Dr. Logan discusses ACL injuries HERE.
PreHab Program: Good range of motion and quad activation prior to surgery will promote a successful outcome after surgery. My PreHab program can be found HERE.
After ACLR Surgery: range of motion and edema control are the mainstays of early recovery. HERE is my tip sheet for a successful first few weeks following ACLR reconstruction.
Mid Recovery: focus on building foundational skills of strength - good form with squats, lunges and also building endurance of the lower extremity muscles. Biking is a great tool to increase quadriceps endurance without too much stress on your knee joint. Daily biking for 20-30 minutes can be a real game changer! HERE is my mid-recovery tip sheet.
Am I ready to return to sport? Dr. Logan's top 10 tips can be found HERE.
What are meniscus tears?
The meniscus can tear from acute trauma or as the result of degenerative changes that happen over time. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Common tears include bucket handle, flap, and radial.
Meniscus tear symptoms:
You might feel a pop when you tear the meniscus. Most people can still walk on their injured knee, and many athletes are able to keep playing with a tear. Over 2 to 3 days, however, the knee will gradually become more stiff and swollen.
The most common symptoms of a meniscus tear are:
- Stiffness and swelling
- Catching or locking of your knee
- The sensation of your knee giving way
- Inability to move your knee through its full range of motion
How do I know if I have a meniscus tear?
X-rays. X-rays provide images of dense structures, such as bone. Although an X-ray will not show a meniscus tear, an X-ray is helpful to look at the knee/lower extremity alignment and other causes of knee pain, such as osteoarthritis.
Magnetic resonance imaging (MRI) scans. An MRI scan assesses the soft tissues in your knee joint, including the menisci, cartilage, tendons, and ligaments.
How are meniscus tears treated?
Both conservative care (PT, bracing, activity modification) and surgery are common treatment techniques. The type of treatment employed is dependent on many factors including: type of tear, duration of tear, activity level, and co-existing osteoarthritis.
Biologics injections, such as PRP (platelet rich plasma), are currently being studied and may show promise in the future for the treatment of meniscus tears.
Am I ready to return to sport?
Determination of readiness to play is a complex decision that includes physical, biomechanical and psychological aspects. HERE is Dr. Logan's top 10 items to consider prior to returning to sports following meniscus surgery.
What is Osteochondral Autograft Transplantation (OATS)
In osteochondral autograft transplantation (or OATS surgery), cartilage is transferred from one part of the joint to another.
Normal, non-injured cartilage tissue is taken from a non-weight bearing area of the joint and becomes the "graft," which will be used to replace the injured cartilage area.
The cartilage graft is taken as a cylindrical plug of cartilage with the subchondral (underlying) bone. The plug is then matched to the surface area of the defect and impacted into place. The patient is left with a smooth cartilage surface instead of the previous defect.
Most commonly, just one single plug of cartilage may be taken; however, on occasion, multiple plugs may be necessary to deal with a larger area of injury.
Osteochondral Allograft Transplantation
If a cartilage defect is too large for an autograft (your own tissue), an allograft may be considered. An allograft is a tissue graft taken from a cadaver donor. The donor graft is testes, sterilized and prepared in a state of the art laboratory to ensure it is appropriate for transplantation.
The advantage of an allograft is generally its size - it can be used to manage larger areas of injury. The graft can also be shaped to fit the exact contour of the defect and then press fit into place.
This cartilage procedure entails taking some of your own cartilage cells, growing them in a lab and implanting them into your cartilage defect (injury site) embedded on a special collagen membrane. It is a two-step procedure.
The process begins with a minimally invasive biopsy, called an arthroscopy procedure, to procure a sample of your cartilage cells (chondrocytes). This sample is then sent to a laboratory and allowed a period of time to grow.
During a second minimally invasive procedure, your cartilage cell sample will be embedded on a special collagen membrane, then implanted into your knee by your MACI specialist. Learn more about MACI at https://www.maci.com/patients/about-maci/
Interested in learning more, request a consultation with Dr. Logan at 720-726-7995.
