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KNEE INJURIES

The Knee

The knee is my favorite joint but is commonly injured in all age groups, especially during athletics and exercise. Physicians can frequently diagnose many knee complaints by first taking a thorough history from the patient, which often reveals a twisting episode, swelling, popping, grinding, giving way or locking. It's also important to know whether the injury is recent or recurrent and if any treatment, tests, or surgery have been done in the past.

Although there are many complicated areas around the injured knee that doctors are concerned about, the most commonly affected structures are the cartilage (menisci) and ligaments. These are found on each side of the joint and there are two other ligaments that cross inside the knee, known as cruciates.

On physical exam, I ask the patient to point to the spot where and when it hurts the most. I'm looking for swelling in the tissues, fluid in the joint, muscle wasting, kneecap grinding, ligament instability, or loss of motion, just to name a few. The knee joint is quite easy to examine and experienced physicians will not cause excessive discomfort to the patient during these maneuvers. X-rays do not show ligament or cartilage damage and are frequently over-utilized with multiple views. Stress x-rays are unnecessary and painful for the patient. Likewise, Magnetic Resonance (MR) scans can be helpful but are not necessary unless the physician feels strongly that the outcome of the scan will contribute to or change the proposed course of treatment.

Although many problems about the knee can be treated conservatively with early mobilization, ice, rehabilitation, physical therapy, and NSAIM, some conditions such as cartilage tears will require arthroscopic surgery. This procedure is done as an out-patient, is quite safe, and has a low complication rate, allowing most patients a quick return to work and recreational activities.

Ligament tears may also require surgical intervention but a thorough discussion of the pros and cons of the procedure, length of rehabilitation, need for post-operative bracing, and close follow-up care is essential. Make sure you clearly understand what you're getting yourself into which is why I frequently encourage prospective surgical candidates to contact some of my previous patients who have had the same procedure done to find out all the specifics and whether they would do it all over again. Virtually all these operations can be done as out-patients.

Bursitis and tendinitis occurring about the knee are usually treated with NSIAM, ice, physical therapy modalities, and possible modifications of activities.

Chondromalacia, or a roughening of the undersurface of the kneecap, is commonly seen in females more than males and can be treated symptomatically with ice and exercise, but may require surgical attention in patients with excessive grinding or pain who have failed to respond to conservative measures. The laser has made this procedure more successful and you should ask your doctor if he uses this equipment and has had the proper training.

Cartilage repair and transplantation is being heavily investigated at this time but currently has limited use on lesions around the knee, specifically the femur, and the technique requires two procedures, one of which is quite extensive.

Finally, many patients ask about braces for knees. Legitimate braces with metal or plastic parts are frequently required after ligament injuries or surgery and are custom fitted. I like to reserve the use of these braces for people with instability or who are post-operative from ligament surgery. Patients who have no instability may want to purchase sleeves or other slip-on devices which are fine but should not be worn too tight as to compromise circulation.

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