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Conditions & Treatments

Knee Injuries & Knee Replacement Surgery

Knee injuries are common in athletes, and knee pain affects many older adults whose joints have worn down over time and may be in need of joint preservation or knee replacement surgery. Einstein’s orthopedic experts can help relieve your pain and get you back in the game, or back to living life. We specialize in a full range of knee injuries and conditions, including:

The meniscus is the cartilage that sits on the rim of your knee joint and serves as a “shock absorber” to reduce joint stress improve stability. A meniscus tear or cartilage injury can occur when your knee is forcefully twisted, or as a result of arthritis and long term degenerative changes. Meniscal tears can result in pain, stiffness, instability, a popping sensation, difficulty fully straightening your knee, and a feeling as though your knee is locked in place when you try to move it.

Depending on the type, size and location of your meniscus tear, your doctor will likely start by recommending ice, rest, over-the-counter pain relievers and physical therapy. In many cases, the pain from a meniscus will resolve on its own. If the pain does not go away over time or if your knee has locking symptoms, your doctor may recommend surgery to repair or remove the meniscus tear, or in certain situations replace it with a meniscus from a donor.

Ligaments are bands of tough, elastic tissue that surround and stabilize your joints through their normal range of motion. There are four ligaments in the knee that connect your thigh bone to your shinbone. The anterior and posterior cruciate ligament stabilizes the forward/backwards shift of your shin bone during movement, and provides stability during twisting motions. Your medial and lateral collateral ligaments prevent your knee from bending too far away from its normal midline. When you tear a ligament, it is common to experience sudden, severe pain and swelling. You may also hear a loud pop or snap. The joint will feel loose, and you may not be able to use the joint effectively.

Depending on the type, size and location of your torn ligament, your doctor may recommend ice, rest, over-the-counter pain relievers, physical therapy, and a knee brace for protection and support. However, injuries in high level athletes or tears that result in significant instability may require reconstructive surgery, which will either repair or reconstruct the torn ligament with a healthy tendon from your kneecap or hamstring, or with tissue from a donor.

Our orthopedic team at Einstein includes experts at the treatment of all types of broken bones, from hairline fractures in the fingers and hand to broken elbows and more serious fractures that require surgery.

A sprain occurs when you overstretch a ligament in your knee, and may result in pain, swelling, tenderness, stiffness and instability. A sprain is less severe than a tear, and may heal on its own with rest, ice and over-the-counter medication. Physical therapy can help strengthen the surrounding muscles to stabilize your knee and prevent reinjury.

In most cases, tendonitis can be treated with rest, ice, anti-inflammatory medications and a proper warm-up before physical activity. In some cases, your doctor may recommend working with a physical therapist. Only in severe cases after other treatments have not been successful does tendonitis require surgery.

Falling directly onto your knee or receiving a sharp blow directly to the front of your knee can cause your kneecap to fracture, which may result in bruising and the inability to straighten your knee or keep it straight. If you can still extend your knee and the fractured kneecap components are not displaced, your doctor may recommend a cast or splint to keep them in place while they heal, during which you may or may not be able to put weight on your leg. If the bone pieces have moved out of place or you can no longer extend your knee, you will likely need surgery. This may involve pins, screws, or wires to hold the fractured bone pieces in place while they heal.

Patellar instability occurs when the kneecap (or patella) moves outside of the groove in which it normally sits. Symptoms of patellar instability include pain, especially under the kneecap and when pressure is placed on the joint as it bends, as well as swelling, stiffness, difficulty walking, a buckling or locking sensation, and noticeable deformity. Depending on the cause of the instability or dislocation, your doctor may recommend a knee brace, crutches, strengthening exercises or surgery.

The quadriceps tendon attaches your thigh muscles to your kneecap, allowing you to straighten your knee. Injuring your quadriceps tendon can result in pain, swelling, bruising, tenderness and difficulty walking or straightening your knee. In the setting of a partial quadriceps tear, your doctor may recommend a brace and crutches to immobilize the knee and reduce the weight placed across the joint while it heals. If the tear is complete or near-complete, you may need surgery to reattach the tendon to the kneecap.

Arthritis is the wearing down of the cartilage of the joints, which can cause pain, inflammation and reduced mobility. In mild cases, your doctor may recommend physical therapy, medications, and assistive devices such as a cane, knee brace or sleeve, or shock-absorbing shoes or inserts. In more severe cases, your doctor may recommend surgery to remove bone spurs and other tissue damage, replace your knee cartilage with cartilage from another area of your body or from a donor, reshape the ends of your bones to relieve joint pressure and smooth out your joint, or replace part or all of your knee with an artificial joint.

 

Treatment Options

Depending on the type of injury, how severe your symptoms are and other factors, your doctor may recommend a variety of options for managing or treating your condition. Many knee injuries can be successfully treated with a non-surgical treatment plan that may include rest, ice, over-the-counter medications, braces/casts or assistive devices to help avoid putting pressure across the joint during healing. Physical therapy to help strengthen the muscles around the joint and stabilize it to prevent reinjury may also be recommended.

In addition to these treatments, the orthopedic team at Einstein specializes in:

Platelet-rich plasma therapy is a type of regenerative medicine that uses the body’s own powerful healing mechanisms. Injecting a concentration of platelet-rich plasma into the injured area of your knee can accelerate the healing of injured tendons, ligaments and joints. Platelet-rich plasma is made by taking a few vials of your blood and using a centrifuge to concentrate the platelets. The injection is usually performed under image-guidance using an ultrasound device.

Arthroscopy is a minimally invasive surgical technique that involves the insertion of a small tube with a camera into your knee joint through a small incision. This allows your doctor to get a clear picture of any cartilage or meniscus tears, fractures or other pathologies that may be present, and perform certain treatments such as bone spur removal, meniscus repair or removal, or torn ligament repair/reconstruction.

Einstein is one of the only health systems in the region to offer this minimally invasive type of ACL reconstruction surgery, which requires a smaller incision than traditional ACL reconstruction surgery, thereby significantly reducing recovery times and pain.

Following a more serious injury such as a completely torn ligament or a shattered kneecap, your knee may require reconstructive surgery. Our orthopedic team is highly experienced in these complex surgeries, and uses minimally invasive procedures whenever possible.

In some cases where the bones or cartilage of your knee is worn, your doctor may be able to avoid replacing your joint by using joint preservation techniques. These may include an osteotomy procedure, which involves reshaping the rough or worn ends of your leg bones where they form your knee joint, as well as cartilage restoration techniques, which usually involve replacing the cartilage of your knee with cartilage from another part of your body or from a donor.

In cases where the cartilage of the knee joint have been worn out, pain and dysfunction may result from the bone ends grinding against each other. In this situation, your doctor may recommend a partial or total knee replacement, depending on where the cartilage is damaged. Our orthopedic team has performed thousands of knee replacement surgeries.


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