Patients often tear the ACL by changing direction rapidly (e.g. cutting or pivoting), slowing down from running and twisting with one foot planted or hyper-extending the knee when landing from a jump. It is less common to have a direct injury to the knee where another person or object lands on the knee causing the ACL to tear.

Most patients will report hearing a knee pop when their ACL tears. As the tear occurs, the knee usually gives out and fills with fluid and blood. This immediate swelling within first 6 to 12 hours after injury is another hallmark of ACL tears.

The combination of the ACL tear and the swelling causes patients to feel pain. Patients are unable to continue their activity when the injury occurs. Most will limp for several days if not longer.

After a few days the swelling usually decreases and the knee begins to feel better. In some cases people won’t even visit a doctor because they think it is a sprain that is healing. Unfortunately if they try to run, jump or pivot the knee will give-way again causing more injury in some cases. It is important to understand that every patient does not experience each of these symptoms. Some report very little swelling or pain while others cannot straighten or bend their knee for weeks.

Although you may not know that you have torn your ACL, if you do experience a significant knee injury with swelling you should follow the R.I.C.E. program. This treatment includes Rest, Ice, Compression and Elevation (RICE). Swelling occurs because the torn ACL causes bleeding within the knee. The knee joint will slowly absorb the blood and the swelling will usually decrease if RICE is followed.

Less active people may be treated non-surgically with a program of muscle strengthening. However, most healthy, active patients should have surgery to restore full knee function. Three decades ago, patients over age 40 were often told they were too old to have surgery. Unfortunately, there are still some ‘old school’ doctors telling patients the same thing even today. However, as our knowledge and surgical options have improved, we now place no age restrictions on surgery.

Factors such as activity level and lifestyle are much more important than age. It is important to note that if the ACL is not reconstructed, most active patients will experience repeat episodes of their knee ‘giving-way’. Each time this happens, other structures such as cartilage and menisci can be damaged, leading to early arthritis. Since the term ‘active’ can mean many different things to different people, let me define it better. In terms of risk of your knee giving way after the ACL is torn, those people that participate in activities that require twisting, jumping, cutting and pivoting are at greatest risk of further injury.

The next blog will discuss the surgical option in more detail including graft choices, all-arthroscopic surgery and double bundle reconstruction. I was one of the first surgeons in Virginia to perform the all-arthroscopic acl reconstruction procedure and currently also offer the more anatomically correct double bundle acl grafts to patients.

Vic Goradia, MD

Sports Medicine, Knee &

Shoulder Specialist

Go Orthopedics

www.GoOrtho.net

Meniscus Cartilage:  The meniscus is a soft, “rubbery”, shocking absorbing cartilage disk between the thigh bone (femur) and the leg bone (tibia). There is a medial (inner) and lateral (outer) meniscus in each knee. 

Articular Cartilage:  Articular cartilage is the white, hard, smooth material at the ends of bones. Because it is normally very smooth the joint is able to freely glide with movement. Along with the menisci, articular cartilage also protects the joint. With injury, normal aging or rheumatalogical diseases, the cartilage can be worn away leaving bone on bone within the joint.

Meniscus Tears:  Meniscus tears are very common injuries that occur from twisting, squatting or hyperextension of the knee. Meniscus tears can occur alone or in combination with ligament injuries. As one ages, the meniscus loses water content and becomes less “rubbery” and can tear with little effort.

Meniscus tears usually cause swelling, catching, giving-way and pain. Unfortunately most meniscus tears do not heal and are likely to get large in size with activity. Medications and injections can help to alleviate pain while arthroscopic surgery is needed to remove or repair the torn meniscus.

How Does Doctor Diagnose the Problem?

Knee Specialist: Although general orthopedic surgeons can diagnose and treat cartilage problems, a surgeon with fellowship training in sports medicine and arthroscopy is best able to offer the best treatment options including the latest available technology.  

Office Visit: During the office visit, your knee specialist will ask about your symptoms and any injuries that occurred. He will then carefully examine the knee for a variety of different conditions. In most cases these two steps can provide the surgeon with a very good idea of your diagnosis. X-rays will also be performed. Although meniscus tears are not visible on x-rays, the x-ray can provide important information regarding arthritis.    

