The Knee Center

Our prestigious Knee program is led by Board Certified Orthopedic Surgeon Dr. Charles Ruotolo, Dr. Brett Spain, Dr. Paul Pipitone, and Arthroscopic Sports Medicine Specialist Dr. Richard McCormack.

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Knee Conditions & Procedures

Performed at The Knee Center at Total Orthopedics

Knee Conditions We Treat

At Total Orthopedics & Sports Medicine, we treat a variety of conditions involving problems with the Knee. Select a condition below to learn more.

ACL Tear

The anterior cruciate ligament (ACL) is a ligament in the knee that prevents the tibia from sliding forward relative to the femur. It is an important stabilizer in the knee. The ACL can be injured during a pivot, when the foot is planted and the knee twists, or when landing awkwardly from a jump. Female athletes are 3 times more likely to sustain an ACL injury compared to males.

Symptoms of an ACL tear may include:

  • Feeling or hearing a popping noise in the knee
  • Pain on the outside and back of the knee
  • Constant swelling within the first few hours of the injury
  • Limited knee movement because of pain or swelling or both
  • The knee feeling unstable, buckling, or giving out

It is worth noting that over 50% of patients who tear their ACL also suffer from an injury to the meniscus.

Causes of the injury may include:

  • Taking a hit very hard on the side of the knee, forcing it to twist unnaturally
  • Overextend the knee joint
  • A quick change of direction while running, landing from a jump, or turning
PCL Tear

The posterior cruciate ligament (PCL) is a ligament located in the back of the knee that connects the femur to the tibia. The PCL keeps the tibia from moving backwards on the femur.

Symptoms of a PCL injury typically include pain and swelling at the time of injury which may also be felt in the calf region. The patient will feel instability in the joint and the feeling of the knee giving out. Pain is reproduced by attempting to bend the knee the wrong way, which strains the PCL. There may be visual deformity

An injury to the PCL requires quite an impact. A common cause of the injury is a bent knee during a motor vehicle accident or an athlete falling on a knee that is bent. If the ligament is not torn but only sprained surgery is rarely needed, but when the PCL is torn it is very common for other ligaments to be torn as well, making surgery a

MCL Injury

The Medial Collateral Ligament (MCL) is the ligament located on the inner side of the knee responsible for connecting the shin bone to the thigh bone. A strain or sprain most often occurs if excessive directional force is applied to the ligament.  

MCL injuries are a common occurrence in sports and more specifically, contact sports.  Direct force is often applied by the opponent to the outside of the leg directly above the knee.  This force causes the ligaments to be stretched past their intended capacity which causes the injury.

Another common incidence for this injury is shoes or cleats getting stuck in the grass or turf.  As the player attempts to change direction the foot remains planted and sudden excessive force is applied to the ligament causing damage.

Symptoms may include:

  • Soreness in the knee
  • Sensitivity to touch or pressure
  • Pain when bending or bearing weight on the knee
  • Inability to bear any weight on the knee
  • Swelling within 24 hours of injury
  • Fluid in the knee
  • Damage to other knee structures
Meniscus Injuries

The two menisci of the knee are labeled the medial meniscus and the lateral meniscus. They are wedges of cartilage that fill the gap between the tibia and femur. The menisci provide stability in the knee by creating a cup for the end of the femur to sit in.

The meniscus can be torn during activities that cause direct contact to or pressure on the knee. A sudden pivot, deep squatting, or heavy lifting can lead to an injury to the meniscus. Sports that require sudden turns and stops, put someone at higher risk for an injury to the meniscus as well.

A “popping” noise will often accompany a meniscus tear. In most cases the patient will be able to walk on the injured knee. In fact, many athletes keep playing with a tear. Over 2 to 3 days, the knee will gradually become more stiff and swollen.

The most common symptoms of meniscal tear are:

  • Pain
  • Stiffness and swelling
  • The knee catching or locking
  • The feeling of the knee “giving way”
  • Loss of full range of motion in the knee
Arthritis of the Knee

Arthritis of the knee is a common condition in the aging population.  Traditionally, arthritis of the knee will take three forms: Osteoarthritis, Rheumatoid Arthritis and Post-traumatic Arthritis

  • Osteoarthritis is usually a form of arthritis that progresses slowly.  As we age, the joint cartilage of the knee tends to degenerate as a result of long term wear and tear and degeneration.  This degeneration can cause bones in the knee to rub together resulting in pain and bone spurs.
  • Rheumatoid Arthritis (RA) is an inflammatory arthritis that slowly destroys the cartilage of the knee.  RA can occur at any age and the likelihood of RA is based on a combination of genetic and environmental factors.  Those with RA most often experience the condition in both knees.
  • Post-traumatic Arthritis may occur over a longer period of time much like Osteoarthritis. In most instances, the degeneration occurs as a result of a previous injury to the cartilage, ligaments or unhealed fracture.  Symptoms may not arise until years after the initial injury occurs.

