KNEE PAIN

Knee Pain & Injury

The orthopedic doctors and sports medicine specialists at iOrtho treat a variety of conditions involving problems with the knee, select a condition below to learn more.

ACL Sprains / Tears

An ACL injury is one of the most common injuries in sports, and it is one of the main injuries that can occur in the knee joint. A torn ACL is most likely to occur in sports that involve planting the foot and rotating the leg at the knee joint, such as soccer, basketball, gymnastics, and football.

The anterior cruciate ligament (ACL) is a crucial ligament in the knee joint responsible for its stability. Running diagonally between the femur and tibia, the ACL, along with the posterior cruciate ligament (PCL), plays a vital role in controlling and stabilizing knee movement, preventing excessive forward and backward motion. Injuries, specifically ACL tears, can occur due to various factors. The ACL's primary function is to restrain anterior displacement of the tibia and internal rotation relative to the femur.

The ACL originates from the anterior part of the tibia and inserts into the femoral intercondylar notch. Its diameter varies based on knee size, typically averaging around 10mm. ACL tears commonly result from sports-related incidents, often due to a sudden twisting motion or direct impact to the knee. These forces exceed the ligament's tensile strength, leading to rupture, which can occur at the ligament's tibial or femoral attachment points or midsubstance.

What Are Anterior Cruciate Ligament (ACL) Tears?

Anterior cruciate ligament tears, or ACL tears, involve the partial or complete separation of the ACL. Diagnosis often relies on the patient's history and clinical examination, with confirmation through MRI, providing additional information about associated injuries for effective treatment planning.

Symptoms and Causes of ACL Injuries

Typical symptoms of an ACL tear include immediate pain and swelling, making walking challenging, with a potential sensation of the knee "giving out." Joint swelling can result in stiffness, limiting knee mobility. In severe cases, bones may be contused or fractured, and additional injuries to the meniscus, articular cartilage, or other ligaments, notably the medial collateral ligament (MCL), can occur.

Nonsurgical Treatments for ACL Tears

In a recent study published in the British Journal of Sports Medicine, the use of a cross bracing protocol alone provided reasonably good results with 90% of knees showing some evidence of healing at 3 months on repeat MRI testing. Also, 100% of patients with a Grade 1 sprain had a normal knee stability exam and 92% returned to pre-injury sports compared to a grade 2-3 sprain where those numbers dropped to 40% and 64%, respectively.

The challenge with this choice of treatment is maintaining the brace and limiting function over the 6 weeks that’s required to achieve healing. Also, the statistical chance of success drops off with higher grade sprains, so this also needs to be considered by the surgeon and patient. Despite these challenges I think it remains a viable option for younger people who are better able to compensate when using crutches and a brace and certainly for those that have lower grade sprains.

Another option available for the higher grade sprains (Grade 2-3) that allows the ACL to heal naturally and also reduces the need for bracing and limitations of activity is the BEAR procedure (Bridge Enhanced ACL Repair). This is a procedure that involves using a minimally invasive technique for putting sutures into the torn ACL and placing a blood soaked implant made of Bovine Collagen around the torn ACL to improve the biology of healing. This novel technique has an up to 80% success rate for high grade sprains. Learn more here.

Surgical Treatments for ACL Tears

Surgery is advisable for individuals returning to high-demand ACL activities like sports or specific occupations. Younger individuals may opt for surgical reconstruction due to the risk of developing osteoarthritis associated with abnormal knee kinematics resulting from ACL deficiency.

Various surgical reconstruction options exist, with a preference for anatomic reconstruction using the native footprint for both femoral and tibial attachments. Graft fixation on the femoral side involves cortical fixation to avoid intra-articular hardware. On the tibial side, an interference screw and/or cortical fixation are utilized. Graft options include allografts, matched to the patient's needs.

Complete ACL tears necessitate surgery, as the ligament will not heal naturally. While living without an ACL is possible, it significantly limits participation in competitive sports and increases the risk of future knee arthritis. Surgical intervention by an experienced ACL tear doctor involves repairing a partially torn ACL or replacing a completely torn ACL with a tissue graft, either autograft or allograft.