What is patella instability?
The kneecap (patella) connects the muscles in the front of the thigh to the shinbone (tibia). As you bend or straighten your leg, the kneecap is pulled up or down. The thighbone (femur) has a V-shaped notch (femoral groove) at one end to accommodate the moving kneecap. In a normal knee, the kneecap fits nicely in the groove.
But if the groove is uneven or too shallow, the kneecap could slide off, resulting in a partial or complete dislocation. A sharp blow to the kneecap, as in a fall, could also pop the kneecap out of place.
Patellar instability can lead to a dislocated patella.
- Complete dislocation: The ligaments that hold the kneecap in place slide to the outside of the knee, taking the kneecap with them. The ligaments may tear or stretch. The kneecap is entirely out of place.
- Partial dislocation (subluxation): The kneecap slips partially out of the groove.
What are the symptoms of patella instability?
- Knee buckles and can no longer support your weight
- Kneecap slips off to the side
- Knee catches during movement
- Pain in the front of the knee that increases with activity
- Pain when sitting
- Creaking or cracking sounds during movement
Do I need imaging for patella instability?
X-rays may be recommended to see how the kneecap fits in its groove. Your doctor will also want to eliminate other possible reasons for the pain, such as a tear in the cartilage or ligaments of the knee.
MRI is utilized to assess the surrounding soft tissues, ligaments and the cartilage. A TT-TG measurement is also performed to assess the relationship between the tibial tubercle and the trochlear groove, which impacts the determination of non operative versus surgical management.
Do I need surgery for patella instability?
Non-operative management includes physical therapy and bracing. Success with non-operative management is influenced by your anatomy (TT-TG and trochlear dysplasia), age, activity level and history of dislocations. If you have chronic patellar instability or a complete patella dislocation, surgery may be recommended.
If an injury causes patellar instability, you may have loose cartilage or bone fragments in the knee that need to be removed. The damage to the surrounding cartilage may need to be addressed (cartilage restoration).
Surgical options include:
- Medial patellofemoral ligament (MPFL) repair to strengthen and repair the ligaments that hold the patella in place.
- MPFL reconstruction to replace a damaged ligament with a hamstring tendon.
- A Tibial tubercle transfer (TTO) to realign the tibia, femur, patella and surrounding soft tissues. This open surgical procedure requires a larger incision and longer recovery than arthroscopic surgery.
- Patella arthroplasty can treat severe arthritis secondary to recurrent dislocations.
Patella Tendon Injuries
Quadriceps Tendon Injuries
Collateral Ligament Injuries
What are Collateral Ligament Injuries?
The collateral ligaments are found on the sides of your knee. They control the side to side motion of your knee.
- The medial collateral ligament (MCL) is on the inside. It connects the femur to the tibia.
- The lateral collateral ligament (LCL) is on the outside. It connects the femur to the fibula (the smaller bone in the lower leg).
Because the knee joint relies on just these ligaments and surrounding muscles for stability, it is easily injured. Any direct contact to the knee or hard muscle contraction — such as changing direction rapidly while running — can injure a knee ligament.
Injured ligaments are considered sprains and are graded on a severity scale.
Grade 1 Sprains. The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched, but is still able to help keep the knee joint stable.
Grade 2 Sprains. A Grade 2 Sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.
Grade 3 Sprains. This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been torn in half or pulled directly off the bone, and the knee joint is unstable.
The MCL is injured more often than the LCL. Due to the more complex anatomy of the outside of the knee, if you injure your LCL, you usually injure other structures in the joint, as well.
What are the symptoms of collateral ligament injuries?
- Pain at the sides of your knee. If there is an MCL injury, the pain is on the inside of the knee; an LCL injury may cause pain on the outside of the knee.
- Swelling over the site of the injury.
