A tear in the anterior cruciate ligament (ACL) is one of the most common knee injuries. An injury to this ligament causes the knee to become unstable and the joint to slide forward too much. ACL tears occur most often in athletes.
ACL reconstruction is usually not performed until several weeks after the injury, when swelling and inflammation have been reduced. The torn ligament is completely removed and replaced with a new ACL. Simply reconnecting the torn ends will not repair the ACL. Part of another ligament, usually in the knee or hamstring is used to create a graft for the new ACL. Choosing the proper type of graft depends on each patient’s individual condition.
Arthroscopy is a minimally invasive procedure that allows doctors to examine tissues inside the knee. It is often performed to confirm a diagnosis made after a physical examination and other imaging tests such as MRI, CT or X-rays.
For some patients, it is then possible to treat the problem using a few additional instruments inserted through small incisions around the joint, including those with meniscal tears, mild arthritis, loose bone or cartilage, ACL and PCL tears, synovitis (swelling of the joint lining) and patellar (knee cap) misalignment.
Because it is minimally invasive, arthroscopy offers many benefits to the patient over traditional surgery. These include:
Arthroscopy is not appropriate for every patient. Your doctor will discuss the options that are best for you.
Cartilage is the smooth coating on the end of the bones that provides cushioning and support for comfortable, fluid movement. Cartilage damage occurs as a result of injury or degeneration and can lead to severe pain and arthritis. The cartilage eventually wears away and leaves the bone unprotected. Fortunately, there are now several techniques used to repair damaged cartilage and restore normal movement.
Cartilage repair is a relatively new field and long-term results are still not proven. These procedures aim to restore movement with the best possible tissue and to prevent further cartilage damage. Two common procedures used in cartilage repair include autologous chondrocyte implantation and osteochondral autograft transplant (OATS).
The menisci are C-shaped pieces of tough cartilage that rest on either side of the knee, which help to distribute body weight across the knee. A meniscus tear is common after a traumatic injury, and most frequently occurs when the knee joint is bent and the knee is then twisted.
A torn meniscus causes pain and swelling, and may also be accompanied by a frequently locking joint and the inability to completely straighten the knee. Some people experience a popping or clicking sensation within the knee as well.
Treatment for a meniscus tear often begins with conservative methods such as rest, ice or over-the-counter medication. If these treatments are not effective and symptoms continue, you may benefit from meniscus repair surgery. Meniscus repair is an arthroscopic procedure in which the torn segment of the meniscus is removed and the torn edges are sutured together, which allows them to heal properly.
Arthritis and certain knee injuries and diseases can damage the cartilage that normally cushions the knee joint, leading to pain and stiffness. A knee replacement may be recommended when more conservative treatments — such as anti-inflammatory medications and cortisone injections — fail to relieve pain or improve movement.
During a total knee replacement, the entire joint is replaced with an artificial prosthesis. The surgery itself lasts between one-and-a-half and three hours. After the procedure, patients usually experience immediate relief from joint pain. Knee replacements today last about 20 years in 85-90% of patients.
Partial knee replacement may be possible for patients with damage to one part of the joint. In a partial knee replacement, only the diseased parts of the knee are removed and replaced; the healthy portions are left untouched. Successful partial knee replacements can delay or eliminate the need for a total knee replacement. They also allow a greater range of movement than standard (non-high-flex) total knee replacements.
The knee cap (patella) connects the muscles in the thigh to the shinbone. In a healthy knee, the patella rests in a groove in the thighbone and slides up and down as you bend and straighten your leg. The knee cap may be injured as a result of a fall, sports injury, motor vehicle accident, overuse, or several other factors. Patients with knee cap disorders may experience pain, stiffness, swelling and instability within the knee.
Treatment for knee cap disorders varies depending on the type and severity of the injury, but may include realigning the joint, removing damaged bone ends, and other kinds of surgical repair. The goal of treatment is to stabilize the knee and restore strength and function, while relieving pain and other symptoms. Your doctor will determine which treatment is best for you.
2010 David J. Chao, MD All Rights Reserved.
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