The posterior cruciate ligament (PCL) is one of two ligaments that criss-cross inside the knee joint to hold the two leg bones (femur and tibia) together. The second (more commonly injured) ligament is the anterior cruciate ligament (ACL). These two ligaments provide stability to the knee joint while still allowing motion.There is interest in knowing if non-surgical treatment has a higher rate of osteoarthritis later in life. A second question is whether surgery to reconstruct the PCL yields bet...

It is estimated that one-quarter of a million ACL injuries occur each year in the United States. As you know, players can be sidelined for months (sometimes longer). This is a concern to many people at all levels from high school to professional sports.Preventing ACL injuries not only protects people from pain and suffering, it can also protect the pocketbook for the individual and for society. The fact is that many of these injuries are accompanied by damage to the surrounding tissues as well. ...

Is it possible to rehab a PCL injury and still remain active? I like to golf, play tennis, and even pickup a game of basketball now and then. The posterior cruciate ligament (PCL) is one of two ligaments that criss-cross inside the knee joint to hold the two leg bones (femur and tibia) together. The second (more commonly injured) ligament is the anterior cruciate ligament (ACL). These two ligaments provide stability to the knee joint while still allowing motion.Results of nonoperative treatment...

Can you please explain to me the main reasons why people who have ACL reconstruction surgery end up rupturing the new ligament and having to start all over again? Up to 10 per cent of all patients who have a primary (first) reconstruction of the anterior cruciate ligament (ACL) will experience a failed result. This could mean the graft failed/re-ruptured or it could mean the knee joint remained unstable after the reconstructive surgery.Experts from the Mayo Clinic in Rochester, Minnesota sugges...

What kind of rehab program should I expect to follow after reconstruction surgery for a chronically dislocating kneecap? I'm prepared for just about anything but thought I'd ask around a bit to see what the standard programs might be. Your postoperative rehabilitation program will be highly dependent on the surgical technique used to reconstruct the soft tissue structures. The patella or kneecap is a very complex structure. Anatomists are still exploring and learning how the patellar tracking me...

We allowed my aging father to have a knee replacement. He's diabetic and overweight so we weren't sure this was such a good idea. Then he got an infection in the joint and the new knee implant had to be removed. Afterwards, we were told that men do have a higher rate of infection after knee replacements . We also found out that diabetics have more problems like this. What's your take on all this? Researchers at the very large and very well-known Kaiser Permanente health care system in California...

I've been told that I might get some benefit from "shock therapy" to my knee for a bad case of "Jumper's Knee." Is this really a safe method of treatment? Running and jumping over and over often leads to a condition in athletes known as or jumper's knee (also known as patellar tendinosis. Pain along the front of the knee during the activity that goes away with rest is a cardinal symptom of this condition. Dancers, gymnasts, and basketball, soccer, and volleyball players are affected most often....

Do you think exercising in a pool for my knee arthritis is really worth all the mess and fuss of getting wet, having to shower, and redo my hair and makeup? It seems easier to just walk on the treadmill but my knees do hurt afterwards. Many studies show the benefit of exercise for people with knee osteoarthritis. But pounding the pavement (or treadmill) can increase pain as you have noticed. Aquatic therapy in a pool of warm, supportive water is one way to get the needed exercise without the add...

The health club I go to has several different pools to choose from. I like going in the water because it makes my arthritic knees feel better. They have a pool with a treadmill in it that I could use. Is that easier or harder than walking on the bottom of the pool? Good for you to include regular exercise in your week! There are many studies that have shown the value of exercise for people with knee osteoarthritis. Pounding the pavement (walking outside the pool) can increase pain. Aquatic ther...

My doctor told me after my total knee replacement, I won't need any special therapy or rehab. My sister who lives in a different state told me she had a special exercise program they called "functional." She says the reason she is doing so well is because they pushed her not to be afraid to move. Do I need that program too? Each surgeon has his or her own post-operative "protocol" (way of doing things) after a total knee replacement. Physiotherapy is an important part of the immediate post-opera...

I'm young and healthy but I have a bad knee. Dinged it up playing handball. Got a big hole in the cartilage that goes down to the bone. Too young for a knee replacement. Looking into these new treatments with Matrix cartilage transplantation. What does this do? How does it work? Does it work? What can you tell me? When you say "matrix cartilage" treatment, we assume you are referring to matrix-assisted autologous chondrocyte transplantation (MACT). There are three goals in mind when using this p...

I was just informed that my retorn meniscus is not all that uncommon. Yet I thought having the surgery to repair it would protect my knee and prevent early arthritis. It never crossed my mind that it might break again. Is this common? Unfortunately, yes -- meniscal tears are common and reinjury is common. In fact, there is evidence of a 24 per cent failure rate for meniscal repairs five years after the operation. This figure is based on a systematic literature review and meta-analysis conducted ...

