Cadaver Cartilage Grafts Prove Promising for Large Cartilage Tears of the KneeA recent review of the most up-to-date research found that large cartilage tears at the knee joint are best repaired with donations from cadavers. The review found that a technique called “Osteochondral Allograft Transplantation,” or OCA, is versatile in terms of what kinds of repairs it can help and has the best long-term effects when compared to alternative surgical options.Chondral is a fancy word for c...

Physicians are changing how they manage meniscal tears, according to a recent study that reviewed treatment methods over a seven year period. Often when new evidence shows a better way to treat a problem it takes years for surgeons to alter their practice methods. This study concluded that surgeons have changed their treatment to reflect the most up to date practice. The authors attribute the change in treatment to new evidence and changes in physician education regarding effective treatment. ...

Researchers at the University of Michigan (Ann Arbor) have performed a systematic review and meta-analysis on ways to prevent anterior cruciate ligament (ACL) injuries. This is important because so many of today's sports injuries affect the ACL. Players can be sidelined for months (sometimes longer). In fact, it is estimated that one-quarter of a million ACL injuries occur each year in the United States.What can be done to prevent these injuries? That is the question posed by many health care an...

As more and more aging Baby Boomers start to develop knee osteoarthritis, researchers are focusing on the whys and wherefores of this condition. Studies have already shown that removing a torn meniscus (knee cartilage) puts patients at a significantly greater risk of developing knee osteoarthritis later on.But what happens to those patients who have a torn meniscus that doesn't get treated? Can the untreated injury also contribute to knee the development of knee osteoarthritis? That is what this...

Many studies show the benefit of exercise for people with knee osteoarthritis. But pounding the pavement (walking) can increase pain. Aquatic therapy in a pool of warm, supportive water is one way to get the needed exercise without the added stress.In this study from the University of Florida, the effects of walking on a treadmill underwater were compared with walking on a land treadmill. It was a small study with 14 adults in ages ranging from 43 to 64. All participants had been formally diagno...

It is a well-known fact that women athletes are at greater risk for knee injuries compared with men. In particular, anterior cruciate ligament (ACL) injuries seem to plague female athletes much more often than men. In this article, orthopedic surgeons from the Department of Orthopaedics and Rehabilitation at Yale University review the risk factors and biomechanical differences between men and women. They also provide a treatment protocol for successful prevention of this problem.There are two ty...

For many years, surgeons have worked to improve and perfect reconstructive surgery for anterior cruciate ligament (ACL) ruptures. Athletes eager to get back to full sports participation were grateful for the opportunity to have the surgery and resume play. But now many years later, surgeons are asking some important questions.ACL ruptures are surgically reconstructed by using a piece of graft material to replace the torn ligament. The graft is taken from the patient's own patellar or hamstring t...

Strength training and aerobic exercise reduce pain and improve function when knee osteoarthritis (OA) causes pain.There are very few reasons why patients with knee OA should not exercise.Exercise therapy for OA should be specific to each patient and prescribed by a physical therapist.Exercise has been shown effective for knee OA even when X-rays show bone-on-bone at the joint.Sticking with the program is the best insurance that the desired results will be achieved.These are the findings of a gro...

There is no cure for chronic pain caused by knee osteoarthritis. But there are ways to help reduce the pain and improve function. Physiotherapy modalities such as diathermy, interferential current, electrical stimulation, and exercise can be very helpful.To help support this statement a group of researchers from four different health care centers in Turkey conducted this study. They compared the effectiveness of each of these treatment tools. They used pain levels, measures of stiffness, ability...

Regenerative medicine is a relatively new term you may start hearing more about. It refers to finding ways to help the body heal itself at the cellular level. For example, tissue from an uninjured part of the knee cartilage can be used to grow more chondrocytes (cartilage cells). Platelet-rich plasma (PRP) is another form of regenerative medicine and the topic of this new study from the OASI Bioresearch Foundation in Milan, Italy.Platelet-rich plasma (PRP) (also known as blood injection therapy)...

Fewer days in the hospital after a total knee replacement usually means lower costs. But how do you accomplish that? One way is to begin physiotherapy within the first 24 hours after surgery. And many surgeons are going in this direction.To help us understand the full impact of this approach, surgeons in Spain evaluated 306 patients with knee osteoarthritis receiving a knee replacement. Two groups of patients were compared. The first group received physiotherapy and started a rehab program withi...

Some people in the medical field say there are no such things as "accidents." There are always reasons why people get sick or are injured. And this idea may be very true when it comes to ruptures of the anterior cruciate ligament (ACL) of the knee.Sure it's easy to say the ligament ruptured when the athlete was tackled and another player landed on that leg. Or when the basketball player's foot was planted on the floor and she got knocked over while trying to pivot and shoot.But the truth is thes...

