THE KNEE

Your knee is a complex joint with many components, making it vulnerable to a variety of injuries. Some of the most common knee injuries include fractures, dislocations, sprains, and ligament tears.

About Dr. Ference and Knee Replacement

knee-x-ray | Dr. Robert Ference

Many knee injuries can be successfully treated with simple measures, such as bracing and rehabilitation exercises. Other injuries may require surgery to correct.

Questions & Answers

Osteoarthritis (Pathological Condition)

Also known as wear and tear, joint disease or degenerative arthritis, is a common problem for many people after middle age. Knee osteoarthritis is the most common type of osteoarthritis and ranked as the most common cause of disability in the U.S. It can be caused by previous knee injuries, fractures, ligament tears, repetitive strain on the knee, obesity, etc.

Symptoms:

Pain
Stiffness
Limited range of motion
Localized swelling

Chondromalacia Patellae (Pathological Condition)

Chondromalacia patella is a common knee problem that affects the patella and the groove when it slides over the femur (thigh bone). This action takes place at the patellofemoral joint.
This condition occurs when the patellofemoral joint that has been structurally damaged. The commonly used term, patellofemoral pain syndrome (PFPS) refers to the earlier stages of the condition. Symptoms are more likely to be reversible with PFPS.

Symptoms:

Grinding sensation when the knee is flexed
Front knee pain when getting up after sitting for a long period of time
Knee pain that worsens when you climb stairs or get out of a chair
Knee tenderness

Plica Syndrome (Pathological Condition)

Plica syndrome is a problem that occurs when an otherwise normal structure in the knee becomes a source of knee pain due to injury or overuse. The diagnosis can sometimes be difficult.

Symptoms:

Knee pain
Swelling
Clicking sensation
Locking
Weakness of the knee

Rheumatoid Arthritis (Pathological Condition)

Rheumatoid arthritis of the knee causes the joints to become tender, warm, and swollen. Although knee osteoarthritis causes pain and stiffness, joint pain with knee RA is more severe.

Symptoms:

Pain
Swelling
Inflammation
Stiffness
Warmth around the knee joints
Fever
Flu-like symptoms
Fatigue

Meniscus tears (Traumatic injury)

The meniscus is a commonly injured structure in the knee. The injury can occur in any age group. In younger people, the meniscus is fairly tough and rubbery, and tears usually occur as a result of a forceful twisting injury. The meniscus grows weaker with age, and meniscal tears can occur in aging adults as the result of fairly minor injuries, even from the up-and-down motion of squatting.

Symptoms:

Pain
Stiff/ swelling
Locking
No range of motion

Anterior Cruciate (ACL) Injury & Posterior Cruciate (PCL) Injury (Traumatic injury)

The posterior cruciate ligament (PCL) is one of the less commonly injured ligaments of the knee. The anterior cruciate ligament (ACL) is more commonly injured.

Symptoms:

Pop or crack when injured
Instability, followed by swelling
Extremely painful
Unable to straighten leg
Tenderness
Pain at the time of impact, extended to calves later on.
Swelling
Instability

Medial and Lateral Collateral Ligament Injuries (Traumatic injury)

The medial collateral ligament (MCL) is more easily injured than the lateral collateral ligament (LCL). It is most often caused by a blow to the outer side of the knee (such as occurring in contact sports) that stretches and tears the ligament on the inner side of the knee.
The classic sign of this injury is hearing a “pop” and feeling the knee buckle sideways. Pain and swelling are immediate. To diagnose a collateral ligament injury, a medical professional will perform several manual tests (applying pressure on the side of the knee to determine the degree of pain and looseness of the joint) and possibly order an MRI to confirm the diagnosis.

Symptoms:

Bleeding
Swelling
Stiff and painful
Unstable
May give away and not support body weight.