I am the head athletic trainer at a large university. We've started keeping some statistics that show our women are more likely to tear their ACLs and a large percentage of both men and women don't come back -- even after going through the whole rehab program. What do your experts have to say about why this may be? Well, of course, most studies focus on only one sport at a time and don't usually compare athletes across the disciplines. So you may be on to something with your record keeping. Pas...

I have a feeling that our 17-year-old son is going to miss out on his senior year of high school football because he's afraid he'll reinjure the torn ACL he spent all summer rehabbing. We can't tell if we should push him back onto the field or just let it drop. His surgeon and physiotherapist say he's ready to go back if he wants to. Fear of reinjury is a natural reaction after an anterior cruciate ligament (ACL) injury in many high school and college athletes. In fact, a recent survey of over 1...

To brace or not to brace: that is the ACL question. I'm going to have surgery tomorrow(!) to reconstruct my ACL. I've been told by one person that I'll be wearing a brace after surgery to protect the knee. But then I heard someone else say bracing isn't necessary and just adds to the cost. Which is it, really? It has been known for many years now that bracing after surgery to reconstruct a ruptured anterior cruciate ligament (ACL) just isn't needed. Study after study have shown there isn't any b...

I heard a report that injuring the ACL of the nondominant leg puts athletes at increased risk of future injuries. Is that true? and what's the explanation for it? There haven't been a lot of studies comparing long-term results following ACL injuries and in particular, what happens to the other leg. Comparing results of dominant versus non-dominant leg is another added dimension. And there are many other factors and variables to consider (e.g., age, gender, sport, type of treatment) that can make...

I had ACL surgery two weeks ago. The physiotherapist was there right after the operation getting me up and going. The next day, she set me up on a home program and I go see her 3 times a week. It seems like a lot of work. Is this kind of rehab really necessary? Won't the knee just heal and get better on its own? There are many different ways to approach the rehabilitation of ACL injuries. Sometimes it is possible to complete a conservative plan of exercise without surgery. This approach is most ...

I am really depressed over the poor results of my knee surgery. I have a condition called osteochondritis dissecans (OCD). Before throwing in the towel, I thought I would check with you and see what you recommend as a next step. As you know, osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur). A joint surface damaged by OCD doesn't heal naturally. Even with surgery, OCD can lead to future joint problems, including degener...

I'm 21 years old. I've been active all my life. Lately I've been noticing that my left knee cap slides off to the side and then pops back. I never know when it's going to happen. I did fall while hiking last summer. Could this be the cause of the problem? It is possible that you have injured some of the soft tissues around the patella (knee cap). A little bit of anatomy will help explain this injury. The patella moves up and down in front of the knee joint along a built-in track called the pate...

It seems like knee medial meniscal tears has become an epidemic in my family. Most of my relatives are pretty overweight so it doesn't really surprise me that this happened. But just to be on the safe side, what can I do to avoid this problem? Older age (50 or older) and being overweight are two key risk factors for medial meniscal tears. Other potential risk factors studied have included patient age, sex, findings on X-rays, activity level, occupation, and a history of previous injuries.Resear...

I started practicing yoga about six months ago to help with a shoulder problem. The shoulder got better but I noticed my knee started acting up. Could the yoga positions caused this. Any idea? Activities associated with an positions such as squatting and the Lotus position have been considered potential risk factors for medial meniscal tears of the knee. As you now know, in assuming the Lotus position, the feet are placed on the opposing thighs. It is a posture commonly used for meditation in th...

How Well Does Arthroscopic Surgery Work for Knee Osteoarthritis? Degenerative knee osteoarthritis (OA) can be treated with physiotherapy, medications, or surgery when appropriate. The focus of this study was the effectiveness of arthroscopic surgery for knee OA. The specific procedure studied is called debridement.The surgeon shaves away any uneven areas of the joint surface and smoothes any jagged edges in the cartilage. If there are any loose fragments in the joint, these are removed as well. ...

I am an assistant coach of a women's basketball team at a small college. In the past, I've worked with both male and female athletes. I've noticed something I wonder about. When an athlete injures his or her ACL and has surgery, they don't all get back on the court in the same time frame. Some don't ever make it back. Is this a matter of personality, competitive edge, type of surgery, or something else? You have asked a good question that has been addressed by some experts looking for answer to ...

I'm four-weeks post-op following ACL surgery for a ruptured knee. I think I'm coming along but I'm wondering about how much motion I need to get back. My knees were always a little lax before surgery and now the ACL side is close to zero extension. But my other knee can straighten even more past zero. Am I going for zero or more? I don't want to be back in the situation where the knee is so loose, it's unstable and likely to blow out again. This is a very good question and one that physiotherapi...

I had ACL surgery last week and I'm now at the physiotherapist's clinic starting my rehab. They are very, very pushy about getting my full motion back like right now. I'm doing my best and feel like I want to tell them to back off! Is this something I should talk to the surgeon about and maybe have him say something? It is agreed and well understood by surgeons and therapists that following surgery to repair or reconstruct a torn or ruptured anterior cruciate ligament (ACL), it is vitally import...