You may be surprised to find out that the number of knee replacements in adults ages 45 to 65 tripled in the last 10 years. What could account for this increase? Researchers at Brigham and Women's Hospital in Boston, Massachusetts may have found the answer.Their research uncovered the following surprising statistics:

Anyone facing the prospect of anterior cruciate ligament (ACL) reconstructive surgery will be faced with one major decision. And that is: what type of graft should be used? In some cases, surgeons may just make that decision for the patient. However, more and more consumers want to participate in this type of decision-making.But there's no clear-cut, single answer to what type of graft should be used. Each one has its advantages and disadvantages. To help surgeons and patients alike, the authors...

After surgery to repair or reconstruct a torn or ruptured anterior cruciate ligament (ACL), patient and physiotherapist diligently work to restore normal knee range-of-motion. Why is this so important?Because studies show that loss of knee motion can lead to osteoarthritis in later years. And restoring and maintaining knee motion is one thing patients can do to possibly prevent (or at least delay) osteoarthritis from developing.In this article, an orthopedic surgeon and a physiotherapist team up...

Physicians use knowledge of risk factors to assess which patients might respond best to each treatment approach available for many problems. In this study, German surgeons take a closer look at factors that might increase the risk of revision surgery after autologous chondrocyte implantation or ACI.ACI is a cell-therapy approach to treat deep or large defects in the knee joint cartilage. It involves using cartilage cells (chondrocytes) to help regenerate articular (joint surface) cartilage. Stud...

If athletes decide to have reconstructive knee surgery for a deficient anterior cruciate ligament (ACL), then is return-to-sport a measure of success for that surgery? Short-term (12 month) studies show that most people have not returned to their preinjury level of sports play following reconstructive surgery for a torn ACL. That's why the authors of this study extended the timeline to look at medium-term results.They surveyed 314 athletes of all ages two to seven years after their ACL surgery. ...

Pain along the outside (lateral) knee is sure to get anyone's attention but especially the active athlete preparing for competition. There are a half dozen problems that can cause this type of symptom but the most common is a condition known as the iliotibial band syndrome (ITBS).In this review article, orthopedic surgeons and a physiotherapist team up to provide us with an updated understanding of the iliotibial band syndrome (ITBS). They review the involved anatomy, offer ideas as to the possi...

Orthopedic surgeon Robert A. Arciero from the University of Connecticut Health Center says that repairing damaged ligaments in the knee is "doomed to fail" if injury to the posterolateral corner remains unrecognized and untreated. Dr. Arciero offers his own solution to the problem.You might not realize it, but the knee actually has corners. It may look like your leg is round on the outside but inside are complex bony and soft tissue structures in a location referred to as a corner. Injury to any...

Knee replacements have been around long enough now that their track record is clear. Ninety per cent of these implants last 15 to 20 years without problems. Patients experience a pain free return to normal function. Reports of patient satisfaction are high. But that doesn't mean problems can't or don't occur -- they can and they do.Three of the most common (and biggest) problems include osteolysis (bone resorption), delamination (plastic covering joint surface wears away), and fracture (of the i...

Surgeons are always looking for ways to improve surgical technique in hopes of better outcomes for their patients. In the case of anterior cruciate ligament (ACL) reconstruction, there's been a slight shift in how the tunnels are drilled through the bone for the graft tendon. Along with that change comes the ability to place the graft in a more natural position. The net result is a more anatomic reconstruction.It is always the case that ACL surgery is done with an eye toward restoring all the da...

Complete knee dislocations don't just occur in athletes or as a result of a traumatic injury. For some people, knee dislocation occurs during daily activities. Knee dislocations have been reported when stepping off a curb, going down a stair, walking, or even while just standing still. This type of knee dislocation is referred to as a spontaneous dislocation, ultra-low energy trauma, or low-velocity injury.Fortunately, low-velocity knee dislocations of this type are rare. Even so, it would be he...

Many people in need of a knee replacement hold off much longer than they should. The reason? They've heard horror stories about how painful the knee will be after surgery. They are told that it's a different kind of pain -- much worse in some ways than the arthritic pain. But in time, the pain will work its way out and they will be able to move pain free once again.In fact, this bad reputation of postoperative pain after total knee replacement has a large measure of truth. There are many physiol...

Athletes who continue to suffer pain and loss of knee function from patellar tendinopathy can benefit from surgery. Significant pain relief and return to full sports participation is possible. These are the reported results from a recent European study.Sixty-four patients with patellar tendinopathy who did not get relief from their symptoms with conservative (nonoperative) care were included in the study. Alignment or overuse problems of the knee structures is a common problem among athletes. St...

