The Knee

knee-xray

We specialize in advanced knee replacement and knee care techniques. Our very own, Dr. David F. Scott, MD, is a specialist in this field. He consults with parts manufacturers, contributes significantly to the ongoing research in this field, and has been a contributor to many significant advances for knee replacement.

The knee joint joins the thigh with the lower leg and consists of two articulations: one between the femur and tibia, and one between the femur and patella. It is the largest joint in the human body and is very complicated. The knee is a mobile trocho-ginglymus (a pivotal hinge joint), which permits flexion and extension as well as a slight medial and lateral rotation.

The knee is relied upon in your regular activity and motion, and a healthy knee allows you to walk, twist, and bend easily. Since in humans the knee supports nearly the whole weight of the body, it is vulnerable to both acute injury and the development of osteoarthritis. At OSC, we are skilled at treating knee injuries and providing care that will get patients moving again.

 

What Causes Knee Problems?

The knee is a complex joint with many components, making it vulnerable to a variety of injuries. Knee pain/injury is the most common reason for visiting an orthopaedic surgeon.

How Are Knee Problems Diagnosed?
  • Medical history
  • Physical examination
  • Tests such as x-rays, ultrasound, and magnetic resonance imaging (MRI).
How Are Knee Problems Treated?

Knee problems are most often first treated with RICE (Rest, Ice, Compression, and Elevation):

  • Rest. Don’t use the knee for 48 hours.
  • Ice. Put an ice pack on the injured area for 20 minutes, four to eight times per day. Use a cold pack, ice bag, or a plastic bag filled with crushed ice wrapped in a towel.
  • Compression. Put even pressure (compression) on the painful area to help reduce the swelling. A wrap or bandage will help hold the knee in place.
  • Elevation. Keep the injured area above the level of the heart. A pillow under the Foot will help keep it up.

If pain and stiffness persist, see a doctor to diagnose and treat the problem. Who might use some of these solutions:

Computer-aided Surgery

Computer-aided surgery (navigation) has received much attention in recent years. This type of surgery involves a camera and computer system to guide the surgeon through the procedure. The proponents of computer-aided surgery believe that it gives the physician the opportunity to better customize the surgery for the patient’s specific anatomy. Claims are made that this allows less invasive techniques and quicker recovery times.
Dr. Scott was the first orthopaedic surgeon in the Inland Northwest area to test and make use of computer-aided surgery technology and also helped to develop the system for a major manufacturer. While this technique can be effective, it’s important to know that current non-computer-assisted techniques are very effective and can be preferable for many patients. Dr. Scott is an expert in this area of computer-assisted navigation, and it’s important to talk with him about the most effective surgery technique for your needs.

Minimally Invasive Surgery

Minimally invasive surgery is true to its name, seeking to minimize tissue damage and recovery times as much as possible. The term “minimally invasive” is used a lot in orthopaedics today, with some perceiving it to be more effective than traditional surgery. Dr. Scott sees it as minimally traumatic as opposed to minimally invasive: like building a model ship in an empty bottle – it can be done but it doesn’t leave you a lot of room to work in its small opening. If the complications of working through the small opening weren’t a factor, you would have a lot more flexibility and freedom to build the best ship possible.
Dr. Scott’s precise approach to the surgery focuses on minimizing the damage to – and taking the best care of – the soft tissue within your joint. His minimally traumatic method is efficient, precise, and tailored to your body. This efficiency translates to shorter surgery time for patients, quicker recovery and the lowest possible complication rate. This kind of surgery isn’t about the size of your scar, but about the quality of the care you receive, the rapid healing you will experience, and the longevity of your successful surgery.
Dr. Scott was one of the first surgeons in the Pacific Northwest to perform less-invasive, minimally traumatic hip and knee replacement. He has the experience required to provide patients the best possible care in the least traumatic way. OSC even provides outpatient knee replacement options for suitable patients.

Partial Knee Replacement (Unicondular Arthroplasty)

Partial knee replacement is similar to total knee replacement. Over time, these types of replacements have become less common as we have found that most injuries involve more than one component of the knee and the procedure and recovery are similar to that of total knee replacement. As with any procedure, your physician can make an informed recommendation around whether partial knee replacement is a good option for your situation.

