ACL:

• The anterior cruciate ligament (ACL) is one of the ligaments in the knee that joins the femur to the tibia and restricts forward displacement of the tibia.  When the ligament is injured it can cause instability of the knee.   An ACL injury is classified as grade I, II, or III, depending on the amount of anterior translation that occurs.

• An ACL tear commonly occurs traumatically while playing sports with the foot planted and then hyperextended, twisted, or bent to the side.  It can also be caused by a blow to the anterior knee, causing the knee to hyperextend. 

• Symptoms include hearing a pop or snap at the time of injury, pain on the outside or back of the knee, swelling, decrease range of motion, buckling, giving out or feeling of instability. 

• If a major tear is found on an MRI it may require surgery to improve the stability of the knee.  Most ACL reconstructions consist of the torn ligament being replaced by a graft, which can be taken from the hamstring tendon, the patellar ligament, or a cadaver.  This is done under general anesthesia.  Small incisions are made on the front of the knee. Immediately after surgery, swelling, pain, decrease strength and decreased range of motion are to be expected.  

Knee Replacement:

• Knee replacements are used to alleviate the symptoms of arthritis.  After years of wear and tear to the knee joint, the cartilage with in the joint can become damaged.  The damage to the cartilage can cause pain, stiffness, and loss of range of motion. A knee replacement should be considered when other treatments are no longer working and the symptoms are interfering with the basic daily activities. 

• Once you are under general anesthesia, an eight- to twelve-inch cut is made in the front of the knee. The surfaces of the femur and tibia are shaped to hold a metal or plastic artificial joint, which is attached either with cement or a special material. The attached artificial parts form the joint, relying on the surrounding muscles and ligaments for support and function.

• Immediately after surgery swelling, minimal to moderate pain, decrease strength and a decreased range of motion can be expected.  

Meniscus Tear:

• The meniscus is the cartilage of the knee.  The meniscus is actually made of two separate pieces of cartilage that are “C” shaped.  The menisci help with shock absorption in the knee and provide stability to the joint.  Meniscal tears can occur in different locations of the meniscus and at varying degrees. 

• A meniscus tear is usually caused by twisting or turning quickly, often with the foot planted. These tears commonly occur with sports. As aging occurs the meniscus can become damaged, making it easier to tear.

• Symptoms of a meniscus tear are dependent on the severity of the tear.  The symptoms can include mild to severe pain at the side or center of the knee, stiffness, swelling, popping, clicking, locking, or instability.  

• Surgery may be recommended depending on the severity and location of the tear.  The surgery either repairs or removes the damaged cartilage.  This is commonly involves a few small holes around the knee for incision sites and is done under general anesthesia.  Symptoms after surgery can vary depending on the type of surgery, severity of the tear, and other factors.  

Chondromalacia Patellae:

• A chondromalacia patellae is degeneration of the cartilage on the underside of the patella. This may be caused by overuse, traumatic injury to the cartilage, abnormal tracking of the patella, excessive forces, or abnormal loading of the patellofemoral joint. 

• Chondromalacia Patellae is pain in anterior knee. The pain may get worse when sitting with bent knees, squatting, jumping, or using the stairs.

• Surgery involves arthroscopic debridement to decrease pain.

Patellar Tendinitis:

• Tendinitis occurs when the tendon, or tissue that connects muscle to bone, become irritated and inflamed.  The patellar tendon comes from the quadriceps muscle and spans from the patella to the tibial tuberosity.  The quadriceps muscle and tendon extend the knee. 

• The most common causes of tendinitis are overuse injuries.  In the knee it is commonly caused by repetitive jumping, running, or squatting.

• Symptoms include pain and tenderness over the patellar tendon.  Early in the condition pain is usually present at the beginning of an activity, lessens during the activity, and worsens after the activity.  

Osgood-Schlatter Condition:

• Osgood-Schlatter condition is characterized by micro fractures to the tibial tuberosity, a bump on the top part of the tibia where the quadriceps tendon attaches.  These micro fractures cause the bone to pull apart and essentially get larger where the tendon inserts.

• This is commonly caused by an overuse injury.  It is more prevalent in teens going through a growth spurt because the tendon is stronger than the bone.  It is also associated with patellar misalignment.

• Symptoms of Osgood-Schlatter condition include pain and tenderness with activity.  Pain is usually resolved when the tibial tuberosity fuses back with the tibia.