I injured my ACL in a stupid accident while shooting baskets in the neighborhood. Now I'm benched for the season in my senior year of college. The surgeon who treated me mentioned the risk of arthritis later and also suggested I see a physiotherapist now to help regain strength and proper alignment. How important is this really? I'm pretty depressed and discouraged and don't give a rip. I'm not sure I have it in me to do a rehab program if I can't play. Your attitude is completely understandable...

X-rays taken today showed some damage to our son's knee diagnosed as juvenile osteochondritis dissecans. Our first stop was to your website to see what we can find out about this problem. The forceful and repeated actions of sports can strain the immature surface of the knee joint in children and teens. The bone under the joint surface weakens and becomes injured, which damages the blood vessels going to the bone. Without blood flow, the small section of bone dies. The injured bone cracks. It ma...

I am a high school athlete working on something called a "senior project." We are supposed to take a topic of interest to us and explore or investigate it thoroughly. I have picked the subject of ACL injuries in athletes because it happened to me and to several of my teammates. I'm glad I found your website to help me. Can you give me a quick overview of what causes ACL injuries to help me get organized? As you have found out the hard way, anterior cruciate ligament (ACL) injuries are more commo...

I lost my job two days before a scheduled total knee replacement. I decided to go ahead with the surgery anyway. I was forced by the lack of health insurance to get up and get going right away. I'm here to report to everyone else what a difference that made! My physiotherapist said I regained more knee motion faster than anyone else she has ever had. Likewise for pain relief: I set my mind to get up and get going. I did and it worked. Please pass this on to your readers. Thanks. Your experience ...

Help me out here. My 82-year-old mother just had a knee replacement. The physiotherapist came in (he looks all of 12-years-old) and is insisting she move that leg and get up out of bed. She is in terrible pain and wasn't all that spry before surgery. Should I say something or just stay out of it? I don't know what to do! Studies show that fewer days in the hospital after a total knee replacement usually means lower costs. And one way to accomplish that is to begin physiotherapy within the first ...

Is it true that people who have a patellar graft for a destroyed ACL will get worse arthritis than if we had gotten the hamstring graft? I know it's too late now that I went the patellar graft route, but I still wonder (especially on days the knee feels arthritic). Long-term studies do show that a knee with an anterior cruciate ligament (ACL) repair or reconstruction is at risk for early arthritis. In fact, studies show patients with an ACL rupture (rupture means torn completely through) eventua...

I am going to have a meniscus transplantation in two days. The surgeon briefly went over what to expect afterwards. Can you give me a few more specifics about the rehab part? What will I do? How long will it take? What should I be careful about? Meniscal transplantation is increasing in popularity and use. It is especially helpful for the person who has had to have the native meniscus removed due to severe damage. Without the protective, load bearing and distribution benefits of the mensicus, th...

Have you ever heard of someone having a knee dislocate out from underneath them? I saw it happen at a party last night. The guy was plenty overweight but still -- can that happen to just anyone? Complete knee dislocations occur most often in athletes or as a result of a traumatic injury (e.g., car or bike accident, fall). But for some people, knee dislocation can occur during daily activities. Knee dislocations have been reported when stepping off a curb, going down a stair, walking, or even whi...

What is the treatment for a knee dislocation in someone too large to have surgery? That's the case with my brother-in-law who is 400 pounds overweight and just recently had his knee collapse underneath him. When a knee dislocates, there is usually ligamentous damage and there may be nerve and blood vessel injuries as well. Multiple ligaments can be ruptured including the anterior cruciate ligament, posterior cruciate ligament, and the medial and lateral collateral ligaments.In some cases, the di...

I have an ACL tear that we are going to try and rehab and avoid surgery. I'm scheduled to see a physical therapist for "strength training and perturbation activities." I get the strength part. What's perturbation? Perturbation activities is another way of saying balance training but specifically activities that challenge your balance (not just build up your ability to balance). For example, you may be given ways to practice standing or walking on unstable or uneven surfaces. Once you can do that...

Have you ever heard of someone with an ACL injury being called a "noncoper"? That's what I was referred to as today and it sounds like criticism to me. Is that what it means really? We can see how a person might get this mistaken view of the term, so we're glad you asked and happy to set the record straight. Twenty-five years ago, it was decided to create something now known as the rule of thirds describing ACL patients. The break down is as follows:One-third of all patients with ACL injuries w...

What do you think about injections or iotophoresis for chronic patellar tendinopathy? I'm checking out every possible treatment option that doesn't involve surgery. Alignment or overuse problems of the knee structures is a common problem among athletes. Strain, irritation, and/or injury of the patellar tendon often produce pain, weakness, and swelling of the knee joint.In the acute form of this problem, patellar tendonitis (also known as jumper's knee) develops. When the condition goes on for mo...

I'm an orthopedic surgical nurse. I notice a lot of guys of all ages coming in these days for ACL repairs. Are men more likely to have these injuries or just more willing to have surgery? I know women are participating in sports and susceptible to ACL tears. I just don't see them in our operating room.

