A tear in the anterior cruciate ligament (ACL) is one of the most common knee injuries. An injury to this ligament causes the knee to become unstable and the joint to slide forward too much. ACL tears occur most often in athletes.
ACL reconstruction is usually not performed until several weeks after the injury, when swelling and inflammation have been reduced. The torn ligament is completely removed and replaced with a new ACL. Simply reconnecting the torn ends will not repair the ACL. Part of another ligament, usually in the knee or hamstring is used to create a graft for the new ACL. Choosing the proper type of graft depends on each patient's individual condition.
ACL surgery requires a few months for full recovery and physical rehabilitation will be needed as well. Surgery is not required for all ACL injuries. Talk to your doctor to discuss if it is the right option for you.
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Arthroscopy is a minimally invasive procedure that allows doctors to examine tissues inside the knee. It is often performed to confirm a diagnosis made after a physical examination and other imaging tests such as MRI, CT or X-rays.
During an arthroscopic procedure, a thin fiberoptic light, magnifying lens and tiny television camera are inserted into the knee, allowing your doctor to examine the joint in great detail.
For some patients, it is then possible to treat the problem using a few additional instruments inserted through small incisions around the joint. Sports injuries are often repairable with arthroscopy. Knee injuries that are frequently treated using arthroscopic techniques include meniscal tears, mild arthritis, loose bone or cartilage, ACL and PCL tears, synovitis (swelling of the joint lining) and patellar (knee cap) misalignment.
Because it is minimally invasive, arthroscopy offers many benefits to the patient over traditional surgery. These include:
Arthroscopy is not appropriate for every patient. Dr. Goldberg will discuss the options that are best for you.
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A torn meniscus is a common injury often caused by forcefully twisting or rotating the knee. It can also be a result of degenerative changes in older adults. A meniscus tear can be repaired through arthroscopic surgery.
How does a meniscus tear happen?
The menisci are C-shaped pieces of tough cartilage that rest on either side of the knee, between the thigh bone and shin bone. They help to distribute body weight across the knee so it can be properly supported by the bones in the leg, and also provide stability to the knee joint. A meniscus tear is common after a traumatic injury, and most frequently occurs when the knee joint is bent and the knee is then twisted. Torn menisci are common in athletes and older adults whose cartilage may have worn away.
A torn meniscus causes pain and swelling, and may also be accompanied by a frequently locking joint and the inability to completely straighten the knee. Some people experience a popping or clicking sensation within the knee as well.
How is a meniscus tear treated?
Treatment for a meniscus tear often begins with conservative methods such as rest, ice or over-the-counter medication. If these treatments are not effective and symptoms continue, you may benefit from meniscus repair surgery. Meniscus repair is an arthroscopic procedure in which the torn segment of the meniscus is removed and the torn edges are sutured together, which allows them to heal properly.
Recovery from meniscus repair surgery can take several months of immobilization and the use of crutches. Most patients recover well from this procedure and are able to return to their normal activities.
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Microfracture is an arthroscopic procedure performed to repair damaged knee cartilage for patients with cartilage injuries or only a minimal amount of damage. This procedure often helps patients avoid or postpone the need for knee replacement surgery. The cartilage is necessary to cushion the area and allow for smooth, painless movement. Microfracture is most commonly performed in athletes who may have suffered cartilage injuries while playing sports.
During the microfracture procedure, a small surgical tool called an awl is inserted into the damaged area of the knee to create small holes, known as microfractures, in the bone near the damage to help release the cells that produce cartilage and restore the damaged area. Patients will need to undergo physical therapy after this procedure, and many are able to resume playing sports and other physical activities within a few months.
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Osteoarticular Transfer System (OATS) surgery replaces damaged cartilage in the knee with healthy cartilage from another area of the joint, relieving pain and restoring movement and function to the joint. The OATS procedure is considered a type of mosaicplasty, which is the name for a general procedure that treats severe cartilage damage.
During the OATS procedure, small plugs of healthy cartilage are removed from areas of the joint that are not in critical need, and transferred to the area of damaged cartilage. This procedure is ideal for patients with small areas of cartilage damage that can easily be repaired with a graft. Patients will need to undergo a lengthy physical therapy program after this procedure in order to restore range of motion and relieve pain and swelling on the joint.
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Partial knee replacement, or unicompartmental knee replacement, treats osteoarthritis and other degenerative conditions of the knee by removing and replacing only the damaged area. This procedure is most often performed on patients with severe arthritis that has not responded to conservative treatments, but still have healthy areas of cartilage left in the knee. Compared to total knee replacement, this procedure offers patients smaller incisions, less bleeding and shorter recovery times.
For partial knee replacement, the damaged bone ends are removed from both the tibia (shin) and femur (thigh) to prepare for the artificial replacement, which is then placed on the smoothed bone ends. The replacement is held in place with cement or screws, and offers significant pain relief for long periods of time, although total knee replacement may eventually be needed.
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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.
During a total knee replacement, the entire joint is replaced with an artificial prosthesis. The surgery itself lasts between one-and-a-half and three hours. After the procedure, patients usually experience immediate relief from joint pain. Physical therapy starts right away to speed healing and to ensure that the patient enjoys full use of the joint. Knee replacements today last about 20 years in 85-90% of patients.
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