Athletes who want to get back into action after an anterior cruciate ligament (ACL) tear are often advised to have surgery as soon as possible. But is this advice really warranted? Do players with deficient ACLs who have surgery have better results than those who don't? These are the questions explored by the author of this article.A literature review was done to answer the question. The author (a physiotherapist and director of the Jerusalem Sports Medicine Institute) searched for information t...

Many people with knee injuries want to wait before having surgery to repair a torn anterior cruciate ligament (ACL). And there is evidence to support this decision for some patients. But in many cases, the ACL isn't the only injury present. Often, the meniscus and joint cartilage are torn, too. How does delaying surgery affect the repair rate for these associated injuries?In this study, a large amount of data from the Kaiser Permanente Anterior Cruciate Ligament Reconstruction Registry was used ...

It's not surprising that a high-energy, traumatic injury to the knee can cause considerable damage. Ligaments like the anterior cruciate ligament (ACL) tend to go first. With greater intensity of force the damage can extend to the meniscus and medial collateral ligament (MCL). And now we know from this new study that before the meniscus or medial collateral ligament (MCL) give way, bone contusion (bruising) occurs first.In fact, the more extensive the bone contusion, the more likely it is there ...

Total knee replacements have been proven to last at least 15 years. But survival of the implant and knee function are too different things. And many total knee patients report persistent knee pain and loss of function despite the new knee.Surgeons are exploring the reasons for this dilemma and looking for ways to improve results. One of those ways is to resurface the patella (knee cap) as part of the knee replacement procedure.Resurfacing the patella involves shaving and smoothing the cartilage ...

Many different techniques have been developed to repair holes in the chondral (cartilage) surface of the knee joint. Studies have been limited to the results of these treatment approaches in adults. In this report, teens between the ages of 14 and 18 years of age are the focus.Each of the 35 participants in the study had knee pain from a large (more than one centimeter-squared) defect in the osteochondral layer of the knee joint. "Osteo" refers to bone, whereas "chondral" directs our attention t...

In this study, orthopedic surgeons from the Shelbourne Knee Center in Indianapolis, Indiana take a look at the results of treatment for a different type of knee meniscus tear. Their focus is on the posterior lateral meniscus root (PLMR).This type of meniscal tear occurs most often when traumatic force is generated that is strong enough to rupture the anterior cruciate ligament (ACL) inside the knee. Along with the ACL tear, a posterior lateral meniscus root (PLMR) tear occurs.With a PLMR type of...

Athletes aren't the only ones to develop knee pain from a condition called patellofemoral pain syndrome (PFPS). Many people of all ages in the general public develop this problem, too. You may be one of them.If you have knee pain after sitting with your knee bent for a long time or with any of the following activities (stair climbing, squatting, kneeling, jumping, running), you may have patellofemoral pain syndrome (PFPS). How could you find out for sure?PFPS is usually diagnosed by the history ...

Anyone working with athletes suffering from patellofemoral pain syndrome (PFPS) will be interested in the results of this study. Strengthening the hip muscles first before working on the quadriceps (thigh) muscles speeds up the recovery process. Pain is less and function improved with this approach.The study was done by a group of physical therapists, athletic trainers, and sports physicians at the University of Kentucky Musculoskeletal Lab. We've known for a long time that a weak, impaired, or ...

Use of Computers to Navigate Knee Replacement Surgery So many people are getting knee replacements, it seems like a routine procedure any more. But there's really nothing routine about getting the implant lined up with the mechanical axis of the bones and joint. And without an accurate placement of the implant, the joint replacement may not last as long as it should.Surgeons are always looking for ways to improve their technique. Efforts are being made to improve implant alignment with knee rep...

Many studies in adults have proven now the importance of the meniscus (cartilage) in the knee. It used to be common to have a torn meniscus just removed surgically. But years of investigation have shown that the end result of that treatment approach is early knee joint arthritis. So now, the damaged meniscus (menisci - plural) is carefully repaired whenever possible.But what about young athletes with the same type of (meniscal) injury? What kind of results do they get with arthroscopic meniscal ...

Off-Road Motorcyclists Should Wear Knee Braces Just in Case The just-in-case factor is one practice in sports that is hotly debated. Should I wear a knee brace "just-in-case" I might injure my knee? This question arises any time an athlete participates in a contact sport with the potential for traumatic injuries. Add high speeds and difficult terrain in the dangerous and intense sport of off-road motorcycling and you may find yourself reaching for that brace, too.But does a knee brace really pr...

Applying an electrical current to the quadriceps muscle may be helpful after anterior cruciate ligament (ACL) reconstructive surgery. Rehab results can be speeded up by using an electrical impulse to aid the muscle contraction. At least those are the results reported in this study from the Center for Knee and Foot Surgery Sports Traumatology Center in Heidelberg, Germany.The use of electrical stimulation has been very controversial in the last 10 years. Some studies show it is helpful. Others re...

