Orthopaedic Medicine is unique in that its success depends, in-part, on the patient becoming an active participant in the rehabilitation process. From surgical decisions to ongoing physical therapy, Heiden Orthopaedics will keep you informed so you can make knowledgeable decisions regarding your recovery.

You can begin learning about your injury with the following brief introductions to some common orthopaedic conditions. For a more comprehensive explanation and diagnostic plan, please schedule an appointment with your doctor at Heiden Orthopeadics.

Knee:

ACL Injury

ACL (anterior cruciate ligament) injuries are quite common during athletic activities like skiing or contact sports in which the foot is planted, the knee is bent and quick changes in direction occur. Because the knee joint holds the body's two longest bones and is responsible for stability and bearing the bulk of the body's weight, knees and the ligaments, cartilage, tendons and bones that make up the joint can be particularly vulnerable to injury.

Patients often notice several symptoms of an injury to their ACL including a sometime audible "pop" at the time the ACL tears. Because torn ligaments bleed, swelling can occur immediately. Other indicators of a torn ligament include pain and instability or a buckling sensation in the joint.

ACL injuries generally occur when the knee is extended beyond its normal range of motion or is twisted sharply. These injuries are classified into three grades. Grade I is considered a sprain and indicates some minor ligament trauma and stretched fibers. A Grade II injury is a partial tear involving more severe trauma and some torn fibers. Finally, ACL injuries are classified as Grade III when the ligament is completely torn.

Treatment for ACL injury usually includes rest, ice, compress and elevation. Once swelling has been managed, a patient has two treatment options including reconstructive surgery or non-operative treatment with rehabilitation and bracing. An orthopaedic specialist can help decide the best course of action based on how old the injury is, how instable the joint is, associated injuries and the level of activity to which the patient wishes to return.

Meniscal Injury

The knee joint includes two crescent-shaped menisci, which act as shock absorbers between the tibia and femur. Once believed to be of little importance to the function of the knee, these structures were routinely removed upon injury. Today, the menisci are acknowledged as crucial contributors to joint stability, force transmission and lubrication and are therefore repaired when injured. In fact, removal of the entire meniscus, as practiced in the 1960's and 70's can actually result in bow-legged or knock-kneed deformities and arthritis.

Injuries to the meniscus are categorized into acute and degenerative tears. Acute tears occur when a bent, weight-bearing knee is sharply twisted. On the other hand, degenerative tears are more common in the 65-plus population and are the result of an aging meniscus which has weakened and become less elastic. Minor events can cause degenerative tears, and symptoms are not always present.

When acute tears are accompanied by symptoms, they can include pain, swelling and irregularities in joint movement. Acute meniscal-tear patients often describe a catching or locking sensation when the tear impedes normal motion. Some tears eventually heal with non-operative rehabilitation. However, when the tear causes pain, swelling, locking or instability, surgical treatment may be necessary.

Chondral Defects

Injuries to the knee's articulating cartilage, or chondral injuries, can result from pivoting or twisting motions that cause small pieces of cartilage (loose bodies) to break off and float around the knee. Symptoms may not appear until later in life, and usually the condition develops due to a series of minor injuries that have occurred over time.

Symptoms of chondral defects include intermittent swelling, pain from prolonged walking or stair climbing, buckling, locking or catching of the joint and a crackling noise - called crepitus - during motion. Depending on the severity and nature of the chondral defect, patients and their orthopeadist can choose between non-operative treatments like weight loss, strengthening exercises, shock absorbent shoe inserts and injections of hyaluronic acid to improve lubrication. When operative treatment is necessary, the most common techniques include shaving or debridement in which the surgeon smoothes the shredded or frayed cartilage to decrease friction and irritation, and microfracture or abrasion, which actually encourages the growth of new cartilage by allowing blood and bone marrow cells to contact the cartilage defect.

Patellofemoral Pain Syndrome

Poor structural alignment and muscular weakness or imbalance can lead to improper tracking of the patella over the femur causing pain around the kneecap. This disorder is known as patellofemoral pain syndrome or "jumper's knee." It often affects senior athletes and those doing a considerable amount of running and jumping.

Athletes with patellofemoral pain syndrome complain of a dull, aching generalized pain in the knee and often cannot pinpoint one specific area. Running, descending stairs, squatting or sitting increases pain levels, and while a full-range of motion can be achieved, complete flexion of the knee is usually painful.

Non-surgical treatments such as activity modification, anti-inflammatory medication, icing, strengthening and balancing exercises, braces and specialized orthotics usually prove very effective for petellofemoral pain. With this condition, surgery should only be considered as a last resort, after other treatments have failed.