I'm having trouble deciding about whether to have knee surgery. I'm only 18 but I have an ACL tear. So I have two options: surgery right away before anything gets worse or rehab and wait to see if surgery is really needed. If it is necessary to have surgery, I can do it later but at a risk of reinjury in the meantime. What should I do? You have a very clear understanding of the typical options offered young athletes with an anterior cruciate ligament (ACL) injury. There are pros and cons to both...

Is it possible to have a whiplash injury to the knee? I heard that term somewhere. What would that be? You may be referring to a mechanism called contrecoup. It's a bit like a neck whiplash injury where the head is thrown forward, then backward, then forward again. The force of the accident is enough to accelerate the head in one direction. Then there is a rebound or movement in the opposite direction as the head whips back. The head movement decelerates (slows down) as the head comes back to a ...

I saw a report on a health show that showed how many people who have an ACL tear also have bone bruising. Why is that such a big deal and how do I know if I had it? Bone contusion or bruising may be an indication of the severity of the injury. It can be viewed on MRI as edema or swelling inside the bone where the bone marrow is located.Bone contusion has long been suspected as part of knee injuries severe enough to rupture the anterior cruciate ligament (ACL). And recently, a study from South K...

I've been following the research on exercise and patellofemoral pain syndrome. I see they are now saying I need to strengthen the muscles around my hip, not just the knee. Can I do these at the same time or do I need to complete one set of exercises before I start another? We've known for a long time that a weak, impaired, or imbalanced quadriceps muscle is a risk factor for patellofemoral pain syndrome (PFPS). But recent studies have shown what you have found out -- that weak hip muscles (exter...

I have knee pain from patellofemoral pain syndrome (PFPS). I'm seeing a physiotherapist who has tested me and put me on an exercise program. One of the tests was to step down from a stair and back up as many times as possible in 30 seconds. I could only do it 10 times. What's normal? The step-down test is used to test the knee in anyone with a healthy knee or with knee pain to determine level of function. It mimics stepping down stairs, which is often very painful for someone with patellofemoral...

Our 16-year-old daughter was just diagnosed with patellofemoral pain syndrome. What can you tell us about this? Was she born with it? Or is she doing something wrong in her exercise routines that have brought this on? Athletes aren't the only ones to develop knee pain from a condition called patellofemoral pain syndrome (PFPS). Many people of all ages in the general public develop this problem, too. It sounds like your daughter has joined in as well!The patella, or kneecap, can be a source of kn...

Years ago, I had an odd type of meniscal tear. It was the back outside corner of the meniscus in my left knee. I also blew out my ACL in the same knee at the same time. It's been 10-years and that knee is a little bit stiff. Did I make a mistake by not having the surgeon repair the torn area? This type of meniscal tear occurs most often when traumatic force is generated that is strong enough to rupture the anterior cruciate ligament (ACL) inside the knee. Along with the ACL tear, a posterior la...

I had a meniscus that was repaired arthroscopically five years ago. I'm just checking to see how long they think this repair job will last me. Different studies report success rates that vary from 70 to 90 per cent. How do they tell whether the meniscus is holding up or not? There are three ways to measure long-term success or results from meniscal repairs. First is the patient's own report. Is the knee stiff or painful? Can you move the knee joint through its full motions?Are there any activiti...

After tearing my ACL during an off-road motorcycling event, I decided to start wearing a brace on that knee. Which one do you recommend? When it comes to wearing braces prophylactically (as a preventive measure) during sports activities, things have changed quite a bit over the years. Sports enthusiasts in this area have gone from wondering if it's really worth it to wear a brace to prevent knee injuries to recommending them routinely.As a result, manufacturers have come out with many off-the-sh...

When I was 16, I tore the medial meniscus in my right knee and had it surgically removed. I've had knee problems ever since. Now my 17-year-old son has done the same thing. Will he be doomed to arthritis like his old man? Not necessarily though all the data from long-term studies isn't in yet. What we do know is that meniscal repair (rather than removal) is done whenever possible. The important role of the meniscus in sharing the joint load and as a shock absorber and knee stabilizer has been we...

I tweaked my MCL playing soccer twice so I went to see a Doctor and was told it would heal on its own and to give it some time. Is really the best advice. Should I wear a brace? Will I need surgery? The MCL or medial collateral ligament is located in the knee on the side closest to the other knee. It helps stabilize the knee joint and prevent injury when force is directed through that side of the knee. An isolated injury to this ligament could very well heal with rest and activity modification.N...

How does the strap work that athletes wear around their knees? I'm not an athlete but my knees hurt and I'm wondering if something like this would help me.

I tore my left ACL during a downhill snowboard accident. I've heard that once the ACL has been injured, there's always an increased risk it could happen again. Is there any way to keep this from happening? Reinjury after an anterior cruciate ligament (ACL) injury is always a niggling concern in the back of the mind of most people. This is especially true for athletes who are putting the knee to the test with their activities.The actual incidence of reinjury varies depending on age, level and typ...