You might not realize it, but the knee actually has corners. It may look like your leg is round on the outside but inside are complex bony and soft tissue structures in a location referred to as a corner. Injury to any of these "corners" that goes untreated can create a painful, unstable knee even after surgery for the presenting knee problem.There are two corners in the front (anterior) and two in the back (posterior. Then add one from each side: medial (side closest to the other knee) and late...

Sixteen studies were deemed acceptable in quality and design to be included in a systematic review of osteochondritis dissecans (OCD) of the knee. The review was conducted by a panel of pediatric orthopedic surgeons from all over the United States.Out of these 16 studies comes 16 recommendations called clinical practice guidelines (CPGs) for the treatment of osteochondritis of the knee in children.Osteochondritis dissecans (OCD) is a problem in the cartilage of the knee that affects the end of t...

If you've watched any amount of sports, you may have wondered what those black or white straps around the athletes' knees are for. Those are a form of patellar orthotics (bracing) called infrapatellar straps or bands. They are designed to reduce knee pain, especially in athletes who experience knee pain with running and/or jumping.Do they work? And if so, how do they work? In other words, what's the mechanism behind their success? This is the first study to really take a look at the effect of in...

Bursitis may be a word you only heard spoken by the elderly but, in fact, this condition can affect people of all ages. Older adults are the most likely to develop pain, swelling, and tenderness around a joint from bursitis. But younger folks can be affected, too.What exactly is this problem? Bursitis is the inflammation of a bursa. A bursa is a sac made of thin, slippery tissue. Bursae (plural) occur in the body wherever skin, muscles, or tendons need to slide over bone. Bursae are lubricated w...

Surgeons looking for ways to prevent infections in patients receiving a knee joint replacement will find this article of interest. Presented as an instructional course, the authors provide information on the incidence of periprosthetic infections, risk factors, diagnosis of infection, and management of the problem.Periprosthetic infection refers to infection in and/or around the implant and joint in which the implant is located. Most of the infections are caused by staphylococcus aureus more com...

How To Have a Speedy But Safe Recovery After ACL Surgery Who would have thought that hopping on one leg could be so helpful? During our younger years, playing hopscotch was just fun. But thanks to this study, we now know the importance of single-leg hopping when preparing athletes to return to their sport. This activity is especially important after surgery for an anterior cruciate ligament (ACL) tear.The researchers (a combined group of physiotherapists, athletic trainers, and sports medicine ...

Knee arthritis affecting only one side of the joint is a common problem. It occurs as a result of uneven load and weight-bearing on the joint. This type of unicompartmental arthritis is the result of malalignment somewhere in the leg.There could be a tendency toward a flat foot on that side putting the knee at an angle that increases pressure on the medial side of the joint (closest to the other knee). The angle of the knee itself is sometimes toward a knock-knee position creating the same type ...

Focus On and Review of the Knee Medial Collateral Ligament Every health care provider must review, study, and keep up with problems presented by patients in their practice. Orthopedic surgeons are no different in this regard. In fact, today's advanced technology has expanded our understanding and knowledge of all aspects of orthopedic conditions.In this review, the medial collateral ligament (MCL) of the knee is spotlighted. Anatomy, biomechanics, injuries, examination, and diagnostic classific...

Surgeons treating patients with anterior cruciate ligament (ACL) tears are always advised to look for damage to other knee structures during the arthroscopic exam. Now there is one more thing to look for: ramp lesions.What's a ramp lesion? It involves the medial meniscus, a C-shaped piece of thick cartilage inside the knee. There are two of these protective liners: medial (side closest to the other knee) and lateral (side away from the other knee).A ramp lesion occurs when one particular edge of...

Evidence-Based Treatment For First-Time Patellar Dislocations The current trend in medicine is to study each medical condition looking for evidence to support specific treatments as being the best way to approach a problem. One of the best ways to develop specific evidence-based treatment programs is to look back on patient outcomes after treatment and see what kind of results were obtained. Then a treatment algorithm (step-by-step process) can be developed.In this article, a treatment algorith...

No Evidence That Modalities Alone Help With Patellofemoral Pain Syndrome Patellofemoral pain syndrome (PFPS) affects one of every four young athletes. Pain along the front of the knee with activities like squatting, running, sitting for long periods of time, and going up and down stairs is common. The condition is so common in runners that it is often called runner's knee.physiotherapists and sports physicians are actively seeking ways to help treat this problem. The goals of treatment are to r...

