Knee Injuries

Ligament Injury

The knee is the largest joint in the body. Two ligaments in the front and back, the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL), give the knee its stability. According to the American Academy of Orthopaedicpediatric sports medicine dfw, Pediatric orthopedic surgeon in dallas fort worth, growth plate specialist orthopedics Fort Worth, pediatric sports medicine surgery dfw, pediatric orthopedics dallas fort worth, pediatric orthopedics fort worth, pediatric orthopedic care dfw, fellowship trained pediatric orthopedic surgeon dfw, pediatric sports medicine clinic dfw, Pediatric orthopedic surgeon dfw, growth plates

Surgeons, over 6 million people and other athletes visit orthopedic physicians for knee problems each year. Kids can develop knee problems during sports or rough contact. Gymnasts, dancers and athletes are at risk for knee ligament injury. The AAOS indicates that sports and activities which involve changing directions quickly, jumping, or slowing down while running or going downhill increase the risk to children of straining their ACL. Your child may not experience pain immediately, but a popping noise preceding swelling may indicate an injury to the ACL. A complete tear may require reconstruction. Treatment for your child may include operative and non-operative choices, based on activity levels and type of injury.

The PCL is injured less often than the ACL. However, common injuries to the PCL ligament include a blow to the knee or hyperextension (i.e. missing a step while walking downstairs). In most cases, surgery is not necessary, unless a piece of the shinbone is pulled away with the ligament.

Four Most Common Knee Problems

  • Knee cap pain - the pain usually become most noticeable when walking up stairs, going down stairs, running or sitting.
  • Pain from a torn meniscus - the meniscus is the cartilage that keeps the femur (the thigh bone) and the tibia (the shin bone) from hurting or grinding when they rub against each other. If the meniscus is torn, stretched or out of place, pain may occur when the joint is moved.
  • Pain from ligament problems - there are four ligaments in the knee: the anterior cruciate ligament, the posterior cruciate ligament, the medial collateral ligament, and the lateral collateral ligament. When the ACL is torn, it is often because the leg rotates while the foot stays planted on the ground. Often times an ACL tear is accompanied by a loud popping sound from the knee and the support of the knee gives way. A posterior cruciate injury happens when the knee is forced backwards or when it receives a hard impact. A medial collateral ligament injury most commonly occurs when the knee is hit from the outside while a lateral collateral ligament injury occurs when the knee is impacted from the inside.
    Pain from tendon problems - inflamed tendons that connect the knee cap to the shin bone can cause pain.

Anterior Knee Pain

One of the most common pains in the adolescent or pre-adolescent is anterior knee pain (pain in the front of the knee).  It can be caused by a number of problems, and should be addressed by a pediatric orthopedic surgeon, who can evaluate all of the potential causes, and be able to treat them without delay. Although adolescents can be large or tall, their bones and joints are still immature, and they must be treated with respect to the open growth plates (the areas around the knee that are still made of cartilage).  Many of the causes of pain can be attributed to the adolescent growth spurt, usually occurring between the ages of 9 and 14.  Many of these problems can be treated with modalities aimed at stretching and rebalancing the joints, without the need for surgical intervention.  Many are due to overuse, which can also be treated conservatively with a specialized pediatric sports rehab program, followed by incorporation of the trainer or coach into the return to sport.

Meniscus Tears

Meniscal tears stem from sports-related injuries or even from seemingly innocuous activities such as squatting. Athletes who play football, basketball, and tennis are especially prone to meniscus tears. The type of movement that most often causes meniscal injury is one in which the foot is firmly planted on the ground while the knee is twisted. Shoes with cleats often contribute to this type of injury by anchoring the lower leg into the ground and preventing it from moving with the knee.

Patello-Femoral Joint Syndrome

Patello-femoral joint (the joint between the knee cap and the anterior femur) syndrome is a major cause of anterior knee pain in this age group. It is a “syndrome” because a number of factors are involved with the dysfunction of the joint, including muscle imbalance, weak hip flexors, relatively weak quadriceps muscles, and hamstring tightness.  Subtle congenital deformities must also be recognized in order to correctly treat these conditions, so your child will not get treatment tailored to adults. Popping of the knee can be caused by too much motion in this joint, causing subluxation or hypermobility with significant symptoms that are often misdiagnosed as “growing pains”.  If surgical intervention is needed, it should be done avoid the growth plates, which is different than the treatment in adults.

