Osteochondritis Dissecans

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Osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone beneath it, comes loose from the end of a bone.

Caused by reduced blood flow to the end of a bone, osteochondritis dissecans occurs most often in young men, particularly after an injury to a joint. The knee is most commonly affected, although osteochondritis dissecans can occur in other joints, including your elbow, shoulder, hip and ankle.

If the loosened piece of cartilage and bone stays put, lying close to where it detached, you may have few or no symptoms of osteochondritis dissecans, and the fracture can often heal by itself. Surgical repair may be necessary if the fragment gets jammed between the moving parts of your joint.

What are the symptoms of Osteochondritis Dissecans?
Signs and symptoms of osteochondritis dissecans may include:

  • Pain. The most common symptom of osteochondritis dissecans, pain may be triggered by physical activity — walking up stairs, climbing a hill or playing sports.
  • Joint popping or locking. Your joint may pop or get stuck in one position if a loose fragment gets caught between the bones during movement.
  • Joint weakness. You may feel that your joint is “giving way” or weakening.
  • Decreased range of motion. You may be unable to straighten your leg or arm completely.
  • Swelling and tenderness. The skin around your joint may become swollen and tender.

What are the causes of Osteochondritis Dissecans?
Osteochondritis dissecans appears to be caused by a reduction of blood flow to the end of the affected bone. This may occur from repetitive trauma of small, multiple episodes of minor unrecognized injury that damage the end of the affected bone. There may also be a genetic component involved, making some people more inclined to develop the disorder.

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Knee Bursitis

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Definition of Bursitis:

A bursa is a closed fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. Bursae is plural for bursa. The major bursae are located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees. When a bursa becomes inflamed, the condition is known as bursitis. Most commonly, bursitis is caused by local soft tissue trauma or strain injury, and there is no infection (aseptic bursitis). On rare occasions, the bursa can become infected with bacteria. This condition is called septic bursitis.

What is knee bursitis?
The knee joint is surrounded by three major bursae. At the tip of the knee, over the kneecap bone, is the prepatellar bursa. This bursa can become inflamed (prepatellar bursitis) from direct trauma to the front of the knee. This commonly occurs when maintaining a prolonged kneeling position. It has been referred to as “housemaid’s knee,” “roofer’s knee,” and “carpet layer’s knee,” based on the patient’s associated occupational histories. It can lead to varying degrees of swelling, warmth, tenderness, and redness in the overlying area of the knee. As compared with knee joint inflammation (arthritis), it is usually only mildly painful. It is usually associated with significant pain when kneeling and can cause stiffness and pain with walking. Also, in contrast to problems within the knee joint, the range of motion of the knee is frequently preserved.

Prepatellar bursitis can occur when the bursa fills with blood from injury. It can also be seen in rheumatoid arthritis and can occur from deposits of crystals, as seen in patients with gouty arthritis and pseudogout. The prepatellar bursa can also become infected with bacteria (septic bursitis). When this happens, fever may be present. This type of infection usually occurs from breaks in the overlying skin or puncture wounds. The bacteria involved in septic bursitis of the knee are usually those that normally cover the skin, called staphylococcus. Rarely, a chronically inflamed bursa can become infected by bacteria traveling through the blood.

How is prepatellar bursitis of the knee treated?

The treatment of any bursitis depends on whether or not it involves infection. Aseptic prepatellar bursitis can be treated with ice compresses, rest, and antiinflammatory and pain medications. Occasionally, it requires aspiration of the bursa fluid. This procedure involves removal of the fluid with a needle and syringe under sterile conditions and can be performed in the doctor’s office. Sometimes the fluid is sent to the laboratory for further analysis. Noninfectious knee bursitis can also be treated with an injection of cortisone medication into the swollen bursa. This is sometimes done at the same time as the aspiration procedure.

Septic bursitis requires even further evaluation and treatment. The bursal fluid can be examined in the laboratory to identify the microbes causing the infection. It requires antibiotic therapy, often intravenously. Repeated aspiration of the inflamed fluid may be required. Surgical drainage and removal of the infected bursa sac (bursectomy) may also be necessary.

