Category Archives: Knee Conditions

The knees sustain a considerable amount of stress each day as they are responsible for carrying a great deal of the load for the human body. Knee injuries are a common occurrence among athletes, but they are also very common among the general population from injuries sustained in extracurricular activities (such as snow skiing and running) or simple accidents (twisting, falling, etc.). Most individuals who sustain a knee injury do so by tearing or rupturing a ligament. Knees that have sustained previous injuries or who are subjected to years of overuse or athletic training are also at risk for cartilage defects, meniscus damage, and degenerative diseases such as arthritis.

Once Dr. Anz has completed a full examination, he will consult with you and discuss your exact injury, as well as the appropriate course of treatment. As a team, you will both work towards the most optimal outcome for your knee injury.

Dr. Anz is skilled to treat a number of knee conditions, and when surgery is recommended, you can depend on his entire team to offer the best care and surgical approach to treat and manage your injury.

Save the Menisci: Meniscal Root Tears

The menisci are c-shaped, rubber-like cartilage discs that reside inside the knee joint.  There are two menisci in every knee, one on the inner side (medial meniscus) and one on the outer side (lateral meniscus). Their function is to increase surface area for weight transmission between the cartilage on the ends of the bone, which decreases pressure between the ends of the bone and adds to stability of the joint.  Both the medial and lateral menisci have stout attachments at the front and back of the tibia, these attachments are often called “roots”. These meniscal roots are important because they hold the meniscus in place to provide stability to the entire meniscus. The stability is obtained by a functional circumferential hoop which the C-shape obtains with attaching at the roots. This functional hoop stability prevents the meniscus from extruding out when pressure is exerted across the joint, effectively keeping the meniscus in place between the two bones.

Meniscus tears can occur in a number of different shapes and scenarios. They can occur as a result of accumulative wear and tear of the joint or as the result of an injury. Sometimes, wear and tear changes in the meniscus can be subtle until an injury event occurs and the scenario is worsened drastically. Tears of the meniscus root are especially concerning because they compromise the functional hoop property of the meniscus, rendering the meniscus non-functional. When there is a tear of the meniscal root the studies have suggested that pressure upon the cartilage is increased to levels similar to having no meniscus at all. This can subsequently cause early degeneration of the joint.

Meniscus root tears are often seen in two groups of patients:

  • The first group consists of young adults and athletes who sustain a root tear with a severe knee injury. This may include injury to the ACL, PCL or other ligaments of the knee. Failure to repair the meniscal root in these circumstances can lead to the development of early osteoarthritis, failure of a ligament reconstruction graft and other potential problems with age.
  • The second group of patients are middle-aged adults. In this population, the injury is “acute on chronic”. There are degenerative changes at the root and then the meniscal root becomes non-functional with an injury event. A sudden knee bending event accompanied by a “pop” in the back of the knee, is often described by patients who have had a root tear. A sudden deep squat or twist are also sometimes described. In this group of patients, rapid development of osteoarthritis can occur.

Symptoms

The primary symptoms of a meniscus root tear include pain on the inside or outside of the knee with mechanical symptoms.  Certain activities such as pivoting, running, climbing, or even getting up from a chair may produce symptoms including popping and catching.  Patients may hear or feel a clicking sound with movement, and the knee may be tender to the touch for some in specific locations.

Figure 1, Coronal view of normal meniscal root

Diagnosis

While an X-ray will not show meniscal damage, it is necessary to evaluate the overall health of the knee joint, as subtle changes on X-rays are common and help to guide treatment. Although a history, physical exam and x-ray are important in diagnosis, an MRI is important to visualize the meniscal root (Figure 1). These root tears can be very difficult to identify on MRI but is most often diagnosed when a “ghost sign” is seen. Meniscal root tears can be seen on coronal, axial and sagittal MRI views. On the sagittal view, as seen in figure 3, there is a ghost sign which is indicative of a meniscal root tear. A normal, healthy meniscus should look like a dark black triangle. On the coronal view, as seen in figure 2, there is a tear of the meniscal root.