Traumatic Patellar Dislocations

Traumatic patellar dislocations are common in young athletes, especially females, with the typical mechanism a rotation of the leg or body around a fixed foot (plant-and-twist). The quadriceps muscles, because they are a large muscle group, contract with a significant force, tearing the tissue on the inside of the knee as the kneecap dislocates to the outside.  The torn tissue usually does not tighten on it’s own significantly, and treatment is needed to regain stability to this joint, or repeated dislocations may ensue, even with more minor activity.

Patellofemoral Pain

If your child complains of pain at the front of the knee during vigorous activity, he or she may be experiencing patellofemoral pain. According to the American Orthopaedic Society for Sports Medicine, the kneecap can come out of alignment under the stress of a connecting tendon. When this happens, the soft tissue around the knee may inflame or the cartilage can wear abnormally, causing discomfort. Your child's orthopedist may recommend stretches and exercises for the knee, rest and medication, or a brace. In extreme cases, the knee must be surgically realigned.

Osteochondral Grafting

The latest advance for joint injury treatment involves restoring lost or damaged cartilage by replacing it with tissue. Osteochondral grafting is one such technique and is primarily used in knee injuries. The development of osteochondral grafting is encouraging news because it paves the way for a quicker, smoother, more successful return to full activity for those suffering torn ACL ligaments or related injuries to the ankle, hip and knee.

Articular cartilage acts as a coating of tissue on the end of bones, enabling the joints to move easily and smoothly. When articular cartilage is damaged or injured, its fragile nature does not allow it to heal quickly, and bones may begin to scrape against each other, causing pain and/or limited movement.

Osteochondral grafting involves transporting normal, healthy bone and cartilage to the site of injury. The harvested material can either be the patient’s own (autograft) or it may come from an outside source (allograft). Allograft procedures are typically used for more sizeable injuries and must be able to “match” the tissue of the patient who is receiving the transplant. Minimally invasive techniques are now being used for osteochondral grafting, which can reduce the size of incisions and the recovery time involved.

Knee Arthroscopy

During arthroscopy, your surgeon gently inserts a small tube called an arthroscope into your knee. A camera attached to this tube shows the inside of your knee on a TV screen. This helps your surgeon view problems with the knee. In many cases, repairs to the knee may also be done using the arthroscope. Surgknee arthroscopy indiana, knee surgery indiana, knee injury indiana, acl reconstruction indiana, acl tear indiana, knee pain indiana, knee surgery indiana, knee replacement indiana, knee brace indiana, knee care indianaery done through an arthroscope may heal faster and have less scarring than open surgery.

How quickly you heal after arthroscopy depends in part on your age, the kind of knee injury you have, and how well your knee responds to treatment. It also depends on how well you care for your knee and follow your health care provider's instructions.

Together, you and your health care team will set goals for your recovery. These goals can be tailored to your needs. Short-term goals may include walking without crutches or getting back to work. A long-term goal will likely be to regain full use of your knee.

Your surgeon may prescribe physical therapy. This can help relieve pain, increase range of motion, and improve strength. Your physical therapist will design a program for you based on your knee problem and recovery goals.

Your physical therapist can help you set goals and work toward them. But a successful recovery depends on you. Follow instructions and keep your appointments.

ACL Reconstruction

acl reconstruction indiana, acl tear indiana, knee pain indiana, knee surgery indiana, knee replacement indiana, knee brace indiana, knee care indianaTreatment for an ACL tear varies depending upon the patient’s individual needs. A torn ACL will not heal without surgery. But non-surgical treatment may be effective for patients who are elderly or have a very low activity level. If the overall stability of the knee is intact, your SBO surgeon may recommend simple, non-surgical options.

Bracing. Your doctor may recommend a brace to protect your knee from instability. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.

Physical therapy. As the swelling goes down, a careful rehabilitation program is started. Specific exercises prepared by our rehabilitation therapy dept. will restore function to your knee and strengthen the leg muscles that support it.

Rebuilding the ligament. Most ACL tears cannot be sutured (stitched) back together. To surgically repair the ACL and restore knee stability, the ligament must be reconstructed. Your SBO orthopaedic surgeon will replace the torn ligament with a tissue graft. This graft acts as a scaffolding for a new ligament to grow on.