What's the best way to treat housemaid's knee? I'm afraid I have a bad case of it from playing with my grandchildren on the floor. Housemaid's knee is a term sometimes still used to describe bursitis. Bursitis is the inflammation of a bursa. A bursa is a sac made of thin, slippery tissue. Bursae (plural) occur in the body wherever skin, muscles, or tendons need to slide over bone.Bursae are lubricated with a small amount of fluid inside that helps reduce friction from the sliding parts. They can...

What can you tell me about having an osteotomy for half-knee arthritis? Will it do any good? Can I really get some new cartilage to grow on the damaged half with this operation? Knee arthritis affecting only one side of the joint is a common problem. It occurs as a result of uneven load and weight-bearing on the joint. This type of unicompartmental arthritis is the result of malalignment somewhere in the leg.Treatment choices depend on the age of the patient, activity level, intensity of the pai...

How is it possible to strengthen muscles to take the place of a torn ligament? I went through a three month rehab program for a torn MCL that worked like a charm. But I still don't get how a muscle can do the job of a ligament. That's a good question and one that we have more answers for now that advanced imaging technology has helped us understand the basic anatomy of ligaments and other soft tissues.People with an isolated medial collateral ligament (MCL) injury have the best chance of recover...

I am a soccer player who plays rugby as a "weekend warrior." I don't want to trash my knees playing rugby because soccer is really my first choice of activities. Is there any benefit to wearing one of those hinge-braces? Preventive or prophylactic bracing is becoming more popular now that there is some evidence that it can reduce the risk of knee injuries. This is especially true for protecting the medial structures of the knee. Medial refers to the side of the knee closest to the other leg.It's...

I fell down the stairs and tore my left ACL. Since I didn't go in right away for surgery, I ended up with an unusual tear of my meniscus called a "ramp" tear. How often do these happen and why did I get one? A ramp lesion involves the medial meniscus, a C-shaped piece of thick cartilage inside the knee. There are two of these protective liners: medial (side closest to the other knee) and lateral (side away from the other knee).A ramp lesion occurs when one particular edge of the medial meniscus ...

I have dislocated my kneecap twice now. Each time it has popped right back in so I haven't had any surgery -- just a brace and therapy. Based on what you know for other people with this problem, what happens now? It sounds like you may be wondering about the natural history of recurrent patellar dislocations. Natural history refers to what happens after an injury in the long-term. For example, will it heal on its own? If not, what should be done to help the healing process?Based on the evidence ...

Our daughter dislocated her knee cap for the first time during slow pitch. She wants to get right back in the game. The orthopedic surgeon is saying six weeks of a brace or splint first. How is this kind of injury handled by other doctors? Despite how often this type of injury occurs in young athletes, there isn't a great deal of evidence to direct treatment. Surgeons use an algorithm (step-by-step approach) to the management of first-time patellar (knee cap) dislocations. This algorithm has bee...

I have knee osteoarthritis. I'd like to do whatever I can that doesn't involve drugs or surgery for as long as possible. What do you suggest? Today physicians understand and try to teach their patients that osteoarthritis is more than just a disease of wear and tear. The entire joint complex is involved. Treatment should be a program of self-management directed by a team of health care professionals.Patient education and nonpharmacologic treatment are the first steps. The goal is to preserve and...

What is a medial patellofemoral ligament injury? And how is it treated? A little bit of anatomy will help explain this injury. Let's start with the patella -- more commonly known as the "kneecap". The patella moves up and down in front of the knee joint along a built-in track called the patellofemoral groove.The kneecap is held in place by several ligaments on either side and by the patellar tendon (attached to the quadriceps muscle). The quadriceps muscle is the large, four-part muscle along th...

I keep dislocating my left kneecap. I've tried exercise, taping, yoga, and kinesiotherapy but nothing keeps it from popping out. What's next? You may be a good candidate for surgery but it's best to see an orthopedic surgeon for an evaluation before going down that road. A review of your history, injury, time since the injury, conservative efforts tried, and length of time carrying out conservative care are all important factors in the success (or failure) of nonoperative care.Studies show that ...

I might need an ACL repair job. The tipping point in deciding is whether or not I want to continue playing sports hard. I'm just a recreational athlete, so it's not like I'm losing millions of dollars by not playing. Can you offer me any information that might help me? There might be several things you will want to consider in making this decision. Does your surgeon think conservative care with a rehab program is enough to get you by if you aren't playing hard?Less active adults (usually older) ...

What is a sleeve fracture of the knee? You are probably not familiar with the term sleeve fracture of the patella (kneecap) because this is a very rare injury. Of all the bone breaks children have, the kneecap is only involved in about one per cent of the cases. And sleeve fractures make up about half of those patellar injuries.What's a sleeve fracture? A little anatomy will help explain what happens. The patella or kneecap sits in front of the knee joint. It isn't attached by a piece of bone o...

