Harlan Selesnick, M.D
 
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Knee

JOCK Doc's Knee Questions

Question

After great steady recovery for the first 3 months post-knee-arthroscopy [lateral meniscal tear and plica excision, smoothing of patellar cartilage due to minor chrondo], the scar tissue under/around the medial lower incision has gotten more aggravated and at 5 1/2 months post-op I can't jog or navigate stairs or kneel. I can literally feel the scar balling up below the kneecap as I bend and extend it. I've tried cortisone shot, ultrasound, massage, vitamin E, magnets, ice/heat. My doc says some 10% of patients have this scar tissue problem and he seems to say deal with it. I am just 24 - This CAN'T be as good as it can get. I can barely do normal activities pain-free! My PT and surgeon are baffled by the bizarre course of my recovery and my inexplicable regression. The knee looks good and the surrounding muscles are strong as anything, but this glob of scar tissue is causing all this discomfort. I've been religious about my rehab, haven't been overdoing it, and this just doesn't make sense to anyone I see. Have you seen anything like this before? Is this something that requires another surgery to excise the scar tissue? But wouldn't that only form MORE scar tissue? Everyone I know who gets my surgery is out and fine within 3 months tops, and I am struggling at over 5 months. Am I simply on the slow end of the healing curve? Does the scar tissue ever break down or is it possible for it to cause permanent discomfort? I feel like something as basic as scar tissue CAN'T be permanent, right?? Please advise.
Eileen

Answer

Most patients after arthroscopy do well quickly post op. Unfortunately, some patients form scar tissue that can interfere with a good result. It is impossible to know which patients will form too much scar. It appears that your surgeon has tried many different methods to rehab your knee and decrease the scar tissue. Unfortunately, your knee is not improving. I believe that you will likely require a repeat arthroscopy to remove excess tissue and make certain no new injury has occurred in the joint. Although scar can redevelop after surgery, it is usually less likely as the surgery involved is less extensive and produces less scar. I recommend you discuss your options again with your surgeon and if you still are unsure consider a second opinion.
The Jock Doc


Question

Would patella tendonitis cause the bersa on my knee cap to become inflamed. I have been to the doctor and they say I have patella tendonitis. I have a vertical bump that runs up almost to the top of my knee cap. All the anti-inflammatory medicine and stretching has not helped. Any ideas? Thanks
John

Answer

Patellar tendonitis is inflammation of the kneecap tendon just below the level of the kneecap. Most cases of patellar tendonitis get better with anti- inflammatory meds, improving flexibility, and a pain-free quad strengthening program. This condition is common in basketball, gymnastics, football, and volleyball. The bursa is a thin fluid filled sac between the skin and the kneecap and tendon. This is usually not associated with tendonitis, but it can be. Bursitis usually responds to anti-inflammatory meds, a compressive wrap, and avoiding bumping the bursa. Occasionally if persistent fluid can be removed from the bursa with a needle by your doctor. Rarely, is surgery indicated.
The Jock Doc


Question

Hey Jock Doc! Thanks for offering this! I'm 29 with a torn ACL. My orthopedist is recommending surgery. He didn't really mention anything about possible complications. I felt like I had to pull info from him. So I've come to the internet to get the full story. I've been through Phys. Therapy and have really strong quad and thigh muscles which allow for a lot of stability despite no more ACL. Since the injury I have been able to dance, lift weights, hike, bike, run and play racquetball which make up the majority of my activities. I sometimes experience a little discomfort, but no pain. Haven't tried snowboarding yet, though. My doctor said that a possible arthritic problem may arise later in life due to the problem. Is that enough of a potential problem to merit surgery? Is this a really low risk surgical method? I'd, of course, like to be fully able to function, but I've heard enough horror stories to make me wary. Just looking for a second opinion. Thanks for your time. Todd

Answer

You have asked an excellent question.. Not every person that tears their ACL needs surgical reconstruction. A surgical decision is based upon the degree of instability, the age of the athlete, what other problems are present in the knee, and as to what level of function the patient desires. If someone is able to do all their activities without pain or buckling then they may be able to get by without surgery and can use a de-rotation ACL brace for pivoting type sports. If a person is young and having problems related to buckling and instability then surgery is necessary to help decrease the risk of arthritic progression. The methods of ACL reconstruction have become more routine and the risks are not very great in the hands of an experienced knee surgeon. Most patients prefer their own tissue (autograft) from the patellar tendon or hamstring. The other useful option is an allograft from a cadaver donor for ACL reconstruction. Since you are functioning well you may try the period of bracing for sports and see how you do. If your knee buckles or becomes painful or weak then you really should consider the surgery. The Jock Doc


Question

Hi there, I had knee surgery on Dec. 16th which included arthroscopic surgery and a lateral release which I was told would be a preventative measure. I go to PT 3 times weekly. The swelling is still a factor. ROM has not improved from 111 in last couple of weeks. PT says my Quadricep muscle is shot but cannot do Quad strengthening exercises due to the exertion to the lateral release?? I currently do wall slides and leg press, but this hasn't seemed to help...any ideas would be GREATLY appreciated. Thank you. Carol

Answer

It appears that either the swelling or post op scar tissue may be limiting your motion and strengthening. I recommend you follow up with your surgeon to help determine what else can be done to help improve your result. Without knowing the specifics of the surgical findings it is hard for me to say if you are progressing at the expected rate. If after consulting with your surgeon your questions are not answered to your satisfaction then you may want to get a second opinion. The Jock Doc


