ACL-PCL-MCL-LCL Injury (Knee Dislocation)

The ACL (anterior cruciate ligament) is the ligament located on the inside, front part of the knee. It is notably one of the most injured ligaments among athletes and can occur in isolation or with another ligament. There are 3 main ligaments or groups of ligaments aside from the ACL that support the knee, the PCL (posterior cruciate ligament), LCL (lateral collateral ligament) and MCL (medial collateral ligament). If one or more of these ligaments are torn during the injury, early reconstruction of all torn ligaments is recommended, approximately 3 weeks after injury. Often, donor tendons have to be used as grafts to adequately reconstruct all of the ligaments. Arthroscopy is also performed to assist in the reconstruction and address any concomitant injury to the meniscus or cartilage. Dr. Lubowitz will discuss graft options with you and his proposed surgical plan. The rehabilitation for these multiple ligament injuries is complex and controlled to protect and stabilize the knee while the reconstructed ligaments heal. Dr. Lubowitz and your physical therapist will guide you along the way through the rehabilitation protocol. Following this thorough rehabilitation program as directed by Dr. Lubowitz, patients are usually able to resume most normal activities within 6-9 months following surgery , and are usually unrestricted after 12 months.

For more information on arthroscopic knee surgery and the treatment of the anterior cruciate ligament (ACL), as well as PCL, MCL, and LCL, please request a consultation with orthopedic knee specialist, Dr. Lubowitz, by clicking the below link.

ACL Tear and Bone Bruise

Injury causing an ACL tear can also lead to a deep bone bruise. A bone bruise occurs when the ligament tears and the bones shift on one another. While bone bruising is a common characteristic of an ACL tear, it typically requires no treatment. Your body will heal the bruising on its own. An ACL injury can be treated using arthroscopic surgery regardless of bone bruising. Following a thorough rehabilitation program as directed by Dr. Lubowitz, patients are typically able to resume activities within 6 months following ACL surgery.

For more information on an ACL tear and bone bruise, please request a consultation with orthopedic knee specialist, Dr. Lubowitz, by clicking the below link. 

ACL Tear and Cartilage Damage

An ACL tear can also result in cartilage damage in the knee. Knee cartilage naturally has poor blood supply and is less amenable to healing. During ACL repair, the cartilage can be smoothed using arthroscopic surgical techniques. However, some cartilage injuries lend themselves to further treatment with procedures that stimulate cartilage growth or replace the injured areas with new cartilage. Dr. Lubowitz will make a decision with you on whether or not cartilage restoration is necessary and will talk about various options. If restoration is performed, the rehabilitation after surgery is limited in order to protect the cartilage until it fully heals. Following a thorough rehabilitation program as directed by Dr. Lubowitz, patients are usually able to resume activities within 6 months following surgery.

For more information on an ACL tear and cartilage damage, please request a consultation with orthopedic knee specialist, Dr. Lubowitz, by clicking the below link. 

ACL and Lateral Meniscus Tear

The lateral meniscus is the cushion pad on the outside of the knee between the femur and tibia. The two main functions of the menisci are to absorb impact, and improve knee joint stability. There are two menisci: the medial and lateral meniscus. The medial meniscus is on the inside of the knee, and the lateral meniscus rests on the outside of the knee. The lateral meniscus is more rounded, and not fully attached to the joint capsule wall. An ACL injury can increase the chances for a lateral meniscus tear.

The center of the meniscus has poor blood supply, which makes it less amenable to healing. Depending on the severity of the meniscal tear, patients may be recommended to have surgical reconstruction. Research has shown that meniscal repairs, in the setting of ACL reconstruction, are more likely to heal.

Dr. Lubowitz will decide if surgical repair is needed, based upon tear size, location, blood supply, and patient age. If a repair is performed, rehabilitation is limited for the first 6 weeks. Following a thorough rehabilitation program, patients are able to resume full activities 3 months after surgery.

For more information on an ACL and lateral meniscus tear, please request a consultation with orthopedic knee specialist, Dr. Lubowitz, by clicking the below link. 

ACL and Medial Meniscus Tear

The meniscus is the cushion pad on the inside of the knee between the femur and tibia. The two main functions of the meniscus are to absorb impact, and improve knee joint stability. There are two menisci: the medial and lateral meniscus. The medial meniscus is on the inside of the knee, and the lateral meniscus rests on the outside of the knee. The medial meniscus is fully attached to the joint on the outer edge, and because of this attachment there is an increased risk for tear. An ACL injury can increase the chances for a medial meniscus tear.

The center of the meniscus has poor blood supply, which makes it less amenable to healing. Depending on the severity of the meniscal tear, patients may be recommended to have surgical reconstruction. Research has shown that meniscal repairs, in the setting of ACL reconstruction, are more likely to heal.

Dr. Lubowitz will decide if surgical repair is needed, based upon tear size, location, blood supply, and patient age. If a repair is performed, rehabilitation is limited for the first 3 weeks. Following a thorough rehabilitation program, patients are able to resume full activities 6 months after surgery.

For more information on an ACL and medial meniscus tear, please request a consultation with orthopedic knee specialist, Dr. Lubowitz, by clicking the below link. 

ACL and LCL Injury

The LCL (lateral collateral ligament) is a ligament located on the outside of the knee and contributes to lateral knee stability. It is uncommon for an LCL injury to be in isolation. Typically, an LCL tear is associated with injuries to the ACL, PCL, or a complete knee dislocation. When the LCL is torn, along with the ACL, it is recommended to have surgery approximately 3 weeks after injury. Early reconstruction for an LCL and ACL tear, requires recreating the ACL with a graft through an arthroscopic technique, and open surgery for the LCL. As directed by Dr. Lubowitz, a thorough rehabilitation program will begin. Patients are typically able to resume most normal activities within 9 months after surgery.