Figure 2, Coronal View with “Ghost Sign”

 

Figure 3, Sagittal View with “Ghost Sign”

Surgical Treatment

Treatment of meniscal root tears can be very difficult, especially in older patients. In older patients, repair can be difficult as tears are not commonly diagnosed until progression of arthritis is more severe. In younger patients, repair is much easier due to decreased prevalence of joint degeneration.

Figure 4, Normal Meniscal Root

An arthroscopic approach is utilized to repair the meniscal root.  Once access is made into the knee, Dr. Anz will visualize the meniscal root (Figure 4). A device is used to pull on the root to confirm the presence of a tear. After a tear is confirmed, Dr. Anz will use a guide to drill a tunnel at the anatomic site of the original root. (Figure 5) This tunnel will become the new home for the torn meniscal root. Sutures will be passed through the torn portion (Figure 6) of the meniscus and shuttled down into the tunnel previously drilled. Once the sutures have been pulled into the tunnel, Dr. Anz will visualize the meniscus and tighten the sutures and secure them with a suture anchor.

Figure 5, Drill bit coming up from root attachment
Figure 6, Sutures passed through the root repair

Post-Operative

After surgery, the patient will be non-weight bearing for 6 weeks to allow for healing of the repair. Physical therapy may be initiated the day after surgery. Range of motion at the knee is limited to 90 degrees of flexion for the first weeks in order to prevent excess stress on the repair. Six weeks after surgery a partial protective weight bearing program is initiated to slowly wean from the crutches. Patients should avoid impact activities, deep squats, and lifting in a deep squat for a minimum of 4 months after surgery to protect the meniscus root repair.

For more information on meniscus injuries, or to learn more about the surgical treatments for meniscus tears offered by Dr. Adam Anz, Orthopedic Surgeon/Sports Medicine Specialist, please contact our office

The Biology of ACL Healing: The Wild Card of Recovery

Ligamentization – The Wild Card

One of the most critical steps in ACL reconstruction is grafting a tendon into the knee to replace the damaged ACL. Following surgery, the graft not only has to heal tightly in its new position but also transition structurally from a functioning tendon to a functioning ligament—a process known as ligamentization. Believe it or not, this process takes time! Microscopic studies, in which physicians have taken small samples of healing ligaments following ACL reconstruction to determine their rate of ligamentization, suggest that this process can take anywhere from 6 to 24 months.

Continue reading The Biology of ACL Healing: The Wild Card of Recovery

When is an athlete ready for contact sports after ACL surgery?

Returning to Sport Following ACL Reconstruction

After ACL reconstruction, the most common question is also the most difficult to answer: “When will I be ready to go back to ___?” In short, there is no blanket answer; there are many factors that determine when the time is right for a patient to return to sport. These factors are physical, biologic and psychological in nature and they affect each patient’s recovery in a unique way. At the end of the day, return to sport is a decision that needs to be made on a patient-to-patient basis, weighing the benefits of continued rest and rehabilitation with the risks and benefits of returning to sport.

Continue reading When is an athlete ready for contact sports after ACL surgery?

PCL Knee Injuries

The PCL, or posterior cruciate ligament, is located inside the knee joint towards the back (or posterior aspect) of the knee. It is responsible for keeping the bone in the leg from moving backward (or posterior) in relation to the bone in the thigh. It is also responsible for stabilizing the knee during rotational movements. The PCL can become injured when the knee is either hyper-extended or forced directly backwards.  Most often, this occurs in a traumatic setting such as a violent fall while skiing, during a motor vehicle accident, or through a serious impact during a sports event.

Symptoms

Knee pain, swelling, and limited mobility are the most common symptoms of a PCL injury. Many times, the symptoms can be similar to  those of an ACL knee injury, however, with a PCL tear instability symptoms will be related to the abnormal ability of the tibia to slide posteriorly in relation to the femur.

Diagnosis

Dr. Anz will perform a thorough physical examination and will palpate and manipulate the knee to assess the degree of injury.  A Posterior Drawer test and Dial Test are important physical exams when a PCL injury is suspected.  Additionally, a stress X-ray and MRI will be used to confirm the diagnosis. PCL knee injuries are graded based on the amount of abnormal movement that occurs upon examination, and injuries range from a partial tear with minimal posterior sag to a complete tear of the PCL.

