KNEE

Arthroscopic Knee Surgery

​​Arthroscopy is a minimally invasive procedure that allows doctors to examine tissues inside the knee. It is often performed to confirm a diagnosis made after a physical examination and other imaging tests such as MRI, CT or X-rays.

During an arthroscopic procedure, a thin fiberoptic light, magnifying lens and tiny television camera are inserted into the knee, allowing your doctor to examine the joint in great detail.

For some patients, it is then possible to treat the problem using a few additional instruments inserted through small incisions around the joint. Sports injuries are often repairable with arthroscopy. Knee injuries that are frequently treated using arthroscopic techniques include meniscal tears, mild arthritis, loose bone or cartilage, ACL and PCL tears, synovitis (swelling of the joint lining) and patellar (knee cap) misalignment.

Because it is minimally invasive, arthroscopy offers many benefits to the patient over traditional surgery. These include:

No cutting of muscles or tendons
Less bleeding during surgery
Less scarring
Smaller incisions
Faster recovery and return to regular activities
Faster and more comfortable rehabilitation​​

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Anterior Cruciate Ligament (ACL) Injury and Repair

The ACL (anterior cruciate ligament) is one of the most commonly injured ligaments in the knee. Running diagonally through the middle of the joint, the ACL works together with three other ligaments to connect the femur (upper leg bone) to the tibia (lower leg bone). ACL injuries occur most often in athletes as a result of direct contact, landing awkwardly after a fall or playing recklessly. About half of ACL injuries are also accompanied by damage to the meniscus, cartilage, bone or other ligaments in the knee.

Signs that you may have injured your ACL include pain, swelling and instability immediately after the injury, followed hours later by greater swelling and pain, limited motion, tenderness and an inability to walk comfortably. While not all ACL injuries will require surgery, leaving the ligament torn or damaged puts the patient at risk for recurring episodes of knee instability. In many cases, patients will not be able to resume high-level athletic activity without surgery. Surgery involves removing the entire torn ligament and replacing it with a new ACL, as simply reconnecting the torn ends will not repair the ACL.

Bursitis

Our joints contain small, slippery sacs called bursae that help muscles and tendons slide smoothly over our bones. Bursitis is the inflammation (swelling) of one of these sacs. Overuse or constant pressure on the knee causes the bursa to fill with fluid. It then becomes irritated, gritty and rough, and can create friction in other parts of the joint as it swells.

Two common sites for bursitis in the knee are the kneecap (prepatellar bursitis) and the pes anserine (“goosefoot”) bursa, located about two inches below the knee where the shinbone meets three tendons from the hamstrings. Pes anserine bursitis often afflicts runners and other athletes as well as people with osteoarthritis (“wear and tear” arthritis), tight hamstrings, obesity, or turned-out knees or lower legs. Symptoms include pain on the inside of the knee or at the top of the shinbone that gets worse with exercise or stair-climbing. Prepatellar bursitis tends to occur in people whose jobs involve long periods of kneeling, who play sports that frequently involve falling or being struck on the knee, who have been in a car accident, or who have rheumatoid arthritis or gout. Symptoms include pain after activity and swelling and tenderness on the kneecap.

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Knee Replacement

Arthritis and certain knee injuries and diseases can damage the cartilage that normally cushions the knee joint, leading to pain and stiffness. A knee replacement may be recommended when more conservative treatments — such as anti-inflammatory medications and cortisone injections — fail to relieve pain or improve movement.

During a total knee replacement, the entire joint is replaced with an artificial prosthesis. The surgery itself lasts between one-and-a-half and three hours. After the procedure, patients usually experience immediate relief from joint pain. Physical therapy starts right away to speed healing and to ensure that the patient enjoys full use of the joint. Knee replacements today last about 20 years in 85-90% of patients.

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