Signs and Symptoms of Knee Arthritis can vary depending on type:

  • Swelling of the knee
  • Stiffness of the knee
  • Sensitivity to touch
  • “Locking” or “buckling” of the joints
  • Increased pain when walking, climbing or after periods of activity
Patella Injury

A patella injury is caused by damage to the cartilage under the kneecap. This cartilage acts as a shock absorber and distributes weight and force throughout the knee. Degeneration of this cartilage can be a result of repetitive concussive forces to the knee joint or the patella. When this cartilage becomes worn or damaged it can cause the kneecap to rub directly against the knee joint resulting in a dull pain. The pain is most often felt during physical activity or prolonged periods of sitting.

This can be a common athletic injury in sports that require excessive running, use of the knee for generating force or change in direction (soccer, tennis, basketball, cycling, gymnasts, equestrians, skate/snowboarders).

Signs and symptoms of a patella injury can include:

  • Dull pain in the knee
  • Aching in the knee
  • Limited range of motion in the knee
  • Sensitivity to touch
  • Difficulty climbing stairs

A patella injury would result in one of these conditions:

  • Chondromalacia Patellae (Runner’s knee) – The result of irritation to the cartilage under the kneecap. This is the most common condition associated with the patella.
  • Prepatellar Bursitis (Housemaid’s Knee) – Swelling and inflammation over the front of knee. Caused by kneeling for an extended period.
  • Patellar Subluxation- The result of an unstable kneecap. The kneecap does not track evenly within its groove. MPFL Reconstruction is required.
  • Kneecap Dislocation- This occurs when the kneecap comes completely out of its groove. This condition is also called a patella dislocation. MPFL Reconstruction is required to fit the kneecap back into the groove.
  • Patellar Tendon Tear- This is a very serious injury that occurs when the tendon connecting the kneecap to the shin is ruptured. There is a 6 month recovery period and 8-10 months for a return to physical activity.
Patella Dislocation

Patella dislocations occur fairly regularly, especially with the younger generation. This injury can occur either in contact or non-contact situations. An athlete can dislocate their patella when the foot is planted and a rapid change of direction or twisting occurs. Usually a pre-existing ligamentous laxity (loose ligaments) is required to allow a dislocation to occur without any contact. Direct blows to a knee will cause dislocations as well. The force of these is obviously much greater and usually causes more severe damage, especially to the surrounding ligaments.

Symptoms may include:

  • Rapid swelling.
  • Excruciating pain until relocation occurs.
  • Continued pain along medial ligaments.
  • Discoloration/deformity at site of ligament injury.

This injury can be treated non-operatively, with immobilization for 7-14 days and a recovery period of 3 to 6 weeks total. Unfortunately, if the injury occurs where the patient’s ligaments are loosened, there will still be a risk for dislocation if the knee is not operated on. Surgical procedures on the patella are usually done in the outpatient setting. Procedures limited to altering soft-tissue tension begin rehabilitation within a week and return to activity can be expected as early as six weeks. Procedures that will repair injuries to the bone itself will require a period of relative immobilization and need 10 to 12 weeks before a return to athletic activity is permitted.

Patella Chondromalacia

Chondromalacia patella is a softening of the cartilage underneath the kneecap and is known as one of the main causes of knee pain. Degeneration of cartilage is often the result of poor alignment of the patella it slides over the lower end of the thighbone (femur). This process is also sometimes referred to as patellofemoral syndrome.

The primary goal for treatment and rehabilitation of chondromalacia patella is to create a straighter pathway for the patella to follow during quadriceps contraction. This generally means resting and icing the knee often, and avoiding movements that are known to irritate the kneecap.

Non-surgical treatment is recommended and would always be the first option, but in some cases arthroscopic surgery must be performed to relieve the pain. This procedure would smooth off the arthritic wear and tear and release the fibrous band of tissue attached to the outside of the patella. This would provide a permanent stabilization similar to a knee brace.

Patella Maltracking

Patella Maltracking is an imbalance in the gliding of the kneecap that aggravates the cartilage in back of the knee. Rather than moving vertically as the knee bends, a maltracking patella is pulled to the outward side as it moves upward in the groove. This may result in pain on the outward and front sides of the knee, clicking sounds, swelling, and pain from both activity and long bouts of sitting.

Common causes of patella maltracking include problems with foot alignment and muscle strength. Muscle imbalances in the quadriceps or gluteus maximus may aggravate this condition as well.