Treatment

Not all PCL tears will require surgery, as certain injuries to the PCL are likely to heal with time.   Dr. Anz may recommend a non-surgical treatment that will involve a rest period, icing, quadriceps strengthening, and bracing.  Anti-inflammatory medication will help alleviate pain immediately after the injury and will allow the patient to make progress with therapy. In certain instances it may be recommended that the PCL undergo surgical reconstruction.

Surgical Treatment

Dr. Anz utilizes an arthroscopic approach to reconstruct the PCL.  In the majority of cases, a donated graft is used. If multiple ligaments are injured, a surgical reconstruction of the PCL, as well as treatment to the other damaged ligaments will be required

Post-Operative

Following a PCL knee surgery, Dr. Anz will require you to wear a brace for at least 6 months as gravity wants to pull the tibia backward and stretch the graft.  During this time, physical therapy will occur with a slow, consistent progression. Initially, the therapy will focus on returning motion back to the injured knee and surrounding muscles while protecting the healing ligament. A progressive strengthening program is very important, and eventually release to normal activities can be expected.

For more information of PCL knee injuries, or for additional resources on PCL reconstruction surgery, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Multi-Ligament Knee Injuries

The knee is stabilized and is able to function properly because of four major ligaments which allow the knee to perform movements such as walking, pivoting, running, and cutting.  These ligaments can be inside the knee joint (intra-articular) or on the outside of the knee joint (extra-articular).  The Anterior Cruciate Ligament (ACL) and the Posterior Cruciate Ligament (PCL) are intra-articular and called “cruciate ligaments” because they cross over each other inside the knee joint. The Medial Collateral Ligament (MCL) and the Posterolateral Complex (PLC) are extra-articular and provide side-to-side stability.

All four ligaments work together during walking and sporting activities.  Each ligament has specific functions and functions which overlap with other structures. When any of these ligaments are stressed beyond its normal strength, a tear can occur.  In serious accidents, damage to more than one ligament is possible.  This is referred to as a multi-ligament knee injury and requires appropriate medical attention.

Symptoms

Multi-ligament knee injuries present acute symptoms that are often more intense than typical isolated ligament tears. Immediate pain, bruising, swelling, and difficulty moving the knee will be present.  Nearby blood vessels and nerves may also be affected causing numbness, tingling, a cooling sensation, and overall weakness. Multi-ligament knee injuries are serious and require immediate medical evaluation.

Diagnosis

A thorough examination, X-rays, and  an MRI are necessary when more than one ligament is suspected to be injured.  If a dislocation has also occurred, reduction (placing it back into its proper position) and stabilization are necessary as soon as is safely possible. In many cases, dislocations are reduced on a playing field or in an emergency room upon arrival.  Sometimes, special studies to evaluate blood vessels are necessary, and in cases of vascular injury, a consultation with a vascular surgeon will be necessary.

Treatment

In the majority of cases that involve multi-ligament knee injury, a surgery will be needed. This is considered a complex knee surgery and may involve more than one technique.  Surgery may be delayed to allow  swelling to decrease. Depending on which ligaments are injured, Dr. Anz will focus on restoring stability to the knee by performing a repair or reconstruction of all torn ligaments. A graft from either the patient or a donor will often be needed. Sutures, anchors, and screws  are used to reattach the injured ligaments or correctly position and secure grafts.

Post-Operative

Dr. Anz will prescribe a thorough and attentive rehabilitation program following a multi-ligament knee surgery. Restrictions regarding motion and weight bearing are important and tailored to an individual’s unique injury.  It is important for patients to achieve full knee extension as soon as possible.  This often involves an early focus on the quadriceps muscle.  Dr. Anz will work as a team with the patient and therapist to ensure that a full recovery can be reached and individualize the rehabilitation process.

For more information on multi-ligament knee injuries, or for additional resources on knee ligament reconstruction surgery, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Meniscus Knee Injuries

The meniscus is a c-shaped cartilage that resides inside the knee joint.  It is located between the cartilage ends of the femur and tibia and increases the surface area for force transmission between the two.  As a result, it decreases pressure, adds to knee joint stability, and provides some shock absorption between the femur and tibia.  There are two menisci in every knee, one on the inner side (medial meniscus) and one on the outer side (lateral meniscus).  Meniscal knee injuries are common among athletes and can affect both menisci. The meniscus is extremely important to evenly distribute force across the knee, and protect the articular cartilage. They also serve as secondary stabilizers of the knee.

