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Knee Disorders

Table of Contents

Two weeks after receiving a partial knee replacement.


ACL Rupture

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ACL injuries are fairly well known orthopedic injuries to anyone who follows sports. These injuries usually are season ending injuries and although most individuals are able to return to the same level of sport participation, not all are able to return to competitive sport.
ACL injuries can occur without significant injury to other structures in the knee, but often other injuries such as a meniscus tear other ligament injury or injury to the cartilage occur at the time the ACL ruptures.
With an ACL, the patient usually feels the ligament tear (or the knee give way) accompanied by immediate pain, swelling of the knee and difficulty putting weight on the leg. Patients evaluated by an Urgent Care or Emergency Department typically have the knee immobilized to prevent additional injury.
In addition to information about the event that lead to the injury, the physical examination provides a great deal of information about the extent of injury. An MRI is ordered to evaluate associated injuries, and often Physical Therapy is used prior to reconstruction to regain muscle control and prepare the patient for surgery.



Knee Arthritis

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Articular Cartilage is the firm white smooth covering at the end of a bone that contacts another bone allowing for motion (joint). Loss of this cartilage for any reason is arthritis. Arthritis can occur due to “wear and tear” but also due to inflammatory disease such as rheumatoid arthritis or psoriatic arthritis, due to trauma of the joint, or disruption of the blood supply to the underlying bone (avascular necrosis).



Knee Cartilage Injury

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Articular Cartilage is the firm white smooth covering at the end of a bone that contacts another bone allowing for motion (joint). Loss of this cartilage for any reason is arthritis. Arthritis can occur due to “wear and tear” but focal arthritis can occur due to trauma of the joint associated with a kneecap dislocation, during ACL rupture or meniscus injury. These lesions can present as cartilage “peeling”, “delaminating”, or as a flap.



Knee Disorders

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Knee disorders are exceptionally common among both active and sedentary individuals. Symptoms may include pain, swelling, a sense of catching or giving way. Certainly many issues of the knee occur after a traumatic injury (car accident, fall, sports contact injury) but many significant injuries can occur without major trauma. ACL ruptures commonly occur during sports, but surprisingly often without a collision event. Meniscus tears commonly occur without any specific recalled trauma. Over the past several years, a separate diagnosis (meniscal root avulsion) has been identified and causes rapid progressing of knee arthritis.
Some diagnoses are best treated surgically, but increasingly with “regenerative” techniques, more and more diagnoses are being treated initially at our offices with non-surgical methods.



Meniscus Tear

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A torn meniscus is a common cause of knee pain, swelling, and a sense of catching. The tear is often caused by a twisting injury but not infrequently the exact event will not be known. The majority of the meniscus has no blood supply, so the tear will not usually heal on it’s own. The majority of the meniscus also has no nerve endings, so the meniscus itself is not painful, but changes in pressure to the adjacent bone and joint lining cause the sense of pain.
A separate group of meniscus tears (meniscus root avulsion) has fairly recently been identified. Due to the dramatic change in mechanics of the knee with these tears (suddenly the knee functions as if there is no meniscus at all) the rapid development of arthritis will often subsequently occur.




Partial Knee Replacement

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This procedure is appropriate for an individual with end stage arthritis isolated to one area (compartment) of the knee. Initially, the symptoms from knee arthritis in one compartment is managed in a similar fashion to symptoms from global knee arthritis. Patients with single compartment knee arthritis may also benefit from a brace designed to remove stress from the arthritic side. If a patient continues to have pain and limitation in functioning due to their arthritic symptoms, surgery may be appropriate.
In general, recovery from partial knee replacement is easier when management of other medical issues such as diabetes are optimized first. In addition, a patient who has been able to maximize their strength and “conditioning” will have an easier time with rehabilitation after surgery. Patients often state they are unable to exercise due to their knee pain. We recommend non-impact activities such as cycling, resistance exercises and pool therapy to maximize fitness level prior to surgery. Water is your friend!
The potential benefits of this procedure include:

  • Shorter hospital stay (including same day discharge)
  • Decreased pain
  • Decreased or stopped blood loss
  • Faster rehabilitation
  • A more “normal” feeling knee when compared to a Total Knee Replacement
  • Similar to a Total Knee Replacement, a Partial knee includes metal and high density plastic components that can wear overtime

 

Total Knee Replacement

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When patients continue to have significant pain and restriction of activities due to end stage arthritis of the knee, and despite non-surgical options (our office offers the full array of these options including therapy, injections, bracing, discussion of weight loss and nutrition) joint replacement becomes a consideration.
Knee Replacement has a good track record for restoring function and decreasing pain.

 

 
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