Severe damage to the anterior cruciate ligament (ACL) of the knee often requires reconstructive surgery. The surgeon uses graft tissue taken from a donor bank (called an allograft) or harvested from the patient (an autograft). But the reported failure rate for this surgery is as high as 20 per cent. That's one out of every five patients -- an unacceptable level for any surgeon.Taking a closer look at the studies published on this topic, there seems to be about a 12 per cent failure rate for allo...

In the orthopedic world, Dr. Frank Noyes is an important name. He has been a front runner in developing new surgical techniques for a variety of orthopedic injuries. In this article, long-term results from an ongoing (and previously reported on) study are published.The topic? Chronic knee instability treated with a femoral-fibular posterolateral reconstruction. This is the most commonly used surgical technique to stabilize a knee with multiple ligaments that are damaged. Without this important s...

The timeline currently used for athletes after anterior cruciate ligament (ACL) surgery goes something like this. Rehab and recovery after surgery takes a good four to six months for everyone. Sports specific training is designed to return athletes to their sport by the end of a year's time.But can they participate at their preinjury level? Are most athletes really back on the field, court, or track by the end of 12 months? That's what this study was all about. It was conducted at the Musculoske...

Knee replacements are great to have around but they don't last forever. Younger, active adults who experience degenerative arthritis of the knee may be too young for a knee replacement. It's likely they will outlive the implant. Getting a second knee replacement is not usually an option. So what can be done instead?Anyone with chronic knee pain who has been evaluated by an orthopedic surgeon and diagnosed with early stages of degenerative arthritis can begin with conservative (nonoperative) care...

People who suffer one patellar (kneecap) dislocation after another search for ways to prevent this from happening. The obvious first question is: what is causing this to happen? Most often the patella pulls away from the knee in a lateral direction. Lateral means sideways in a direction away from the other knee.To better understand how knee problems occur, it is important to understand some of the anatomy of the knee joint and how the parts of the knee work together to maintain normal function. ...

Sometimes surgery to reconstruct a ruptured anterior cruciate ligament (ACL) in the knee doesn't give the expected results. Either the patient continues to have a painful, unstable knee that gives out from underneath them or the knee is stiff and doesn't move well. Joint infection and arthritis are two other problems that can develop.Why does this happen? In this article, surgeons from the University of Utah explore all sides of the dilemma of the failed ACL reconstruction from patient factors t...

There are many different ways to approach the problem of an anterior cruciate ligament (ACL) injury of the knee. A partial tear may respond well to conservative (nonoperative) care. But if rehab doesn't yield the desired results (or in the case of a competitive athlete), the ligament may need surgical repair. The surgeon stitches the ends of the ligament back together.A fully ruptured ACL often requires surgical reconstruction. It doesn't work to try and pull the ends of the ruptured ligament ba...

Young athletes (children and teens) who have stabilization surgery for repeated dislocations of the patella (knee cap) have a 93 per cent success rate following the procedure. "Success" means their pain is less and their function is better. Yet when surveyed, these same patients report a much lower subjective (opinion) level of satisfaction. This study is another one to show a "disconnect" between surgical success and patient's perception of the results.Let's take a closer look. One surgeon perf...

For the patient who has a total knee replacement, knee stiffness can be very disappointing and limiting. Imagine not being able to go up stairs foot after foot (that requires 83 degrees of knee flexion). Or not being able to sit down and tie your own shoes (you need 106 degrees of knee flexion for that).This type of stiffness is fairly common after a knee replacement. What be done about it? Right now, there are two main options. You can try the conservative route with exercise and manual therapy...

By far more patients have a total knee replacement (TKR) over a unicompartmental knee arthroplasty (UKA). The risk of having additional surgery after a unicompartmental implant may be the driving factor behind this decision. This study was done to compare results after both procedures.The difference between a total knee replacement and unicompartmental knee arthroplasty is more than just the implant itself but let's review that first. As the name suggests, with a total knee replacement (TKR), th...

Adults who have a total knee replacement often ask their surgeons, "How soon before I can drive?" Even more than the patient who has a total knee replacement, concerned family members want to know, "Is it safe to drive?" The usual guideline for return-to-driving is six to eight weeks after surgery. Driving restrictions primarily apply to patients who have had a right knee replacement (assuming they drive an automatic vehicle).But the question has come up about getting back behind the wheel soone...

Knee injuries resulting in anterior cruciate ligament (ACL) tears are fairly common -- especially in athletes and sports participants. With full tears, ACL reconstruction is usually required. Most athletes are concerned with how soon can they get back into action on the court or in the field. An equally important question is: how well does the new ACL hold up over time? Is osteoarthritis inevitable?To find out, this group of sports physiotherapists and orthopedic surgeons performed a long-term (...