Recovery after ACL replacement surgery is initially rapid, but full rehabilitation and return to activity may take several months, as the ACL requires extended time to heal completely. If you suspect a knee injury involving an ACL tear, contact ACL injury specialists for a comprehensive consultation.

 

PCL Sprains / Tears

The posterior cruciate ligament (PCL) is one of the four main ligaments in the knee joint that stabilizes the knee. The PCL runs between the femur and the tibia. Together with the anterior cruciate ligament (ACL), the PCL controls and stabilizes the knee joint, preventing it from moving too far back and forth. Certain injuries can cause PCL tears. The role of this ligament in stabilizing the knee is to control posterior displacement of the tibia as well as external rotation relative to the femur.

The PCL originates from the central portion of the tibia posteriorly and inserts on the medial wall of the femoral intercondylar notch. The diameter of the ligament varies based upon the size of the knee but generally averages in the range of 10mm. Incidence and Pathophysiology PCL tears are common sports related injuries. The injury typically occurs as a result of a hyperextension force/load or posterior force at the level of the tibia which is applied to the knee. Under these conditions the tensile strength of the ligament is superseded by the energy of the applied stress and the ligament ruptures. The tear pattern can be a rupture of the ligament at its tibial or femoral attachment or a midsubstance rupture of the ligament.

 What Are Posterior Cruciate Ligament (PCL) Tears?

Posterior cruciate ligament tears, or PCL tears, are a partial or complete separation of the posterior cruciate ligament. The diagnosis of a PCL tear can often be made based on history and clinical findings, however, an MRI is the diagnostic imaging test of choice for confirmation. An MRI scan can also give information regarding associated injuries as mentioned above which can be important for planning optimal treatment.

 Symptoms and Causes of PCL Injuries

The typical symptoms of a PCL tear are pain and swelling that occur immediately after the PCL injury and reach their peak over a short period. People with PCL tears often have difficulty walking, and the leg may “give out” at the knee. Knee joint swelling may make the knee stiff. In fact, a PCL injury doctor will usually be able to find a limited range of motion in the knee during examination, along with the stiffness and swelling. A result of the instability episode and the knee partially dislocating, not infrequently the bones are contused or in some cases even fractured. In addition the medial and or lateral meniscus can be torn. In some cases there can be damage to the articular cartilage surface of either the femoral condyles and or the tibial plateaus. Finally, additional ligaments can be injured along with the ACL, most commonly the MCL (medial collateral ligament).

 Nonsurgical Treatments for PCL Tears

Non-surgical treatment is appropriate when there are no associated injuries that require repair, the age range is > 30 and there is no plan to participate in high PCL demand activities. Under these circumstances, the knee can be treated symptomatically initially and then participate in a rehabilitation program to strengthen muscles that also work to dynamically stabilize the knee in the same way that the PCL does.

A local PCL tear doctor can evaluate and determine if your PCL injury will require surgical or nonsurgical treatment. Initial treatment should focus on reducing the severity of the inflammatory response as well as taking precautions so as not to cause further injury to the knee.

The typical first aid intervention for a PCL tear is PRICE: protection, rest, ice, compression, and elevation. If PRICE is performed soon after the PCL injury, the treatment can relieve pain and help the torn PCL to heal. Over-the-counter pain medications such as ibuprofen are usually enough to control pain after the first 24 hours, but your PCL injury doctor may prescribe more potent pain medications. After the initial swelling has subsided, your PCL tear doctor can recommend a physical therapist to aid you in a thorough rehabilitation program that will help reduce pain and improve knee function.

 

Surgical Treatments for PCL Tears

A PCL surgery is generally considered advisable when the individual is likely to return to high demand PCL activities. These can include sports such as football, soccer and basketball or work such as heavy construction or police enforcement. Under these circumstances, the PCL deficient knee may subluxate (partially dislocate) during high stress activities and cause further and often more serious knee injuries.

Age is also a factor and a younger person may be more likely to benefit from a surgical reconstruction given the propensity for PCL deficient knees to develop osteoarthritis as a result of abnormal kinematics that develop as a result of PCL deficiency. In regard to the types of surgical reconstruction that are available, there are many. At iOrtho our current preference is an anatomic reconstruction using the native footprint for the femoral and tibial attachment of the PCL.