Surgical treatment is most frequently recommended for individuals with ACL tears accompanied with other injuries. The most likely candidates for surgical treatment are active individuals in sports or jobs with heavy manual work that requires pivoting or pushing off with the knee. Surgery is also recommended for people with unstable knees or injuries combined with damage to the menisci, articular cartilage, joint capsule, or ligaments.

Surgery to rebuild an anterior cruciate ligament is done with an arthroscope using small incisions. Arthroscopic surgery is a less invasive technique, with the benefits of less pain from surgery, less time spent in the hospital, and quicker recovery times.

Torn ACL Surgery

The Anterior Cruciate Ligament (ACL) works a lot like a guy wire that keeps the femur and the tibia stable. When an athlete tears their ACL, usually it is from a sudden impact that can cause an audible pop oracl reconstruction indiana, acl tear indiana, knee pain indiana, knee surgery indiana, knee replacement indiana, knee brace indiana, knee care indiana at least a great deal of pain.

Generally speaking, a partially torn ACL stands a chance of recovery without surgery. If the ACL is completely torn, most will need surgery to repair the ligament. Many of those with a torn ACL will need surgery to get back to activity. The procedure itself takes about one hour.
Torn ACLs are one of the most common problems associated with sports. It is important to understand your options if you have a torn ACL.

If you have a completely torn ACL, you will likely need surgery to repair this ligament. If you have a partially torn ACL, depending on the extent of the tear, some people are able to rehabilitate the knee with extensive therapy AND COMMITMENT TO EXERCISE to the point that they have use of the knee again. But you may not have the same strength in the knee joint that you had prior to your knee injury.

Generally speaking, the more you expect to play aggressive sports in the future, the more likely you will need knee surgery to repair a fully torn or partially torn ACL. If you are professional athlete, chances are you will need surgery to get back to full activity.

If you have a torn ACL, the good news is that the problem is fairly common as knee injuries go, and in the hands of a surgeon who specializes in knees, the post surgical knee can be as effective as the knee prior to injury. But most of that depends on the willingness of the athlete to invest the time to rehabilitate and strengthen the knee.

Use of the patellar tendon or hamstring to repair a torn ACL

You should be aware that repairing the torn ACL does NOT involve sewing two torn ends together. Think of your ACL as a rubber band. Once it snaps, it can not be sewn together. Instead, you have to replace the rubber band completely. And that is exactly what the knee surgeon does. They attach a new rubber band to your shin, thread it through your knee and anchor it your femur.

acl reconstruction indiana, acl tear indiana, knee pain indiana, knee surgery indiana, knee replacement indiana, knee brace indiana, knee care indianaYou should ask your physician HOW they repair the ACL. Some knee surgeons use a patellar tendon while many others use a hamstring ligament. There are pros and cons to each.

Harvesting a patellar tendon from the front of the knee makes for a more painful recovery and painful rehabilitation. However, professional athletes who are used to pain from training are more able to tolerate this approach, especially considering that the patellar tendon is viewed by some surgeons to be a higher performance replacement for the torn ligament than the hamstring. Using a hamstring ligament is less painful on rehab of the knee, and some surgeons feel that for most people, the strength of the ligament is sufficient.

Overall, most surgeons would agree that the performance of the knee after ACL replacement is directly linked to how much commitment is given to strengthening the knee with exercises. With the right knee specialist, and with specialized knee rehab, a professional athlete can regain their competitive form and play professional sports again.

Using an arthroscope, the knee surgeon can repair the knee through two tiny half-inch incisions instead of a longer incision which requires a longer recovery and causes a bigger scar. The surgeon will remove a strand from the patellar tendon or hamstring, which will ultimately become the new ACL. A hole is then drilled through the shin bone and a new ACL is threaded through. The new ligament is prepared and secured into place. A plastic dowel locks the new ACL into place. About 30 minutes later, the anesthesia will wear off and the patient is dismissed from the hospital.

During the recovery process, a patient will start off by walking around. A few months later golf is acceptable. After five or six months, the patient is usually allowed to play sports without restriction.


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Whether your treatment involves surgery or not, physical therapy plays a vital role in getting you back to your daily activities and will help you regain knee strength and motion.

If you have surgery, physical therapy first focuses on returning motion to the joint and surrounding muscles, and is followed by a strengthening program designed to protect the new ligament. This strengthening process gradually increases the stress across the ligament. The final phase of rehabilitation is aimed at a functional return to the patient’s lifestyle activity level.

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