I had my ACL repaired two years ago and just reinjured it again. My surgeon wants me to try physiotherapy for a few months. If that doesn't work, I can have surgery again. Can they repair this a second time? Revision surgery for failed anterior cruciate ligament (ACL) rupture is uncommon but sometimes a necessary procedure. The surgeon confirms there is ACL deficiency with clinical testing and (if necessary) arthroscopic examination.Physiotherapy can be helpful to correct any postural issues rel...

I tore my anterior cruciate ligament doing something as simple as gardening. The doctor thought it was probably ready to go and almost anything could have caused the rupture. I'm older so I've put off having surgery to repair it. Is that a mistake -- does it even matter exactly when the surgery is done? Older age can make a difference in outcomes after anterior cruciate ligament (ACL) repair or reconstruction. Graft rupture, increased stiffness, and decreased activity level are reported more of...

I'm looking at having surgery done to repair (or possibly remove) the meniscus in my right knee. They think only the inside edge is damaged but we'll find out after they take a look. What kind of therapy program will I be expected to follow (if any) after surgery? Your post-operative rehab program may depend on several things. First, the extent of surgery is a deciding factor. Repairing the meniscus is different from removing it. Second, each surgeon has his or her own preferences and protocols....

I'm getting the impression that when you have a torn knee meniscus, it's always better to have it repaired, rather than removed. What are the success rates with meniscal repair versus removal? Over the years, it has been discovered that removing the meniscus entirely is not a good idea. Too many people developed early osteoarthritis after a meniscectomy. So, the standard procedure has gradually changed from complete removal to repair of the torn meniscus whenever possible. And when it has to be ...

My knee has a hole in the cartilage. I gather there are all kinds of ways to treat the problem. I can either have it repaired or they can replace the cartilage. What works best? Damage to the articular layer of cartilage that lines the joint can cause pain, swelling, and eventually degenerate into arthritis. It doesn't have the ability to heal itself when damaged so that's why treatent is important. Surgical treatment of holes in the articular cartilage of the knee has taken a decided turn in th...

I have a torn meniscus in my knee confirmed by MRI. Can I avoid surgery and just do some kind of knee exercises until it heals on its own? There's a lot of confusion right now about the best treatment for tears of the knee meniscus. For sure, we know that removing this C-shaped cartilage in the knee is a bad idea. That just leads to degeneration of the joint and painful arthritis. Repairing the damage and letting the body heal has proven to be a much better alternative.But even with a partial me...

I was with my elderly aunt when she tore her knee meniscus. She was just crossing the street with me and pop goes the weasel! The doctor says these things can happen just like that but there must be a reason. Do you know what is really going on? It might help you understand what is happening if we review the anatomy of the meniscus (menisci for more than one). In each knee, the menisci sit between the femur (upper leg bone) and the tibia (lower leg bone). These structures are sometimes referred ...

I'm the only one in a family of eight children who has a knee problem called patellofemoral pain syndrome. We are all involved in sports of some kind. What am I doing wrong that I have this problem but no one else in the family does? Patellofemoral Syndrome (PFS) is a condition that causes pain in and around the patella (knee cap). In the normal, healthy adult, the patella moves smoothly up and down over a groove on the femur (thigh bone) as the knee bends and straightens. PFS can develop when t...

If I lost weight, would it have any effect on my knee pain? I've been told I have something called patellofemoral pain syndrome. I'm 16 years old and probably 65 pounds over weight. Patellofemoral Syndrome (PFS) is a condition that causes pain in and around the patella (knee cap). In the normal, healthy adult, the patella moves smoothly up and down over a groove on the femur (thigh bone) as the knee bends and straightens. PFS can develop when the patella is not moving or tracking properly over t...

I injured my knee. The MRI showed damage to the posterolateral corner. What can I expect if I don't have the surgery recommended by the doctor? The posterolateral corner (PLC) of the knee designates a group of ligaments and muscles along the back and outside edge of the knee joint. These include the lateral head of the gastrocnemius (calf) muscle, the popliteus (muscle), and three specific ligaments.Damage to this corner of the joint is rare but can occur with traumatic injury from a sports-rela...

I was in a car accident and ended up with an uncommon knee injury called a posterolateral corner. I like to play competitive sports. Will I be able to get back to these activities once this heals up? The PLC is in the knee where two ligaments and one tendon meet. Posterior refers to the back side of the knee joint. Lateral tells us the affected area is to the side. So we are talking about the posterolateral (side of the knee toward the back) area where the lateral collateral ligament, popliteofi...

I've been told that with the new minimally invasive knee replacements, there's less blood loss, a lower risk of infection, and faster discharge from the hospital. Is that true? Anyone thinking about having a knee replacement may be wondering whether to stick with the standard surgical procedure or go for the minimally invasive technique. That may surprise you since it would make sense that a smaller incision would be better.With a minimally invasive approach, there's less disruption of the surro...

Can you give me a summary of what's happening with cartilage repair for knees these days? I have what's considered a full-thickness defect in the joint cartilage of my right knee.