What about the other knee bursae?

A second bursa of the knee is located just under the kneecap beneath the large tendon that attaches the muscles in front of the thigh and the kneecap to the prominent bone in front of the lower leg. This bursa is called the infrapatellar bursa, and when inflamed, the condition is called infrapatellar bursitis. It is commonly seen with inflammation of the adjacent tendon as a result of a jumping injury, hence the name “jumper’s knee.” This condition is generally treated with ice, rest, and oral anti-inflammatory and/or pain medicines.

A third bursa of the knee is called the “anserine bursa.” It is located on the lower inner side of the knee. This bursa most commonly becomes inflamed in middle-aged women. This condition is referred to as anserine bursitis. Anserine bursitis is particularly common in those who are obese. These patients can notice pain in the inner knee while climbing or descending stairs. Anserine bursitis is generally treated with ice, rest, and oral anti-inflammatory and/or pain medicines, although cortisone injections are also given.

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Kneecap Dislocation

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Definition of Kneecap Dislocation:

Kneecap dislocation occurs when the triangle-shaped bone covering the knee (patella) moves or slides out of place. The problem usually occurs toward the outside of the leg.

What are the causes of Kneecap Dislocation?
Kneecap (patella) dislocation is often seen in women. It usually occurs after a sudden change in direction when your leg is planted. This puts your kneecap under stress.

Dislocation may also occur as a direct result of injury. When the kneecap is dislocated, it can slip sideways and around to the outside of the knee.

What are the symptoms of knee dislocation?

  • Knee appears to be deformed
  • Knee is bent and cannot straighten
  • Kneecap (patella) dislocates to the outside of the knee
  • Knee pain and tenderness
  • Knee swelling
  • “Sloppy” kneecap — you can move the kneecap too much from right to left (hypermobile patella)

The first few times this occurs, you will feel pain and be unable to walk. However, if dislocations continue to occur and are untreated, you may feel less pain and have less immediate disability. This is not a reason to avoid treatment. Kneecap dislocation damages your knee joint.

What are the first aids for Kneecap Dislocation?
If you can, straighten out the knee. If it is stuck and painful to move, stabilize (splint) the knee and get medical attention.

Your health care provider will examine the knee, which could confirm that the kneecap is dislocated.

A knee x-ray and, sometimes, MRIs should be done to make sure that the dislocation did not cause a bone to break or cartilage to be damaged. If tests show that you have no such damage, your knee will be placed into an immobilizer or cast to prevent you from moving it for several weeks (usually about 3 weeks).

After this time, physical therapy can help build back your muscle strength and improve the knee’s range of motion.

If the knee remains unstable, you may need surgery to stabilize the kneecap. This may be done using arthroscopic or open surgery.

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Meniscus Injury (Meniscal Tear)

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What is knee pain due to Meniscus Injury?

The meniscus is a small “c” shaped cartilage that acts as a cushion in the knee joint. They sit between the femur and the tibia bone, one on the outside and one on the inside of the knee. A meniscus tear occurs when the cartilage tear and are injured usually during movements that forcefully rotate the knee while weight bearing.

What is a Meniscus Tear?
A meniscus tear occurs when these pieces of cartilage tear and are injured usually during movements that forcefully rotate the knee while bearing weight. A partial or total tear of a meniscus sometimes occurs if an athlete quickly twists or rotates the upper leg while the foot is firmly planted. This often occurs in field sports such as soccer and football.

How is Meniscus Tear diagnosed?

A meniscus tear is diagnosed by taking a complete history and performs a physical exam. Pain, pops, or clicks during this test may suggest a meniscus tear. An MRI may also be done to see the extent of the tear.

What are the treatments for Meniscus Tear?

Treatment varies depending upon the extent and location of the meniscus tear. The treatment options are available from oral medications,  injection, physiotherapy, platelet rich plasma therapy and surgical intervention.