Knee Implants

In a knee replacement, up to four parts are implanted in the knee, replacing damaged portions of the femur, tibia, and patella. These plastic (tibia and patella) and metal (femur and tibia) implants use state-of-the-art materials designed to replicate the natural movements of the knee and last as long as possible. There has been development of different materials such as the mobile-bearing and gender-specific knee that you may have heard about in recent years. Dr. Scott is on the forefront of new knee replacement technology and can talk with you about the best implant materials for your need. As in a natural knee, wear and tear of a knee replacement will still occur with regular movement over time.

Cement or Cementless Materials

One decision an orthopaedic surgeon has to make when considering knee replacement is the use of cement in the procedure. Cement is used to connect the replacement parts to the bone and can be a very viable option as it can last for 20 years or more. Alternatively, cementless replacements rely on the bone to naturally fuse with the new parts. This can take time and often has a longer recovery period than cement procedures. This option is effective, however, and can be a viable option for younger patients. As with any procedure, your surgeon will evaluate your unique situation, and can work with you to identify the best treatment for your knee replacement.

Biologic Reconstruction Alternatives

Dr. Scott is leading the way in alternatives to joint replacement. More recently, there has been an explosion in the interest in biologic alternatives – surgical options that do not require implanting metal parts. This includes viscosupplementation, osteotomy, meniscal repair and transplant, and cartilage transplant techniques.

Knee Arthroscopy

Arthroscopy involves placing a small arthroscope that contains a camera through a small incision into the knee. This allows the doctor to gain a larger and clearer view of what’s really going on inside the knee. This type of procedure is minimally invasive and can be effective for identifying and treating knee problems including torn ligaments, damaged cartilage, and more.

Cartilage Transplant (OATS Allograft or Bulk Allograft)

Due to injury, cartilage in the knee may have been removed or damaged and can become increasingly painful over time. Like cartilage repair, cartilage transplant uses donor tissue to replace the missing or damaged cartilage. Patients who are younger and have not yet developed arthritis in the joint may benefit from cartilage transplant surgery. This kind of transplant can help alleviate pain, providing more cushion to the joint as it functions.

Meniscus Transplant (Allograft)

When you have sustained significant damage in the form of a meniscus tear and have had damaged tissue removed from the knee, wear over time can cause increased pain. Patients who are younger and have not yet developed arthritis in the joint may benefit from meniscus transplant surgery. This surgery can help to alleviate pain and repair the tissue cushioning by replacing the damaged meniscus with donor cartilage.

What Are the Most Common Knee Problems?

The symptoms and treatment of the knee vary, depending on the type of problem.

  • ACL Injury

    ACL Injury

    An anterior cruciate ligament, or ACL, injury is a tear in one of the knee ligaments that joins the upper leg bone with the lower leg bone. The ACL keeps the knee stable.

    Causes:

    • Changing direction rapidly
    • Slowing down when running,
    • Landing from a jump
    • Athletes who participate in skiing and basketball, and athletes who wear cleats, such as football players, are susceptible to ACL injuries

    Symptoms may include:

    • Hear a popping noise
    • Feel your knee give out at the time of injury
    • Have severe pain
    • Are unable to move the knee
    • Limping
    • Swelling at the injury site

    Examination may include:

    • Medical History
    • Physical exam
    • X-ray

    Range of treatment:

    • Rest
    • Ice
    • Compression
    • Elevation
    • Bracing
    • Physical Therapy
    • Surgery
  • MCL Injury

    MCL injury

    The medial collateral ligament (MCL) is one of four ligaments that are critical to the stability of the knee joint. The MCL spans the distance from the end of the femur (thigh bone) to the top of the tibia (shin bone) and is on the inside of the knee joint. The MCL resists widening of the inside of the joint, or prevents “opening-up” of the knee.

    Causes:

    Injuries to the MCL are usually caused by a direct blow to the outside of the knee. These types of injuries often occur in contact sports, such as football or soccer.

    Symptoms:

    • Pain directly over the ligament
    • Swelling over the torn ligament may appear
    • Bruising
    • Generalized joint swelling
    • Instability of the knee

    Examination may include:

    • Physical examination
    • MRI

    Range of treatment:

    • Rest
    • Ice
    • Compression
    • Elevation
    • Physical Therapy
    • Bracing
    • Surgery
  • PCL Injury

    PCL Injury

    The posterior cruciate ligament (PCL) is a ligament within the knee. Similar to the Anterior Cruciate Ligament (ACL), it connects the thigh bone (femur) to your shin bone (tibia). Although it is larger and stronger than the ACL, the PCL can be torn. Injuries that tear the PCL often damage some of the other ligaments or cartilage in the knee, as well. In some cases, the ligament can also break loose a piece of underlying bone. Degrees of severity of the injury include:

    1. The PCL has a partial tear.
    2. The ligament is partially torn and is looser than in Grade I.
    3. The ligament is completely torn and the knee becomes unstable.
    4. The PCL is damaged along with another ligament in the knee.

