What are some common causes of knee pain?

Most patients with knee pain have a ligament sprain, a ligament tear, a meniscus or "cartilage" tear, loose bodies, or osteoarthritis.

What are some of the most common causes of knee pain in runners? 

Runners often suffer from overuse injuries or repetitive stress injuries. These include stress fractures, stress reactions, tendonitis, meniscal tears, ITB Friction syndrome, and exacerbation of pre-existing arthritis.

Runners are a great group to treat; they will do anything to return to running! But that can also get them in trouble.

The MRI image at left is a hip. The bright white signal was a stress fracture.

If this patient had not "listened" to her body and come in when she did, the stress fracture would have become a complete fracture and surgery would have been necessary.

Runners may continue running with many other ailments -- my job is to let you know when it is okay to keep going, and when rest is necessary to prevent further damage.

What is a meniscus and how does it tear?

The image at left reveals a normal meniscus sitting between the femur above and the tibia below. The meniscus is a C-shaped structure in your knee that is made of fibro-cartilage. It acts as a cushion for the knee when it's bearing weight.

Most meniscal tears in adults are attritional ... that is, the meniscus simply wears out from years of use. Most adult patients with a torn meniscus don't recall how or when it happened.

The presentation is usually quite different in children or adolescents. Their tears are usually traumatic in nature and will usually arise from a non-contact twisting injury. 

What are the most common symptoms of a meniscus tear?

Many adults have a tear and do not even know it. These are typically degenerative or attritional tears.

Painful tears in adults are usually larger "flap" tears.

These tears typically will cause pain with kneeling, squatting, pivoting, or going down stairs.

Occasionally they will even hurt at night when you roll over in bed.

This image shows a flap tear of a meniscus.

Do all meniscus tears require surgery?

No. Many degenerative or attritional tears can be managed non-operatively, and you can return to your "normal" lifestyle. After your tear occurs, your knee might be sore for a few weeks. If you notice your pain is lessening, just wait for a while before considering surgery. Most degenerative tears are "watched" in my office for 6 weeks before we consider surgery as an option. I operate only on tears that cause significant pain or instability, or when the torn piece becomes caught between the femur and tibia.

Can meniscal tears be "fixed"?

In most cases with people under 30, the meniscus can be repaired or sewn together. As we age, and our tears become more degenerative in nature, the likelihood of a tear being "repairable" decreases dramatically and a removal of the torn portion is necessary to alleviate pain.

I have been told I am "missing cartilage" in my knee...what does this mean? 

There are two forms of cartilage in the knee; the two meniscal cartilage discs or cushions, and the articular cartilage on the ends of the bones.

Cartilage defects on the end of the bones could be the result of a traumatic injury, Osteonecrosis, Osteochondritis Dessicans, or simply the early stages of Osteoarthritis.

When a surgeon says you are "missing cartilage" in your knee, more often than not, he or she is referring to the articular cartilage on the end of your bone.

What can be done to repair a hole or defect in the cartilage? 

This first image shows an acute, or fresh cartilage defect, which occurred in association with an ACL tear.

We elected to fix this with a cartilage plug or osteochondral autograft transfer system ... what's called an OATS procedure, shown in the second image below.

If the defect or hole in the cartilage is isolated, fresh or acute, and it's NOT secondary to arthritis, there are a number of other options available:

• Arthroscopy and Chondroplasty (removal of loose fragments)
• Microfracture
• OATS Procedure
• Autologous Chondrocyte Implantation

All of the above options are discussed in this section.

What is an ACL tear?

The ACL is the Anterior Cruciate Ligament. There are more than four major ligaments that essentially hold the knee together.

Without one or more of these ligaments, the knee would be loose and you would feel like your knee was giving way or buckling.

The ACL is the most commonly torn knee ligament. The ACL is usually torn as the result of a non-contact twisting injury.

You will usually feel or hear a pop, the knee will buckle, and within a short period of time, significant swelling will occur.

Do all ACL tears require surgery?

No. Many ACL tears can be treated non-operatively. Many factors go into the decision-making process. Some patients have ACL tears and no instability symptoms. Others are profoundly symptomatic, even with simple stair climbing, turning, or twisting.