- Instability — the feeling that your knee is giving way.
How are collateral ligament injuries treated?
Non Surgical Care
Ice. Icing your injury is important in the healing process. The proper way to ice an injury is to apply crushed ice directly to the injured area for 15 to 20 minutes at a time, with at least 1 hour between icing sessions. Chemical cold products (blue ice) should not be placed directly on the skin and are not as effective.
Bracing. Your knee must be protected from the same sideway force that caused the injury. You may need to change your daily activities to avoid risky movements. A hinged knee brace will likely be recommended to protect the injured ligament from stress. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.
Physical therapy. Your doctor may suggest strengthening exercises. Specific exercises will restore function to your knee and strengthen the leg muscles that support it.
Most isolated medial collateral ligament injuries can be successfully treated without surgery. If the collateral ligament is torn in such a way that it cannot heal or is associated with other ligament injuries, surgery may be necessary.
Stress X-rays are helpful in determining the competence of the ligament. If the integrity of the ligament appears non-functional, surgical repair or surgical reconstruction (a graft) may be indicated.
What is a PCL injury?
Injuries to the posterior cruciate ligament are not as common as other knee ligament injuries. In fact, they are often subtle and more difficult to evaluate than other ligament injuries in the knee.
Often, a posterior cruciate ligament injury occurs along with injuries to other structures in the knee, such as cartilage, other ligaments, and bone.
What are the symptoms of PCL injury?
The typical symptoms of a posterior cruciate ligament injury are:
- Pain with swelling that occurs steadily and quickly after the injury
- Swelling that makes the knee stiff and may cause a limp
- Difficulty walking
- The knee feels unstable, like it may "give out"
How do I know if I have a PCL injury?
X-rays. Although they will not show any injury to your posterior cruciate ligament, X-rays can show whether the ligament tore off a piece of bone when it was injured. This is called an avulsion fracture. In the case of a chronic injury, stress X-rays may be ordered to assess how much the tibia moves back (posterior) in a kneeling position.
Magnetic resonance imaging (MRI). MRI scans create better images of soft tissues, like the posterior cruciate ligament, than X-rays.
How are PCL tears treated?
Non Surgical Treatment
If you have injured only your posterior cruciate ligament, your injury may heal quite well without surgery. Your doctor may recommend nonsurgical treatment options:
RICE. When you are first injured, the RICE method — rest, ice, gentle compression, and elevation — can help speed your recovery.
Immobilization. Your doctor may recommend a special brace to prevent the tibia bone from sagging backward (gravity tends to pull the bone backward when you are lying down). To further protect your knee, you may be given crutches to keep you from putting weight on your leg.
Physical therapy. As the swelling goes down, you will start a careful rehabilitation program. Specific exercises will restore function to your knee and strengthen the leg muscles that support it. Strengthening the muscles in the front of your thigh (quadriceps) has been shown to be a key factor in a successful recovery.
Surgery may be indicated if you have combined injuries. For example, if you have dislocated your knee and torn multiple ligaments including the posterior cruciate ligament, surgery is almost always necessary. Additionally, patients with an isolated PCL tear may benefit from reconstruction if they have persistent instability or pain that is not improving with non-operative treatment.
Rebuilding the ligament (PCL Reconstruction)
A torn posterior cruciate ligament is typically reconstructed, or rebuilt. The torn ligament is replaced (reconstruction) with a soft tissue graft. This graft is most often taken from another part of your body, or from another human donor (cadaver). It can take several months for the graft to heal into your bone.
Surgery to rebuild a posterior cruciate ligament is typically performed with an arthroscope using small incisions; however, some surgeons will still make an additional incision on the side of the knee. Arthroscopic surgery is less invasive than traditional open surgery. The benefits of less invasive techniques include less pain from surgery and quicker recovery times.
Surgical procedures to repair posterior cruciate ligaments continue to improve. More advanced techniques help patients resume a wider range of activities after rehabilitation.