MRI: If a meniscus tear is suspected an MRI might be ordered. An MRI can identify meniscus tears and cartilage damage but only arthroscopy can accurately determine the extent of damage and simultaneously provide treatment.

Treatment of Cartilage Problems

Removal of Torn Meniscus: Most meniscus tears do not heal without surgical treatment. However, some small tears or incomplete tears may stop hurting and not require surgery in the short-term. Repeat injury could cause the tear to become larger and ultimately require surgery. Meniscal tears can be treated with arthroscopic surgery through two small skin punctures.  After surgery patients are permitted to fully move the knee and walk. Most patients do not even use crutches.  Most patients require a few visits of physical therapy to regain strength and function.

Tears in the outer 1/3 have healing potential and can be repaired. These tears are much less common and usually occur with a sudden injury in young people. After meniscus repair surgery, a brace and crutches are required. Physical therapy is required for all patients. Return to twisting, pivoting, jumping and sports activities is usually permitted at 4-6 months.

As with most orthopedic injuries, early diagnosis and treatment customized for the individual patient leads to the best outcomes.

Vic Goradia, MD

Sports Medicine Specialist

Go Orthopedics

http://GoOrtho.net

The next type of swelling around the knee joint is inflammation of a bursa known as bursitis. Most people of heard of bursitis but often confuse it with arthritis. There are bursa sacks throughout the body. The most common one around the knee is directly on top of the kneecap known technically as the pre-patellar bursa. Normally the bursa is a thin fluid filled sack that you can’t even feel. However, when it is injured it enlarges as it fills with fluid and/or blood. This can happen when you are hit directly in the front of the knee or fall on the knee. Pre-patellar bursitis is also seen frequently in people who work down on their knees such as carpet layers and those that clean their kitchen floors by hand. That is the reason this condition used to be referred to as “housemaid’s knee”.

The final type of swelling is actually fluid or blood within the knee joint. If the swelling occurs suddenly after an injury then it often means that some structure inside of the joint has torn (this is known as an acute injury). If the swelling occurs gradually over time without a specific injury then you could still have something torn but it is usually as a result of wear and tear or overuse (i.e. chronic condition).

The most common acute knee injuries are fractures, torn ligaments, and torn cartilage. They can cause pain, stiffness, swelling, catching, locking, giving way and weakness.

If untreated any of the above conditions can become chronic. Other causes for chronic swelling would be arthritis and chrondromalacia. This last condition is where the normal cartilage that covers the bone within the knee joint begins to wear down. Once the cartilage is worn down to bone or in multiple different areas then it is known as arthritis.

Regardless of the type of swelling, most conditions can initially be treated with rest, ice, compression and elevation (R.I.C.E). You can also take over-the-counter pain relievers or anti-inflammatories. If there is severe pain that cannot be controlled, deformity, loss of feeling or movement then you should see a doctor more urgently.

In the coming weeks we will discuss many of these conditions in more detail. If you have questions or comments please feel free to post them.

Vic Goradia, MD

Sports Medicine Specialist

Go Orthopedics

http://GoOrtho.net

Heat illness begins as muscle cramps and progress to more serious conditions such as heat exhaustion and even heatstroke.  Cramps should be treated aggressively with drinking water, stretching and moving into the shade. If symptoms do not improve then clothing should be loosened or even removed. If cramps persist or any other symptoms begin such as fatigue, nausea, vomiting, headache , clammy skin or rapid breathing then immediate medical attention should be sought. 

At the same time it is important to eat healthy with plenty of protein and complex carbs while limiting sugar, salt and fried foods. The proteins and carbs will provide longer lasting energy. Sugars give you a quick boost followed by a fall in blood sugar which results in a sluggish feeling. Sports drinks can be very beneficial in replacing electrolytes but some have very high amounts of sugar. Many people are also turning to energy drinks. Again most are high in sugar as well as caffeine. Neither of these are good when trying to prevent dehydration.

The bottom line is to eat well, drink plenty of water and treat any signs of heat illness aggresively. Good luck and I hope everyone stays safe and injury free as they return to football.

Vic Goradia, MD

Sports Medicine Specialist

Go Orthopedics

http:/goortho.net