Our Experts Answer Your Questions
Our orthopaedic surgeons provide information about typical knee issues. If you are having knee pain – because of sports injuries, medical conditions, or for other reasons – the Orthopaedic & Spine Institute experts can help.
Q. If I have a torn anterior cruciate ligament (ACL), do I have to have surgery?
A. Shyam Brahmabhatt, MD, replies:
The ACL is one of the main ligaments that stabilizes the knee. It connects the femur (thigh bone) to the tibia (shin bone). This common knee ligament injury tends to occur more often in people who engage in sports such as football, soccer, basketball, or skiing. Because the ACL weakens with age, the risk of tearing it increases in those 40 and older.
Whether or not you undergo reconstructive surgery for a torn ACL depends primarily on your activity level, risk for injuring other structures of the knee, and symptoms (pain and limited stability, strength, and movement). For some people, a lengthy period of rehabilitation (exercise and training) may be enough to stabilize the knee and enable them to return to their pre-injury lifestyle. If your orthopaedic surgeon recommends surgery, the techniques we use today are less invasive and in most cases, can be performed on an outpatient basis. Rehabilitation is accelerated, so patients recover more quickly and return to work sooner.
Q. Is it really safe for children and teenagers to participate in regular athletic competition?
A. Kevin A. Gingrich, MD, replies:
There’s no doubt that moderate exercise is a good thing for kids, especially when you consider the rise in the incidence of childhood obesity in the U.S. In the last decade, however, youth sports seem to have become more intense. Rather than switching sports with the seasons, today’s student athletes tend to play the same sport year round. Fueling this trend is an increased emphasis on competition and extreme performance. In the long run, the intensity of using the same muscles over and over again can cause joint damage.
Your best bet is to encourage your child to participate in different kinds of sports throughout the year, so they work different muscle groups. In addition to being physically fit, they’ll learn the value of teamwork and reap the psychological and emotional benefits of physical activity.
Q. What are the advantages of arthroscopic knee surgery?
A. Peter Wang, Jr., MD, replies:
In the past, when performing knee surgery, we had to create a large incision in the knee and remove the entire meniscus (the cartilage that cushions the space between the femur and tibia) so that we could see the other structures of the knee. Today, arthroscopic surgery allows the surgeon to operate through tiny incisions in the knee with specialized microscopic instruments. These instruments magnify the tissue so we can perform very fine work without having to open up the knee or remove the meniscus. Compared to open-knee surgery, with arthroscopic procedures, there is less pain after surgery, patients recover more quickly, and return to regular activities sooner.
Q. How long does it take to return to my normal activities after ACL surgery?
A. David Craft, MD, replies:
Results vary for each individual, since no two people are alike. I would recommend making a list of all your questions before you meet with your doctor, so he can discuss your particular care with you.
Some questions you may have:
How quickly can I walk without crutches?
How long will it be until I can work out again?
When can I run again?
When can I participate in activities in which I cut side to side?
Q. What is a torn meniscus and what should I do?
A. Benjamin I. Chu, MD, replies:
A torn meniscus is one of the most common knee injuries. The meniscus is a cartilage shock absorber which acts as a cushion between the thigh bone and the shin bone.
Initially, we may recommend non-surgical treatment for a torn meniscus. This includes rest, ice, and anti-inflammmatory medications. One focused anti-inflammatory treatment is a cortisone injection to temporarily reduce the pain within the knee. We may also prescribe physical therapy to strengthen the muscles around the knee.
When non-surgical treatment is not effective, then meniscus tears can be treated with arthroscopic surgery. This minimally invasive procedure results in less pain and a quicker recovery than surgery through a large incision. Although we tend to be more cautious in recommending surgery for older patients, if they continue to have pain despite non-surgical treatment and are otherwise in good health, surgery is still an option.
Q. My doctor says my daughter has chondromalacia patella (pain in her kneecap). What can be done for this condition?
A. Thomas C. Peff, MD, replies:
Common in young girls, chondromalacia patella is the softening and breakdown of the cartilage behind the kneecap. The condition results from structural problems such as being knock kneed, which causes poor joint alignment. This malalignment keeps the kneecap from sliding smoothly in its groove over the femur. Instead, the kneecap grates over the thigh bone, making the cartilage behind it rough and causing chronic joint pain and inflammation.
Treatment for chondromalacia varies and may include physical therapy to strengthen the muscles around the knee, or the use of tape or a knee brace (known as a J sleeve) to stabilize the knee. If the dislocation is severe, we may recommend surgical realignment of the knee.
Q. What is a knee sprain and what do I do about it?
A. Thomas E. Greene, MD, replies:
A knee sprain is an injury to one or more of the four major ligaments in the knee—the anterior and posterior cruciate ligaments or the lateral and medical collateral ligaments (MCL). Sprains are most common in the MCL. We grade sprains according to severity:
Grade 1: the ligament is stretched but not torn
Grade 2: the ligament is elongated and becomes loose (called a partial tear)
Grade 3: the ligament is completely torn into two pieces
Depending on its severity, treatment of a sprain varies and may include reduced activity with a brace, or surgical repair. A sprain can be a very serious injury that takes a long time to heal.