Meniscus Tear

knee-pain-nj

The Meniscus is a cartilage block that attaches onto the top of the tibia plateau and makes contact with the femur. There is a lateral and medial meniscus, with the medial meniscus being more “C-shaped” and the lateral meniscus being more “O-shaped.” The meniscus cushions the joint and acts as a shock absorber. As a result, the meniscus reduces the amount of stress on the joint. It is important for joint congruency, load transmission, joint stability, and it serves as an extension and flexion block.

Symptoms:

  • Pain
  • Swelling within the Joint
  • Cannot achieve full leg flexion or extension
  • Feeling as if your knee gets stuck or locks out
  • Knee stiffness
  • A sensation of giving away or instability in the knee.

Diagnosis:

  • Your physician will evaluate your injury by taking a complete medical history, including mechanism of injury, prior injuries and symptoms. Your physician will complete a physical examination of your knee. Your physician may recommend an MRI which is the best way for seeing a meniscus tear. Your physician may recommend surgery or may suggest physical therapy pending the degree of damage to the meniscus.

Treatment:

  • Rest – stay off your leg as much as possible, or use an ambulatory device, such as crutches
  • Ice – use ice for 20 minutes on with 40 minutes off throughout the day, for the first 72 hours since the injury occurred
  • Compress – use a compression sleeve or ace wrap. This will help to reduce the swelling.
  • Elevate your leg – keep your knee elevated.
  • Take an anti-inflammatory or pain medication prescribed by your physician.

Surgery:

  • Arthroscopic surgery is a possible solution for a meniscus tear. The surgeon will insert a tube into the knee. This tube has a light and camera on the end and makes it easier for the doctor to remove the damaged meniscus.

Rehab:

  • After the surgery, physical therapy will be recommended to strengthen the muscles surrounding the knee joint.

Prevention:

  • Strong muscles in the thigh – quadriceps, adductors, and hamstrings.
  • Stretch before and after you exercise.

Patella-Femoral Syndrome

The patella is held in place by the quadriceps muscles and it also attaches to the tibia via the patella ligament (aka as the patella tendon). The back of the patella is covered in hyaline cartilage. When a patella femoral injury occurs, it is usually the result of a mal-tracking issue. The vastus medialis oblique atrophies and as a result there is a lateral pulling of the patella, often causing pain behind the kneecap. The patella serves to increase the efficiency of the quadriceps muscles, absorption and transmission of PF joint reaction forces, and serves to protect the anterior knee.

Possible causes of patella femoral problems:

  • Posture
  • Knock-kneed (Genu Valgum),
  • Lack of iliotibial band flexibility
  • Tightness of hip flexors, hamstring, and gastrocnemius.
  • Weak vastus medialis muscle.

Symptoms:

  • Pain behind the knee cap
  • Pain while sitting for a long of period of time
  • Pain is worse when moving downhill or down stairs.
  • Popping, snapping, or grinding in the knee.

Diagnosis:

  • Your physician will evaluate your injury by taking a complete medical history, including mechanism of injury, prior injuries and symptoms. Your physician will perform a complete physical examination of your knee. Your physician may recommend an x-ray.

Treatment:

  • Rest – Avoid exercises or activities that cause you pain.
  • Ice – use ice for 20 minutes on/ 40 minutes off throughout the day, for the first 72 hours since the injury occurred, and after exercise.
  • Take an anti-inflammatory or pain medication as prescribed by your physician.
  • If tightness exists, then resist patella motion by taping and bracing. You can also use a knee sleeve to keep the patella in place and offset lateral tracking.
  • Strengthen the adductors and inner quadriceps muscle, specifically your vastus medialis oblique.
  • Orthotics may be recommended by your doctor or physical therapist to offset physical imbalances.

Surgery:

  • A surgical release may be recommended by your physician if patella femoral syndrome persists. A release is done through arthoscopic surgery and it is a release of the lateral retinaculum. This is always used as a last resort and is followed up by physical therapy.

Rehab:

  • Your physical therapist will work with you to strengthen the adductor muscles and inner quadriceps muscle, specifically your vastus medialis oblique.

Prevention:

  • Keep your inner thigh muscles strong.
  • Stretch before and after you exercise.

Anterior Cruciate Ligament

This ligament is connected from the medial horn of the medial meniscus and passes superior and laterally to the lateral femoral condyle. The ACL is placed in the center of the knee and provides major stability for the knee. The ACL checks:

  • anterior translation of the tibia on the femur
  • internal and external rotation of the tibia
  • Hyperextension of the tibia.

Most often, the ACL is damaged when the foot is planted and someone or something strikes the knee. Also a sudden stop or sharp turn with the foot planted can also tear the ACL. ACL “non-contact” injuries occur more often in females than in males.

Symptoms:

  • Instability in the knee, “giving – out” sensation of the knee
  • Pain in the knee
  • Swelling within the joint
  • Discoloration

Diagnosis:

  • Your physician will evaluate your injury by taking a complete medical history, including mechanism of injury, prior injuries and symptoms. Your physician will perform a complete physical examination of your knee. Your physician may then recommend an MRI which is the best way for seeing an ACL tear.

Treatment:

  • There are a few treatment options with an ACL tear. The treatment options can be determined by the degree of the tear, the age of the person, and the lifestyle that the person lives.

Surgery:

  • The surgeon performs an arthoscopic surgery. The surgeon will drill holes in the tibia and the femur, remove the damaged ACL, and he will replace the old ACL with a graft. The graft is anchored in by screws.

There are two types of grafts that are available:

  • Allograft – obtained from a cadaver
  • Autograft – obtained from your own body; either a hamstring or patellar ligament, etc.

Prior to Surgery, when the injury first occurs:

  • Rest – stay off your leg as much as possible, or an ambulatory device can be used, such as crutches.
  • Ice – use ice for 20 minutes on with 40 minutes off throughout the day, for the first 72 hours since the injury occurred
  • Compress – use a compression sleeve or ace wrap. This will help to reduce the swelling.
  • Elevate your leg – keep your knee elevated.
  • Take an anti-inflammatory or pain medication prescribed by your physician.
  • Strengthen your quadriceps muscles.

Rehab:

  • Rehabilitation from an ACL injury progression is based on protocol and how the patient adapts to the procedure.
  • Your therapist will also stress getting full knee flexion and knee extension.

Prevention:

  • Strengthen the hamstring and quadriceps muscles.
  • Strengthen the core muscle.
  • Make sure you have full hip range of motion.

Knee Replacement

The Knee has 2 joints, the tibiofemoral joint and the patella-femoral joint. The tibiofemoral joint is where the femur articulates with the tibial plateau. The patella-femoral joint is the way the patella articulates with the femur. The cartilage that covers these joints can be damaged over time and cause chronic pain and impede daily living.

Symptoms:

  • Chronic Knee Pain

Diagnosis:

  • Your physician will evaluate your injury by taking a complete medical history, including mechanism of injury, prior injuries and symptoms. Your physician will perform a complete physical examination of your knee.

Treatment:

  • Surgery

The surgeon will place prostheses on all aspects of the joints articulating surfaces. There will be artificial prostheses on the femoral condyles, the tibial plateau and behind the patella. These coverings replace the damaged cartilage at the joint lines. The knee stability comes from the congruity of the joint, as well as, the muscles that surround the knee.

Rehab:

  • Following surgery, your physical therapist will work with you to strengthen the muscles that surround and help to stabilize your knee: your quadriceps, hamstrings, adductors, and calf muscles.
  • Your therapist will also stress getting full knee flexion and knee extension.
  • Your physician may suggest you use an ambulatory device; such as forearm crutches or a cane.