Meniscus injuries can affect both men and women of any age.  In younger people, it is often associated with a sports injury or traumatic accident, whereas in older adults it occurs due to wear and tear of an active lifestyle.  Tears in older patients due to lifetime wear are termed degenerative meniscus tears. The integrity and stability of a meniscus is directly related to its due to its shape and composition.  If a meniscus sustains a significant tear it can lose its ability to remain between the ends of the femur and tibia.  As a result, pressure upon the articular cartilage can increase predisposing one to degradation and wearing of the articular cartilage. Smaller meniscus tears do not disrupt the integrity of the meniscus and provide mechanical symptoms of catching and locking.  Care must always be taken to protect as much of the meniscus as possible in instances of injury.

Symptoms

The primary symptoms of a meniscus tear include pain on the inside or outside of the knee with mechanical symptoms.   Certain activities such as pivoting, running, climbing, or even arising from a chair may produce symptoms including popping and catching.  Patients may hear a clicking sound with movement, and the knee may be tender to the touch for some in specific locations.

Diagnosis

Upon the initial visit Dr. Anz will perform a complete physical examination and will move the knee in a series of tests that will help to determine where the injury is located.  While an X-ray will not show meniscal damage, it is necessary to evaluate the overall health of the knee joint, as subtle changes on X-rays are common and help to guide treatment. Although a meniscal tear can be diagnosed by a patient’s symptoms and through the physical exam alone, an MRI is important to confirm diagnosis as well as inspect the cartilage surfaces throughout the knee joint.

Treatment

Small meniscal injuries may be painful after initial injury and then improve with time.  In cases where it appears that a small tear is present, Dr. Anz may recommend an initial non-surgical course.  This will include rest, physical therapy, icing, anti-inflammatory medications, and possibly bracing.  If symptoms continue, Dr. Anz may recommend surgery.  This will depend on the patient’s age, activity level and activity goals.

Surgical Treatment

If the meniscus has a small symptomatic tear, a tear that is shredded beyond repair, or a tear in the inner third of the meniscus, then each can be treated using an arthroscopic approach that allows Dr. Anz to remove the area of the tear. Arthroscopic knee surgery uses tiny keyhole incisions, a small camera to visualize the inside of the knee, and specialized instruments to perform the surgery. During a partial meniscectomy only the damaged meniscus is removed, and great care is taken to only remove the involved part of the tear and leave as much of the healthy meniscus as possible.

Some meniscal tears can be repaired, especially those that exist in the outer two thirds of the meniscus.  Sometimes a repair can involve sutures placed from inside the joint, and sometimes an incision must be made on the outside of the knee using a combined arthroscopic and open procedure.  Strong stitches are placed through the tear to bring the tissue back together and allow for healing.

Post-Operative

Dr. Anz will prescribe a specific rehabilitation protocol after surgery on the meniscus, and physical therapy will vary depending on how complex the surgery was. Patients are strongly advised to follow the advice of their therapist and to follow the recommendations about when to put weight on the injured leg.  Patients who had a full meniscus repair will be required to observe motion restrictions in a knee brace for up to six weeks.

For more information on knee instability or meniscus knee injuries, or to learn more about the surgical treatments for meniscus tears offered by Dr. Adam Anz, orthopedic knee surgeon, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

MCL Knee Injuries

The MCL is a ligament that links the shinbone (tibia) and thighbone (femur), and is located on the inner aspect of the knee.  It is an extra-articular ligament (not located inside the knee joint), and as a result has a good blood supply.  The MCL may be injured as the result of a direct blow to the outer edge of the knee or from landing abnormally on the leg.   MCL injuries are often seen in soccer, football, basketball, and snow skiing.  The MCL can also be injured during daily activities such as tripping or missing a step. MCL knee injuries range in severity, including stretch injuries or partial tears to the ligament and complete disruption of the fibers of the ligament.

Symptoms

Symptoms of an MCL knee injury will vary.  The most obvious symptom is pain, with bruising and swelling on the inside of the knee joint. A subtler symptom involves the feeling of instability when the leg is placed in certain positions. With complete disruption, instability may be quite noticeable.

