The ACL is one of the cruciate ligaments of the knee. The other cruciate ligament is the posterior cruciate ligament (PCL). The two cross one each other in the knee joint to form an “X”. Both have the important responsibilities of providing back and forth motion of the knee and rotational stability. The PCL is less commonly injured than the ACL. Common causes of ACL injuries include the following:
- Forcefully changing direction
- Suddenly slowing down
- Landing awkwardly while falling
- Direct contact (i.e. a tackle, fall, or blow to the knee)
Symptoms can range in severity depending on the seriousness of the injury. Males are more likely than females to sustain an ACL injury. Athletes who are not in good physical condition are also more likely to sustain ACL injuries.
ACL injuries commonly present with the following symptoms:
- Decreased range of motion
Following an ACL injury, patients may have trouble bearing weight on the injured knee. For this reason, crutches are often used after an injury occurs.
A physical examination, x-ray, and MRI are used to diagnose ACL injuries.
ACL injuries that do not involve a tear can be treated using the following nonsurgical treatment options:
- Rest, Ice, Compression, Elevation (RICE)
- Immobilization (bracing)
- Activity modification
- Anti-inflammatory medications
- Physical therapy
In most cases, a nonsurgical treatment plan will include all these treatment options.
Torn ACLs generally require surgical intervention. An arthroscopic ACL reconstruction is performed. During the procedure, an orthopaedic surgeon replaces the torn ACL with a new one made from an autograft (the patient’s tissue) or an allograft (tissue taken from a cadaver). The procedure takes 1-2-hours. In most cases, patients fully heal 6-8-months after surgery and are allowed to return to competition or activity.
Athletes typically sustain meniscal tears while squatting and twisting. They can also sustain them due to direct contact. Patients with severe arthritis can sustain a tear in many ways. If arthritis is severe enough, a tear can occur while sitting or standing.
Often times, patients hear a popping sound when they tear their meniscus. Typically, pain and swelling occur immediately after the injury. If athletes continue to bear weight on a knee with a torn meniscus, it is very likely that swelling will get worse and eventually the knee will become stiff. For this reason, patients who sustain a meniscus tear are advised to rest and elevate their leg. Other symptoms that typically present with a meniscus tear include:
- A catching or locking sensation of the knee
- Knee instability
- Decreased range of motion
A torn meniscus is serious enough to be seen by an orthopaedic specialist. “Toughing it out” is not a good idea.
A medical history, physical examination, and medical imaging studies (x-ray and MRI) are used to diagnose meniscal tears.
Rest, ice, compression, and elevation (RICE) and anti-inflammatory medications can be used to reduce pain and inflammation associated with a meniscus tear. A brace can also be worn to stabilize and protect the injured knee.
Badly torn menisci may need to be surgically repaired, especially if they limit a patients ability to perform athletic or day-to-day activities. During surgery, an orthopaedic surgeon removes or repairs the meniscus. Meniscus tears are common orthopaedic injuries. Patients with meniscus tears do well when their injury is treated properly.
Osgood-Schlatter Disease (Knee Pain)
Symptoms of Osgood-Schlatter disease include the following:
- Knee pain
- Muscle tightness
The just below the kneecap and near the shin bone is where symptoms will typically be experienced. Physical activity tends to makes symptoms worse and rest tends to improve them.
A medical history and thorough physical examination are used to diagnose Osgood-Schlatter disease. During a physical exam, an orthopaedic specialist examines the knee to make sure that there a no fractures or soft tissue injuries that might be producing the symptoms the child is experiencing. In many cases, x-rays will be also be ordered to rule out these injuries.
The symptoms of Osgood-Schlatter will decrease on their own if the patient limits his or her physical activity levels. For this reason, a short period of rest and a slow, gradual return to activity are recommended. Stretching exercises and anti-inflammatory medications can be used to manage discomfort and pain.
A condition known as an unstable kneecap develops when the patella does not run in its designated groove on the side of the femur. This can occur because the groove is shallow and/or uneven. Patients with an unstable kneecap are at an increased risk to experience a knee dislocation.
Many symptoms may be associated with an unstable kneecap, including the following:
- Anterior knee pain
- Knee stiffness
- Knee buckling
- Knee catching
- Pain when squatting
- Pain that gets worse with exercise
- Crepitus sounds in the knee
The presentation of these symptoms is enough to warrant an appointment with an orthopaedic specialist, as an unstable kneecap can lead to more serious injuries.
An orthopaedic specialist uses a medical history, physical examination, and medical imaging studies (x-rays and MRIs) to diagnose an unstable knee cap.
Nonsurgical treatment of an unstable kneecap is geared towards managing symptoms, improving stability, and preventing a dislocation. Anti-inflammatories may be taken to decrease pain, a brace may be worn to stabilize and protect the knee, and exercises can be done to ensure the knee muscles and ligaments are strong.
If an unstable kneecap dislocates, it may go back into place on its own. If it does not, a reduction may need to be performed. A physician should always be the one to perform a reduction.
An unstable kneecap that causes chronic knee dislocations may require surgical intervention. The goal of surgery is to tighten the tendons and deepen the femoral groove where the patella moves through. After a successful surgery and subsequent physical therapy program, patients no longer have to worry about their kneecap being unstable.
The following conditions can be treated using shoulder arthroscopy:
- Rotator cuff tears. The muscles of the rotator cuff control internal and external rotation of the shoulder. They also help lift it. The rotator cuff tendons insert on the top of the humerus. When they are torn due to overuse, athletic injury, or aging processes, they may need to be repaired. Rather than make a large incision and traumatizing the large deltoid muscles, an orthopaedic shoulder surgeon uses tiny incisions and arthroscopic equipment to perform surgery.
- Labral tears. The glenoid labrum is a rim of cartilage that surrounds the glenoid cavity. It acts as a suction that keeps the head of the humerus in the glenoid cavity. A labral tear occurs when part of the labrum is torn and the head of the humerus no longer sits in its proper position as a result. The risk of partially or completely dislocating the shoulder goes up when a patient has a torn labrum. Like rotator cuff tears, labral tears can be treated using arthroscopic surgical procedures. For the same reasons as mentioned above, this is advantageous for patients who have a tear that needs to be surgically repaired.
As orthopaedic surgical techniques and equipment become even more advanced, it is expected that arthroscopic shoulder surgery will reach out and help an even larger patient population than it already does.