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Lateral Collateral Ligament (LCL) Repair

The lateral collateral ligament (LCL) is one of the four knee ligaments. It spans the distance from the end of the femur (thigh bone) to the top of the fibula (thin, outer, lower leg bone) and is on the outside of the knee. The lateral collateral ligament resists widening of the outside of the joint.  It is injured from a direct force from the side of the knee, causing moderate to severe knee pain which often leads to knee surgery.

Once your Hinsdale Orthopaedic knee surgeon identifies the need for surgical intervention, you will be scheduled for LCL surgery. Repair may be performed for injuries within a few weeks if the tear of the ligament is from the upper or lower attachment.  If the ligament is torn in the middle or the injury is older than 3 weeks, then a reconstruction is performed to stabilize the knee.  The reconstruction can be performed using a tendon graft (either from the patient or a cadaver tendon) through bone tunnels.

Following surgery the knee is maintained in a brace for 6 to 8 weeks.  Rehabilitation is initiated after surgery to regain motion of the knee and strength. Return to sports may occur after 4-6 months of the reconstruction.

Arthroscopy of the Knee

Knee arthroscopy is a minimally invasive technique used to treat knee conditions that historically were treated through larger open incisions.  There are a variety of conditions that cause knee pain including tendon tears, meniscus tears, loose bodies within the knee area, and osteoarthritis.  When non-surgical methods fail to solve the problem, surgical intervention may be the answer.  Knee arthroscopy is an excellent technique that may be utilized in the treatment of knee injuries.

Knee arthroscopy is often performed under general anesthesia.  After adequate anesthesia has been administered, small incisions are made to gain access to your knee joint. Through one incision, a camera is placed into the joint.  Through the other, small instruments can be used to address the problem. The length of the procedure varies depending upon the injury. Once the procedure has been completed, your surgeon will indicate the rehabilitation plan for you and the repaired knee.
 

Patellar Tendonitis

Patellar tendinitis is an injury that affects the tendon connecting your kneecap (patella) to your shinbone. The patellar tendon plays a pivotal role in the way you use your leg muscles. It helps your muscles extend your knee so that you can kick a ball, run uphill and jump up in the air.

Patellar tendinitis is most common in athletes whose sports involve frequent jumping — such as basketball and volleyball. For this reason, patellar tendinitis is commonly known as jumper's knee. However, even people who don't participate in jumping sports can experience patellar tendinitis.

Symptoms

Pain is the first symptom of patellar tendinitis. The pain usually is located in the section of your patellar tendon between your kneecap (patella) and the area where the tendon attaches to your shinbone (tibia).

Diagnosis

These injuries can occur due to repetitive sports activity.  Our knee specialists bring a compassionate and caring approach to every condition and injury assessment.  During your assessment they will perform a thorough evaluation and examination to determine the extent of your injuries, including a complete review of your medical history.

Our specialists may also utilized diagnostic tools such as an MRI, X-ray or CT scan to confirm the extent of your condition.

Treatment

Hinsdale Orthopaedics’ knee specialists typically begin with less invasive treatments before considering other options, such as surgery. Conservation treatment plans may include pain relievers such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others) and may provide short-term relief from pain associated with patellar tendinitis.

Therapy

A variety of physical therapy techniques can help reduce the symptoms associated with patellar tendinitis, including:

  • Stretching exercises: Regular, steady stretching exercises can reduce muscle spasm and help lengthen the muscle-tendon unit. Don't bounce during your stretch.
  • Strengthening exercises: Weak thigh muscles contribute to the strain on your patellar tendon. Eccentric exercises, which involve lowering your leg very slowly after you extend your knee, are particularly helpful.
  • Patellar tendon strap: A strap that applies pressure to your patellar tendon can help to distribute force away from the tendon itself and direct it through the strap instead. This may help relieve pain.
  • Iontophoresis:  This therapy involves spreading a corticosteroid medicine on your skin and then using a device that delivers a low electrical charge to push the medication through your skin.


If conservative treatments fail to resolve this condition, your HOA knee specialists may elect additional treatment options such:

  • Corticosteroid injection: An ultrasound-guided corticosteroid injection into the sheath around the patellar tendon may help relieve pain. But these types of drugs can also weaken tendons and make them more likely to rupture.
  • Platelet-rich plasma injection: An injection of platelet-rich plasma has been tried in some people with chronic patellar tendon problems. Studies are ongoing. It is hoped the injections might promote new tissue formation and help heal tendon damage.

