Knee injuries such as meniscus tears and ACL tears are treated at Newton Wellesley Orthopedic Associates in Newton and Wellesley, MA and sometimes require knee surgery.
Conditions Affecting the Knee
Knee arthritis is a common condition. Many types of arthritis can affect the knee resulting in pain and swelling. Possible treatments include exercise, medication and knee surgeries including knee replacement and arthroscopy.
Anterior Cruciate Ligament (ACL) Injury
Injury to the anterior cruciate ligament (ACL) occurs very commonly in athletes of all levels. The ACL is a stout ligament located in the center of the knee joint, which is one of the key ligaments responsible for stabilizing the knee during lateral and pivoting maneuvers.
An athlete may experience a sudden “pop” during a cutting or twisting maneuver on the field, followed quickly by swelling, pain and stiffness in the knee. Examination of the knee with an ACL injury may demonstrate instability and very often other structures in the knee are injured. X-rays are often normal but MRI examination typically demonstrates the torn ligament.
MRI Images of a Knee with ACL Injury (Normal Knee on the Right for Comparison)
Treatment focuses on getting the acute inflammation and swelling to subside with a combination of rest, ice, anti-inflammatory medications and sometimes physical therapy. In select patients, ACL reconstruction may be necessary if the athlete wishes to return to play at their previous level of competition. The ligament is never repairable and must be reconstructed with a tendon graft, either borrowed from the patient (a hamstring tendon or part of the patellar tendon) or from a cadaveric donor (allograft). Whatever the source of the tendon graft, the standard of care today is arthroscopic ACL reconstruction. Daniel Quinn, MD highlights the details of this procedure in the video below.
The surgery is typically performed as a “day surgery” which does not require an overnight stay in the hospital. Aftercare consists of a regimented rehabilitation protocol emphasizing return of strength and motion in a protected manner.
What is a Torn Meniscus?
A torn meniscus is one of the most common sports injuries of the knee. The meniscus is a C-shaped cartilage structure, and two of them are located in the knee joint. The medial meniscus is more often torn than the lateral meniscus and can also develop degenerative tears in a patient who also has arthritis of the knee. The lateral meniscus can also be torn, but usually from an athletic injury, and can be seen with injuries of other structures such as the anterior cruciate ligament (ACL) or medial collateral ligament (MCL).
Patients who have a meniscus tear often report a prior twisting injury to the knee, often during sports requiring a lot of lateral movement such as basketball, soccer, football, or tennis. The pain is often at the joint line between the femur (thigh bone) and tibia (shin bone). The pain is aggravated by bearing weight on the knee and with knee motion. Clicking and locking may be present. In severe cases, a part of or the entire torn meniscus may be displaced into the wrong side of the joint, causing the knee to be completely locked and immobile (see MRI image below).
X-rays of the knee are usually negative, although they may show arthritis in older patients. MRI may need to be performed in order to confirm the diagnosis, although this is not 100% necessary in order to proceed with treatment since the diagnosis is often obvious with a simple history and physical examination from an experienced orthopedic surgeon.
Treatment of a Torn Meniscus
Treatment of a mild meniscus tear usually begins with rest, ice, elevation and a compression wrap. Over-the-counter anti-inflammatory medications can be useful. If the knee pain fails to improve over time, a cortisone injection may be useful to break the cycle of inflammation or pain, particularly for meniscus tears associated with knee arthritis. Occasionally, partial meniscectomy (cleaning up the frayed or torn part of the meniscus) or, more rarely, meniscus repair can be performed. The choice of operation depends largely on the exact geometry of the tear and where it is located. Tears located in the peripheral “red zone” of the meniscus have a better blood supply and are more likely to heal with a repair whereas tears in the more central “white zone” have little chance of healing and are better treated by removing the small torn portion to alleviate catching, locking, and pain symptoms.
Though surgical treatment of meniscus tears once involved making a large incision and opening the knee joint, the modern standard surgical care for meniscus tears consists of minimally invasive arthroscopic treatment. Pain is less, recovery is faster, and scars are often difficult to see.
In the videos below, the technique of partial meniscectomy and meniscus repair are presented by Daniel Quinn, MD.
Video Demonstration of Arthroscopic Partial Meniscectomy
Video Demonstration of Arthroscopic Meniscus Repair
Patellar tendonitis, also referred to as jumper’s knee, is a condition of the tendon that connects the patella (kneecap) to the shinbone. Physical therapy and medication is helpful in reducing the pain. Surgery is only done rarely for this condition.
Patellofemoral syndrome occurs at the point where the back of the kneecap (patella) meets the thigh bone (femur) resulting in pain or discomfort. Though this condition is sometimes called runner’s knee, the cause of the pain is not clear. Surgery is only done in very bad cases.