A torn meniscus is a common injury often caused by forcefully twisting or rotating the knee. It can also be a result of degenerative changes in older adults. A meniscus tear can be repaired through arthroscopic surgery.
The menisci are C-shaped pieces of tough cartilage that rest on either side of the knee, between the thigh bone and shin bone. They help to distribute body weight across the knee so it can be properly supported by the bones in the leg, and also provide stability to the knee joint. 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. Torn menisci are common in athletes and older adults whose cartilage may have worn away.
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.
Recovery from meniscus repair surgery can take several months of immobilization and the use of crutches. Most patients recover well from this procedure and are able to return to their normal activities.
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The knee is made up of two different types of cartilage that provide support to the joint and allow for smooth and pain-free movement. Articular cartilage is found on the end of most bones and acts as a cushion to prevent one bone from rubbing against another. As we age, this cartilage may lose its cushioning or become damaged by injury or overuse.
An articular cartilage injury is known as a chondral injury and often occurs as a result of pivoting or twisting on a bent knee. It can also be caused by a direct blow to the knee, and often accompanies injuries to a ligament like the anterior cruciate ligament. A chondral injury can cause locking, catching, swelling and pain in the knee and can be mild or severe.
After diagnosing a chondral injury through X-ray or MRI, your doctor may recommend lifestyle changes, medication or surgery, depending on the severity of the damage.
Microfracture is an arthroscopic procedure used to treat severe articular cartilage damage that affects the full thickness of the cartilage. Microfracture aims to stimulate the growth of new cartilage by scraping the damaged area and cause bleeding, which helps heal the area. After small holes are created in the damaged area, a clot is created that eventually turns into scar cartilage. This cartilage is durable and sufficient to support the knee for several years, although it is not as strong as the natural articular cartilage. The development of the new cartilage usually takes 2 to 6 months and can continue to improve for 2 to 3 years.
Carticel® is a two-step procedure that involves taking a biopsy (sample) of a patient's own cartilage, and culturing it in a lab to create a healthy, sufficient amount. The newly produced cartilage is then implanted into the knee to restore the articular cartilage surface. Most patients undergo a physical rehabilitation program after implantation in order to help patients adjust to their reformed knee.
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Osteoarthritis, also known as degenerative joint disease, is a common condition of the knee that occurs as a result of gradual damage to the cartilage in the joint. This condition can cause pain, tenderness, stiffness and swelling and can severely affect your daily life as the disease progresses. While joint replacement surgery is often a last resort for treating osteoarthritis, other more conservative treatments are available that may benefit some patients.
Bracing helps to stabilize a damaged joint and may reduce mild pain and inflammation. Braces are available over-the-counter, or may be customized to perfectly fit a patient’s knee. These braces help prevent the knee joint from bending and relieve pressure on the damaged joint. Braces are often used in addition to another form of treatment.
Although you may think that exercise would only make joint pain worse, it is actually beneficial to people with osteoarthritis. Regular exercise actually helps reduce pain and stiffness, build strong muscles and increase flexibility. Recommended exercises include walking, biking and swimming. Losing weight as a result of a healthy diet and exercise can also help relieve pressure on the knee and as a result reduces pain as well.
Viscosupplementation is a relatively new procedure that involves injecting hyaluronic acid into the knee joint. The hyaluronic acid acts as a lubricant to allow for smooth movement of the bones and is injected over the course of 3 to 5 sessions.
The FDA has approved several forms of hyaluronic acid to treat osteoarthritis of the knee. Our practice uses Synvisc and Euflexxa to treat patients who do not experience relief from medication, but do not wish to undergo knee surgery.
Glucosamine and chondroitin sulfate are natural substances that help build and repair cartilage, and can therefore be used to treat cartilage damage. As nutritional or dietary supplements, these substances can help relieve pain and slow cartilage damage, serving as a natural alternative to NSAIDs. Although the actual results of glucosamine and chondroitin sulfate on treating joint pain are still uncertain, these supplements are considered safe and inexpensive.
Orthotics are soft inserts worn in the shoe that are available over-the-counter or custom-made from your doctor. They help stabilize uneven pressure on the knee and also help the lower leg rest properly in the knee joint to prevent uneven wearing down of the cartilage. Orthotics can correct abnormal foot function and protect the feet from further damage.
ConforMIS is a custom-designed knee implant used to treat osteoarthritis. After diagnostic MRIs that determine the individual patient's specific condition, an implant is designed to help reduce pain and restore mobility to the damaged knee joint. These implants are then placed in the knee through a less invasive procedure that only replaces the damaged areas. Many people who undergo total knee replacement surgery only have arthritis in one or two compartments of the knee. The new technology of ConforMIS implants leave unaffected areas alone and focus on correcting your individual problems.
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Total Knee Replacement
The knee is a hinge joint where the thigh bone (femur) and the bone of the lower leg (tibia) meet. Arthritis (particularly osteoarthritis) and certain knee injuries and diseases can damage the cartilage that normally cushions the 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 end of the femur is replaced with a metal shell. Then the end of the tibia is fitted with a plastic cup and a metal stem that fits into the shell on the femur. This reduces friction in the joint, easing pain and allowing a greater range of movement. The main ligament of the knee (the posterior cruciate ligament) may be left in place, removed or replaced with an artificial post. The kneecap may also be replaced with, or supported by, a piece of plastic. The surgery itself lasts between one-and-a-half and three hours.
After the procedure, the patient rests in a recovery room and then in a hospital room. Patients usually experience immediate relief from the joint pain suffered before the replacement. However, there will be some post-operative discomfort. Physical therapy starts right away to speed healing and to ensure that the patient enjoys full use of the joint. Therapy progresses from use of walkers and crutches to walking on stairs and slopes, with home exercises to supplement formal sessions. In addition, continuous passive motion (CPM) machines can reduce recovery time and the risk of muscle contracture without straining the joint.
Knee replacements today last about 20 years in 85-90% of well-selected patients.
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