Diagnosis

Dr. Anz will perform a detailed physical exam where he will apply various tests to determine knee mobility, pain, and stability. These tests help to detect injury to the ligament ligament.  One exam is performed by bending the knee to 25 degrees and putting pressure on the outside surface of the knee. When MCL damage is suspected Dr. Anz will usually order a stress X-ray to document to extent of injury.  An MRI is often necessary in order to determine the healing potential of the ligament.

Treatment

Many isolated MCL injuries can be treated non-operatively. Excellent results are typically seen by allowing the MCL to heal through immediate range of motion, icing, physical therapy, and bracing.

Surgical Treatment

If the MCL injury is a grade III injury, or is injured along with other ligaments, it may not heal on its own.  In this case, an open procedure to reconstruct the MCL may be necessary.   During the reconstruction process, Dr. Anz may use a graft from either the patient or a donor. This choice will be made with the patient after a detailed discussion of the risks and benefits.

Post-Operative

Therapy is the most important part of a post-operative course.  Dr. Anz will prescribe a complete rehabilitation program that should be followed closely to completion following surgery. Therapy will be progressive and will focus on regaining mobility and motion to the injured knee, followed by a strengthening and a functional rehabilitation program.

For more information on the treatment following an MCL knee injury, or for more information on isolated or multi-knee ligament injuries, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Malalignment of the Lower Extremity

The knee joint is a crucial component of the lower extremity mechanical axis in the human body. In orthopedics, proper alignment of the lower extremity is essential for normal joint function, muscle development, biomechanics, and dynamic balance.  If the lower extremity is improperly aligned, problems can arise in the knee joint including damage to the articular cartilage and/or meniscus because forces across the knee are not evenly balanced.  An improper alignment of the lower extremity is often called a malalignment. Over time, a malalignment may cause damage to the knee joint and its ligaments and can cause various symptoms in both young and older individuals.

Some people are born with a malalignment, while others can develop malalignment due to a traumatic event or damage to structures on one side of their knee..  There are a number of problems that can arise due to a malalignment, including articular cartilage damage, meniscal damage, and a ligament injury.

There are two types of malalignment in the knee:

  • VARUS: The term “bow legged” refers to a varus malalignment. This occurs when weight does not pass evenly through the knee and instead passes through the inside  (or medial compartment) of the knee joint (inside). With this condition, patients are more likely to develop degeneration of this side of the knee and are at a risk of having medial meniscal tears and cartilage injury.  With time, patients may also stretch out the ligaments on the outside of their knee and develop instability during walking.  A varus thrust involves visible instability upon walking.
  • VALGUS: The term “knock kneed” refers to a valgus malalignment.  This occurs when the weight-bearing axis passes through the lateral side of the knee (outside), predisposing this side to injury and wear.

Varus and valgus alignments occur on a spectrum.  Some people may have a mild amount of varus or valgus which does not cause any problems.  However, extreme cases of varus and valgus involve weight transmission across the knee joint which is not balanced.  This can cause unequal wear in the knee joint as one side experiences greater force than the other side.

Symptoms

Some change in the mechanical axis is normal through childhood development, however, malalignments which persist after childhood can affect one’s stance and gait (pattern of walking).  Patients may report that they have been “bow-legged” or “knock-kneed” since childhood.  These patients may or may not develop problems later in life depending on the extent of their alignment.  Patients that develop a malalignment due to other causes often report an initial injury many years ago.  They then noticed a gradual onset of pain on one side of their knee.   Mechanical symptoms such as knee swelling, popping, catching, and a reduced range of motion may also be present.

Diagnosis

The diagnosis of malalignment will require a physical examination as well as X-rays that capture the entire lower extremity mechanical axis.  Dr. Anz will examine the hip, knee and entire lower extremities. Full length standing X-rays will document the weight-bearing axis (overall alignment) of the leg and evaluate the overall status of the knee.  For patients with mechanical symptoms, an MRI will help to evaluate the cartilage and meniscus of the knee joint.