    Causes:

    • Striking the knee
    • Falling on the knee while it’s bent
    • Sports injuries

    Symptoms may include:

    • Popping sensation
    • Swelling (mild to severe)
    • Knee pain
    • Wobbly sensation in the knee
    • Trouble walking or bearing weight on the knee

    Examination may include:

    • Medical History
    • Physical examination
    • X-Ray
    • MRI

    Range of treatment:

    • Rest
    • Ice
    • Compression
    • Elevation
    • Physical Therapy
    • Bracing
    • Surgery
  • LCL Injury

    LCL Injury

    Knee ligament sprains or tears are a common sports injury. Athletes who participate in direct contact sports like football or soccer are more likely to injure their lateral collateral ligaments.

    Causes:

    • Sideways force to the knee
    • Direct blow to the inside of the knee

    Symptoms may include:

    • Pain
    • Swelling
    • Instability
    • Locking or catching

    Examination may include:

    • Physical Examination
    • Patient History
    • X-rays
    • MRI

    Range of treatment:

    • Rest
    • Ice
    • Medication
    • Compression
    • Elevation
    • Physical Therapy
    • Bracing
    • Surgery
  • Meniscal Injury

    Meniscal Injury

    The meniscus is a rubbery, C-shaped disc that cushions the knee. Each knee has two menisci and keep your knee steady by balancing your weight across the knee. A torn meniscus can prevent your knee from working right. There are three types of tears, minor, moderate and severe.

    Causes:

    A meniscus tear is usually caused by twisting or turning quickly, often with the foot planted while the knee is bent. These tears can occur when you lift something heavy or play sports.

    Symptoms may include:

    • Minor tear
      • Slight pain
      • Swelling
    • Moderate tear
      • Pain at the side or center of the knee
      • Increased swelling over time
      • Knee stiffness
      • Limited mobility
      • Sharp pain when twisting the knee or squatting
    • Severe tear
      • Catching, popping, or locking of the knee
      • Inability to straighten the knee
      • Instability of the knee
      • Stiffness and swelling

    Examination may include:

    • Medical History
    • Physical Examination
    • X-ray
    • MRI

    Range of treatment:

    • Rest
    • Ice
    • Compression
    • Elevation
    • Physical Therapy
    • Bracing
    • Surgery
  • Patellar Tendinitis

    Patellar Tendinitis

    Patellar tendinitis is a condition that affects the tendon connecting your kneecap (patella) to your shinbone. The patellar tendon plays an important role in the way you use your leg muscles as it assists your muscles to extend your knee. Patellar tendinitis is a condition that occurs when the tendon becomes inflamed and irritated, most often seen in younger athletes who do repetitive jumping and the reason patellar tendinitis is often called “jumper’s knee.” Patellar tendinitis is most often seen in participants of sports including basketball and volleyball, although can also be seen in runners and other types of athletes.

    Causes:

    Patellar tendinitis is a common overuse injury. It occurs when you place repeated stress on your patellar tendon. The stress results in tiny tears in the tendon, which your body attempts to repair. But as the tears in the tendon become more numerous, they cause pain from inflammation and a weakening of the tendon structure. When this tendon damage persists over more than a few weeks, it is called tendinopathy.

    Symptoms may include:

    • Pain directly over the patellar tendon
    • Pain with activity
    • Aching pain
    • Tenderness
    • Swelling
    • A crunching sensation over the swollen tendon.

    Examination may include:

    • Medical History
    • Physical Examination
    • X-ray
    • MRI

    Range of treatment:

    • Rest
    • Ice
    • Medication
    • Physical Therapy
    • Injections
    • Surgery
  • Osteoarthritis of the Knee

    Osteoarthritis of the Knee

    Osteoarthritis (OA) is the most common form of knee arthritis. OA is usually a slowly progressive degenerative disease in which the joint cartilage gradually wears away. It most often affects middle-aged and older people.

