The term meniscus refers to one of two crescent-shaped cartilages in the knee. Tears of the meniscus are common and can often cause knee problems. The symptoms from a meniscus tear can start gradually or suddenly. Symptoms include pain, loss of motion, clicking, catching or locking of the knee. While many meniscus tears can be treated conservatively with a combination of anti-inflammatories, activity modification and select physical therapy, some require surgical treatment. While most meniscus tears require removal of the torn tissue (partial meniscectomy), some tear patterns, especially in younger patients and after discrete injuries, may be amenable to repair.
The anterior cruciate ligament (ACL) is a ligament in the center of the knee that is injured most often from playing “twisting-pivoting” sports such as soccer, football, and basketball. Once the ligament is torn, it does not heal and cannot be repaired. Instead, this injury often requires surgical reconstruction in order to successfully return to sports. There are many techniques of reconstruction including the use of the patient’s own tissue or tissue from a tissue bank. The recovery time varies and ranges from 6 months to one year.
Articular Cartilage Injuries:
Articular cartilage is the smooth surface that lines the end of the bones of the knee. Focal areas of damage can occur from specific injury events or from overuse over time. These conditions can often be managed with conservative measures such as rest, the use of medication, or even injections. However, some will require surgical intervention. The surgical options vary from arthroscopic debridement and microfracture to more complex treatments such as autograft or allograft osteoarticular transplantation (OATs) or autologous chondrocyte implantation (ACI).
The synovium is soft tissue lining of the inside of the knee. Inflammation of this lining, or synovitis, has numerous causes. The symptoms include pain, stiffness, and swelling. Synovitis can usually be treated with anti-inflammatories, activity modification and corticosteroid injections, but on occasion requires knee arthroscopy for symptom resolution.
Collateral Ligament Tears:
The knee has two collateral ligaments. One ligament is on the inside of the knee (between the two legs) and is called the medial collateral ligament (MCL). The other is on the outside part of the knee and is called the lateral collateral ligament (LCL). The MCL is the most commonly injured ligament of the knee. It usually responds in a matter of weeks to conservative treatment including protected weight-bearing, bracing and therapist-guided physical rehabilitation. Occasionally, the MCL does require surgical intervention. The LCL is much less commonly injured but requires surgery more often than the MCL when it is injured. Surgery for both requires and open incision and often the LCL will require reconstruction rather than repair. Surgical recovery is often several months since the injury is more severe than injuries treated nonsurgically.
Patella (kneecap) Dislocations:
The patella can dislocate to the lateral or outside part of the knee usually after a twisting event. This most often occurs when playing basketball or soccer. When the patella dislocates, ligaments can stretch or tear or the cartilage of the femur or patella can be chipped off. Treatment depends on the severity of the injury but can usually start with rehabilitation, but can take several months in order to regain all pre-injury function. Surgical options vary from arthroscopic or open surgery to remove loose bodies and re-align, repair, or reconstruct the soft tissues of the knee to tibial tubercle osteotomy which is a re-alignment procedure that involves moving the bony attachment of the patellar tendon.
Multiligament Knee Injuries (Knee Dislocations):
If two or more ligaments of the knee are completely torn, it is classified as a knee dislocation. These injuries are less common than single ligament injuries and are more severe. Occasionally, nerves and arteries are also damaged. These are complex injuries that often require initial evaluation in an emergency room. However, once the injury is evaluated, they are often managed with complex repair or reconstruction of the damaged ligaments at one or more surgical procedures.
Tendon Ruptures (Patella and Quadriceps):
The patellar tendon or quadriceps tendon can tear from high energy sporting injuries or traumatic falls. Patellar tendon tears usually occur in patients less than 40 years old and quadriceps tendon tears occur in patients over 40 years old. The hallmark of both conditions is that the patient cannot extend the knee under their own power. Both conditions usually require surgery in order to repair the affected tendon. The recovery time is often 6-12 months.
Limb Malalignment (Varus and Valgus):
Young patients with arthritis can develop either bowed legs (varus) or knock knees (valgus). This can be due either to prior injury or a developmental deformity. In order to optimize function and delay the development of degenerative arthrosis, procedures can be done to correct the alignment. These procedures can be done in many ways and all are available at Fondren Orthopedic Group. These include procedures that break and realign the bones of the tibia or the femur and use plates/screws, metal rods, or the Ilizarov frame to heal the bone in the appropriate position.
Cartilage or other substances can break off inside the knee joint and become “loose bodies”. These can occur from an injury, can develop gradually over time, or can be due to other causes such as benign tumors. These loose bodies can act like a “rock in your shoe” and usually necessitate removal. This can be done arthroscopically
Osteochondral Defect (OCD):
OCD lesions usually occur in children but may occur or persist into adulthood. They usually occur on the end of the femur bone. It is not clear how or why they occur, but it is felt that it may be due to repetitive injury or from some level of abnormal development. In this condition, a portion of the bone and the cartilage surface has become loose from the rest of the knee. The symptoms are usually pain, swelling, or mechanical catching or locking. It can be managed with rest from activity or surgery. The type of treatment depends on the size, location, severity of the damaged area and the age of the patient.
The four bones of the knee can all be injured and break. This is called a fracture. Fractures of the distal femur (end of the thigh bone), proximal tibia (top of the shin bone), proximal fibula, and patella (knee cap) fractures may be treated with immobilization in a cast or brace but they may also require surgery. The severity and pattern of the fracture determines how it is treated.
If you would like your symptoms diagnosed or evaluated, or would like to see if you are a candidate for knee surgery, contact one of our physicians at a location near you.