Surgical Repair for a Meniscus Tear

A large meniscus tear that causes symptoms or mechanical problems with the function of the knee joint may require arthroscopic surgery for repair. In this procedure, a small camera is inserted into the joint through a small incision, while surgical instruments are inserted into the joint through a second, small incision. With the camera, the surgeon can see the entire joint and remove and repair the torn pieces of meniscus. The goal is to save as much of the original, normal meniscus cartilage as possible.

During meniscus repair surgery the torn section of meniscus is either removed (a partial meniscectomy) or the torn edges are joined back together with suture or tacks.

Common Ask Question:
Can Meniscus Tear heal on its own?

Ans: it all depends on where the tear is located and how large. If the tear is on the outer rim or edge of the meniscus there is a blood supply and it can heal. If it is in the middle or inner edge the chances of it healing are much less. As for the surgery the latest studies indicate that you should not have the procedure done unless the knee is locking. The reason for this is in the anatomy. The meniscus sits on top of cartilage. The meniscus deepens the joint and helps control the movement of the femur on the tibia. If you take away this piece of meniscus you expose the underlying cartilage to stresses that it would not normally have. This will cause the cartilage to deteriorate which in turn causes a condition of bone on bone. This will lead to the early or premature need for a total knee replacement. What you should be doing is strengthening the entire leg from the hip to the foot. The stronger the muscles are the less likely you are to have problems. So work on this aspect. If you are having locking of the knee or the inability to fully use the range of motion then you should be looking at a surgical answer to this problem. In either case the stronger that you make the leg the easier the recovery.

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Knee Ligament Injuries

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Ligament injuries in the knee – such as an Anterior Cruciate Ligament (ACL) — are dreaded by professional and amateur athletes alike. They can be painful and debilitating. They can even permanently change your lifestyle.

But there’s good news. While an ACL injury or other ligament damage once ended the career of many an athlete, treatment is much more successful now.

So what’s behind these feared injuries? Ligaments are tough bands of tissue that connect the bones in your body. Two important ligaments in the knee, the ACL and Posterior Cruciate Ligament (PCL),  connect the thigh bone with the bones of the lower leg. But too much stress on these ligaments can cause them to stretch too far or even snap.

ACL injury and other ligament injuries can be caused by:

  • Twisting your knee with the planted.
  • Getting hit on the knee.
  • Extending the knee too far.
  • Jumping and landing on a flexed knee.
  • Stopping suddenly when running.
  • Suddenly shifting weight from one leg to the other.

These injuries are common in soccer players, football players, basketball players, skiers, gymnasts, and other athletes.

There are four ligaments in the knee that are prone to injury.

  • The Anterior Cruciate ligament (ACL) is one of the two major ligaments in the knee. It connects the thigh bone to the shin bone. ACL injuries are a common cause of disability in the knee.
  • The posterior cruciate ligament (PCL) is the second major ligament in the knee connecting the thigh bone to the shin bone.
  • The lateral collateral ligament (LCL) connects the thigh bone to the fibula, the smaller bone of the lower leg.
  • The medial collateral ligament (MCL) also connects the thigh bone to the shin bone.

Anterior Cruciate Ligament (ACL) Injury

One of the most common knee injuries is an anterior cruciate ligament sprain or tear.

Athletes who participate in high demand sports like soccer, football, and basketball are more likely to injure their anterior cruciate ligaments.

If you have injured your anterior cruciate ligament, you may require surgery to regain full function of your knee. This will depend on several factors, such as the severity of your injury and your activity level.

About half of all injuries to the anterior cruciate ligament occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments.

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 split into two pieces, and the knee joint is unstable.

Partial tears of the anterior cruciate ligament are rare; most ACL injuries are complete or near complete tears.

Causes of ACL Injuries?

The anterior cruciate ligament can be injured in several ways:

  • Changing direction rapidly
  • Stopping suddenly
  • Slowing down while running
  • Landing from a jump incorrectly
  • Direct contact or collision, such as a football tackle

Several studies have shown that female athletes have a higher incidence of ACL injury than male athletes in certain sports. It has been proposed that this is due to differences in physical conditioning, muscular strength, and neuromuscular control. Other suggested causes include differences in pelvis and lower extremity (leg) alignment, increased looseness in ligaments, and the effects of estrogen on ligament properties.