Question

I recently had arthroscopic knee surgery on my knee (12/27/99). I had a completely torn ACL so the doctor removed it. I have been doing PT since then in order to strengthen my muscles. My goal is to avoid reconstructive knee surgery. As of now, I am almost back to the complete range of motion in my knee. I am a senior at college and live a very athletic life. I participate in all sports possible. Recently my knee has been "catching" in an extended position. My doctor said that I have a lot of scar tissue built up and that is the "catching" problem. I have been instructed to message the portals on a daily basis to break up the scar tissue. Does this sound okay. If so, what do you think are my chances of avoiding reconstructive surgery. Thanks. Joe

Answer

Young athletic people usually require ACL reconstruction to regain necessary stability to return to competitive sports. Although rehab and de-rotation bracing will allow some athletes to return to competition, the risk of re-injury and later on arthritis make many sports medicine specialists recommend this more aggressive approach. The catching you are experiencing may be due to scar tissue, quad weakness, or a meniscal tear. I recommend you talk further with your orthopedic surgeon as to which treatment options are best for you now and in the future. The Jock Doc


Question

About 4 months ago, I had arthroscopic surgery on my knee for a torn menicus and I also had a cyst on the side of my knee that the doctor tried to break up. Just recently I can see the cyst returning and I am beginning to feel the same pain in my knee. What needs to be done to get rid of this cyst and is the anything I can do to help alleviate this discomfort? I workout and would like to continue to do so." Rose

Answer

Occasionally when a meniscal cartilage tear occurs joint fluid can collect around the edge forming a fluid filled cyst. If the cyst is not painful or does not limit function it can be left alone. Usually, an arthroscopic procedure repairing the cartilage damage will cause the cyst to go away. If your cyst has returned it is best to see your orthopedic surgeon to help determine the cause of the recurrence. You may need a repeat arthroscopy if the meniscus has re-torn and possibly on open incision to remove the cyst and repair the capsule and meniscal edge to prevent a recurrence. The Jock Doc


Question

I have recently been diagnosed with a first degree MCL strain. I am wondering how long - if at all - I should be avoiding strenuous activity and what kind of therapy I should be following, i.e., rest, exercise, ice, etc. Also, please address what could happen if I don't avoid activity, i.e. further injury, prolonged healing, etc. Kim

Answer

A tear of the medial collateral liagament of the knee(MCL) is divided into 3 grades. A 1st degree sprain is a micro tear of the ligament and usually heals in 4 weeks. Rehab should include a brief period of rest followed by cycling, swimming and gradual strengthening of the quads and hamstrings. Return to sports usually is when symptoms allow. Second and third degree sprains(partial/complete tears) are more severe injuries and require a period of bracing, rest followed by a rehab program. The Jock Doc


Question

I am 39 female, have OA both knees, getting worse. My Rheumatologist is going to try Synvisc in both knees. What results do people get? Denise

Answer

Synvisc is a lubricant that improves the viscosity of the knee joint fluid, thus reducing the painful compression of the joint. Approximately 75% of those patients receiving one Synvisc injection to the knee weekly for 3 weeks have a decrease in their symptoms for 6-12 months. If effective the injections can then be repeated in some patients thus decreasing the symptoms and delaying the need for a knee joint replacement. The Jock Doc


Question

I appreciate the opportunity to ask you this question. I injured my knee about 5 years ago playing basketball. I had a meniscus repair followed shortly thereafter by an ACL reconstruction. I have had a couple of meniscus tears since and have had them stitched up for what appeared to be a successful repair, at least for a while. I am 33 years old and have not had any problems for about 2 years until today. I turned around in the office today and felt the now familiar feeling of a cartilage tear. I am not looking forward to going in for knee work for a 6th time and would like to know if there is some alternative with new technology or should I suck it up and get it over with - again ? I am 6'2"" about 165 lbs and have always been active biking, a little low intensity basketball and other activities. I have been working with a local Orthopedic Surgeon in Stockbridge, MA and would also like to know if I should go to a larger city such as Boston or Springfield, MA. My local Doctor has a good reputation, however, I sometimes wonder if we, in the Berkshires, are out of touch with procedures and new materials. Thank you. Mike

Answer

I commend your physician for repairing your meniscal tears rather then removing the meniscus and thus increasing the risk of arthritic changes developing. However, I am concerned that you may have some instability present for you to keep having new tears occurring so frequently. I recommend you return to your orthopedic surgeon for his opinion and if you still are unsure then a 2nd opinion may be indicated. Dr. Arnold Scheller (team doctor, Boston Celtics) sees a great many knee problems and may be a good 2nd opinion source. There are no new non surgical treatments for significant meniscal tears in young patients. The Jock Doc


Question

I had surgery on my knee back in October and I am still having pain when I walk or climb stairs, I have been through almost 10 weeks of Physical therapy and am still having pain. My sister said she saw a show on TV, where a woman had that same surgery 4 times and was still experiencing pain, she said they had a name for the condition. Can you give me any idea of what to do, or if I can give my doctor some input based on your experience? William

Answer

Pain or weakness walking up or down stairs is usually related to problems involving the kneecap (patella femoral disorders or chondramalacia). Usually physical therapy aimed at improving kneecap tracking and pain free quad strengthening will decrease symptoms.. Without more specific information I can not be of much more help. I recommend you discuss your pain with your surgeon and if symptoms persist consider a 2nd opinion. The Jock Doc


Question

My 14 year old daughter needs ACL reconstruction however her growth plates are still open. She is a very active in sports. The doctor recommended we wait for 6 months for them to close. I have also been told that the hamstring can be used with a special device and the drilling will not go past the growth plate. Need your help, what is the best method. Thanking you. Steven