If conservative approaches are not able to resolve the pain and in rare cases your doctor might suggest surgical intervention for the patellar tendon. Some of these procedures can be accomplished through small incisions around your knee.

Sprains and Strains

A sprain is a stretch and/or tear of a ligament, the fibrous band of connective tissue that joins the end of one bone with another. Ligaments stabilize and support the body's joints. For example, ligaments in the knee connect the upper leg with the lower leg, enabling people to walk and run.  

A sprain is caused by direct or indirect trauma (a fall, a blow to the body, etc.) that knocks a joint out of position, and overstretches, and, in severe cases, ruptures the supporting ligaments. Typically, this injury occurs when an individual lands on an outstretched leg; slides into a base; jumps up and lands on the side of the foot; or runs on an uneven surface.

While the intensity varies, pain, bruising, swelling, and inflammation are common to all three categories of sprains: mild, moderate, and severe. The individual will sometimes feel a tear or pop in the joint.

A severe sprain produces excruciating pain at the moment of injury, as ligaments tear completely, or separate from the bone. A moderate sprain partially tears the ligament, producing joint instability, and some swelling. A ligament is stretched in a mild sprain, but there is no joint loosening.

Chronic strains are the result of overuse (prolonged, repetitive movement) of muscles and tendons.

Inadequate rest breaks during intensive training precipitates a strain. Acute strains are caused by a direct blow to the body, overstretching, or excessive muscle contraction.

Symptoms

Typical symptoms include pain, muscle spasm, muscle weakness, swelling, inflammation, and cramping. In severe strains, the muscle and/or tendon is partially or completely ruptured, often incapacitating the individual. Some muscle function will be lost with a moderate strain, where the muscle/tendon is overstretched and slightly torn. With a mild strain, the muscle/tendon is stretched or pulled, slightly.

Diagnosis

One of our highly-trained knee specialists will perform a thorough evaluation and examination to determine the extent of your condition, including a complete review of your medical history.

Our specialists may also utilized diagnostic tools such as an MRI, X-ray or CT scan to confirm the extent of your condition.

Treatment

Treatment for knee sprains involves a combination of activity modification, anti-inflammatory drug treatments and a comprehensive stretching and strengthening program. Surgical intervention is rarely necessary.

Posterior Cruciate Ligament (PCL) Injury

The PCL has been described as one of the main stabilizers of the knee.  It is broader and stronger than the ACL.  It connects the femur (thigh bone) to the tibia (shin bone).  PCL injury commonly occurs in sports such as football, soccer, basketball, and skiing.  A forceful hyperextention of the knee or a direct blow just below the knee cap will disrupt the PCL.  For example, the football player who is tackled with a direct hit to the knee may hyperextend the limb and rupture the PCL.  The basketball player who lands on the court directly on a bent knee may tear his PCL.  

Symptoms

Most patients are able to walk on their injured knee. However, with an acute injury, the knee will likely become swollen and stiff. Symptoms of PCL injury include chronic pain, stiffness and intermittent swelling. 

Diagnosis

These injuries can occur due to a traumatic incident or chronic and degenerative activity.  Our knee specialists bring a compassionate and caring approach to every condition and injury assessment.  During your assessment they will perform a thorough evaluation and examination to determine the extent of your injuries, including a complete review of your medical history.

Our specialists may also utilized diagnostic tools such as an MRI, X-ray or CT scan to confirm the extent of your condition.
 

Treatment

Your Hinsdale Orthopaedics knee specialists may recommend an arthroscopic technique which is commonly used to repair or replace torn ligaments of the knee. Arthroscopic knee surgery incorporates the use of small (< 1 cm) incisions (portals) around the joint, and the use of a specialized camera (arthroscope) among other specified arthroscopic surgical instruments. The goal of arthroscopic surgery is to repair and restore the joint to optimal strength, while maintaining range of motion. Due to the minimally invasive nature of the arthroscopic technique, damage to surrounding muscles, ligaments, tendons, nerves and blood vessels is significantly reduced. Ligament surgery involves the removal of damaged ligament fragments and replacement of the ligament with either the patient’s own soft tissue or tissue from a cadaver; known as an autograft or an allograft respectively. Ligament surgery may either be performed as an outpatient, or inpatient procedure with an overnight hospital stay.

