Knee problems affect millions of Americans every year, advances in surgical techniques are decreasing the continuation of knee afflictions.
Athletes with torn ligaments in the past were usually advised to end their careers. With the advancement of ACL, MCL, and arthroscopic advancements, the athlete can return to the field, and their performance does not suffer.
For those face chronic knee problems, replacement surgery is an option, but surgery is not the first nor the recommended treatment for knee injuries and diseases. In fact, they are usually a last resort after less aggressive therapy fails to relieve pain.
Unless you are an elite athlete or have a definitive diagnostic imaging, such as an MRI, that shows a ligament tear, most knee treatment begins with physical therapy. The stretching and strength exercises can help to relieve pain by improving the function of surrounding muscles and mobilizing fluid to decrease swelling. Physical therapy includes exercises, splinting, orthotics, bracing, and heat and cold therapy. It is intensive and always follows more aggressive surgery for knee injuries.
It shouldn’t be understated the importance of physical therapy after surgical intervention on the knee. When a knee is replaced, the need for range of motion exercises and strengthening practices can sometimes mean the difference between a successful surgery and one is considered failed due to continued patient pain.
If you need ligament replacement or knee replacement surgery, it is important to note that physical therapy starts immediately after the surgery is complete and continues for months. Often, the overall health of the patient must determine if the surgery and physical therapy are medically possible for debilitated patients.
Injections and Medications
Injections and medications are usually the next step in treating knee pain, although they are frequently used concurrently with physical therapy. Medications are typically non-steroidal anti-inflammatory medications, such as ibuprofen or naproxen.
Although some of these are available over the counter, the prescription strength brands are more effective in relieving knee pain, and you may find that the prescription forms relieve the pain without further issue. This type of medication also reduces swelling, and that helps to take some of the pressure off the joint.
Narcotics are only used in the post-surgical period and in cases where the pain is severe enough to impact the activities of daily living. Most orthopedists use these medications with caution due to their main side effects, such as dependence, constipation, and sedation.
Treatment resistant pain usually requires the use of an intra-articular steroid injection. The primary ingredient in these injections include lidocaine and a long acting steroid, varying among providers.
In most cases, the lidocaine provides immediate relief, but its effects will decrease within a week to ten days. It is hoped that the steroid, which takes longer to achieve its pain relieving effect, will have become effective and relieved the chronic knee pain.
By injecting this solution into the articular space, the medication is far more likely to achieve acceptable pain relief.
In some cases, they can prevent surgery or at least delay it enough to allow for physical therapy to provide a better assessment of the joint’s stability. Injections are minimally invasive, can be performed in the office, and can be repeated up to three to four times per year.
Ligament Repair and Replacement
When ligaments are torn, the problem extends beyond conservative measures and requires surgical repair. Four important ligaments are responsible for keeping the knee moving and stable. The two collateral ligaments run alongside the inside and outside of the knee: the lateral collateral ligament (LCL) and the medial collateral ligament (MCL).
Within the center of the knee are two ligaments that cross each other: the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). Any single ligament can become strained, sprain, ruptured, or torn, but many times the injuries to the ligaments happen in combination, such as an ACL/MCL tear.
Replacement surgery is the treatment of choice for torn ligaments. Autograft replacement means that a ligament is taken from another place in your body – either the patellar tendon or the hamstring tendon — and used in place of the torn tissue. Allograft replacement means that the ligament is taken from a deceased donor.
In the future, a synthetic graft material may be available, but this technology is currently in development and testing phases. For now, only viable human grafts are eligible for this procedure. It often takes months to rehabilitate from ligament repair surgery, and physical therapy comprises the core method to returning the knee to function following the procedure.
Arthroscopic Surgery, Grafting, and Other Interventions
A host of other surgical interventions are available for treating knee conditions that do not involve the ligaments. For instance, meniscal tears can be approached in several surgical approaches.
Arthroscopic surgery is the use of small actuators that insert into the knee through inch-long incisions. It removes bits of cartilage that are diseased, evacuates swelling, and ensures that the meeting surfaces of the bones are smooth.
In addition, bone grafts are also gaining in popularity for cartilage problems.
As with ligaments, the donor bone material can come from the patient, a cadaver, or synthetic material. Cartilage replacement may become necessary with advanced cases of osteoarthritis or trauma that completely destroys the tissue.
Other interventions are used for various problems. Illiotibial band issues are often treated with a tendon release surgery. In fact, many of the various tendons that support the knee and lower leg can benefit from release surgery if they are inflamed or impinging upon other joint structure.
Some surgeries are exploratory to determine the extent of knee damage, although the preciseness of MRIs has made this surgery less common.
Knee Replacement Surgery
Finally, when the knee is beyond repair due to arthritis or trauma, total knee replacement is often the solution. Due to the incredible leaps in minimally invasive technology and the engineering of replacement joints, this surgery is becoming increasingly common.
It is the gold standard procedure for chronic, treatment resistant knee pain secondary to arthritis, trauma, or any chronic damage to the joint tissues.
Ligament damage is usually treated separately from knee replacement, but rarely does the ligament problem exist independently of other knee issues.
Most patients requiring replacement have completed at least six months of physical therapy, undergone injections, and possibily explored the benefits of arthroscopic surgery. Only with a full examination of your medical history and general health can knee replacement surgery be recommended.
Rehabilitation is important after the surgery, and the rigorous nature of the treatment may surprise some replacement patients. For instance, failure to exercise the joint can lead to pain, stiffness, and failure of the implant allow for the complete range of motion in the joint.
In addition, infection of the joint space and the bone are possibilities, but these are inherent in any surgical procedure.
Although it is not a common side effect, infection can make the recovery period longer than normal. If you and your orthopedist feel that other treatments are not effective for your knee pain, making the decision to replace your knee may be the only option available to restore your mobility and decrease your discomfort.