Answer

Most sports medicine surgeons prefer to wait till an athletes growth plates are closed before performing anterior cruciate reconstruction. This eliminates the chance of abnormal growth of the operated leg. Although there are techniques then can spare the growth plate, positioning the ACL holes in the bone can be less then ideal in some patients. Unless your daughter is having significant problems with instability, I recommend she wait till her growth plates have closed as this gives her more options for ACL reconstructions. The Jock Doc


Question

We are students at Mesquite High School in Gilbert Artizona. Our sports medicine class is doing a research project on knee injuries and treatments. We have been assigned arthroscopic surgery and would appreciate any information you could send us. Nicole & Lori

Answer

Arthro means joint and scopic means use of a scope to look within the joint. Arthroscopy can be performed on knees, hips, wrists, elbows, ankles, shoulders, and even the big toe. It can be used to smooth arthritic surfaces (chondraplasty), repair torn cartilage (meniscal repairs), remove loose bodies, remove spurs, and repair tendons and ligaments. The arthroscopes are between 2-5mm in size and the instruments between 1-10mm in size. I recommend you contact the Arthroscopy Association of North America (http://www.aana.org) for additional information. The Jock Doc


Question

My Wife was recently diagnosed with 'Chondromalatia' in her right knee. The specialist said that there was no treatment and that it will go away on its own before she is 45. Can you confirm this? Where can I get more info on this subject? Jim

Answer

Chondramalacia is a condition where there is softening or roughening of the articular cartilage on the ends of the bones. In the advanced stages wear the cartilage has worn out and the bone ends touch this is osteoarthritis. Most people have varying degrees of chondramalacia and most do not have symptoms. It is important to determine the location in the knee of the chondramalacia as well as the degree of the wear. Many patients that are symptomatic can be treated with physical therapy followed by a home exercise program with relief of their symptoms. I suggest you get a 2nd opinion from a sports medicine specialist if your wife is still having symptoms of pain, weakness, stiffness, or cracking. The Jock Doc


Question

I had arthroscopic surgery on 12/23 (it is now 12/27). I am scheduled to see my OS assistant, since my OS is on vacation, on 12/30. I would like to know what I can expect in the next week or two. I would like to also know what to ask the PA since my OS will not be there. From what I remember on surgery day, I had a large medial meniscus tear in which he removed a portion of meniscus and shaved around tear. I currently have swelling and am walking with a limp. I have had little pain up until today (4 days post op). I had increased pain while sleeping and increased pain during this day. What is down the road for me with the removal of the meniscus? Am I at risk for a further tear in that area or any alignment problems? Any other information you can provide would be greatly appreciated. Thanks! Marylou

Answer

It sounds like your recovery is as expected so far. The swelling and pain gradually resolve over a couple weeks. Your surgeon will likely place you in a rehab program to decrease your pain, to decrease swelling, restore a normal range of motion, and improve your strength and gait. The long term effects of a partial menisectomy (removal of cartilage) depends upon the size and location of the tear, your age, and your activity level. I suggest you discuss this with your doctor upon his return. The Jock Doc


Question

What pain level can I expect from arthroscopic knee surgery. How long before I will be able to play volleyball? I am a 62 year old male who will be having surgery on Dec. 30th. I am confident with my doctor. He has taken regular x-rays in standing, and laying positions and had MRIs taken. Don

Answer

Arthroscopic knee surgery is usually painful for 48 hours post op, after which the pain gradually improves. This can vary depending upon what problems are corrected at the time of the arthroscopy. As far as return to volleyball, once again depends on what problems the surgeon is correcting such as meniscal tears, loose bodies, or arthritis. Most patients can return to sports in 4-8 weeks with most types of "scope" procedures. The Jock Doc


Question

I recently had an arthroscope on my right knee. He trimmed what was left of my worn lateral cartilage and gave me what he called a 'lateral release' to improve the poor positioning of my patella. He also said I had worn out the surface behind my knee cap. It has now been 8 weeks and I am urgently trying to get back on the rugby league field. I am cycling, walking, swimming and running in the pool etc. but my knee is hardly improving. I've tried physio and acupuncture, do you have any other suggestions. Steve

Answer

Arthroscopic surgery for problems related to the patella "kneecap" are complex procedures with varied rates of recovery. It is not unusual for patients that have a chondraplasty (smoothing of the kneecap) and a lateral release (realignment of the kneecap) to require several months of rehab before they can return to athletic competition. I recommend you discuss your lack of progress with the surgeon who may they modify your workout or rehab program. If you fail to progress in the next several weeks at that time you may want to get a second opinion. The Jock Doc


Question

On January 10th I am going to be having arthroscopic surgery on the MCL, what is the recovery time? Christine

Answer

Arthroscopic surgery is performed inside a joint "arthro." This surgery in the knee is useful for cartilage problems, loose bodies and disorders of the ACL and PCL. However, the MCL is outside the joint and can not be repaired arthroscopically and if necessary to repair requires an open incision. I recommend you discuss your problem in more detail with your orthopedic surgeon who can explain again your problem, the solution, and the recovery time. The Jock Doc


Question

I have a knee problem called acute patella dislocation. My knee often pops out of place and it usually goes back in by itself. The doctors recommended surgery but first wanted to try physical therapy. That didn't work. Before my knee would go out when I was running or doing exercise. Lately it's been going out just when I walk. Even more recently it goes partway out and is very uncomfortable. My question is that I want some information about the kinds of surgery that I can have. I know that one is a lateral release. The other one I think is a re-alignment or something like that. The lateral release will leave me laid up for 3 months. The bigger surgery will leave me laid up for 6 months. It's one where they break the patella and do something to help my knee. Could you please tell me the name of this ""bigger"" surgery? Also I would like to know about both surgeries, such as, how long will I be laid up, how long will I be on crutches, and how long will I be in a larger knee brace or an immobilizer? Please help me with this. I'm only 15 years old and I don't know about having surgery, I'm really scared. Thank you. Teri

Answer

Patella femoral disorders are very common in teenage women. These can be difficult to treat and physical therapy aimed at improving the tracking of the kneecap and strengthening the inside quad muscle (vastus medialis) can help reduce symptoms in most patients. Unfortunately, your problem appears more severe and conservative treatment has failed up to this point. An arthroscopic lateral release is the cutting of the tight tissue on the outside of your kneecap thus allowing after post op rehab improved patellar tracking and stability. Not all patients would benefit from this alone if the mal-alignment is severe enough. In those patients a realignment procedure done with a traditional incision would include a lateral release, tightening of the inside soft tissues and possibly cutting the bone below the kneecap (tibial tubercle osteotomy) to improve the patellar tracking. The most common osteotomies done now are the Fulkerson or Maquet. The post-op protocol usually requires at least 4 weeks of bracing and crutches followed by several months of physical therapy. I recommend you and your parents spend some time going over the options with your orthopedic surgeon to help determine what is likely to help you the most. The Jock Doc


Question

Hello, I need a rehab program for my knees. I have difficulty squatting all the way down and with stiffness. I also walk straight legged which cause pain after a while. I am 30 y/o, male and very active. I am also experiencing lower back pain I think as a result of my bad walking posture. Thank you. Jeffrey

Answer

It would be very hard to recommend an exercise program without knowing the diagnosis and condition of your knees and back. I recommend you see an orthopedic surgeon who can accurately diagnosis your condition and place you with the appropriate conditioning program. The Jock Doc


Question

MRI results show that my 14 year 5'11"" 160 pound son has a complete tear of his ACL. Our current doctor says he will operate on him when my son turns 151/2, because the doctor says he will have to go through his growth plate. At 151/2 he says my son should be at the height he will keep until adulthood. My son is very active in sports. He received this injury during football season. He currently is wearing a brace. Do we have another alternative? Your response would be greatly appreciated. Sylvia

Answer

Usually it is best to wait to perform ACL knee reconstructions when growth is complete. Most ACL techniques involve drilling through the bone at the anatomic attachment points of the original ACL for accurate graft placement. Drilling or screw fixation can violate the growth plates thus risking a growth disturbance if the surgery is performed before skeletal maturity. Although there are some techniques that do not violate the growth plate, the usual recommendation is to keep the leg strong through exercise and to use a derotation brace for pivoting sports. It sounds like your orthopedist is giving you good advise and I recommend you adhere to his planned surgical schedule. The Jock Doc


Question

Hello. I am a runner who spent the last year of my life training for the Marine Corp Marathon only to be sidelined by Chondromalacia of the left knee in late July. They had a hard time diagnosing it and after 2 months of pt, a cortisone shot and finally an MRI they diagnosed it. ( At first they thought IT band, then meniscal tear) I continued on a regimen of of PT for another month and was allowed to do the exercises at home as well as weights and walking at the gym. The thought was that while it was healing it was doing so at a very slow pace. So it is now about 5 weeks after I ended PT. I can walk about 30 minutes at a low grade (at about 4 mile an hour) and have been given orthotics (I severely overpronate). I am however not seeing much improvement beyond this. I cannot workout more than every other day and if I do a lot of walking (with the orthotics) my knee cracks terribly and I do have pain. After all that here is my question. When do I need to decide that this mode of treatment is not working? How long do you wait before surgery? I have been told my condition heals by itself in about 90% of the people who have it. Is it common for it to take 4-6 months to heal? I am going to see a new orthopedist next week as my current doctor said that if I cannot run for 10 minutes without pain I need to either give up running completely or have surgery. Also as a side note. What are your thoughts on acupunture for a condition like mine? Thank you. Cathy

Answer

Patients with kneecap problems such as roughness under the kneecap (chondramalacia) frequently improve with a physical therapy program. However, after 5-6 months you should have noticed significant improvement. I agree that a second opinion is a good idea to confirm the diagnosis and offer additional treatment options. It is likely that you may require an arthroscopy if you don't improve. I do not think acupuncture will help your condition, but I see no harm in trying if you so desire. The Jock Doc


Question

Approximately one year ago while training for a 15K, I began to experience a sharp pain on the outside of my knee about three miles into a run. It remained sore for a few days and I decided to take about a week off and then try again. The next time I ran, it only took 5 minutes before it began to hurt. Not having health insurance at the time, I checked with some running pals of mine to see if they had ever experienced anything like it. One friend told me that it sounded a little like illiotibial band syndrome, and that he had some stretching exercises that might help. For the next month I did the exercises he recommended. My only form of cardiovascular exercise was swimming. After a month it was time to test the knee again. Same as before, it took about 5 minutes and I was done. Unable to run, and no insurance to find out what was wrong, I continued to swim. Then my friend introduced me to the Precor EFX Elliptical machine. It was great! The machine closely simulated the running motion, but, without the impact. I was able to do this form of exercise with no pain whatsoever. I continued to exercise on the elliptical machines for the next few months hoping that without the impact, whatever was wrong with my knee would heal. Then one day another friend asked me if I wanted to play a pickup game of basketball. My knee felt pretty good and I hadn't run on it in a while so I thought I would give it a go. Not expecting to last very long, I was able to play for over an hour without pain. This was great, I could run again. Well, the very next night, I went out for a run and in less than five minutes the pain was back. I was extremely frustrated and confused not knowing why one night I could play basketball with all the jumping and changing of direction, and then the next night not even able to jog for five minutes. From that point on I hardly exercised at all. I recently got a new job with health insurance and immediately made an appointment to see a doctor. I was convinced there was something wrong with my knee and he was going to help me. I figured he would find the problem, perform surgery, have me rehab for a few weeks and I would be good to go. Well, after listening to my long story and examining my knee, he tells me it is not my knee, but my back. ??? He ordered a series of lumbar spine x-rays and tells me things looked pretty normal, but that my L5 nerve may be somewhat irritated and that this might be causing the pain. Maybe, because when he had me dorsiflex my right foot and resist the downward pressure of his hand, my right leg was in fact weaker than the left. He recommended I do low back exercises and abdominal crunches, as well as hamstring stretches since I am very tight in this area. He also recommend a try to run through the pain. I know I can do this, I could have done it all along, but, I thought if I continued to run on my leg things would get worse. He said if things start to get better to come back in four months. If things seem to be the same or get worse, I am suppose to go back in two months and he will order an MRI to see what he can find. Now I am more confused than ever. What I don't understand is why I could exercise on an elliptical machine for an hour without pain, and play basketball for an hour without pain, but, could not even jog up and down the street for five minutes without it hurting. I have done what the doctor has told me to do for two weeks and have no relief yet. I know it is still early and that my condition might improve, but I'm skeptical. Should I seek a second opinion. My leg aches right now sitting in a chair not doing a thing. Any help would be greatly appreciated. Mike

Answer

It is very hard to diagnose your problem without seeing you. It is possible to have pain in the knee coming from the back or the hip "referred pain." It is also possible that your knee pain could be related to a meniscal cartilage tear or other knee related problem. Since you are frustrated, I recommend you either return to the first orthopedist and ask for the MRI and other testing to establish the diagnosis or seek a second orthopedic opinion. The Jock Doc


Question

I am a 36 year old tri-athlete (iron man competitions) from Coffs Harbour, Australia. In August, 1998, I suffered a tibial plateau fracture. Surgery was performed, with synthetic graft being put into the knee and a pin inserted. This pin stayed in until March, 1999, when I had an arthroscopy to clean up the knee and remove the pin. My questions is: Is it safe for me to resume some sort of running after an injury such as this? After being told that my running days are over and that I would be lucky to walk without a limp, I am now doing some light jogging with good results. However, I worry that I might be doing some damage that I may pay for in my later years. I am otherwise very fit and healthy. I would really appreciate any advice you can give me. Bryan

Answer

A tibial plateau fracture is an injury to the upper part of the tibia just below the knee. Your fracture was serious because it extended into the knee joint itself. Whether it is safe to run depends on the degree of joint involvement and the extent that arthritis is likely to develop. I recommend you ask the doctor who performed the surgery the condition of your knee joint and whether running is contraindicated. The Jock Doc


Question

I am a 65 year old male with significant knee pain and increasing weakness eventhough I exercise extensively at least 3 to 4 times each week, lifting weights and riding a stationary bike. About 10 years ago, I had arthroscopic surgery and was told then I would be unable to down-hill ski etc which I have been able to do every winter since. My exercising has allowed me to continue a relatively high level of physical activity. I have tried anti-inflammatory medications, pain killers and very expensive knee braces but nothing seems to help. I cannot stand or walk for any time period at all. Knee replacement is my next option but that cannot occur until at least February. What can be done for a short term basis to alleviate some of this pain? -----

I am a 65 year old male who is a prime candidate for knee replacement. I had arthroscopic surgery almost 10 years ago but even though I have been bone-on-bone, I have been able to maintain a relatively active physical life, playing golf, bike riding, and down-hill skiing because I lift weights and ride a stationary bike 3 to 4 times each week. But now the pain has become unbearable. My next option I believe is knee replacement since expensive knee braces, anti-inflammatory and pain killers do not work. Knee replacement cannot occur until after February. What is available on a short term basis to cut this pain and swelling? James

Answer

The indication for knee replacement surgery is when a patient can no longer live with the pain. It appears you have almost reached that point. However, many patients can be helped non surgically for a period of months with injection of hylaronate into the knee joint. There are 2 forms of these injections available in the US (Synvisc and Hyalgan). I recommend you see your orthopedic surgeon or rheumatologist to see whether these injections can help your condition. About 80% of patients with degenerative arthritis of the knees will benefit from these injections. The Jock Doc


Question

Where can I learn about patella femural syndrome? June

Answer

Patella femoral syndrome is really a combination for potential problems. It involves the ability of the patella (kneecap) to track normally (glide) with the femur. Many patients are knock kneed (genu valgum) are these predisposes some patients to kneecap problems. Also a muscle imbalance with a weakened inside quadriceps muscle (vastus medialis) can result in poor tracking and pain. A roughened surface on the backside of the kneecap or femoral articulation (chondramalacia) can also contribute to symptoms. Most patients with patella femoral syndrome will improve greatly with a rehab program aimed at improving patella tracking, pain free strengthening of the vastus medialis, and a modification for their training techniques. I recommend you see your orthopedic surgeon who can help determine the cause of your symptoms and help you get better. The Jock Doc


Question

I am a 16 year old swimmer. I hurt my knee playing soccer quite some time ago, and now, I am unable to run, swim, or basically do anything. Sometimes I hear a pop in my knee and it drives me through the wall. I don't know if it is swimming or my soccer injury, but I can't bend it, and I have problems whenever I place pressure on it. Alex

Answer

Your source of knee pain may be related to problems around the patella (kneecap) or a meniscal cartilage tear. Most problems related to the patella can be successfully treated with a physical therapy and rehab program. Most meniscal tears require arthroscopic surgery to fix. I recommend you see an orthopedic surgeon to establish an accurate diagnosis and initiate treatment so you can soon return to the sports you enjoy. The Jock Doc


Question

My Right Knee has begun to deteriorate. The inner portion (about 50%)is now bone-on-bone. My Doctor took x-rays to show this and has referred me to a specialist. He did tell me that in his opinion, there is nothing short of a new knee that will help. I'm 45 yr old. So, what kind of exercises can I do the slow down the process. I want to put off surgery for as many yrs as possible. Jim

Answer

It is difficult to predict how rapidly your knee will wear out. It is important you maintain good muscle strength in the thighs, but you must be careful that strengthening be done pain free and with minimal crepitus (cracking with motion). Also staying thin may help. In order to minimize symptoms your doctor may recommend an unloading brace that will allow you to bear weight on the good part of your knee. Also injections of Synvisc or Hyalgan can help to reduce symptoms in 75% of patients for up to 6 months. Since you are young for a knee replacement I recommend you discuss these recommendations with your orthopedic surgeon as to what is appropriate for you. The Jock Doc


Question

My 14 year old son plays football, baseball and basketball. He is 6'1" and only weighs 152lbs. He has been experiencing pain on the outside of his left knee when he is running/jogging and doing workouts for football. He has no pain when he is walking. We've taken him to his primary care physician and he said said without an x-ray that it was sprained. We asked him to order an x-ray or MRI and he said this kind of sprain is common among tall lanky teens, and there was no need for any other tests. Because of our HMO, we can not just take him to an orthopedic doctor, our HMO requires a referral from our PCP. Do you think we should insist on a referral, MRI or x-ray? Or do you agree with the PCP that this is a sprain? Can a complete diagnosis be made without sending him for tests? Sports are his life and with bad knees at his age we are concerned that he'll have to cut his sport life short. Sport Loving Mom

Answer

I believe you should insist that your son be seen by an orthopedic surgeon. The orthopedist could determine whether an MRI is needed. Causes of pain on the outside of the knee include a lateral meniscal cartilage tear, a stress fracture, a ligament sprain, synovitis, and iliotibial band syndrome. Each of the causes requires a specific treatment and thus an accurate diagnosis is essential. The Jock Doc


Question

I am a 36 year old male who actively participates in sports, mostly twice-a-week soccer in a local League. Recently I completely tore the ACL, tore the meniscus and suffered a grade 2 or worse sprain of the MCL (based on my MRI/X-rays are perfect). I am currently rehabbing with a pyhsio with a view to surgery in a couple of weeks. I have been told of three choices regarding where to get the 'new' ACL - the patellar tendon, the hamstring or from a donor. Which do you consider the best solution? (I am aware of the AIDS/Hepatitis risk associated with donor tendons but consider that sufficiently minimal to not warrant being a determinant. I also hear that rehab is easier with the donor tendon but that patellar will most likely be the strongest mend... Thanks. Stuart

Answer

You have done your homework well. The 3 main sources of reconstructing your ACL are your own patellar tendon, your own hamstring tendons, or a graft from a cadaver (allograft). Each has their own benefits. However, no studies definitely show one graft source to be superior. However, studies have shown that proper surgical technique and graft placement are the major factors in a successful result. Hard work with rehab is also crucial. I would ask your orthopedic surgeon what he/she feels most comfortable with and go with that choice for my graft. The Jock Doc


Question

On the front of my left knee I have a very small bump just below my kneecap. At times, the area does swell and it is difficult to straighten my leg. As long as I continue to do squats, leg extension, semi-straight leg dead lifts, (all with correct form, of course) and bike, there is no pain or swelling. I was just curious as to what this is. Thanks for your time. Chad

Answer

It is difficult to say what you have without actually examining your knee. It is possible the bump could be a form of tendonitis, bursitis, a loose piece within the knee, or an extra piece of bone. If it does not go away I recommend you see your doctor to make certain this does not need treatment. The Jock Doc


Question

I recently had surgery to repair a torn ACL. A couple of days after my surgery I noticed a bump on my knee, my surgeon didn't seem too concerned about it but six months later he discovered that the bump was a piece of my knee cap. My patella had somehow been broken into three pieces. He recommends surgery to insert pins but is not sure it will work because the pieces are so worn from all the grinding. What do you recommend? Carmen

Answer

One source of graft for ACL reconstruction is the patellar tendon. This is an excellent graft source as it is stronger then the original ACL . A piece of bone is taken with the graft from the patella (kneecap) and the tibia. This allows the surgeon to secure the graft with a screw or staple and allows for immediate motion and rehab. Occasionally when the graft is taken a fracture of the kneecap can occur. If these fractures do not heal then they may require fixing. I recommend you follow your orthopedist's advice and consider fixing the kneecap to help decrease the pain and arthritic risk long term. However, if you are not comfortable then you should get a second opinion. The Jock Doc


Question

Dear Doc, I'm a 44 yr. old marathon runner. I tore the medial meniscus (degenerative tears, meniscal debridement)) in both my knees after a track workout. I had surgery on one knee and will be having surgery on the other knee in two weeks. I used to enjoy racing. Will I be able to get back where I was? Most times I could place in my age group. Currently I don't enjoy biking or swimming as much Rick