The patella (more commonly known as the "kneecap") moves up and down in front of the knee joint along a built-in track called the patellofemoral groove. It is held in place by several ligaments on either side and by the patellar tendon (attached to the quadriceps muscle). The quadriceps muscle is the large, four-part muscle along the front of the thigh.Although you can take your hands and passively move the kneecap from side to side, this is not an active movement you can make your patella do wi...

Injuries to the anterior cruciate ligament (ACL) of the knee are all too common in athletes. But they can also occur in older, active adults. What type of tissue graft works best? Should it be an autograft (taken from the patient) or an allograft (donor tissue from a donor bank)?Besides the allograft vs. autograft decision, there are two popular places where the tissue can be harvested. The first is from the patellar tendon just below the kneecap. This graft is referred to as the bone-patellar t...

The number of surgeries to replace part or all of the knee joint has tripled in the last 10 years. Along with that increase has come many changes in the way reconstructive knee surgeries are done. In this specialty update, all aspects of knee surgery are researched and reviewed.What can you expect to find in this article? First, an analysis of trends and costs associated with knee surgery. Then the authors present an update on surgical techniques and complications. These two sections are followe...

Treatment of holes in the articular cartilage of the knee has taken a decided turn in the last 15 years. Surgeons have found ways to either repair or replace the cartilage. Results have steadily improved so the question now is: which method works best?In this systematic review, surgeons from the Sports Medicine Center at Ohio State University compare autologous chondrocyte implantation (ACI) against other surgical treatment techniques for this problem.Here's a little more background information ...

There's a lot of confusion right now about the best treatment for tears of the knee meniscus. For sure, we know that removing this C-shaped cartilage in the knee is a bad idea. That just leads to degeneration of the joint and painful arthritis. Repairing the damage and letting the body heal has proven to be a much better alternative.But even with a partial meniscectomy (removing the ragged edges) and/or repair (stitching the rest back in place), there are still a fair number of patients who do b...

Predicting Who Will Respond Positively to McConnell Taping for Knee Pain Knee pain from patellofemoral pain syndrome (PFPS) can be helped with a simple taping treatment. But not everyone gets pain relief from this technique. In this study, researchers from Taiwan looked for specific factors or patient variables that might account for the success of this treatment.Patellofemoral Syndrome (PFS) is a condition that causes pain in and around the patella (knee cap). In the normal, healthy adult, the...

Are you thinking about having a knee replacement? Wondering whether to stick with the standard surgical procedure or go for the minimally invasive technique? The results of this study concur with others that there really isn't an advantage of one over the other.That may surprise you since it would make sense that a smaller incision would be better. With a minimally invasive approach, there's less disruption of the surrounding soft tissues and less blood loss.Some studies have shown that there is...

In this review article, orthopedic surgeons from around the country bring us up to date on the latest research and evidence on the management of knee osteoarthritis in young, active adults. This patient population presents quite a challenge as they want to remain active but may be too young for a total knee replacement.What are their options? On the conservative (nonsurgical) side is exercise, physiotherapy, bracing, medications, and injections (steroids or viscosupplementation). When surgery is...

There are many ways to measure the results of surgery for a torn anterior cruciate ligament (ACL). Pain, stability of the knee, and range-of-motion are commonly used. In this study, quality of life (QOL) is the main measure used to assess outcomes. And for the first time, the two main repair methods are compared using quality of life as the primary measure of results.Quality of life looks at how the patients view the results. Would they rate their outcomes as poor, fair, good, or excellent? Woul...

If you enjoy participating in sports but need surgery to repair or remove a damaged meniscus, this report may interest you. Experts in the surgical treatment of meniscal tears compared the effect of arthroscopic repair versus (partial) removal of the meniscus. The main area of interest was the effect of these two procedures on sports activity after surgery.

Studies show that a torn anterior cruciate ligament (ACL) that isn't repaired can leave the knee unstable and at risk for gradual degeneration of the joint. Surgery to reconstruct the ligament and repair any damage done to the meniscus is supposed to protect the joint. But does it really?In this report, a surgeon from France who has been following 100 of his patients gives us a run down on how they are doing 20 to 25 years after reconstructive surgery. Results from this patient group have been r...

Injuries, defects, lesions, or tears of any kind in the joint cartilage can end a sports athlete's career. Today, there are improved ways to treat cartilage injuries, especially in the knee. One of those methods is called mosaicplasty. This article reviews the uses and long-term results of mosaicplasty in an athletic population.What is mosaicplasty? It's a form of osteochondral autografting. That doesn't really explain anything, does it? Let's start with the last part of the term: grafting tissu...

People with knee osteoarthritis are encouraged to maintain an active lifestyle and to exercise those arthritic knees. But that seems counter intuitive -- if your knees hurt, why would you move and exercise them more? This report based on over 2200 people with knee arthritis confirms (again!) the advice to exercise and stay active.

