Knee Questions

Can a torn ACL be repaired?

No, a torn Anterior Cruciate Ligament is not repairable. Usually a torn ACL does not snap in half. It often has a split second of injury where it stretches first then tears. Think of a piece of gum which stretches first before it tears but once torn the pieces are actually too long to be pressed back together end to end to the original length.

What do you put in when a meniscus is taken out?

When you have a partial or total menisectomy (removal of the meniscus) no tissue is put in its place. There is a loss of that structure. The loss of a meniscus can increase the stress of the joint and, with time, can predispose to arthritis. In some instances, younger active patients can consider a meniscal transplant, replacing the meniscus with an allograph.

What causes a meniscus tear?

Many people refer to a meniscus tear as a torn cartilage. This is partially correct. It is a fibro-cartilage structure in the joint that acts as a cushion or shock absorber. I like to think of it as a gasket. They are very pliable and rubbery. But, as we all grow older they become less pliable and more prone to injury from even minor trauma. You can tear a meniscus with a true trauma such as a twist or fall. But in many cases it is torn from just wear and tear on the knee joint. Sometimes it takes very little to injure a meniscus and you may not even remember the incident at all.

If you take out the meniscus, isn’t that bad for the knee joint? Do you put anything in its place?

Most menisci are torn at middle age or older. When the torn cartilage is removed by an arthroscope, nothing is used to replace it. However, unlike the former open operative procedures which removed the entire meniscus, arthroscopy only removes the injured part. So, the rest of the meniscus is still there acting a shock absorber, though not quite as effective. This does create an increase stress on the joint and the chance or risk of arthritis, though not inevitable, is higher after this type of surgery. It usually manifests itself in about 15 – 20 years.

Can you repair a torn meniscus?

Yes – over the recent two decades, more information has been gained about repairing a torn meniscus. We know that the blood supply to the meniscus is limited, only in the perimeter one-third. And, that blood supply recedes as we all get older. So, in a younger patient, usually below the age of 40, meniscal repair is possible if the tear is in the outer perimeter.

What happens if I decide not to fix a torn meniscus and leave it there?

Just because you have a meniscus tear does not mean you have to have surgery. But, a meniscus tear will not heal itself. If it is torn, it is not functioning correctly, but it is causing pain. So, if the pain and consequent disability is such that it is becoming a problem, you should consider the surgery. If the cartilage is left torn, it will, with time, cause some abrasion to the joint surface which increases the risk of arthritis.

I think I injured my knee and have an appointment in 3 days with a doctor. What should I do in the mean time?

A knee injury can be a dramatic event. If you have seriously injured your knee and it starts to swell, discolor, you lose your motion and you are having increasing pain – then you need to be seen in an emergency room by a qualified physician. If your injury has some discomfort but does not seem severe, you can wait for your appointment. In the meantime, put ice on the knee, elevate your leg above the level of your heart and take over the counter pain medications. But remember, if there is any question regarding the severity of your injury, it is better to error on the side of conservatism and be evaluated in the ER.

What is the difference between X-rays and an MRI?

X-rays and a CT scan both use radiation to visualize structures, mostly bones in the body. But, an MRI uses a magnetic field to visualize not only the bones but also the soft tissues around the bones. For diagnosis of Osteoarthritis, routine x-rays are good. But, to visualize a torn meniscus, torn ligament, or other soft tissue problems, the MRI is best and without the radiation.

What is the recovery time after an arthroscope?

An arthroscope is typically done as an outpatient procedure, meaning you go home the same day. Unless otherwise instructed, most patients are allowed to bear weight on the leg the same day without crutches or bracing. Although the knee is swollen because you just had an operation, you are encouraged to be on your leg the same day. Rehabilitation is about 3-6 weeks which may or may not include some physical therapy. But, in general you have very few restrictions over that period of time.

What is Synvisc-One?

Synvisc-One is one of a series of newer treatments for Osteoarthritis called visco-supplementation. This particular injection is a one shot dose of Hylan GF -20, a joint lubricant that occurs naturally in the knee, but with age or arthritic disease can breakdown and loses it protective qualities. Synvisc- One replaces this natural fluid and binds to the joint surface. Synvisc-One often gives pain relief for a minimum of 6 months and often longer.

What is the grinding noise in my knee?

Grinding or “crepitation” which is the technical term for the noise you hear and feel as you go up and down stairs most often is from the knee cap (patella). It is the result of cracking of the underside of the patella and/or the trochlea (the notch of the knee). It can cause pain, swelling and giving way. In most early cases it is treated with medications, home exercise programs and sometimes physical therapy. In more advanced cases surgery may be required.

What can I do to preserve the cartilage in my knee?

When we talk about preserving cartilage, we are actually talking about the articular cartilage, the joint surface cartilage. Its preservation is the key to decreasing the risk of arthritis. The articular cartilage is designed to last a life time. But once injured, it can fail in a cascade of problems. The best way to protect it is not to injure the structures around it. So, meniscal problems and ligament problems can lead to injuring the cartilage. However, repetitive stress can also lead to cartilage problems such as in appropriate weight training. Increased stresses can crush articular cartilage can create cracks and fissures. Preserving the articular cartilage is a difficult lifelong problem while still maintaining an active life style.