ACL Tears Treatment
The ACL (anterior cruciate ligament) is one of the most commonly injured ligaments in the knee. Running diagonally through the middle of the joint, the ACL works together with three other ligaments to connect the femur (upper leg bone) to the tibia (lower leg bone). People who play sports that are likely to damage the knee -- such as basketball, football, skiing and soccer -- are at greatest risk for injuring the ACL. Only about 30% of ACL injuries result from direct contact with another player or object. The rest occur when the athlete decelerates while cutting, pivoting, or sidestepping; lands awkwardly; or plays recklessly. About half of ACL injuries are accompanied by damage to the meniscus, cartilage, bone or other ligaments in the knee.
Signs that you may have injured your ACL include pain, swelling and instability immediately after the injury, followed hours later by greater swelling and pain, limited motion, tenderness and an inability to walk comfortably.
A common type of knee injury is damage to the articular cartilage, the smooth substance that covers the ends of the bones and keeps them from rubbing together as you move. Cartilage, or chondral, damage is known as a lesion and can range from a soft spot on the cartilage (Grade I lesion) or a small tear in the top layer to an extensive tear that extends all the way to the bone (Grade IV or "full-thickness" lesion). Sometimes a piece of cartilage breaks off and causes more damage to the cartilage and bone as it is ground in the joint.
Common chondral lesions in the knee are:
- Chondromalacia / Degenerative Chondrosis (Cartilage tears away unevenly, with shallow walls)
- Osteochondritis Dissecans / Osteochondral Fracture (Cartilage breaks away with a piece of the bone)
- Chondral Flap (Cartilage separates from the bone and moves like a door with a hinge at one end)
- Chondral Fracture (Cartilage separates from the bone and floats free)
Chondral lesions may be degenerative (a "wear and tear" problem) or traumatic (caused by an injury such as falling on the knee, jumping down, or rapidly changing direction while playing a sport). They do not always produce symptoms at first because there are no nerves in the cartilage. Over time, however, lesions can disrupt normal joint function and lead to pain, inflammation and limited mobility. The lesion may gradually worsen or cause other problems in the joint.
Cartilage also lacks blood supply, so the body cannot usually repair chondral lesions on its own. However, some severe tears that injure the bone can promote the growth of scar tissue known as fibrocartilage, a tough material that replaces the missing articular cartilage but does not provide as smooth a gliding surface.
Knee Osteoarthritis Treatment
Osteoarthritis, also known as wear-and-tear or degenerative arthritis, is the most common form of the disease, affecting millions of people in the US each year. This condition is most common in older patients whose cartilage has worn down over time, and in athletes who have worn down their cartilage from overuse and repetitive motions.
Patients with osteoarthritis may experience pain, swelling and stiffness within the joint, which tend to worsen as the condition progresses. Your doctor can diagnose this condition after evaluating your symptoms and performing an X-ray examination of the knee. Several other factors should be taken into consideration when diagnosing osteoarthritis, including evaluation of the patient's spine, nearby joints, posture and gait.
Treatment for osteoarthritis initially focuses on relieving pain and other symptoms, and may include rest, physical therapy, bracing and anti-inflammatory medication. More severe cases of osteoarthritis may require surgery to reposition the bones or replace the joint. Most procedures can be performed through arthroscopy, which significantly reduces bleeding, scarring and recovery times.
Arthritis and certain knee injuries and diseases can damage the cartilage that normally cushions the knee joint, leading to pain and stiffness. A knee replacement may be recommended when more conservative treatments -- such as anti-inflammatory medications and cortisone injections -- fail to relieve pain or improve movement.
Made of cushioning cartilage, the C-shaped meniscus performs many functions in the knee: it stabilizes the joint, helps it carry weight, facilitates turning in many directions, and keeps the femur (thighbone) and tibia (shin) from rubbing together. Athletic injury (trauma) or weakened tissue associated with aging or illness (degeneration) can tear the meniscus. Movements most likely to result in a meniscal tear are twisting the knee, pivoting, cutting and rapidly decelerating. A meniscal tear may occur at the same time as an ACL tear.