Symptoms of ACL Injuries?

When you injure your anterior cruciate ligament, you might hear a “popping” noise and you may feel your knee give out from under you. Other typical symptoms include:

  • Pain with swelling. Within 24 hours, your knee will swell. If ignored, the swelling and pain may resolve on its own. However, if you attempt to return to sports, your knee will probably be unstable and you risk causing further damage to the cushioning cartilage (meniscus) of your knee.
  • Loss of full range of motion
  • Tenderness along the joint line
  • Discomfort while walking

Examination of ACL Injuries

  • Physical Examination and Patient History
    During your first visit, our doctor will talk to you about your symptoms and medical history.During the physical examination, our doctor will check all the structures of your injured knee, and compare them to your non-injured knee. Most ligament injuries can be diagnosed with a thorough physical examination of the knee.
  • Imaging Test – Other tests which may help our doctor confirm your diagnosis include:X-rays. Although they will not show any injury to your anterior cruciate ligament, x-rays can show whether the injury is associated with a broken bone.
  • Magnetic resonance imaging (MRI) scan. This study creates better images of soft tissues like the anterior cruciate ligament. However, an MRI is usually not required to make the diagnosis of a torn ACL.

Treatment of ACL Injuries

Treatment for an ACL tear will vary depending upon the patient’s individual needs. For example, the young athlete involved in agility sports will most likely require surgery to safely return to sports. The less active, usually older, individual may be able to return to a quieter lifestyle without surgery.

Nonsurgical Treatment
A torn ACL will not heal without surgery. But nonsurgical treatment may be effective for patients who are elderly or have a very low activity level. If the overall stability of the knee is intact, your doctor may recommend simple, nonsurgical options.

  • Bracing. Our doctor may recommend a brace to protect your knee from instability. 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, a careful rehabilitation program is started. Specific exercises will restore function to your knee and strengthen the leg muscles that support it.

Surgical Treatment
Rebuilding the ligament: Most ACL tears cannot be sutured (stitched) back together. To surgically repair the ACL and restore knee stability, the ligament must be reconstructed. Our doctor will replace your torn ligament with a tissue graft. This graft acts as a scaffolding for a new ligament to grow on.

Grafts can be obtained from several sources. Often they are taken from the patellar tendon, which runs between the kneecap and the shinbone. Hamstring tendons at the back of the thigh are a common source of grafts. Sometimes a quadriceps tendon, which runs from the kneecap into the thigh, is used. Finally, cadaver graft (allograft) can be used.

There are advantages and disadvantages to all graft sources. You should discuss graft choices with your own orthopaedic surgeon to help determine which is best for you.

Because the regrowth takes time, it may be six months or more before an athlete can return to sports after surgery.

Procedure: Surgery to rebuild an anterior cruciate ligament is done with an arthroscope using small incisions. Arthroscopic surgery is less invasive. The benefits of less invasive techniques include less pain from surgery, less time spent in the hospital, and quicker recovery times.

Unless ACL reconstruction is treatment for a combined ligament injury, it is usually not done right away. This delay gives the inflammation a chance to resolve, and allows a return of motion before surgery. Performing an ACL reconstruction too early greatly increases the risk of arthrofibrosis, or scar forming in the joint, which would risk a loss of knee motion.

Get professional Opinion and Treatment about your Knee Ligament Injury. Minimal Invasive to treat your Ligament Injury by Experienced Knee Sports Surgeon. Call us +65 97731458 to schedule for an appointment.

Knee Pain

Dr Ambrose Yung Knee, Sports and Orthopaedic Centre Knee, Sports and Orthopaedic Clinic
 

Stop your Knee Pain today. Effective treatment, Non Surgery. Discuss with our Knee Specialist for the Diagnosis, Treatment and Prognosis of your Knee Pain. Call us +65 97731458 to schedule for an appointment.

