The anterior cruciate ligament (ACL) is one of 4 major ligaments that stabilize the knee and ensure it moves properly. Tears of the ACL occur via both contact and non-contact mechanisms, and the injury is often accompanied by a 'pop' and rapid onset of swelling. Afterwards, there is often residual instability or 'giving way' of the knee. In younger and more athletic patients and people with frequent or disabling instability, anterior cruciate ligament reconstruction is often recommended. Rehabilitation and bracing without surgery can be effective treatments in patients who do not have disabling symptoms. For more information please click here.
The menisci are semi-circular, wedge-shaped cartilage structures located on the inside (medial) and outside (lateral) aspects of the knee joint. They provide a protective cushion, shielding the joint surface from stress, and help ensure that the knee moves properly. Injury to the meniscus cartilage is common and often occurs from twisting or bending forces, although tears can also occur without identifiable trauma. A limited blood suppy to the cartilage makes spontaneous healing very unlikely. Symptoms usually include pain, swelling, and occasionally locking. If the symptoms are unacceptabe to the patient, surgery is often indicated and usually involves arthroscopy to excise the torn portions of the cartilage, although repair of the cartilage is also sometimes possible. For more information please click here.
The posterior cruciate ligament (PCL) helps stabilize the knee in concert with the other knee ligaments. The PCL is often injured with force coming from the front and can be accompanied by a 'pop' and the rapid onset of swelling. Occasionally, there is persistent instability or 'giving way' of the knee which may warrant surgical reconstruction, although physical therapy and/or bracing is often sufficient to control symptoms. For more information please click here.
The medial collateral ligament (MCL) is the major stabilizing ligament on the medial (inside) knee. It is often injured by a force directed onto the outside or lateral aspect of the lower leg, causing the knee to buckle inward. A tear (sprain) of the MCL usually results in pain and swelling along the medial knee and can result in instability. Most MCL sprains can be treated with ice, rest, immobilization, and time (it takes 2 to 6 weeks to heal, depending on severity), but sometimes surgery is recommended. For more information please click here.
Anterior knee pain is generated by abnormalities in the complex relationship between the patella (kneecap) and femoral trochlea (groove in the front of the thighbone at the knee). There are a variety of possible ways this joint can become painful, including patellar subluxation, when the kneecap partially comes out of the groove; chondromalacia, when there is softening or wearing of the joint surface cartilage; and irritation of the soft tissue constraints of the joint. The pain is usually most pronounced during bending or squatting activities, on stairs (up or down), after sitting for a long time, and during or after running or jumping. Exercises to stretch tight muscles and strengthen core, hip, and leg muscles as well as avoiding exacerbating activity can be helpful, although sometimes formal physical therapy is needed. If the symptoms don't respond, occasionally surgery is recommended. For more information please click here.
Patellar dislocation occurs when the patella 'jumps the groove' and comes out of its normal track in the trochlea, or groove, on the front of the thighbone at the knee. The injury can happen from a direct blow to the knee or from a non-contact twisting mechanism. The knee becomes immediately painful and swollen. Sometimes the patella returns to its position on its own, but, if it doesn't, there is a marked deformity of the knee and an inability to straighten it out and the patella may have to be reduced (put back in place) by a doctor, usually in the ER. Treatment with bracing and exercises is usually enough to get the knee back in shape, although sometimes surgery is necessary. For more information please click here.
Degenerative arthritis (DJD) of the knee is an extremely common affliction in our aging population. In DJD, the cartilage-bearing surfaces of the end of the femur (thighbone), the top of the tibia (shinbone), and the backside of the kneecap (patella) become worn, initially by softening, cracking, or fraying and later on becoming completely worn away. There are numerous factors which increase one's risk for DJD, including prior injury, family history, obesity, occupation, and limb malalignment, while often there is no identifiable risk factor. Symptoms include pain--often achy pain made worse with prolonged standing or walking or changing positions, swelling, stiffness, weakness or giving way, and increasing deformity. The diagnosis is usually made by simple history, physical exam, and plain x-rays; MRI is not usually necessary. There are a number of treament options available; which approach your doctor recommends will depend on a number of factors, including age, activity level, severity of symptoms, severity of x-ray changes, and what treatments have been attempted already. (For non-operative treatment recommendations from the American Academy of Orthopaedic Surgeons, click here). If non-surgical treatments fail, joint replacement surgery can often provide lasting relief of symptoms. Osteotomy of the tibia can be a successful alternative for younger patients with arthritis confined to the medial aspect of their knee. For more information about DJD of the knee, please click here.