    Symptoms:

    • Pain that typically develops gradually
    • Joint stiffness and swelling
    • Difficulty bending or straightening the knee
    • Symptoms that are worse in the morning
    • Increased pain after activity
    • Locking or buckling of the knee
    • Symptoms that change with the weather

    Examination may include:

    • Medical history
    • Physical examination
    • X-ray
    • Blood tests

    Range of treatment:

    • Change in types of activities
    • Weight loss
    • Exercise to increase range of motion and flexibility
    • Physical Therapy
    • Braces and walking devices
    • Change in shoe wear
    • Ice/heat
    • Medications
    • Injections
    • Surgery, if necessary

    Research:

    Orthopaedic surgeons are continuing to search for new ways to treat arthritis of the knee. Current research is focusing on new drugs as well as on cartilage transplants and other ways to help slow the progress of arthritis.

  • Patellar Fracture

    Patellar Fracture

    One of the most comment knee injuries, patella fracture is an injury to the kneecap. The patella is coated with cartilage on its undersurface and is important in providing strength of extension (straightening) of the knee joint.

    Causes:
    • Injury such as a fall directly onto the knee or a hard blow to the front of the knee
    • Indirect fracture from a contraction of the quadriceps muscle
    Symptoms may include:
    • Pain when your knee is touched
    • Pain when with movement of your leg
    • Swelling
    • Bruising
    • Ability to straighten your leg but not bend it.
    • Inability to stand or bear weight on your leg
    Examination may include:
    • Medical history
    • Physical examination
    • X-ray
    Range of treatment:
    • Rest
    • Ice
    • Medication
    • Physical Therapy
    • Bracing
    • Surgery
  • Patellofemoral Pain Syndrome

    Patellofemoral Pain Syndrome

    Very common, Patellofemoral pain syndrome, often called ‘Runner’s Knee’  is a term used to describe pain originating from the kneecap and femur, or thigh bone.

    Causes:

    While the exact cause is unknown, it’s believed that the way the knee cap tracks along the groove of the femur can lead to irritation of the cartilage on the underside of the knee cap.

    Symptoms may include:
    • Pain in one or both knees
    • Pain that tends to worsen with activity
    • Discomfort while descending stairs
    • Pain after long periods of inactivity
    • Popping or grinding of the knee
    • Swelling
    Examination may include:
    • Medical history
    • Physical examination
    • X-ray
    • MRI
    Range of treatment:
    • Rest
    • Ice
    • Compression
    • Elevation
    • Medication
    • Physical Therapy
    • Custom Orthotics
    • Surgery
  • Baker’s Cyst

    Baker’s Cyst

    A Baker’s cyst, or popliteal cyst, is a pocket of fluid that forms a benign lump behind the knee.

    Causes:
    • In children, a cyst involves the bursa, a small sac of fluid behind the knee, joining with the sac that cushions the knee bones (synovial sac).
    • In adults
      • Arthritis
      • Knee Injury
    Symptoms may include:
    • Tightness
    • Stiffness
    • Swelling that may increase with standing
    • Slight pain with bending or straightening knee
    Examination may include:
    • Medical history
    • Physical examination
    • Ultrasound
    • MRI
    Range of treatment:
    • Rest
    • Ice
    • Compression
    • Elevation
    • Medication
    • Aspiration/injection
    • Surgery
  • Osgood Schlatter Disease

    Osgood Schlatter Disease 

    Very common among adolescents, Osgood Schlatter Disease (OSD) is not actually a disease, but an overuse injury that can be quite painful, but usually resolves within 12 to 24 months. OSD is an inflammation of the bone, cartilage and/or tendon at the top of the shinbone, where the tendon from the kneecap attaches.

    Causes:

    Often more common during 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 may include:
    • Pain
    • Swelling
    • Tenderness just below the kneecap
    •  Knee pain that worsens with exercise
    • Decreased pain during rest
    • Tightness of the surrounding muscles, especially the thigh muscles (quadriceps)
    Examination may include:
    • Medical history
    • Physical examination
    • X-ray
    • MRI
    Range of treatment:
    • Rest
    • Ice
    • Medication
    • Surgery in rare cases

Outpatient Knee Replacement

We specialize in advanced knee replacement techniques and now have outpatient options available for knee replacements right here in Spokane, Washington.

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