Even though half a million knee replacements are done each year in the United States, there are other treatment options for some patients. If one side of the joint has worn down from problems with alignment, an osteotomy is one possible alternative choice. In this review article, the uses and types of osteotomies available are presented. The authors also discuss when to perform an osteotomy and when to avoid using this technique.

It's clear now that damage to the meniscus (cartilage) of the knee should be repaired whenever possible. But there's another type of cartilage in the knee called the articular cartilage. This is the cartilage that lines the joint and sits right up against the bone.

Knee injuries can really lay an athlete low. Those injuries affect the medial side of the knee most often (the side closest to the other knee). The soft tissues involved are first the superficial medial collateral ligament, then the deep medial collateral ligament, and finally, the posterior oblique ligament.

A knee replacement has become so common any more we tend to forget that it is still major surgery and a fairly complex one at that. With so many aging adults in America, the number of total knee replacements has increased dramatically. And along with that has come the need for revision surgery. Such a second surgery may be done when the implant fails or the patient has knee pain that doesn't go away with exercise.

Attention Rutherford Physio & Sports Clinic clients who have had or are considering having 'autologous chondrocyte implantation' for their knee (the worn cartilage replaced by their own healthier cartilage.) This article discusses the long-term follow-up of patients who have had this procedure done so will be of interest to you.

Has your Doctor or physiotherapist at Rutherford Physio & Sports Clinic diagnosed your knee with a meniscal tear? This article provides an up-to-date review of the types of treatment being used for your injury, from therapy to surgery.

Is your 'quad" injured? Rutherford Physio & Sports Clinic clients suffering from quadriceps injury may find this article of interest, which explains the conservative and surgical treament options for quadriceps injury and tendinosis.Many will remember the attack on U.S. ice skater Nancy Kerrigan when she was struck on the knee during a practice session by a hired assailant. The injury forced her to withdraw from the competition at that time. Most traumatic knee injuries are not that dramatic but can ...

Have you sustained a traumatic knee dislocation? This is likely the first systematic review of case studies of treatment of knee dislocation and compares timing of surgery and outcomes in terms of stability, stiffness and function. Rutherford Physio & Sports Clinic would be interested to note that in most cases early mobilization and intensive rehabilitation postoperatively yielded the best results.

Research has shown that corticosteroids injected into the joint work for reducing knee pain caused by osteoarthritis. But how long does the effect last? Osteoarthritis is a chronic problem, so long-term solutions are needed. Just how well do steroid injections work? According to the results of this study: the pain reducing effect lasts about one week. Steroid injections offer short-term pain relief but they aren't advised for more than that.Since we know that almost half of all adults age 80 and...

Six risk factors for patellofemoral pain syndrome (PFPS) in young athletes have been identified in this study. Some of them are modifiable, which means they can be changed. And that means this painful knee condition may possibly be prevented. That's good news since PFPS is one of the most common painful and chronic knee problems faced by military recruits and athletes elsewhere.

The verdict is in on the subject of meniscectomy (removal of the meniscus) -- don't do it unless it's absolutely necessary. And sometimes there is no way around it. But whenever possible, surgeons repair the damage and save as much of the natural meniscus (knee cartilage) as possible. The menisci (plural for meniscus) sit between the femur (thigh bone) and the tibia (lower leg bone). These structures are sometimes referred to as the cartilage of the knee, but the menisci differ from the articula...

Injuries of the anterior cruciate ligament (ACL) of the knee are common among adults of all ages. Athletes seem to be the primary patient population but they are not alone. Adults of all ages but especially between 20 and 40 are among the most common patients to present with traumatic or degenerative injury of the ACL. Physiotherapists who help rehab these folks are making every effort to find the most optimal postoperative program -- one that will reduce pain and restore function, neuromuscular...

Knee replacements are common among older adults with painful joint arthritis. It has been assumed that the decrease in pain after recovery from joint replacement surgery translates into improved motion, strength, and function. But physiotherapists working with these patients have noticed problems with climbing stairs and a slower walking speed long after recovery and rehab.

In this article, the American Academy of Orthopedic Surgeons (AAOS) presents a Clinical Practice Guideline for the nonoperative treatment of knee osteoarthritis. Guidelines like this help all health care professionals treating patients with knee arthritis using noninvasive approaches. Patient education, self-management techniques, physiotherapy, and exercise are just a few ways this problem can be approached conservatively.The 22 guidelines offered are based on an extensive review of published s...

Japanese researchers may have an answer to the problem of osteochondritis dissecans (OCD). This painful knee condition affects teens and young adults who are usually still growing. That means the growth plates around the joints have not closed completely yet. Damage to the joint cartilage and first layer of bone (called subchondral bone) occurs causing knee pain with activity. Until now, it's been unclear just what happens to cause this condition.Rest from activity and walking with crutches (non...