Knee pain refers to pain that occurs in and around your knee joint. Knee pain can be caused by problems with the knee joint itself, or it can be caused by conditions affecting the soft tissues, ligaments, tendons, or bursae that surround the knee.

The severity of knee pain can vary widely. Some people may feel only a slight twinge, while others may experience debilitating knee pain that interferes with their day-to-day activities. In most cases, self-care measures can help you cope with knee pain.

The knee consists of two long leg-bones held together by muscles, ligaments, and tendons. Many knee problems are a result of the aging process and continual wear and stress on the knee joint. Other knee problems result from injury or a sudden movement that stiffens the knee.

Knee Pain

 

Some common conditions of Knee Problem include:

  • OSTEOARTHRITIS – Knee pain is a common problem in Asia, especially in individuals above the age of 40. The most common cause of knee pain is degenerative osteoarthritis. Women are more prone to the disease. It is characterized by mild to debilitating pain.
  • LIGAMENT INJURIES – Ligament injuries in the knee; such as an anterior cruciate ligament (ACL) are dreaded by professional and amateur athletes alike. They can be painful and debilitating. They can even permanently change your lifestyle.
  • MENISCAL TEAR – The meniscus is a small “c” shaped cartilage that acts as a cushion in the knee joint. They sit between the femur and the tibia bone, one on the outside and one on the inside of the knee.
  • PATELLAR TENDONITIS – Patellar tendinitis is a common overuse injury. It occurs when repeated stress is placed on the patellar tendon. The stress results in tiny tears in the tendon, which the body attempts to repair.
  • CHONDROMALACIA PATELLA – Chondromalacia patella is a common cause of kneecap pain or anterior knee pain. Often called “Runner’s Knee,” this condition often affects young, otherwise healthy athletes.
  • DISLOCATING KNEECAPS – Kneecap dislocation occurs when the triangle-shaped bone covering the knee (patella) moves or slides out of place. The problem usually occurs toward the outside of the leg.
  • BAKER’S CYST – A Baker cyst is swelling caused by fluid from the knee joint protruding to the back of the knee. The back of the knee is also referred to as the popliteal area of the knee.
  • BURSITIS – A bursa is a closed fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body.
  • PLICA SYNDROME – Often called “synovial plica syndrome,” this is a condition that is the result of a remnant of fetal tissue in the knee. The synovial plica are membranes that separate the knee into compartments during fetal development.
  • OSGOOD-SCHALLATER DISEASE – Osgood-Schlatter disease is a disorder of the lower front of the knee where the large tendon under the kneecap (patellar tendon) attaches to the bone of the leg below.
  • OSTEOCHONDRITIS DISSECANS – Osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone beneath it, comes loose from the end of a bone.
  • GOUT – Gout is a rheumatoid form of arthritis that causes the inflammation, joint pain and swelling especially in the toe, knee and ankle, also reducing their mobility.
  • SHIN SPLINT – Shin splints are a member of a group of injuries called “overuse injuries.” Shin splints occur most commonly in runners or aggressive walkers.

When do you need to see Knee Specialist about your Knee Pain?
If you are unsure of the cause of your symptoms, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention. Treatment of knee pain must be directed at the specific cause of your problem. Some signs that you should be seen by a doctor include:

  • Inability to walk comfortably on the affected side
  • Injury that causes deformity around the joint
  • Knee pain that occurs at night or while resting
  • Knee pain that persists beyond a few days
  • Locking (inability to bend) the knee
  • Swelling of the joint or the calf area
  • Signs of an infection, including fever, redness, warmth
  • Any other unusual symptoms

Treatments for Knee Pain
Treatment of knee pain depends entirely on the cause of the problem. Therefore, it is of utmost importance that you understand the cause of your symptoms before embarking on a treatment program. If you are unsure of your diagnosis, or the severity of your condition, you should seek medical advice before beginning any treatment plan.

Stop your Knee Pain today. Effective Treatment, Non Surgery. Discuss with our Knee Specialist for the Diagnosis, Treatment and Prognosis of your Knee Pain. Call us +65 97731458 to schedule for an appointment.