Treatment

Some patients who are diagnosed with a malalignment can be treated conservatively without surgery. A thorough understanding of the problem and avoiding certain activities can be helpful.  Additionally, stretching and strengthening of the quadriceps, hamstrings, and calf muscles will help provide stability to the knee joint.  Weight loss, core and lower extremity strengthening, shoe modifications, and bracing to shift the mechanical axis may also be recommended.

Surgical Treatment

In certain instances, surgery may be recommended. Surgery to correct a malalignment requires an osteotomy (or cut in a bone) and realignment.   This may be performed on the leg bone (tibia) or thighbone (femur) and may also be combined with other procedures.  In certain instances of a ligament injury in the setting of malalignment, a staged surgery may be necessary.  For instance in patients with malalignment and chronic ligament injuries, two surgeries may be necessary.  The first surgery will involve an osteotomy correction of the malalignment followed at a later date by ligament reconstruction surgery. There are also procedures to treat chondral injuries that may result from the malalignment.

Post-Operative

Depending on the specifics of the surgery patients may be immobilized following surgery for a period of time and may be restricted from putting weight on their leg. Physical therapy is always important and will focus on patient mobility, returning motion at the appropriate time, and regaining strength back to the injured knee and surrounding muscles.  Rehabilitation is a crucial part of the recovery process and is recommended to achieve optimal results.

For additional resources on knee conditions involving a malalignment of the knee, such as a varus or vargus knee disorder, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

FCL/LCL Knee Injuries

There are four major restraints to the knee joint, including the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and posterior lateral complex (PLC).  The PLC is on the outer side of the knee and has three major components: the fibular collateral ligament (FCL), the popliteus muscle and tendon, and the popliteofibular ligament.  The FCL may also be referred to as the lateral collateral ligament (LCL) because of its location on the outside of the knee.  It is attached to the femur (the bone in the thigh) and the fibula (one of the two bones in the lower leg).  The FCL and entire PLC helps stabilize the knee during rotation and side-to-side motion.  These structures can become damaged/torn with certain twisting injuries.

In some instances, the FCL may heal on its own after injury; however, in certain instances, the ligament is torn to the extent that an FCL repair or reconstruction is necessary.  When the FCL is injured, other ligaments are often injured as well. This is referred to as a multi-ligament knee injury and typically requires a large amount of impact or force, such as high-impact sporting collision, fall, or a traumatic accident.

Symptoms

Injuries to the FCL/LCL can occur in a variety of situations.  A direct hit to the inside portion of an athlete’s knee or impact with a twisting motion may cause an injury to the FCL and other structures of the knee.  Initially after a FCL/LCL injury, there will be significant swelling and bruising on the outside (lateral side) of the knee.  Bruising and swelling will often be accompanied by pain and instability.  Fluid in the knee joint (a knee effusion) and a catching sensation may also be present.

Diagnosis

Dr. Anz will conduct a thorough physical examination of the knee evaluating the location of pain, range of motion of the knee, status of strength and sensation, as well knee stability. He will perform a series of tests to evaluate all of the ligaments of the knee and determine if there is abnormal gapping of the knee during the exam.  Stress X-rays are necessary to determine the degree of injury.   Depending on the nature of the injury as well as results of the examination and X-rays, the most appropriate intervention will be prescribed.  This may include non-operative or operative measures.  Dr. Anz may also include an MRI as part of the evaluation to help determine exactly which structures are injured and to assess the structures that surround the initial injury.

Treatment

Isolated FCL injuries can often be treated with non-surgical measures such as an extended rest period, icing, anti-inflammatory medications, and bracing of the injured knee. Physical therapy may also be recommended to help regain mobility and function, as well as overall strength back to the knee joint.

Surgical Treatment

For FCL injuries that are more severe, Dr. Anz may recommend a surgery to repair or reconstruct the FCL. Due to the location of the FCL, a repair or reconstruction cannot be performed arthroscopically, so an open approach to the surgery is necessary.    In some instances, structures other than the FCL may also require repair or reconstruction.

Post-Operative

Dr. Anz will prescribe a complete rehabilitation program following FCL knee surgery. The outcomes of reconstructions and repairs often yield very good results.  It’s important for patients to fulfill their physical therapy program completely, and those who do, are usually able to demonstrate excellent return of stability following the rehab process.  Most patients can usually return to full function within 6-12 months after surgery depending on the nature of the injury.