Answer

The success of your surgeries will likely hinge on the degree of arthritic changes already present in your knees as well as the size and type of meniscal tears. Your orthopedic surgeon will have to advise you on the level of running that will be safe. It is possible that you may be advised to run less often, shorter distances, or on softer surfaces such as a golf course or cushioned track. It may also be helpful to substitute swimming or cycling for some of your running, thus maintaining your aerobic conditioning without stressing your knees as much. The Jock Doc


Question

Concerning "arthroscopic surgery" of the knee to repair torn meniscus and smooth away badly damaged surfaces due to osteoarthritis, what exactly takes place? My knee injuries have left me unable to walk at all without assistance for 5 weeks. Now, pain and huge swelling never reduce, joint is extremely stiff and filled with fluid, etc. MRI confirms all this and surgery is suggested by my orthopedic surgeon. Thank you. Barbara

Answer

The success of arthroscopic surgery for arthritic knees depends on factors such as the extent of the arthritis, age of the patient, activity level of the patient, and the rehab program necessary post op. Without examining your knee and seeing your MRI it is difficult to tell you your likelihood of success. As a general rule arthritic knees improve in about 75% of patients that have arthroscopic surgery for arthritis of the knees. The Jock Doc


Question

I would like to know What is done when you have Arthroscopy on a knee. How long is recovery? Do you have to stay off your feet completely or just minimum use? Will I be able to go to work next day? Would appreciate quick response before I have surgery. Thank you so much for your help. Maria

Answer

Arthroscopy of the knee is usually an outpatient procedure. The most common reason for knee arthroscopy is to remove or trim a torn piece of meniscal cartilage. Other common arthroscopic procedures include smoothing damaged articular cartilage (chondroplasty) or repairing a torn meniscus with sutures or absorbable arrows. Most arthroscopies require just a day or two on crutches. A rehab program is usually begun post op to regain normal motion and function. Usually one can return to work in a couple of days , but mostly sitting initially. The specifics of your knee surgery should be discussed with your surgeon as your problem might be different. The Jock Doc


Question

I jog 2-3 miles most every day of the week on a treadmill. I just turned 50 and my knees bother me. The pain is in the back of each knee (usually knee pain you hear about is in the front). If I sit for 15-30 minutes, it is hard for me to straighten up, pain is in back of both knees, and I have to delay walking for only about 10 seconds but then can walk upright. I haven't injured them in a fall, I wear good jogging shoes. and am otherwise healthy. Any suggestions? Thank you. Ceilia

Answer

It is possible that your problem could be related to swelling in the knee causing stiffness and pain in the back of each knee. Causes of this include a meniscal cartilage tear, early arthritis, or a baker's cyst. Another possible cause is a lack of flexibility causing hamstring tightness, pain and stiffness. I recommend you see your orthopedic surgeon who can establish a diagnosis and hopefully get you back running quickly. The Jock Doc


Question

I am the 50 year old female that asked you the question about pain in the back of my knees and trouble standing up. Just read a previously asked question that resembles mine. Sorry to be redundant. My secondary question is: Can I just endure the pain and stiffness when getting up and down or sitting on the floor with legs tucked under, or will I just make it worse by letting it go? Thank you. Ceilia

Answer

Once again it is hard to say if you are potentially causing damage by not seeking medical care. I believe that a quick exam by your orthopedist can help answer your questions. The Jock Doc


Question

I was diagnosed 7 yrs ago with torn medial meniscus. I didn't do the surgery, but still have some clicking and some occasional pain. The mri now shows increased wear on the weight bearing portion of the knee.Should the surgery be done now or will I cause more arthritic problems than I may already have. Ken

Answer

The decision as to whether a torn meniscus requires arthroscopic surgery depends on many factors including your age, activity level, the degree of pain, whether the knee locks, the type and size of the tear, and the degree of arthritis already present in the knee. As a general rule a young , active person with a meniscal tear should have it repaired or trimmed to decrease the risk of arthritis progressing. Your orthopedic surgeon can help advise you as to the best treatment choice at this time for your knee based on the above type questions. The Jock Doc


Question

I have torn cartilage and a baker's cyst in my left knee. My doctor has scheduled arthroscopy surgery for Sept 23rd to repair the torn cartilage, he wants to leave the cyst alone and see what happens. I am 47 and in good health-I do aerobic & strength training workouts. My question is: How long will it take for me to resume these types of workouts? My doctor says I will be able to walk on my leg the same day and be back to normal in a few days. Linda

Answer

A labral cartilage tear may be the result of a shoulder dislocation or subluxation. Occasionally the tear can be there long enough to collect fluid. This fluid collection is known as a labral cyst. If the cyst is large enough it can compress the suprascapular nerve which could result in significant rotator cuff weakness. Most cysts do not get that big however. In patients repairing the labrum may cause the cyst to resolve. Occasionally the cyst may also require removal. Most of these procedures can be performed arthroscopically. You may require a sling post op for up to 4 weeks followed by a rehab program. The Jock Doc


Question

I am a 49 year old male, heavy equipment operator. I think I have been diagnosed with Meniscus cartilage tears. The joint usually doesn't pain much but does pain in the back of the knee, the soft portion. After sitting I can't fully straighten my knee for a few steps, the back part is so tight and sore. Why does this portion pain when the problem seems to be in the joint or have I been misdiagnosed? My doctor has seen x-rays and MRI. Jeffrey

Answer

It is not unusual to experience pain or stiffness in the back of the knee. Meniscal tears if large enough may limit motion. Also, if there is fluid in the knee it may collect in the back of the knee (Baker's Cyst) resulting in stiffness and pain. Usually if the problem inside the knee is corrected the cyst and stiffness will go away. An MRI scan may be helpful in diagnosing the size and type of meniscal tears, if fluid or a cyst are present, and whether there are associated arthritic changes. Depending on the findings you might require arthroscopic surgery to correct the problem. The Jock Doc


Question

My son hyperextended his padella in his knee on football turf. Is this serious? How long will it take to heal? Abraham

Answer

Hyperextension injuries of the knee usually do not injure the patella (kneecap). Most commonly these injuries result in ligament damage such as ACL tears. It is possible that your son may have dislocated his kneecap which can result in damage to the cartilage or inside lining of the joint. Without more detailed information I can not say the seriousness of the injury. However, many injuries to the patella will heal with non-surgical treatment involving a rehab an quad strengthening program. I recommend you speak to your orthopedic surgeon to obtain a better understanding of your son's injury. The Jock Doc


Question

I had knee surgery back in 1982 to remove a piece of torn meniscus that was locking up my joint. The orthopedic surgeon removed the piece of meniscus and then proceeded to abrade and drill the bone. He said that the bone marrow would seep out and fill in the hole where the piece came out. In the past 17 years I have had bouts of pain and swelling in that knee. In other words the knee has never been the same as before surgery. In the last 6 months I have had increased pain and swelling in that knee. You can also feel the joint grinding if you place your hand on the knee. I started back to graduate school a year ago and have added an extra 25 lbs. due to sitting in front of a computer most of the day and not exercising. I am contemplating seeing a surgeon to see if anything can be done for the condition. I do not want anything to interfere with my schooling at this time such as major surgery laying me up for weeks. Can you give me any advice as to what a surgeon will say or do about this condition. I am 46 years old. Bill

Answer

It appears that in addition to removing part of your meniscal cartilage your surgeon also drilled a defect in the articular cartilage of the knee. The surgeon hoped that a new "fibrocartilage" would form to replace the defect. Unfortunately, fibrocartilage is not as strong and over time arthritic changes can begin to develop. I recommend you consult your orthopedic surgeon who will likely order standing x-rays of your knees to help determine the degree of wear present. An MRI may also be helpful. Depending on the findings there are a variety of possible treatments. When you have more information I will be happy to offer my advise. The Jock Doc


Question

I am a 22 y/o male 6-5, 225 lbs. 2 years ago I had a plica resection preformed on my right knee, since the operation I have improved however I still have an early morning popping in the knee with terminal flexion or repetitive extension. This is not the regular morning "cracking." I was told that it was scar tissue from the medial portal entry, and to massage it. I did this and the popping still continues. Currently it is not painful, however I am worried that whatever is popping will result in further degrading of the retropatellar surface which was DX. with grade 1 lesioning on the medial facets. I would like your opinion as to what it could be and the possible treatments. Jeffery

Answer

Occasionally, after arthroscopic knee surgery, a thickened area of scar tissue can develop in the area where the arthroscope or instruments were inserted into the knee (portal). Your doctor was right when he suggested that gentle massage the area to break up the scar and give it time. Generally, if the scar tissue is not painful no addtiional treatment is necessary. Usually new wear and tear of the knee does not occur from this thickened tissue. If symptoms worsen however than additional physical therapy or injection of the scar might be necessary. The Jock Doc


Question

Hi. I am 18 and I had arthroscopic surgery on my knee two years ago. They cut the ligament off of my kneecap to realign it. It's started to hurt again and I am told to do exercises, ice it, and take Ibuprofen to ease the pain and make it better. It is not working. Do you have any advice on how to handle this situation? Kimber

Answer

Patellar realignment procedures to improve the position and function of the kneecap are commonly performed surgeries. A key to success is a proper rehabilitation program post operation aimed at restoring normal motion and function. It is particularly important to strengthen the vastus medialis (inner quadriceps muscle) for the best chance of success. It is likely you rehabbed the knee successfully post operation. However, it is possible that you did not maintain proper quad strength and thus symptoms may have returned. It is also possible that there is a new area of wear beneath your patella (chondramalacia). Since you have tried rehabilitation and your symptoms have persisted I recommend you return to your Orthopedic Surgeon for a follow up exam. The doctor may recommend a high resolution MRI scan to help determine the exact cause of your symptoms. Depending upon your exam and the MRI, you may possibly require another arthroscopic procedure. Good luck. The Jock Doc


Question

I am a tennis player who has been plagued by patellar tendonitis for 20 years, even when I stopped playing tennis for many years. I have a low fat diet, take ibuprofen when I play, ice when I finish, and use magnets (which have worked for other injuries). I religiously stretch my hamstrings and quads as well as do strengthening exercises for my quads. I never play more than twice a week. Do you have any suggestions? Steve

Answer

Patellar tendonitis "inflammation of the kneecap tendon" is a common problem in the jumping athlete. Most patients with patellar tendonitis respond to non surgical treatment. Treatment usually involves stretching, painfree quad strengthening, proper shoe wear, soft cushioned orthotics, and anti- inflammatory medications such as ibuprofen. Unfortunately, you have tried most of the treatments without success. An MRI scan may show if your tendon has a partial tear that has not healed. Also the scan may reveal any other problems with the knee that may have added to chronic symptoms. Depending upon your exam and the MRI your orthopedic surgeon may recommend surgery to correct the problem. Surgery is usually very successful in patients with chronic patellar tendonitis (partial tears). The Jock Doc

 
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