Tunnel preparation is performed independently to allow for matching the natural footprint of the reconstructed PCL. Graft fixation preference on the femoral side is cortical fixation so that there is no hardware inside the knee and the graft and tunnel and incorporate fully without a potential osseous deficiency if the graft ever suffered a subsequent tear and the procedure had to be done again. An interference screw and/or cortical fixation on the tibial side. Graft options include allograft and the type is matched to the patient.

A complete PCL tear will not heal without surgery. While you can live without a PCL, a completely torn PCL will greatly limit your ability to compete in competitive sports and may increase your risk for knee arthritis in the future. Young, otherwise healthy individuals, especially athletes, may wish to pursue surgical treatment for PCL tears.

An experienced PCL tear doctor can repair or rebuild the torn ligament. A partially torn PCL can be repaired by suturing the torn ligament, while a completely torn PCL must be replaced. Tunnel preparation is performed independently to allow for matching the natural footprint of the reconstructed PCL. Graft fixation preference on the femoral side is cortical fixation so that there is no hardware inside the knee and the graft and tunnel and incorporate fully without a potential osseous deficiency if the graft ever suffered a subsequent tear and the procedure had to be done again. An interference screw and/or cortical fixation on the tibial side.

Your PCL injury doctor may use a tissue graft taken from another part of your body or use a donor graft harvested from a cadaver. Remember that while people initially recover quickly after PCL replacement surgery, rehabilitation and full return to activity may take several months, as the PCL takes many months to fully heal.

If you have sustained injury to your knee and think you may have a PCL tear or other PCL injury, contact the PCL injury doctors at iOrtho today for a consultation.

MCL Sprains / Tears

The Medial Collateral Ligament (MCL) is a pivotal ligament in the knee joint that provides stability. Positioned on the inner side of the knee, the MCL connects the femur to the tibia. Together with other ligaments, such as the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), the MCL plays a crucial role in maintaining knee stability by preventing excessive side-to-side movement. MCL sprains or tears can occur due to various injuries, impacting the ligament's ability to resist forces applied to the outer part of the knee.

The MCL originates from the medial femoral condyle and attaches to the inner part of the tibia. The ligament's width varies based on individual anatomy. Incidents leading to MCL injuries are often related to sports, with a direct impact to the outer knee or a sudden twisting motion being common mechanisms. The MCL's tensile strength may be overwhelmed by these forces, resulting in either a sprain, where the ligament is stretched, or a tear, where the ligament is partially or completely ruptured.

Symptoms and Causes of MCL Injuries

Common symptoms of MCL sprains or tears include immediate pain and swelling along the inner side of the knee. Patients may experience difficulty walking, and the knee may feel unstable. MCL injuries can also be associated with a limited range of motion during examination. In more severe cases, additional injuries may occur, such as damage to the meniscus or other ligaments.

If you are experiencing a MCL injury, schedule an appointment with iOrtho today.

LCL Sprains / Tears

The lateral collateral ligament (LCL) is a pivotal ligament situated on the outer side of the knee joint, contributing significantly to its stability. Connecting the femur to the fibula, the LCL, along with other ligaments like the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), plays a crucial role in preventing excessive side-to-side movement of the knee. LCL sprains or tears can result from various injuries, affecting the ligament's ability to resist forces applied to the inner part of the knee.

 Symptoms and Causes of LCL Injuries

Common symptoms of LCL sprains or tears include immediate pain and swelling along the outer side of the knee. Walking may become challenging, and individuals may perceive instability in the knee. During examination, a limited range of motion may be observed. In more severe cases, additional injuries, such as damage to the meniscus or other ligaments, may occur.

If you are experiencing a LCL injury, schedule an appointment with iOrtho today.

Cartilage Injury & Arthritis

Arthritis is a condition in which one or more joints are inflamed. Virtually any joint in the body can become inflamed, but arthritis in the knee is very common. Knee arthritis can be very painful and even disabling.

Non-Inflammatory Knee Arthritis

The hyaline cartilage surfaces can be damaged as a result of repetitive stress and time. This is a degenerative process of cartilage change and is called osteoarthritis. This is the common type of cartilage damage that is experienced by many people.