It's clear now that unrepaired anterior cruciate ligament (ACL) injuries are often accompanied by damage to other soft tissue structures of the knee. Patients are advised to have surgery sooner than later. And surgeons are advised to carefully evaluate the joint for any additional ligament or cartilage tears before doing surgery for the ACL. But sometimes patients opt out of surgery and decide to wait before having the operation. In those cases, without the stabilizing force of the ACL, do patie...

Parents of teens with osteochondritis dissecans (OCD) and any adult who ever had OCD as a teenager will find this review of interest. Diagnosis, prognosis, and treatment of OCD are the key features. A special focus on surgical options brings us up-to-date on the treatment of OCD.Osteochondritis dissecans (OCD) describes an injury to the area of bone just under the cartilage surface, an area called the subchondral bone. OCD affects the knee most often and develops in active teens between the ages...

If you have painful knee arthritis, exercising the knee may be the last thing on your To Do list. But studies like this one show that knee flexion and extension exercises do help. They improve strength and help your knee respond quickly to any change in position. The result can be less stiffness, faster walking speed, and a lower risk for falling. If you are a young athlete, that may not sound very important. But if you are an older adult, these benefits may grab your attention.

In some countries with universal or nationalized health care, a joint replacement is considered an elective procedure. That means the person chooses to have the operation but it's not an emergency procedure. So despite pain and loss of motion or function, that individual must wait in a queue (line) until the resources are available to them. This could take weeks to months. In the meantime, they are advised to stay active. What's the best way to do that? Should patients exercise on land or in a p...

Long-term results after anterior cruciate ligament (ACL) surgery aren't always perfect. But for the majority of patients, the outcome is favorable and patients are happy with the results. In this study, the authors take a look at knee joint range-of-motion 10 to 14 years after ACL reconstruction. They found that even a small decrease in knee motion (flexion or extension) can make a big difference in the final results.

Have you ever heard someone say they tweaked their knee? Has that ever happened to you? You take a step wrong or move in just a way that causes a sudden, sharp pain along the inside (medial side) of the knee. You may have just experienced a grade I or II (mild) injury to the medial collateral ligament (MCL).

Little by little, total knee implants have been improved over the years. But it hasn't happened by magic. Makers of the implants sponsor studies like this one to evaluate what works, what doesn't, and what changes are needed to improve the results. Better quality of life and longer lasting implants are two main goals with total knee replacements (TKRs).

Highly active people who injure their anterior cruciate ligament (ACL) in the knee are often faced with an important treatment decision: surgery or no surgery? Wouldn't it be great if there was a test that people could take to help them answer this question?

Over the years, surgical technique for the repair of a ruptured or deficient anterior cruciate ligament (ACL) has evolved and changed. Most recently, in the 1990s, surgeons went from using a two-incision tunnel to a one-incision technique. Results of each method have been studied and are now compiled in this report.

Cartilage injuries in the knee can be a big problem. Healing is very slow, if it happens at all. That's because the cartilage in the knee doesn't have much of a blood supply. Getting athletes with a full-thickness (down to the bone) cartilage tear back on their feet and returned to their sport can be a challenge.

Physiotherapists provide rehab and retraining for patients after severe leg injuries. Regaining normal motion and motor control, improving strength, and restoring kinesthetic awareness (sense of position) are some examples of what physiotherapy addresses for these patients.

Degenerative joint disease (also known as osteoarthritis or OA) is a common problem in the aging adult. Two out of 10 people over the age of 60 develop OA. Knee arthritis is especially common. Pain and loss of motion from this condition can really limit activities and lead to increasing disability.

Physiotherapists faced with patients who have knee pain must make sure the problem is really coming from the knee. This is true for all musculoskeletal problems, whether it's back, neck, shoulder, hip, knee pain, and so on.

Tearing or rupturing the anterior cruciate ligament (ACL) is a common knee injury, especially in people who participate in certain sports. And, as more people become active, surgeons are performing more ACL rupture repairs than ever before. Surgeons usually repair the ACL using a graft to hold the ligament together. Unfortunately, the graft doesn't always hold and the repair fails. This means the patient needs revision surgery for another attempt at repairing the injury. Up to now, doctors haven...

Is there a reason why patients stop kneeling after a partial knee replacement (PKR)? If there is, doctors and physiotherapists haven't been able to find it. And without the ability to kneel, daily activities can become quite restricted.

The treatment of meniscus injuries has progressed and changed over the years. Meniscectomy (removing the meniscus) was the first procedure used. But long-term studies showed degeneration of the joint cartilage as a result. Meniscal repair is now performed whenever possible.