Knee problems affect people of all ages.
These can be due to sudden injury or simple overuse and repetitive activity. Arthritis can be another common cause of knee pain and dysfunction.
Sports involving contact, running, jumping, and quick turns can make you more prone to knee injuries. Young patients are more prone to instability including tears of the ACL or other ligaments, but also dislocating kneecap. As patients age into their 50’s and 60’s, it is common to develop symptoms related to arthritis. Meniscus tears are common at almost any age.
Our fellowship-trained surgeons and mid-level providers offer comprehensive detailed evaluations and a wide variety of treatment strategies. As board-certified, fellowship-trained specialists who actively participate in national and international academic sports medicine and knee societies, we offer the highest levels of evidence-based medicine and state-of-the-art techniques to optimize your care.
Anatomy of the Knee Joint
The knee is one of the largest joints in the body, formed by the lower end of the femur, upper end of the tibia and the patella (kneecap). Several ligaments help hold the knee stable including the ACL, PCL, LCL, and MCL. The Quadriceps and Hamstring muscle groups attach to the bones of the knee joint and help to move it. The bony surfaces of the joint are covered in articular cartilage to provide smooth motion with minimal friction. Special cartilaginous tissues known as menisci fit between the femur and tibia. These act as a cushion between the articular surfaces and absorb the shock during movement.
Knee Evaluation
A hands-on evaluation of your knee will help assist in determining the cause of your knee problems. Appropriate evaluation typically includes:
- A history of your injury or pain
- Focused physical examination
- X-rays when needed
- Appropriate advanced imaging studies, (e.g. MRI or CT scan) if necessary
- Selective injections can be used to determine where your pain originates
Treatment
The causes of your knee injury or condition, as well as your level of activity, will lead your doctor to develop a personalized treatment plan with you. In most cases, non-surgical treatment methods are preferred. But in certain cases, you may have poor outcomes if surgical intervention is delayed. Helping you through this decision-making process is one of the most important parts of our jobs as surgeons.
We direct treatment alternatives based on your problem. Conservative options range from methods activity modification to physical therapy, regenerative medicine techniques, and injections. Surgical interventions are also considered, including advanced arthroscopic techniques.
Arthroscopic and Minimally Invasive Surgery
Our orthopedic specialists are trained in the most up-to-date, minimally invasive techniques. We have the training and skills needed to repair nearly any knee problem with arthroscopic methods. In fact, minimally invasive arthroscopic techniques are our standard practice for nearly every knee surgery besides fracture care or replacements.
Arthroscopic repair can be performed for all of the following conditions and more:
- ACL Reconstruction
- Meniscus Tears
- Damaged Cartilage
Knee Replacement
Knee replacement has come a long way. The surgical techniques are better leading to much lower risks and shorter stays in the hospital. In fact, most of our patients go home the same day or spend just one night in the hospital. The materials last longer, with the most advanced replacements wearing 95% slower than previous implants.
What is the ACL?
The anterior cruciate ligament connects the bottom end of the thighbone to the top of the shin bone. The PCL and the ACL together form an X within the knee joint and play important roles knee stability. It keeps your knee from shifting and twisting too far when you walk and run.
How do Anterior Cruciate Ligament tears happen?
When you turn or twist suddenly, your knee can buckle and twist out of place. During sports, getting stuck on the outside of the knee can tear this ligament. But many ACL tears happen when you plant and twist on the knee while running. Landing awkwardly after jumping is another common way to tear the ACL.
How are ACL tears treated?
The ACL does not grow back on its own. Minor sprains of the ACL can heal, but complete tears often need surgical reconstruction of the ligament. ACL surgery is usually done within the first few weeks of injury. Recovery time after ACL surgery can be as short as 6 months or as long as two years, depending on what your doctor recommends for your specific needs.
What happens during an ACL surgery?
ACL surgery is usually arthroscopic. The damaged parts of the ACL are removed and a new ligament graft is fashioned from other tendons or hamstring muscles. The graft is then formed into a new ACL and inserted into the joint, replacing the torn ligament with healthy tissue.
What kinds of tissue are used for ACL graft?
Tissue can be taken from your own body to be fashioned into a new ACL. The most common tissue used are the patellar tendon and the hamstring tendons. If you are still young and playing competitive sports at the high school or collegiate level, these kinds of ACL graft will generally give you the strongest tissue with the lowest chance of tearing it again.
In some cases, your doctor may recommend an allograft instead. This type of graft causes less pain with surgery and can offer a faster recovery, so adults can get back to work and life sooner. This kind of graft can have a higher rate of recurrent tearing for people at elite levels of athletic competition. But it is strong enough for average adults in recreational athletics.
What is a meniscus?
The meniscus is a piece of cartilage in the knee joint that acts as a shock absorber and helps distribute body weight. It is shaped like a crescent moon. It is attached to the tibia at anchor points in front and back.
How do meniscus tears happen?
A meniscus tear can occur when the knee gets twisted, or from overuse injuries associated with certain sports. Meniscus tears are common with other injuries such as ACL tears. AS we get older, meniscus tears happen more easily. They can happen with a simple misstep in the yard or off of a curb.
How are meniscus tears treated?
Not all meniscus tears need surgery. If the tear is small and symptoms are mild, then patients may be advised to rest their knee for a while or wear a brace. Small tears might heal on their own, or simply become asymptomatic.
