Knee Injuries and Treatments in New Jersey

When it comes to sports injuries, knees are the most vulnerable part of the body and the number one reason for a visit to an orthopaedist.

NJ Knee Doctors and Surgeons

No matter what the level of athlete, the knee is the most likely part of the body to be injured. Injuries can include ligament strains and tears (ACL, MCL, PCL and meniscus), tendonitis, IT band syndrome, chondromalacia, and conditions related to the patella (knee bone).

As the largest joint in the body, the knee is essential for competing in almost every sport and performing any exercise activity, which leads to its high-risk profile. Overall, knee injuries make up about 55% of all sports injuries.

Athletes who play soccer, field hockey, gymnastics, lacrosse, skiing, snowboarding and volleyball are most susceptible to ACL injuries, while MCL injuries are commonly seen in hockey and wrestling. Overuse injuries of the knee can be found in other sports such as cycling, swimming, water polo, rugby, and running.

Common Conditions

Adolescent Conditions:

In addition to knee pain, symptoms of knee injuries include:

  • Swelling and stiffness
  • Warmth and redness
  • Limping or instability
  • Inability to fully straighten the knee
  • “Locking” of the knee
  • “Popping” sound or giving out at the knee

When self-care methods and noninvasive techniques (such as injections performed at NJOI) have been exhausted, knee surgery can often be performed arthroscopically, which requires only small incision size and reduces recovery time.

Procedures

Ligament Repair or Reconstruction

Ligaments are composed of a strong, elastic band of tissue and support and limit the movement of a joint. Ligament damage, which often occurs from sports injury, results in joint instability. A torn ligament of the knee also results in severely limited knee movement, which causes the inability to twist, pivot or turn the leg. In this case, surgery is often required to repair the damaged ligament.

There are four ligaments in the knee that may be affected:

Anterior Cruciate Ligament (ACL) The anterior cruciate ligament, located in the front center of the knee, controls rotation and forward movement of the tibia (shin bone). It is the most commonly injured ligament.

ACL injury has an annual incidence of more than 200,000 cases with approximately 100,000 of these knees reconstructed. This is because the ACL is the primary stabilizer of the knee joint and is required for pivoting or cutting activities. The majority of ACL injuries (~70%4) occur while playing agility sports, and the most often reported sports are basketball, soccer, skiing, and football. An estimated 70% of ACL injuries are sustained through non-contact mechanisms, while the remaining 30% result from direct contact.*
* http://orthoinfo.aaos.org/topic.cfm?topic=a00297

Lateral Collateral Ligament (LCL) The lateral collateral ligament runs along the outside of the knee and gives stability to the outer knee. The injury can range from a stretch, partial tear, or complete tear of the ligament. The LCL is usually injured by pressure or an injury that pushes the knee joint from the inside, which results in stress on the outside part of the joint.

Medial Collateral Ligament (MCL) The medial or tibial collateral ligament is located in the inner part of the knee, and gives stability to the inner knee. It is injured more often than the LCL, since blows to the outer side of the knee is a more common occurrence.

Posterior Cruciate Ligament (PCL) The posterior cruciate ligament, located in the center of the knee, controls backward movement of the tibia (shin bone). PCL injuries are less common than anterior cruciate ligament (ACL) injuries, and they often go unrecognized. The PCL is broader and stronger than the ACL. Injury most often occurs when a force is applied to the anterior aspect of the proximal tibia (the portion of the shin bone closest to the knee) when the knee is flexed.

Posterior-Lateral Corner (PLC). The posterior-lateral corner (PLC) is part of the knee joint that is on the outside back of the knee, compromised of many intertwined ligaments, tendons and soft tissue. This is also an area of extensive treatment at NJOI. 

Arthroscopic Surgery of the Knee

Using small incisions, our surgeons perform arthroscopic surgery using a small tube-shaped instrument that is inserted into a joint. The surgeon may repair the torn ligament by reattaching it, or reconstruct the torn ligament by using a portion (graft) of a tendon from various parts of the patient’s leg, such as the kneecap or hamstring. This is called an autograph (your own tissue) and is used most commonly by the surgeons at NJOI as it provides better healing tissue with a decreased chance of graft failure than tendon graft from a deceased person (called an allograft).

Repair surgery is performed when recent (acute) injury occurs to the MCL, LCL, and/or PLC. The surgeons at NJOI are fellowship trained in sports medicine and are experts at numerous techniques that are utilized to repair and reconstruct the various ligamentous injuries of the knee.

Knee Cartilage Procedures: Meniscal Repair/Reconstruction, Osteotomy, Microfracture, Autologous Chondrocyte Implant (ACI), Osteoarticular Transfer System (OATS)

Every year, approximately six million people visit a doctor because of damage to knee cartilage, called articular cartilage.

Articular cartilage is a firm, rubbery material that covers the ends of bones in the knee joint. It reduces friction in the joint and acts like two ice cubes rubbing on one another. The meniscus cartilage in the knee acts as a “shock absorber” between the two bone ends. When cartilage becomes damaged or deteriorates, it limits the knee’s normal movement and can cause significant pain. Damaged cartilage can worsen and the smooth motion of two ice cubes sliding on one another can become like two pieces of sand paper in end stage arthritis, which may eventually require knee replacement surgery.

Osteotomy

Osteoarthritis can also cause damage on one side of the knee joint. An osteotomy is performed to shift the weight off the damaged side of the joint in order to relieve pain and restore function in the knee. Osteotomy literally means “cutting of the bone.” In a knee osteotomy, either the tibia (shinbone) or femur (thighbone) is cut and then reshaped to relieve pressure on the knee joint.