Patellofemoral Pain Syndrome of the Knee

Patellofemoral pain syndrome is a term used to describe pain originating from the region of the patella (kneecap) and femur (thigh bone). It is an extremely common condition and probably the most common complaint of athletes. and non-athletes presenting to the orthopaedic specialists at Hinsdale Orthopaedics. Other names for this syndrome include: retropatellar pain, anterior knee pain, and chondromalacia patellae. None of these terms accurately describe the cause of this pain, which remains elusive and poorly understood.

Symptoms

Symptoms of patellofemoral pain typically present primarily in the front of the knees. Pain is especially present when sitting with bent knees, squatting, jumping or using the stairs.  You may also experience occasional knee buckling, in which the knee suddenly and unexpectedly give way and does not support your body weight.  A catching, popping or grinding sensation when walking is also common.


Diagnosis

One of our highly trained knee specialists will perform a thorough evaluation and examination to determine the extent of your condition, including a complete review of your medical history.

Our specialists may also utilized diagnostic tools such as an MRI, X-ray or CT scan to confirm the extent of your condition.
 

Treatment

Treatment for patellofemoral pain syndrome involves a combination of activity modification, anti-inflammatory drug treatments and a comprehensive stretching and strengthening program. Surgical intervention is rarely necessary and is generally reserved for cases of severe and symptomatic malalignment.

 

Patellar Tendon Rupture

The patellar tendon works with the muscles in the front of your thigh - the quadriceps - to straighten your leg. Although anyone can injure the patellar tendon, tears are more common among middle-aged people who play running or jumping sports. A complete tear of the patellar tendon is a disabling injury. It usually requires surgery to regain full knee function.

Patellar tendon tears can be either partial or complete:

  • Partial tears:  Many tears do not completely disrupt the soft tissue. This is similar to a rope stretched so far that some of the fibers are torn, but the rope is still in one piece.
  • Complete tears:  A complete tear will disrupt the soft tissue into two pieces.  The patellar tendon often tears where it attaches to the kneecap, and can break a piece of the bone as it tears. When the patellar tendon is completely torn, the tendon is separated from the kneecap. Without this attachment, you cannot straighten your knee.

Symptoms

Symptoms or signs of patella tendon tear and ruptures include an indentation at the bottom of your kneecap where the patellar tendon tore, bruising, tenderness, cramping.  Your kneecap may move up into the thigh area because it is no longer anchored to your shinbone, inability to straighten your knee or difficulty walking due to the knee buckling or “giving way”.

Diagnosis

One of our highly-trained knee specialists will perform a thorough evaluation and examination to determine the extent of your condition, including a complete review of your medical history.

Our specialists may also utilized diagnostic tools such as an MRI, X-ray or CT scan to confirm the extent of your condition.
 

Treatment

Our knee specialists typically begin with less invasive, conservative treatment options before considering other options, such as surgery.  We may elect to utilize bracing with a knee immobilizer or physical therapy to allow for appropriate healing time prior to choosing surgical interventions.  When conservative treatment plans are unsuccessful, surgical procedures may be performed to fix the tear or ruptured area and bring stabilization back to the knee joint.
 

Osteomyelitis of the Knee

Osteomyelitis is a bone infection caused by bacteria or other germs in the bloodstream.  Most bone infections are caused by bacteria, but it can also be caused by fungi or other germs.  Bacteria can enter the bloodstream from infected skin, muscles, or tendons next to the bone. This may also occur under a skin sore.  Infection can also begin in another part of the body and spread to the bone through the blood.  In children, the long bones of the arms or legs are most often involved. In adults, the feet, spine bones (vertebrae), and hips (pelvis) are most commonly affected.

Symptoms

Symptoms may include bone pain, fever, general discomfort, uneasiness, ill-feeling, local selling, redness and warmth, chills, excessive seating and swelling of lower extremities such as ankles, feet and legs.