For more information on an ACL and LCL injury, please request a consultation with orthopedic knee specialist, Dr. Lubowitz, by clicking the below link. 

ACL and PCL Injury

The PCL crosses behind the ACL inside the knee joint and prevents the tibia from sliding too far back. If the PCL alone is torn, surgical reconstruction is not always needed. However, if the PCL is torn along with the ACL (or other ligaments), reconstruction is usually required. This surgery is accomplished through the arthroscope and uses a graft to recreate both the ACL and the PCL. Once the ACL and PCL injury has been treated, and after a thorough rehabilitation program, as directed by Dr. Lubowitz, patients are typically able to resume normal activities within 9 months following surgery.

For more information on an ACL and PCL injury, please request a consultation with orthopedic knee specialist, Dr. Lubowitz, by clicking the below link. 

ACL and MCL injury

The MCL (medial collateral ligament) is located on the inner part of the knee, and connects the femur to the top of the tibia. It is very common that an MCL tear accompanies an ACL injury. An ACL reconstruction is performed after the MCL is allowed to heal naturally. However, the MCL does not always heal, and sometimes requires surgery. Failure to treat the MCL, when indicated, increases the risk of the ACL to not properly heal. Arthroscopic reconstruction is the preferred approach for an ACL tear, although, when an MCL tear is present, MCL reconstruction is usually performed through a small open incision. Once the ACL and MCL injury has been treated, patients will begin a rehabilitation program, as directed by Dr. Lubowitz. Typically, patients are able to resume normal activities within 6 months after surgery.

For more information on an ACL and MCL injury, please request a consultation with orthopedic knee specialist, Dr. Lubowitz, by clicking the below link. 

Synovitis

Synovitis is a term given to a condition caused by the abnormal inflammation of the knee lining. This tissue is known as the synovium. While the exact cause of inflammation can vary, when it occurs, it can result in chronic pain, swelling, catching, or knee stiffness. Synovitis can affect one small, localized area (known as localized synovitis), or can spread throughout the knee joint and become more difficult to treat (known as diffuse synovitis). The knee joint lining can pinch between the leg and thigh bones.

Symptoms and Diagnosis

Symptoms of synovitis include knee pain, weakness, stiffness, or swelling. Knee locking, or a catching sensation, may also result. Dr. Lubowitz will conduct a comprehensive patient history and physical examination. It is difficult to diagnose synovitis through an X-ray; an MRI is usually needed and may show a thickening of the joint lining or other pathology.

Treatment

Surgery is usually the best treatment option for patients with symptomatic synovitis, if non-surgical treatment has failed. Dr. Lubowitz will perform an arthroscopic surgery to remove the inflamed, scarred, or pinching portion of the lining, which is called synovectomy. Dr. Lubowitz will ensure that healthy joint lining will not be removed.

Post-Operative

Following arthroscopic knee surgery, physical therapy will be prescribed to initiate range-of-motion and to restore strength and function to the knee. Physical therapy is important in the early days following surgery to prevent post-op stiffness. Most patients walk normally within 7 days and return to full activity in less than 4 weeks. Others with significant swelling may require a slower rehabilitation.

For more information on synovitis, please request a consultation with orthopedic knee specialist, Dr. Lubowitz, by clicking the below link. 

Loose Bodies

Loose body is the term applied to small fragments of articular cartilage that break off in the knee joint as a result of a knee injury or degeneration. Loose bodies float around within the knee joint and cause pain, catching, locking, or swelling depending upon where the fragments migrate. These fragments of bone and cartilage can come in all sizes and shapes, and can also occur as the result of long-term wear and tear to the knee. When a loose body becomes lodged within the knee joint, pain and instability will follow. This tends to recur until the loose pieces of cartilage are removed through surgery.

Symptoms and Diagnosis

Pain and a catching sensation within the knee are the primary symptoms of a loose body within the knee joint. Swelling usually follows. Some cases are associated with locking or buckling. Dr. Lubowitz will review the patient history and will ask about previous injuries and surgeries, and will also conduct a series of physical examination tests. An X-ray may show large, bony loose bodies, but an MRI is required to evaluate for loose cartilage without bone. Often, small loose bodies may be missed using MRI, and it is necessary to treat a patient with symptoms. The arthroscopic camera is the ultimate standard for confirming the location, size, and severity of loose bodies.

Treatment

Dr. Lubowitz will perform an arthroscopic knee surgery. Tiny incisions will be made and a camera will be used to visualize the inside of the knee joint. Then, Dr. Lubowitz will begin to remove the loose fragments and smooth or perform restoration to the damaged cartilage (bone lining from where the loose bodies broke off or came free). In patients who have symptoms as a result of loose bodies, surgery is usually the only way to provide relief. If left untreated, the loose fragments in the joint may lead to further deterioration of the articular cartilage. In the majority of cases, surgery is very successful and thus knee pain and mobility are improved tremendously.

Post-Operative

Dr. Lubowitz will provide a detailed rehabilitation and physical therapy program during your first post-op visit following arthroscopic knee surgery. Therapy will focus on slowly returning motion back to the injured knee, followed by a progressive strengthening program to protect the repaired joint. Most patients walk normally within 7 days and return to full activity in less than 4 weeks. Others with more complicated conditions may require crutches, or a slower rehabilitation.

For more information on loose bodies, please request a consultation with orthopedic knee specialist, Dr. Lubowitz, by clicking the below link.