I had a procedure called a mosaicplasty to plug a hole in my knee cartilage. I'm not sure it really worked. It's been six months and I still have pain and swelling in that knee -- enough to interfere with my ability to walk, run, and hike. The surgeon who did the procedure has suggested an arthroscopic exam for what she calls a second look. I'm undecided -- is there really any value in this? Mosaicplasty is a procedure that involves harvesting plugs of cartilage and bone from one part of the kne...

I am a 20-year-old competitive gymnast. I have a serious hole in the left knee cartilage that needs repair. I'm wondering if my sex (female) and my sports participation in gymnastics are in my favor or against it for healing naturally versus having surgery. Probably the biggest reason orthopedics has focused so much in the last 10 years on the repair and healing of cartilage defects is because of athletes like you. Athletes from all disciplines can be affected -- these injuries have been reporte...

Ten years ago, I tore my ACL. I didn't have insurance at the time, so I waited five years before I had the surgery to repair the problem. Everything seems to be working out but I always wonder if that delay will make a difference in the end.

I'm weighing the pros and cons of having surgery for an unstable knee. The surgeon is proposing reconstructing the torn ACL and repairing the meniscus. I've been told that without this operation, I could end up with early arthritis and eventually need a total knee replacement. How do I know that won't happen anyway with or without the surgery? When it comes to what will happen in the future after a decision of this type, there's no crystal ball. Surgeons make recommendations like this based on t...

I'm 72-years old but still very active. The problem is my left knee has a hole in the cartilage that's been there 10 years or more. My young grandson had some kind of surgery where they put new cartilage cells in the hole and patched over the top. Could I qualify for this kind of procedure? You may be referring to a procedure called autologous chondrocyte implantation or ACI. Autologous means the cells harvested for the implantation come from the patient who needs the repair. In other words, you...

Mother complains about her aching arthritic knees. We can even hear them creaking when she stands up. Her doctor keeps telling her to stay active and exercise. But how can she when she hurts so much? People with knee osteoarthritis are encouraged to maintain an active lifestyle and to exercise those arthritic knees. But as you point out, that seems counter intuitive -- if your knees hurt, why would you move and exercise them more? But study after study confirms that this is good advice. For exam...

Surgeons in Sweden began performing cartilage repair procedures called autologous chondrocyte implantation (ACI) back in 1987. More than 20 years have passed since then. That's time enough to check back and see how things have gone and what kind of results have been achieved. Patients who had this procedure were asked two basic questions: 1) Are you better, same, or worse? and 2) If you had it to do over again, would you have this surgery?What exactly is the procedure? Autologous chondrocyte im...

My 16 year old son is a long-distance runner. He started having a lot of knee pain and his doctor said it was Runners Knee and prescribed rest. What is it and is there anything else he can do for it? Runner's knee, or chondromalacia patellae, can be caused by several things. In young people, it's most often caused by overuse, such as running. It can also be caused by injury, misalignment of the kneecap or arthritis.The standard treatment for this problem is rest and limited activity. Nonsteroid...

I think I may have torn a cartilage in my knee. What are the symptoms? If you feel you have injured the cartilage in your knee, it is important to have this checked by a doctor. Self-diagnosis could lead to other knee problems because you could be wrong. In any case, these are the most common and probable signs and symptoms of an injured cartilage of the knee:

I had surgery to reconstruct the ligament on the inside of my knee. When can I return to hockey?

I have a grade III (ruptured) medial collateral ligament of my knee. The surgeon wants me to go to PT for rehab and I think I really need surgery. Would other surgeons agree with this recommendation?

I'm looking into the possibility of putting off a knee replacement by either having an osteotomy done or a unicompartmental knee replacement. Which one is a better choice?

I have a painful knee from damage to the articular cartilage. What do you recommend for surgical treatment?

I have a full-thickness tear in the cartilage covering my knee joint. The surgeon says they can can do an operation and take some of my healthy cartilage and patch it up nearly as good as new. Will my repair just wear away as I continue to use that knee?

I've had two surgeries so far for a full-thickness cartilage defect in my right knee. The results have been disappointing as I can't do any of the fun sport activities I like. Someone suggested a knee replacement. Would something like that work? Cartilage lesions of the knee joint can be difficult to repair in order to restore painfree function. Full-thickness (clear through the cartilage to the bone) can be especially problematic. Patients are often unable to cope with the pain. In fact, a rece...

Please help -- I am completely freaked by the fact that my new ACL is infected. Will I lose it? What will happen if I do? Don't panic. If you are under the care of a surgeon, the graft site can often be saved. The treatment consists of several steps. First the infection is confirmed by removing some fluid from the joint and testing it for bacteria. Staphylococcus aureus (staph infection) is the most common organism found. It sounds like you've had this testing done and the infection was confirme...

Q: My 18-year-old son is in need of an ACL reconstruction. The surgeon laid out all of the different choices -- hamstring tendon graft, patellar tendon graft and choosing from using his own tissue or going with a donor bank. What's best in regards to quick recovery and returning to sport? Anterior cruciate ligament (ACL) reconstructions are one of the most commonly performed surgical procedures among young athletes today. Rehab is often advised first in order to save the athlete from having su...