Diagnosis

When osteomyelitis is suspected by one of our knee surgeons, they may order tests following a thorough physical exam.  These tests may include, blood cultures, bone biopsy (which is then cultured), bone scan, bone x-ray, complete blood tests, and MRI of the affected bone area and possibly a needle aspiration of the area around the affected bones.

Treatment

The goal of treatment is to get rid of the infection and reduce damage to the bone and surrounding tissues.  Antibiotics are given to destroy the bacteria causing the infection.  If the patient has an additional condition such as diabetes, additional medications may be ordered to contain the infection.

Osgood Schlatter Disease

Osgood-Schlatter disease can cause a painful lump below the kneecap in children and adolescents experiencing growth spurts during puberty. Osgood-Schlatter disease occurs most often in children who participate in sports that involve running, jumping and swift changes of direction — such as soccer, basketball, figure skating and ballet.

While Osgood-Schlatter disease is more common in boys, the gender gap is narrowing as more girls become involved with sports. Osgood-Schlatter disease affects as many as 1 in 5 adolescent athletes. Age ranges differ by sex because girls experience puberty earlier than do boys. Osgood-Schlatter disease typically occurs in boys ages 13 to 14 and girls ages 11 to 12. The condition usually resolves on its own, once the child's bones stop growing.
 

Symptoms

Symptoms of Osgood-Schlatter disease include pain, swelling and tenderness at the bony area on the upper shinbone, knee pain worsening with activities such as running, jumping and climbing, and tightness of the surrounding kneecap muscles and thigh (2quadriceps) muscles.


Diagnosis

One of our highly-trained knee specialists will perform a thorough evaluation and examination to determine the extent of your condition, including a complete review of your medical history.

Our specialists may also utilized diagnostic tools such as an MRI, X-ray or CT scan to confirm the extent of your condition.
 

Treatment

Osgood-Schlatter disease usually improves without surgical treatment.  After a child’s bones stop growing the situation typically resolves without orthopaedic interventions.  Our orthopaedic knee specialists may prescribe mild over-the-counter medications to relieve pain during the growing period.

Meniscus Tears

The meniscus is a very important shock absorber of the knee made of a strong substance called fibrocartilage. It protects the surface of the joint and provides a mechanical cushion. A large percentage of our body weight is distributed through the meniscus as we walk, run, and jump. The meniscus adds to the stability of the knee joint by helping the shape of the femur bone conform to the tibia. The meniscus also plays a role in the nourishment of the smooth cartilage that covers the bones.

Symptoms

An acute meniscal tear may be heard as a “pop” and felt as a tear or rip in the knee. This may be followed by swelling of the knee as a result of blood or fluid accumulation. Patients with meniscal tears often describe a popping or catching in their knee. Some actually can feel something out of place. In the most dramatic situations the knee will actually “lock”, preventing the patient from fully straightening or bending the knee. The pain or discomfort is usually along the joint line or where the femur and tibia bone come together. It often starts out relatively painful; then with time, much (if not all) of the pain disappears except with certain activities. Some patients will have the tear become asymptomatic (no symptoms) for a time, especially if their activity level decreases significantly.

Diagnosis

These injuries can occur due to a traumatic incident or a fall or previous injury dynamic.  Our knee specialists bring a compassionate and caring approach to every condition and injury assessment.  During your assessment they will perform a thorough evaluation and examination to determine the extent of your injuries, including a complete review of your medical history.  Since meniscal tears do not show up on plain X-rays (the meniscus does not contain calcium the way bones do), your dedicated HOA knee surgeon may perform some specialized tests, such as an MRI scan, which are helpful in further evaluating the damaged meniscus.

Treatment

Depending on the severity of the meniscus tear, your HOA knee surgeon may utilize conservative treatment options to avoid surgery and allow the body’s own healing properties to work.  If conservative treatment does not provide relief, they may elect to recommend surgical intervention, often utilizing minimally invasive procedures, such as arthroscopic surgery to repair the torn meniscus area.

Recovery

If your Hinsdale Orthopaedics knee surgeon elects to perform surgery, you may be wearing a brace for six weeks after your surgery while walking and placing weight on the repaired knee.  While wearing the knee brace, our surgeon will start you on a physical therapy program to strengthen your knee and help you return to your normal daily activities.

 

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