For other cases where surgery is necessary, there are two main options: repair or removal of the torn area. Doctors have several different techniques that they can use depending on the type of meniscus tear.
Surgery for meniscus tears is typically arthroscopic surgery. Doctors make small holes in the skin and use different tools to clean out damaged meniscus tissue or sew it back together.
Dr. Larson has helped study new ways of repairing meniscus tears that were previously thought to be irreparable, specifically horizontal tears, with great success. He has also consulted for Smith & Nephew, teaching these new meniscus repair techniques to other surgeons.
How long is recovery after meniscus surgery?
Recovery after meniscus surgery can be anywhere from 2-12 weeks depending on the type of surgery.
With a simple removal of damaged meniscus tissue, you can walk on the knee the same day. Patients typically resume normal daily activities after 4-6 weeks. Return to sports or strength training would depend on the types of activities they were engaged in before their meniscus injury.
If the meniscus can be repaired, recovery will usually be longer. You may not be able to walk on it for 4-6 weeks. You may need physical therapy for up to 3 months. Return to normal sports and strength training may take between 3 and 6 months. But the benefit is having a healthy meniscus afterward to protect your knee and reduce your risk of arthritis.
Why replace the entire knee if only part of it has arthritis?
If only one compartment of the knee is damaged, then partial knee replacement could be a viable surgical option. With the right indications, partial knee replacement could be the only surgery you need for relief from knee pain.
Is a partial knee replacement just delaying a total knee replacement?
Absolutely not! In the right patient, a partial knee is can be the only surgery you need. If the rest of your knee is healthy, it will often stay that way after replacing the damaged area. MRI and arthroscopic evaluation can be done before surgery to help make this decision. By carefully evaluating the knee for other injuries, we can help make sure that your partial knee replacement lasts for 20 years or more.
Why would I get a partial replacement instead of replacing the entire knee?
There are many benefits to a partial knee replacement compared to a total knee replacement. There is generally less pain and lower risk of complications. Recovery is usually faster, with most people using a cane or walker for much less time than after a total knee. And studies generally show that people feel like a partial replacement moves more naturally than a total knee replacement.
In most cases, a partial knee provides better results with less pain and faster recovery than a total knee when provided for the right patient.
Can it wear out?
It is possible to wear out any joint replacement. And even though studies show 90% of Oxford partial knee replacements will last 20 or more years, some will need to be revised. The most common reasons for this are developing arthritis in other parts of the knee or the implants loosening from the bone. But the implants themselves are very durable. In fact, the company backs them with a lifetime guarantee.
Are you a candidate for a partial knee replacement?
The ideal candidate for a partial knee replacement has arthritis isolated to the inner portion of the knee joint. A stable knee is key to long term success, so you need intact an intact ACL and other knee ligaments must be healthy. You should have little or no cartilage damage in the other two areas of the knee. And the meniscus on the lateral aspect of the knee should be normal without tears.
Medical problems like vascular disease and diabetes also play an important role in the success of any joint replacement and must be evaluated on an individual basis.
Can Oxford Partial Knee Replacements be performed outpatient?
Yes, just like many other joint replacement surgeries, you may be able to go home on the same day as your partial knee replacement. In fact, partial knee replacements were some of the earliest joint replacements to be performed as an outpatient. The decision to stay overnight or go home the same day is one that your surgeon will help make with you.
The patella, also known as the kneecap, is a small bone that sits in front of the knee joint.
It helps to protect the knee and acts as a pulley for the quadriceps muscles. The patella can dislocate (come out of place) after a slip, twist, fall, or another knee injury.
If a patella dislocates, it can cause pain, swelling and difficulty walking. In some cases, the patella may go back into place on its own. But many times, it requires treatment in the emergency room.
What are the risk factors for patella dislocation?
The following increase your risk of patella dislocation:
- having a previous dislocation of the patella or family history of unstable kneecaps
- any history of trauma to the knee, including a past leg fracture
- anatomical variations in the shape and angle of the knee causing poor alignment
- injury due to skiing or other sports injuries
When are patellar dislocations most common?
Patellar dislocations are most common in young adults, particularly those who play sports. Some people have anatomic variances that make them more likely to dislocate their kneecaps. If this is the case, dislocations often begin between 12 and 14 years of age.
Can patella dislocations be treated without surgery?
Most patella dislocations can be treated without surgery. Treatment may include rest and using crutches to let the injured ligaments heal, ice packs to reduce swelling, and compression bandages to reduce swelling.
Physical therapy may also be recommended to help improve range of motion and strength. If these measures are unsuccessful, surgery may be necessary.
What surgical options are available for patellar dislocations?
Surgery may be necessary if a patellar dislocation does not respond to conservative treatment measures. The most common surgical procedures include realignment of the muscles and tendons that provide active stabilization to the joint, osteotomies to correct any abnormal bone angulation or a lateral patellofemoral ligament reconstruction.
The different kinds of surgery correct the different kinds of problems that may contribute to your knee instability. And some options may not be available if the patient is not done growing yet. Your doctor will discuss which options are the best for you.
Services Provided
- OxfordTM Unicompartmental Knee Replacement
- FlowerAmnioFlow TM
- PRP Injections
- Arthritis Care
- Meniscus Repair
- Knee Replacement
- Cartilage Restoration
- ACL Reconstruction
- Dislocating Patella