For additional information regarding FCL knee injuries, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Knee Cartilage Injuries

Cartilage is a type of tissue found in the joints of the body. Articular cartilage is a specific type that covers the ends of the bones within a joint allowing smooth, pain-free movement. There are other types of cartilage found in the joints as well.  This includes cartilage that covers the discs in the spine, or cartilage that makes up the meniscus of the knee. All forms of cartilage have varying properties and functions, however, articular cartilage is a form that is commonly injured in the knee. Articular cartilage is strong, but once damaged, the tissue has a very limited ability to heal because of its limited blood supply. Due to the limited healing potential of cartilage, articular cartilage injuries (often referred to as chondral injuries) may worsen if left untreated. When the deterioration and damage involves a large part of the joint and is accompanied by inflammation of the joint, the term applied to the injury is degenerative osteoarthritis.

Articular cartilage can become damaged through a number of ways.  These are highlighted below:

  • Cartilage can become damaged through sports accidents or acute trauma
  • When knee alignment is not perfect, chronic overuse and repetitive weight bearing can cause cartilage injury
  • Age plays a vital role in the health of articular cartilage. As an individual ages, cartilage can deteriorate due to our active lifestyles
  • Focal damage (injury to a small, specific localized area) to cartilage can range from softening of the cartilage to to complete detachment of a piece of cartilage leaving the underlying bone exposed.
  • Chondromalacia is a medical term describing cartilage injury with grading of 1 to 4. Grade 1 chondromalacia refers to softening of cartilage.  At the other end of the spectrum, grade 4 chondromalacia refers to a full thickness cartilage injury where the cartilage is worn down to bone or is detached as a full segment of cartilage.  An osteochondral defect (OCD) occurs when there is damage to both the cartilage and the bone layer below.

Symptoms

A constant, dull ache, accompanied with joint swelling and stiffness, are the most common symptoms associated with a cartilage defect or injury.  These symptoms can start as an ache and turn into chronic pain over time. If cartilage pieces become dislodged, they can cause popping and catching symptoms.  The symptoms will worsen with activity.  In early staged injuries, pain can be managed with conservative measures, while injuries that have progressed may benefit from a surgical procedure.

Diagnosis

Pain in the knee from a cartilage injury can mirror many other conditions. Because of this, Dr. Anz will gather as much information as possible during the initial interview and will conduct a thorough physical examination to evaluate the pain and mobility of the knee. An X-ray will be performed at the initial visit, and an MRI may also need to be obtained.  Once a cartilage injury has been diagnosed, Dr. Anz will assess the stage and level of injury and provide a treatment plan.

Treatment

Minor cartilage injuries often respond well to conservative treatment measures.  This includes avoiding activities that cause symptoms to flare up, as well as icing of the knee, elevation of the injured knee, anti-inflammatory medications, and physical therapy.

Surgical Treatment

For severe cases of cartilage damage, Dr. Anz may recommend a surgical treatment. Most treatments are in place to provide pain relief and mobility for patients.  The surgery performed for chondral damage will be based upon the grade of the injury as well as the method Dr. Anz believes will provide the best outcome. The patient’s age, activity level, fitness goals, and lifestyle, will all be taken into account before a treatment plan has been provided. Most of the procedures that are performed to treat cartilage defects can be done arthroscopically.  Dr. Anz offers the following procedures to treat articular cartilage injuries and chondral defects: Microfracture (marrow stimulation), debridement and chondroplasty,, and osteochondral allograft transplantation.  Experimental procedures utilizing stem cells are on the horizon for treating cartilage defects, and Dr. Anz has been directly involved with research in this area.

Post-Operative

Proper rehabilitation is one of the most important aspects of the effectiveness and successful outcome following a surgical procedure for articular cartilage injuries. Dr. Anz will consult with each patient regarding what is expected of them after surgery and will recommend a physical therapy rehabilitation program which should be fulfilled completely in order to achieve the most optimal results. The program will be broken down into phases that will consist of transitions from movement and mobility to strengthening and regaining full function of the knee.

If you have any further questions or are interested in scheduling an appointment with Dr. Anz to discuss your symptoms, which you believe might be a cartilage injury of the knee, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute.