seated position. The patient often will have swelling associated with their pain. If the patella jumps out of place, it can be seen sitting outside of its normal, central location. The patient will have immediate pain, an inability to bear weight on the leg, and an inability to bend or straighten the knee.

Treatment

The mainstay of treatment for any condition associated with patellofemoral syndrome is non-operative treatment. Whether the problems involves too much rotation of the thigh bone (femur) or shin bone (tibia), a femoral groove that is not deep enough to keep the patella within the groove, over-pulling of the quadriceps muscles and ITB on the outside of the knee, weakness of the quadriceps muscle, an ineffective ligament on the inner aspect of the kneecap, or a combination of these factors, non-operative treatment is always tried first. If the patella has jumped out of place, a patellar dislocation, the patient often will need to go to the Emergency Room to have the patella put back in place. After this, non-operative treatment is initiated. Non-operative treatment may use a brace to help keep the patella in place, anti-inflammatory medications, a cortisone injection into the knee joint, or a combination of these. Physical therapy is started to strengthen the quadriceps muscles on the inside of the thigh specifically, stretch the ITB and hamstrings, strengthen the upper thigh and hip muscles, and strengthen the core muscles. This non-operative treatment regimen is very successful for the majority of patients and allows them to get back to their desired activities.

In cases where non-operative treatment does not provide relief or the patient is not satisfied with their level of activity, operative treatment is recommended. If the problem involves too much rotation of the thigh bone (femur), shin bone (tibia), or both, the bones are surgically rotated back to normal alignment. If the femoral groove is not deep enough to keep the patella within the groove, the groove can be deepened, however, this is rarely necessary. If the symptoms are caused by an over-pulling of the quadriceps muscles and ITB on the outside of the knee, weakness of the quadriceps muscle, an ineffective ligament on the inner aspect of the kneecap, or a combination of these factors, the ligament on the inner aspect of the kneecap can be tightened or reconstructed and the tissues on the outside of the knee can be released if necessary. Postoperatively, a physical therapy program is created, based on the operative procedures performed, in order to get the patient back to his/her desired activities.