Non-surgical treatment is recommended and would always be the first option, but in some cases arthroscopic surgery must be performed to relieve the pain. This procedure would smooth off the arthritic wear and tear and release the fibrous band of tissue attached to the outside of the patella. This would provide a permanent stabilization similar to a knee brace.

Hamsting Injury

A pulled hamstring is a common term that refers to a strain of one or more of the hamstring muscles, which are located in the back of the thigh. Depending on the severity of the strain injury, the muscle can actually tear and many people can hear an audible “popping” noise when the muscle is damaged.

These injuries are labeled as acute or chronic. Causes that may lead to an acute injury are:

  • A poor job warming up/stretching
  • Poor lower back flexibility
  • Abnormal biomechanics

Chronic hamstring injuries are usually the result of an improperly rehabilitated acute injury, but may occur as the result of small amounts of trauma over a long period (common for distance runners). Poor hamstring flexibility increases the likelihood of a small tear in the muscle, which in turn causes the muscle to shorten and become tighter. Prompt and appropriate initial treatment are very important so that a viscous circle does not become established.  Tears of the hamstring from their origin in the buttock may require surgical repair.

Osteochondritis Dissecans

Osteochondritis dissecans involves a loss of blood supply or even death to part of the cartilage within the knee joint. The cause of this may be related to repetitive trauma (undiagnosed injury(s) that damage the bone and cartilage). It can also come about due to genetic family history.

This condition most often affects teens between the ages of 11-18, especially teens who are active in high-impact sports, such as football, basketball, soccer and weight-lifting. As noted above, it is thought to be related to repeated impact to, or use of the knee, which over time slows or stops the blood flow to the cartilage. It is very common for the patient not to be aware that any cartilage injury has taken place until pain or loss of mobility occurs.

Some common symptoms of Osteochondritis Dissecans are:

  • Pain, especially when fully bending or straightening the knee
  • Knee catching and locking when bending
  • Swelling and tenderness
  • Difficulty moving
  • Loss of full range of motion
Knee Procedures

At Total Orthopedics & Sports Medicine, we treat a variety of conditions involving problems with the Knee. Select a procedure below to learn more.

Arthroscopic ACL Reconstruction Surgery

The ACL is one of the major stabilizing ligaments in the knee. When this structure suffers a tear, it does not heal naturally and can lead to knee instability. ACL reconstruction surgery is one of the most commonly performed orthopedic procedures and can be carried through a Minimally Invasive approach with the utilization of an arthroscope. An arthroscope is a surgical tool, a about the size of a pencil, with a camera that illuminates the structures inside the knee. The arthroscope is connected to a larger screen, allowing the surgeon to see the interior of the knee through this small incision, rather than a larger one. This method significantly decreases the risk of complication and will lead to an expedited recovery.

In the first step of this procedure, the surgeon will make two small incisions in the skin and in one of them, inserts the arthroscope.  The ruptured ligament is removed and that area is cleaned of any debris. Two tunnels are created to accept the new tendon graft, which will serve as the new ACL. The graft is usually taken from the patella tendon, but can be drawn from the hamstring as well.

The surgeon will utilize screws to hold the graft into place while the ligament heals. If any other areas of the knee are damaged due to a prior injury, the remainder of the knee is easily accessible and any other injury can be dealt with during the same procedure.

The patient is typically allowed to return home the same day, and they will be scheduled for a postoperative review 7-10 days after the procedure.

Arthroscopic MCL Reconstruction Surgery

An injury to the MCL is one of the most common to an athlete but, unlike an ACL tear, many MCL tears are treated non-surgically. However, if the ligament is torn in a way that it is unable to heal or it accompanies damage to another ligament, surgery may be recommended.

MCL reconstruction surgery can be carried through a Minimally Invasive approach with the utilization of an arthroscope. An arthroscope is a surgical tool, a about the size of a pencil, with a camera that illuminates the structures inside the knee. The arthroscope is connected to a larger screen, allowing the surgeon to see the interior of the knee through this small incision, rather than a larger one. This method significantly decreases the risk of complication and will lead to an expedited recovery.

In the first step of this procedure, the surgeon will make two small incisions in the skin and in one of them, inserts the arthroscope.  The ruptured ligament is removed and that area is cleaned of any debris. The graft, generally taken from the Achilles’ Tendon, is inserted and will serve as the new MCL. The surgeon will utilize screws to fix the graft to the bone and hold it into place while the ligament heals. If any other areas of the knee are damaged due to a prior injury, the remainder of the knee is easily accessible and any other injury can be dealt with during the same procedure.

The patient is typically allowed to return home the same day, and they will be scheduled for a postoperative review 7-10 days after the procedure.

Arthroscopic PCL Reconstruction Surgery

The PCL connects the femur to the tibia and is located in the back of the knee. It is the strongest ligament in the knee and it takes an immense amount of force to tear it, usually a high impact automobile or sports accident. When this ligament is severely torn, the patient must be operated on to restore knee function.