Dislocation/ Patellar Subluxation (Traumatic injury)

Patellar Subluxation happens when the kneecap is pulled towards the outside of the knee. As this happens, the kneecap does not slide centrally within its groove.
Also called patellar subluxation, patients who experience an unstable kneecap have a kneecap that does not slide centrally within its groove. Depending on the severity of the patellar subluxation, this improper tracking may not cause the patient any problems, or it may lead to dislocation of the patella (where the kneecap fully dislocates out of the groove). Most commonly, the tracking problem causes discomfort with activity, and pain around the sides of the kneecap. Patellar subluxation is a condition that usually affects adolescents and sometimes younger children.

Symptoms:

Painful
Kneecap pops or gets out of the socket

Patella Tendon Rupture (Traumatic injury)

The patellar tendon is prone to rupturing in individuals with a history of patellar tendon injury such as jumper’s knee or degeneration due to age. Injuries of this type serve to weaken the patellar tendon and in the event of strong eccentric quadriceps contraction (contraction during lengthening of the muscle), such as landing from jump, the patella tendon may snap or rupture most commonly at the lower end of the patella.

Symptoms:

Extremely painful an
Clear pop at the time of injury
Swelling
Inability of holding weight
Inability to straighten the knee or hold it straight
Fracture and Stress Fractures

PFS/ Patellofemoral Syndrome/Runner’s Knee (Repetitive Injury)

Patellofemoral pain syndrome is pain in the front of the knee. It frequently occurs in teenagers, manual laborers, and athletes. It sometimes is caused by wearing down, roughening, or softening of the cartilage under the kneecap.

Symptoms:

Pain under or around the kneecap
Pain hurt after bending to running, climbing stairs, leg exercises etc.
Clear knee cracking or a need to be cracked to decrease pain.
Incapable of sitting for long periods of time without straightening out the knee to make it crack.

ITB (IlioTibial Band Syndrome - Repetitive Injury)

liotibial band syndrome is inflammation and pain on the outer side of the knee. The iliotibial band is a layer of connective tissue. It begins at a muscle near the outer side of your hip, travels down the outer side of your thigh, crosses the outer side of the knee, and attaches to the outer side of your upper shin bone (tibia).

Symptoms:

Pain over the outside of the knee joint
Swelling at the spot of discomfort
Snapping or popping feeling as knee bends

Knee Tendonitis (Repetitive Injury)

Patellar tendonitis is the condition that arises when the tendon and the tissues that surround it, become inflamed and irritated. This is usually due to overuse, especially from jumping activities. This is the reason patellar tendonitis is often called “jumper’s knee.”

Symptoms:

Dull ache
Tenderness
Mild swelling

Knee Bursitis (Repetitive Injury)

Knee bursitis is inflammation of a bursa located near your knee joint. Knee bursitis causes pain and can limit your mobility. Treatment for knee bursitis often includes a combination of self-care practices and doctor-administered treatments to alleviate pain and inflammation.

Symptoms:

Feels warm when knee is touched
Appears swollen or feels spongy when knee is touched
Painful or tender

Osgood-Schlatter Disease/ Jumper’s Knee (Repetitive Injury)

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.

Symptoms:

Pain at the bony edge below your knee
Tibial tuberosity swollen or inflamed
Tenderness and pain becomes worse during and after exercise.
Pain when contracting the quadriceps against resistance or when contracting the muscles with the leg straight.

Partial or Total Knee Replacement?

How do I know if I’m a candidate for a partial knee replacement as opposed to a total knee replacement?

Dr. Ference explains in this video what he looks for in your xrays to determine in you are a candidate for a partial knee replacement using Mako robotic technology. Your knee is a joint made up of three different compartments: the inside knee, the outside knee, and the front of the knee called the patella. Generally speaking, your knee pain is caused by the wearing-away of cartilage as a result of arthritis or an injury. Once the cartilage is damaged, there is no longer a cushion between the bones so your knee becomes painful and inflamed. If the cartilage is only wearing away in one part of your knee you will feel pain in only one of those three compartments. The best way for Dr. Ference to diagnose how much disease is in the knee joint is by an x-ray. If he sees that only one of your knee compartments is diseased, you may be a candidate for a partial knee replacement. If you have pain and more arthritic damage in two or three compartments of your knee, it is more likely you would benefit from a total knee replacement (also called a total knee arthroplasty). For a video recorded interview I did with more details, click here.

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