We do not know why some people are more symptomatic than others -- which is why surgery is not the right answer for everybody. Typically a reconstruction is necessary if you plan to return to competitive activities involving cutting, pivoting, twisting, and rapid side-to-side movements .

How is the ACL reconstructed?

Please view the sports medicine videos on this site. 

 What is a Double Bundle ACL Reconstruction?

The native ACL is made up of two bundles; the anteromedial bundle and the posterolateral bundle. Over the last 20+ years surgeons have been reconstructing only the anteromedial bundle.

Why? Good Question. We did not realize how important the posterolateral bundle is. Over the last 5 years, though, a growing number of surgeons, myself included, have been switching over to a double bundle technique that reproduces the "normal" anatomy of the ACL before it was torn. To my knowledge, I am the only Orthopedist in the Hudson Valley currently performing this technically challenging procedure. This link will take you to the site of Dr. Freddy H. Fu, who has been researching this technique for years.

Which "graft" should I choose for my ACL reconstruction?

A graft is the tissue we use to give you a new ACL. The choices available break down into two large categories. Autograft is your own tissue, and allograft is cadaveric tissue. If you elect to use your own tissue, the three grafts available are bone-patella tendon-bone grafts, quadriceps tendon grafts, or hamstring grafts. There are many different allografts available to reconstruct the ACL. Whether to use an allograft (from a cadaver) is a very important decision and requires a thorough discussion with your surgeon. A Double Bundle reconstruction uses a soft tissue graft to recreate both native ACL bundles.

I have Arthritis in my knee....what are my options?

• Oral anti-inflammatories such as Advil, Motrin, Aleve, etc. can be effective, but check with your doctor to be sure you can safely take these medications.
• Physical therapy
• Injections: Cortisone, an anti-inflammatory, or a course of Synvisc, Supartz, Hyalgan or Euflexxa.
• Arthroscopy??? For severe arthritis, an arthroscopy will most likely not offer any long-term benefit. In mild cases of arthritis, with a meniscus tear, an arthroscopy might improve your symptoms -- but your arthritis will continue to progress.
• Joint Replacement surgery
  

What are Synvisc, Supartz, Hyalgan or Euflexxa? Will they help me?

These substances are a form of Hyaluronic Acid. All three are similar, but they're not identical. They are very thick, viscous substances that are injected directly into the knee. Patients with mild to moderate osteoarthritis will usually have significant relief from pain after a series of 3-5 injections.

From the Supartz website:

Hylauronic Acid (HA) is a non-surgical, non-pharmacological pain-relieving therapy for osteoarthritis of the knee. It is made of highly purified sodium hyaluronate (hyaluronan or HA). Hyaluronan is a natural chemical found in joint tissues and in the fluid that fills the joints (synovial fluid). The body’s own hyaluronan acts like a lubricant and shock absorber in synovial fluid of a healthy joint.

What are my knee replacement options?

Knee replacement surgery has changed significantly over the past 5 years. We have better prostheses, better pain managment, and better exposure techniques -- all of which may improve your overall recovery.

We rarely need to cut muscle to approach the knee ... the muscle-sparing approach.

We use computer navigation equipment to improve the chances that the alignement of the prosthesis will be as close to "perfect" as possible.

We have many more choices about the type of prosthesis we can use to better match your needs ... based on your size, your age and activity level, your gender, and other factors.

CHECK THIS KNEE REPLACEMENT PROCEDURE SECTION FOR MORE INFORMATION.

Which Knee Replacement system do you prefer?

Are all knee replacements the same?

Each system has it shortcomings and benefits. We currently use knee replacement systems that will accommodate a woman's unique anatomy, a patient with arthritis in only one compartment, a patient with arthritis in two compartments, and various prosthetic alternatives that exist for patients who require a total knee replacement.

CHECK THIS KNEE REPLACEMENT PROCEDURE SECTION FOR MORE INFORMATION.

SO YOU WANT TO BE A KNEE SURGEON ... CHECK OUT THIS SECTION AND HAVE FUN !!

You or your children or grandchildren might enjoy this website, where you can actually perform "virtual knee surgery."