PCL reconstruction surgery can be carried through a minimally invasive approach with the utilization of an arthroscope. An arthroscope is a surgical tool, a about the size of a pencil, with a camera that illuminates the structures inside the knee. The arthroscope is connected to a larger screen, allowing the surgeon to see the interior of the knee through this small incision, rather than a larger one. This method significantly decreases the risk of complication and will lead to an expedited recovery.

The surgeon will make two small incisions in the skin and in one of them, insert the arthroscope.  The ruptured ligament is removed and that area is cleaned of any debris. A tunnel is created to accept the new graft, which will serve as the new PCL. The graft is usually taken from the patella tendon but can be drawn from the hamstring as well.

The surgeon will utilize screws to fix the graft to the bone to hold it into place while the ligament heals. If any other areas of the knee are damaged due to a prior injury, the remainder of the knee is easily accessible and any other injury can be dealt with during the same procedure.

The patient is typically allowed to return home the same day, and they will be scheduled for a postoperative review 7-10 days after the procedure.

Total and Partial Knee Arthroplasty

Knee arthroplasty, also called knee replacement is a surgical procedure to resurface a knee damaged by arthritis. Metal and plastic parts are used to cap the ends of the bones that form the knee joint, along with the kneecap. This surgery may be considered for someone who has severe arthritis or a severe knee injury. It is known as one of the most common operations in America, as 700,000 are performed annually.

The surgeon removes damaged cartilage and bone from the surface of the knee joint and replaces them with the metal and/or plastic parts. In a partial knee arthroplasty, the surgeon only replaces one part of the knee joint.

Signs arthroplasty may be needed:

  • The pain persists or recurs over time
  • The knee aches during and after exercise
  • Loss of mobility
  • Stiffness or swelling of the knee
  • Knee stiffens up after sitting for period of time
  • Feeling pain as a result of a past injury
MPFL (Patella) Reconstruction

Medial patella-femoral ligament (MPFL) reconstruction is a procedure used to correct serious and recurring dislocation of the kneecap. MPFL is the major ligament which stabilizes the patella and helps in preventing patellar subluxation or dislocation. A kneecap dislocation can be caused by a direct blow to the knee, a twisting injury to the lower leg, strong muscle contraction, or because of a congenital abnormality of the joint surfaces.

The surgery includes using a ligament taken from elsewhere in the body or a donated replacement. The surgeon reconstructs the MPFL to keep the kneecap in the trochlear groove, preventing further dislocation. After surgery, patients will complete physical therapy for 3 to 6 months to ensure the muscles are strong and stable. Patients can expect to return to unrestricted activities by 6 months to 1 year after surgery.

Arthroscopic Meniscectomy

A torn meniscus is a very common knee injury, especially for athletes. Each knee has two menisci, which are C-shaped pieces of cartilage that act as a cushion between the shin and thigh. Any activity that forces someone to twist or rotate the knee while putting weight on it, can lead to a torn meniscus. Based on the location and severity of the tear, your surgeon will determine whether a meniscectomy must be performed.

A meniscectomy can be carried through a minimally invasive approach with the utilization of an arthroscope. An arthroscope is a surgical tool, a about the size of a pencil, with a camera that illuminates the structures inside the knee. The arthroscope is connected to a larger screen, allowing the surgeon to see the interior of the knee through this small incision, rather than a larger one. This method significantly decreases the risk of complication and will lead to an expedited recovery.

The surgeon will make two small incisions in the skin and in one of them, inserts the arthroscope. The ruptured meniscus is removed and that area is cleaned of any debris. The surgeon will preserve as much of the meniscal tissue as possible, in order to prevent degeneration of the knee. The remaining tissue is smoothed over so that there are no frayed ends.

The patient is typically allowed to return home the same day, and they will be scheduled for a postoperative review 7-10 days after the procedure.

Microfracture Surgery

Microfracture is a surgical option used in the treatment of areas of damaged cartilage. When a patient has a small area of damaged cartilage (as opposed to widespread arthritis), microfracture may be performed in an attempt to stimulate new cartilage growth.

A microfracture creates small holes in the bone. The surface layer of bone is hard and lacks good blood flow. By penetrating this hard layer, a microfracture allows the deeper, more vascular bone to access the surface layer. This deeper bone receives more blood supply and the cells can then get to the surface layer and stimulate new fibrocartilage growth.

A good candidate for microfracture surgery would be a patient who is experiencing severe pain and swelling that is caused by cartilage damage in smaller defined select areas. This is the ideal procedure for an athlete who is unable to participate in their sport because of the symptoms. This is because the rehabilitation following the procedure is very rigorous and requires dedication in order to build the new cartilage.

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