Is it ever too late to have surgery for a hole in the knee cartilage? I'm 43 and too young for a knee replacement but is there something else they can do for this before my entire knee is torn up with arthritis? A hole in the knee cartilage usually refers to damage in the articular cartilage. This area of the joint is a smooth, fibrous covering over the two bones that form a joint. If you were to look at this structure on a chicken leg, it is the equivalent of the gristle at the end of the drums...

Our 14-year-old daughter was involved in figure skating. She ended up with an ACL tear that required surgery. Despite our concerns, she went back to practice before she was done with the rehab program. Now the surgeon says the knee is too loose. Is that just a coincidence, or could it be because she disregarded all advice to wait on returning to the ice? The number of athletes who injure their knees and need anterior cruciate ligament (ACL) repair or reconstruction is on the rise. Every year, al...

When I was in my 20s, I tore up my anterior cruciate ligament pretty bad. After surgery, I ended up with a wide, wrinkly, ugly scar that measures eight inches long. I'm almost 40 now and I recently saw my son's friend's knee. He had an ACL repair last year. You wouldn't believe the two tiny, thin scars he ended up with. How are they doing this surgery now anyway? Anterior cruciate ligament injuries can be repaired, but more often are reconstructed. In a repair procedure, the torn ligament is sti...

I've been newly diagnosed with knee osteoarthritis. I've been on-line all day looking for some sound advice. There's so much out there, I don't know where to start. What do you advise? The American Academy of Orthopedic Surgeons (AAOS) recently published Clinical Practice Guidelines for the nonoperative treatment of knee osteoarthritis. Guidelines like this help all health care professionals treating patients with knee arthritis using noninvasive approaches. Patient education, self-management te...

I need a little advice. I'm 42-years-old and I tore my ACL skiing. I'm pretty much ready to hang it up anyway, so I'm wondering if I really need to do all the exercises the therapist has given me. I just don't want to work that hard but I'm a little embarrassed to say so. You are not alone in this dilemma. Rehabilitation after ACL injuries is often a lengthy process with therapy two to three times a week for several months and a home program for much longer than that. Studies show that athletes ...

I've been going to a rehab facility for training after having an ACL repair on my left knee six weeks ago. I'm very eager to get back into full sports participation (I'm on the volley ball team and cross country in college). I notice my therapist does an entirely different program with me than the other therapist in the clinic does with her patients. I'm wondering if I'm in the better group -- or if the other type of therapy would advance me faster. How do I go about finding out? Despite more th...

I'm wondering something about a unilateral knee replacement. It's been almost a year since I had this procedure done on my right leg, and I still can't go up and down stairs easily. Will this gradually get better? Perhaps, but probably not without a little help. Studies show that a loss of muscle strength and power are typical after unilateral knee replacement (UKR). UKR refers to the placement of an implant on one side of the knee (either medial on the inside half of the joint closest to the ot...

What's the latest on taking glucosamine for knee arthritis? One health magazine says, Take it, an article in today's newspaper says, Don't bother. Which is it? Despite all the media hype around taking glucosamine and/or chondroitin, guidelines for the nonoperative treatment of knee osteoarthritis from the American Academy of Orthopaedic Surgeons (AAOS) do NOT support the use of these supplements. There simply isn't enough evidence to show any clinical benefit of these supplements for individuals...

I am a 13 year old girl with knee pain that only goes away when I sit and do nothing. The doctor says I have osteochondritis dissecans. I looked this up on-line and found out it's from an injury or repetitive sports activity. I'm not a sports freak, ballerina, gymnast, or athlete of any kind. So why do I have this problem? Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur). The problem occurs where the cartilage of the k...

I'm not a super athlete but I do like to compete in several areas such as soccer, cross country, and tennis. I notice whenever it's soccer season, I seem to have the most problem with my patellar tendon. I keep tweaking it and it never heals all season long. This doesn't happen with any of the other sports I engage in. Can you help me figure out what I'm doing wrong?

What kind of treatment is prescribed for osteochondritis of the knee if surgery isn't done? Osteochondritis dissecans (OCD) is a problem that affects the knee, mostly at the end of the big bone of the thigh (the femur). Repetitive motion, compression, and friction causes damage to the first layer of bone underneath the cartilage called subchondral bone.As the condition becomes worse, the area of bone that is affected may collapse, causing a notch to form in the smooth joint surface. The cartilag...

I tore my left ACL completely in a weird accident while out golfing with my kids. Since I'm not really all that active (and I am admittedly overweight), the surgeon recommended physical therapy instead of surgery. I'm wondering if this is really the best thing for me. Maybe I should just have it repaired and be done with it. What do you think?

My knees seem to be kinda wobbly. I never know when they are going to go out from underneath me. Are there some exercises I can do to get them back in shape? Quite frankly, I'm worried about taking a fall.

Mother seems to be awfully stiff in the mornings. Once we get her up and moving, she seems to do much better. She does have some knee pain, but it's the stiffness that really holds her back. What can be done about this -- anything?