Damage to the cartilage surface in this category generally occurs along a spectrum of change beginning with softening of the cartilage which then progresses to superficial cracking and then deeper cracks followed by erosions and eventually areas of complete cartilage loss. These spectrums of changes are referred to as chondromalacia.

The cartilage surface can also be damaged as a result of a single traumatic event. This can happen with a dislocation episode such as that encountered in an ACL injury or a patella dislocation. It can also happen with a knee fracture which extends into the joint disrupting the joint surface.

This type of damage is often referred to as a traumatic defect distinguished often by its focal geography and can often be measured in very discrete terms with surrounding healthy cartilage. This appearance could be altered obviously, if the joint was degenerating prior to the traumatic event having occurred. The focal or diffuse nature of the cartilage injury (pattern) is one of the main features, which guides treatment options likely to be effective.

 

Inflammatory Knee Arthritis

Inflammatory arthritis is very different from the non-inflammatory type. The cartilage damage is secondary not to repetitive stress or time or a single event trauma but is the result of a chemical process which occurs often because of an autoimmune disease. The autoimmune process causes the synovium to “attack” the cartilage surface. Instead of providing nutrition and support to the cartilage, the synovial cells secrete enzymes which essentially digest the cartilage causing it to break down and resorb.

Since knee arthritis treatments are different depending on the type of arthritis, it is important to know which type of arthritis you have – schedule an appointment with an orthopedic expert to understand this condition more.

Meniscus Tears

The meniscus is a crucial piece of cartilage located in the knee joint, acting as a cushion between the femur and tibia. Responsible for distributing weight and absorbing shock during movement, the meniscus plays a vital role in maintaining knee stability and function. Tears in the meniscus can occur due to various injuries, impacting its ability to provide essential support to the knee.

The meniscus consists of two crescent-shaped structures, one on the inner side (medial meniscus) and the other on the outer side (lateral meniscus) of the knee. Injuries leading to meniscus tears are often associated with twisting motions or forceful rotations of the knee. The tear can occur in different patterns, including radial tears, longitudinal tears, or bucket-handle tears, affecting the inner or outer edge of the meniscus.

Common symptoms of meniscus tears include pain, swelling, and stiffness in the knee. Patients may experience a catching or locking sensation, limiting the range of motion. In some cases, the knee may feel unstable or give way. Meniscus tears can also be associated with the sensation of the knee "giving out" during activities.

If you have sustained injury to your knee and think you may have a meniscus tear, schedule an appointment with one of our orthopedic experts, or walk-in to our immediate care center iOrthoNOW.

Patellar Tendon Tears

The patellar tendon works with the muscles in the front of your thigh to straighten your leg. Small tears of the tendon can make it difficult to walk and participate in other daily activities but are treated effectively with rest and NSAIDS whereas large tears often require surgery and physical therapy to recover.

One of the main causes of tendon tearing is the weakening of the patellar tendon through repetitive stress and  inflammation, called patellar tendinitis (Jumper’s Knee).

When a patellar tendon tears there is often a tearing or popping sensation. Pain and swelling typically follow, and you may not be able to straighten your knee. An individual may also experience bruising, tenderness, moving kneecap, difficulty walking and cramping.

If you think you are experiencing a patellar tendon tear, schedule an appointment with one of our orthopedic experts, or walk-in to our immediate care center iOrthoNOW.

Robotic Total Knee Replacement

Robotic Total Knee Replacement becomes necessary when individuals experience advanced osteoarthritis or other degenerative knee conditions that affect the entire knee joint. Severe joint pain, stiffness, and decreased mobility can significantly impact daily activities and quality of life. Total knee replacement involves surgically removing damaged bone and cartilage and replacing it with artificial components, restoring joint function, alleviating pain, and allowing patients to regain an active lifestyle.

Robotic Partial Knee Replacement

Robotic Partial Knee Replacement is a surgical option for individuals with severe knee pain and disability primarily affecting one knee compartment. It is a minimally invasive procedure suitable for active patients with limited joint damage, preserving healthy tissues and providing long-lasting pain relief and improved mobility.

If you suspect you have pain in any of these areas, it's important to consult a medical professional for a proper diagnosis and appropriate management.