OCTOBER 12, 2017
Torn ACL? Don’t Rush to Knee Surgery
The anterior cruciate ligament (ACL) runs through the middle of the knee and toward the front. It keeps the tibia (shin bone) from sliding forward and helps control the back and forth motion of the knee joint. Although knee ligament injuries are considered sprains and can range in severity, the ACL is usually torn or nearly torn whenever it’s injured because it bears so much force.
Athletes in sports like football, soccer, skiing, and basketball are at higher risk for an ACL tear, and females in certain sports are also at higher risk due to a variety of physical as well as training variables. Regardless of the sport or activity, though, these most common ways of causing an ACL tear can put enough pressure on the knee to “pop” the ligament:
Sudden stop or slowing while running (or skiing) forward
Abrupt change of direction
Landing wrong from a jump
Collision directly to the knee
Symptoms of an ACL injury include a popping feeling and instability of the knee at the time of injury, followed quickly by pain and swelling. Tenderness and trouble walking also often happen within 24 hours. Seeing an orthopedic doctor specializing in the knee or sports medicine is important if you have these symptoms. Your doctor will examine you and likely order x-ray images and an MRI scan because it’s very common for other knee joint injuries to accompany an ACL tear.
Surgery is not always necessary for a torn ACL. Low activity patients may opt for bracing and physical therapy to strengthen the other structures of the knee in place of the weakened ACL. However, surgery is the most often recommended solution for those who want to return to sports or higher activity levels. Timing is key for these patients. The doctor may prescribe physical therapy in preparation for surgery because the knee must be allowed to return to a state of minimal swelling and even regain some range of motion BEFORE surgery takes place. Otherwise, range of motion may not return properly at all. Surgery is eventually performed using a tissue graft in place of the torn ACL. More physical therapy is prescribed after surgery. Our doctors have a physical therapy team in our office. They work closely with the therapists to make sure each patient is getting the right treatment every time.
MARCH 27, 2017
“I'm a runner. The outside of my knee hurts, just above the joint. Should I see a doctor?”
Whether the pain is in both legs or one leg, seeing an orthopedic doctor is a good idea. Often we suggest seeing a doctor for chronic or gradual pain when YOU'RE ready, but this type of pain may be caused by an IT Band problem. It needs medical intervention sooner, not later. Iliotibial Band Syndrome (IT Band Syndrome) happens sometimes to runners, bikers, and others in endurance sports. It's also called "Jumper's Knee" after athletes who over-stress their knees with repetitive, explosive movements.
The IT Band runs from the outer hip area, down the outside of the leg, and attaches to the top of the shin bone. It stabilizes the knee by changing positions as the knee bends and straightens. Since the knee is a bony area, there's a fluid-filled sac called a bursa between the IT Band and the knee joint. The repeated change in positions can cause both IT Band AND bursa inflammation when you log a lot of miles, up your mileage suddenly, or intensely jump a lot.
Ignoring the pain caused by IT Band Syndrome can lead to scarring in the protective bursa. Scar tissue isn't as agile as healthy tissue, so decreased knee range of motion and more pain as activity decreases can result. Both of these outcomes are negatively life altering, especially for athletes.
An orthopedic doctor specializing in the leg and knee area and/or sports medicine is the best medical professional to properly diagnose and treat IT Band Syndrome. He or she will take your heath history, examine you, and may get an MRI to confirm your diagnosis. IT Band Syndrome caught before scar tissue develops can be treated without surgery. Often, rest or a change in athletic activities will help. Ice, physical therapy, and injections may be options as well. Surgery is for those who have developed IT Band Syndrome as a chronic condition and who are not helped by other, more conservative measures.
AUGUST 15, 2016
“My knee pain moves around. Will my doctor think I'm crazy?”
Knee pain that moves around all over the place is just your body telling you to adjust your movements a little here, a little there. Hopefully you'll find a place of comfort within a short amount of time. Knee pain that's getting worse all over can be wear and tear from osteoarthritis, or a symptom of repetitive overuse. Knee pain that moves around the FRONT of the knee but can't be exactly pinpointed may be Patellofemoral Pain Syndrome (PFPS). It can be more bothersome than other types of "moving" knee pain because it affects such a large area.
PFPS affects the kneecap (patella), which covers a large portion of the front of the knee. Since the kneecap moves around, so does the pain. Jumping, running, climbing stairs, kneeling, sitting for too long, and many other activities can cause pain and stiffness. There are all sorts of structures that make the kneecap work correctly: two large tendons above and below it, and cartilage, tissue, and a fat pad underneath it. When any of these fail to provide the right motion or cushion, pain starts to develop. Overtraining is one of the most common causes.
Because PFPS can also be caused by misalignment somewhere else in the legs, it's important to see a knowledgable and experienced doctor. During your initial examination, he or she will look at your body alignment and ask about other musculoskeletal problems to see if the underlying problem starts in another joint.
Once diagnosed, treatment for PFPS is often straightforward. An orthopedic doctor specializing in joint problems and/or sports medicine can diagnose knee pain correctly and set up a treatment program customized to your exact situation. If you are an athlete, you may be able to cut back and change your training for a while instead of having to give it up altogether. The doctor can work with a licensed physical therapist to make sure you are strengthening the knee area safely and effectively and not causing further injury. Anti-inflammatory medication, ice, injections, and other conservative treatments may also be helpful if you and your doctor decide they're right for you. Surgery is rare and usually only for those who don't respond to conservative therapies.
PFPS is an active area of orthopedic research. Seeing a doctor who stays up to date on current studies will help you get the smartest treatment.