Knee Microfracture Surgery

Knee microfracture surgery is a common procedure used to repair damaged knee cartilage. Employing an arthroscopic technique, the surgeon makes very small holes, called microfractures, in the bone near the damaged cartilage. These holes release cells in the bones that build new cartilage that replaces the damaged tissue.  This procedure, which uses the body’s own healing abilities for tissue regeneration, was first introduced two decades ago and has proved highly successful.

Autologous Chondrocyte Implantation (ACI)

Autologous chondrocyte implantation (ACI) is a state-of-the-art procedure used to treat cartilage damage of the knee. It is a two-step procedure.

The first procedure is performed arthroscopically in less than 30 minutes. The surgeon harvests a small portion of articular cartilage from the patient’s knee. These cells are sent to a cell expansion laboratory and grown in a culture, thus multiplying them.

Growing enough cells takes about 4-6 weeks. They are then sent back for implantation.

The second stage of the operation is an open surgical procedure whereby a small patch is sewn over the articular cartilage defect.  The cells that have been harvested are then injected underneath a tissue patch where they adhere to the patient’s knee to form cartilage that resembles the native joint cartilage.

ACI is appropriate for patients with partial cartilage damage of the knee. The overall success rate of ACI is approximately 85% in allowing patients to return to pain-free activities.

Osteoarticular Transfer System (OATS)

Osteoarticular Transfer System (OATS) uses healthy cartilage from another area of the joint to replace damaged knee cartilage, which relieves joint pain and restores movement and function. The OATS procedure is a type of mosaicplasty, which is the general name for a procedure to treat severe cartilage damage. This procedure is meant for patients with small areas of cartilage damage that can be most easily repaired with the use of a graft. In the OATS procedure, small pieces of healthy cartilage are removed from non-essential areas of the joint and transferred to the area of the damaged cartilage.

Knee Meniscal Repair/Reconstruction

The meniscus is the soft rubbery bumper cushion that sits between the thigh bone and the leg bone. There are two menisci in the knee: a medial (inside) and a lateral (outside) meniscus. These structures act as shock absorbers that decrease the stress incurred by the articular cartilage found on the end of the thigh bone and leg bone. Meniscus injuries are quite common, especially in sports, and occur in patients of all ages.

Meniscus tears are common in active sports participants, especially in those activities requiring cutting and pivoting. In the United States, there are an estimated 850,000 meniscus surgeries performed each year, the vast majority of which are meniscus removal (meniscectomy) operations.* The meniscus on the side closest to the other knee (medial) is torn more frequently, and men injure their meniscus more often than women.

At NJOI, we perform arthroscopic meniscal repair to treat torn meniscus cartilage.  This is an outpatient, minimally invasive surgical procedure.  A partial meniscectomy is performed when the characteristic of the torn meniscus would not heal with repair. This procedure removes only the torn segment of the meniscus, leaving the healthy portion of the meniscus intact. This can be very effective if the meniscus tear is relatively small. Tears of the meniscus that cause “mechanical symptoms” –locking of the knee, clicking or popping and inability to fully straighten the knee–tend to respond best to surgical treatment.

Meniscus allograft replacement surgery is a minimally invasive method to restore previously removed torn cartilage with donor tissue. The new meniscus is sewn in place and requires postoperative protection to allow healing, and like all such procedures, is followed by physical therapy.

* http://www.mdguidelines.com/meniscus-disorders-knee

Total Knee Replacement

The knee is the largest joint in the body. People depend on it for a vast array of regular activities. Several common forms of arthritis are the cause of the majority of knee pain. When all other measures to relieve knee pain and disability have been exhausted, NJOI experts may recommend total knee replacement.

In a total knee replacement, the damaged cartilage and bone from the surface of the knee joint is removed and replaced with a prosthetic surface of metal and plastic.

Since knee replacement surgery was first performed in 1968, there have been vast improvements in surgical materials and techniques, making total knee replacement one of the most successful of all medical procedures. According to the Agency for Healthcare Research and Quality, more than 600,000 knee replacements are performed each year in the United States.* Most patients who undergo total knee replacement are aged 50 to 80, but the experts at NJOI evaluate each patient individually to determine the best course of action.

*Source: Total Knee Replacement – American Academy of Orthopaedic Surgeons AAOS

Partial Knee Replacement (Unicompartmental Knee Replacement)

The knee is divided into three major compartments: the medial compartment (the inside part of the knee), the lateral compartment (the outside part), and the patellofemoral compartment (the front of the knee between the kneecap and thighbone).

In a partial knee replacement, the surgeons at NJOI replace only the damaged part of the knee joint, keeping the healthy portions of the knee intact.

In a unicompartmental knee replacement, the expert surgeons at NJOI replace that damaged compartment with one of the various types of implants, which are customized for each patient. This surgery typically results in a speedier recovery than total knee replacement.

Following a medical history and examination, imaging studies (x-rays and/or MRI) will assist us in evaluating the knee cartilage to determine a diagnosis.

Source: Unicompartmental Knee Replacement – American Academy of Orthopaedic Surgeons AAOS

Knee Doctors and Surgeons in NJ

The NJ knee specialists at The New Jersey Orthopaedic Institute are experienced in both surgical and non-surgical interventions of knee pain, injuries and conditions including arthritis, bursitis, dislocations, meniscal tears, ACL injuries and many others. Contact us today to schedule an appointment. Serving patients in Wayne, Clifton, Butler, Bridgewater, Morristown and surrounding areas in New Jersey.