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Doctors' Answers to "Frequently Asked Questions" - Knee Problems

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 08/22/1999]
Question: I am in Germany.
My Father is born 1939. For many year he was playing soccer, indoor and outdoor. So now his knees are severely damaged. His doctor starts to treat him with hyalart. But in Germany this is incredibly expensive. How can I acquire Hyalart online or by order? Do I need receipt or medical advice or anything similar?
sincerely, Martin Heberle

Answer: No idea.

Inflamed Cartilage in Knee [posted 1/8/99]
Question: How long does it take for inflamed cartilage to heal? Also, my knee is swollen and I had a friend who is a LPN, and he said I might have hyper-extended it. I was wondering how long I should stay off my knee?

Answer: Several weeks assuming you are taking non-steroidal anti-inflammatories.

Osgood-Schlatter Disease [posted 11/25/98]
Question: My son was diagnosed with Osgood-Schlatter disease when he was 9yrs. old. The doctors said it was caused from growing to fast. They made him drop out of all sports. When he got in his 30's he had to have surgery. His 10yr. old daughter is now showing signs of the disease. she also has grown very fast. She is the size of a 13yr.old and very active in sports. What I would like to know is if this disease is hereditary. Any information you could give us would be appreciated. Thank You.

Answer: Usually thought to have an inherited basis, although the exact cause is unclear. It tends to occur in long tall teens who exercise a lot and may be related to the type of connective tissue that they inherit. Treatment focuses on rest, non-steroidal anti-inflammatories and occasional surgery.

Knee Problems & Arthritis [posted 10/30/98]
Question: I am a 34year old female, 8 days post op arthroscopy to the right knee. My doc said that I have arthritic changes in my knee. I have a .5 cushion instead of a 2.5 cushion under the patella (in the groove?). He said that I have an area of bare bone on the medial condyle of the femur. It's my understanding that the research involving transplant has virtually stopped. Are there any exercises I can do to help with this condition? Is there any new research in the area of transplantation? I'm only 34 and I don't want my activity level to decrease. I do aerobics and weight training daily (prior to surgery) and without the exercise I am feeling really low. How long does it normally take to get back in the swing of things? Thank you for your time. I always forget to ask when I'm in the office.

Answer: Currently, once the cartilage is gone it is gone and there is no option that will restore it. There is research (and treatment) on injecting a semi-synthetic liquid into the knee that mimics the fluid of the knee. This has delayed knee replacements several years in general. Also, I have some patients who have gotten dramatic relief from chrondin sulfate and glucosamine. Theorectically, these should have little effect;but, they seem to have little toxicity. Exercises will not help and may accelerate the problem.

Knee Problem Solutions [posted 10/13/98]
Question: I have had numerous knee surgeries since 1978 and am currently having severe knee pain. I have had carbon fiber implants for the patella tendon together with a maquet and a patellar implant. I recently had a MRI which was inconclusive as to the cause of the pain. The doctor says I have a "plica" which I'm not sure what this is and the knee shows signs of wear and tear with arthritis. At this point he feels I will benefit from cortisone injections. I have had this in the past and it did not seem to work, should I feel comfortable with having this done again or should I try and live with the pain, which was my other option? The pain is intense at times making walking difficult and physical activities near impossible. I am 36 years old and would like to be able to enjoy my 9 year old son by joining him and my husband on bicycle rides and hikes and am unable to do so. Please advise what other remedies might be available to me, I have done the physical therapy to ! no avail as well.

Answer: Cortisone is certainly an option. There is also a new drug for injection which is a synthetic variation of the normal fluid in your knee. Injecting these (usually 3 or 4 times) can produce decreased pain in many patients. Check with your orthopedic surgeon.

Any New Knee Treatments on the Horizon? [posted 10/9/98]
Question: I am 29 years old, and have undergone 11 knee surgeries on my right knee. I have had 2 pattelar transfers, a retinaculatr release, numerous knee shaves and arthroscopic procedures, a staple removed,and a patellectomy. I am in constant pain, and my knee is always swollen. I can't do anything without swelling, pain, and my knee giving out. I have been to physio, and I am as active as I can be. I walk, and do strengthening exercises. My present ortho says he does not know of anything that could help me. My problem has been traced back to my second patellor tendon transfer, which was too restrictive, and the staple was left in for 13 years.(It was finally removed after it had started to loosen up) I cannot believe there is nothing that can be done to help me. I am desperate for answers.

Answer: Well, there is a new drug, a synthetic compound similar to the fluid in normal knees. Injecting this(usually 3 or more injections) will help most patients with osteo of the knee and delay knee replacement. I'd contact my orthopedic specialist and inquire about this option, fairly new.

Synbisc & Knee Surgery [posted 10/2/98]
Question: Have you ever heard of a drug called SYNBISC? I believe it is used in knee surgery????

Answer: Yes, this is a synthetic molecule similar to the fluid of a normal joint. It is injected into the joint usually about once a month for 3-4 times to see if it will relieve the pain of osteoarthritis. The early studies have demonstrated that it helps for about 2-3 years to delay joint replacement. Risks center around infections at the injection site.

Knee and Foot Swelling [posted 8/11/98]
Question: I am currently taking betapace and coumadin for an irregular heartbeat. I have been experiencing swelling in the left foot and knee. Would these drugs in combination cause this? I am also taking cardizem, lanoxin, and zocor for high blood pressure and cholesterol.

Answer: No, asymmetrical swelling usually indicates a problem with the venous return from that leg.

Knee Problem [posted 8/6/98]
Question: I am a twenty two year old male football player and weight lifter. I have had two surgeries on my left knee. I continue, however, to have a lot of cartilage and fluid problems in my left knee. I have tried a lot of anti- inflammatory drugs. Can you tell me if there is anything else I can take or do, such as taking Halotestin?

Answer: Probably nothing if you are seeing a good sports medicine physician. Do not take halotestin, this may accelerate the cartilage loss.

Knee Cartilage Degeneration [posted 7/23/98]
Question: X-ray shows degeneration of cartilage. I am 77 and am active - tennis and travel professionally. Is there any treatment possible? Or must I just live with it?

Answer: Probably live with it - pretty common by 77 unfortunately. I have had some patients get relief with over the counter chrondium sulfate. This doesn't seem toxic and is worth a try, but there aren't too many other alternatives. Some are experimenting with injecting fetal cartilage cells in the joints-I'd avoid this until more research is done. The last resort if the pain is too severe and cannot be controlled is joint replacement, but your knee will never again be as flexible (less pain however).

Knee Replacement [posted 7/17/98]
Question: I am considering joint replacement. Have the life expectancy of the joints improved? Also, what is the normal hospital stay, and recovery?

Answer: It sounds difficult, but really isn't. Don't replace your knee until the pain is unbearable and you have no alternative. The new joint will hurt less, but will never work as well as your joint. Hospital time is usually 4-7 days with about 2 weeks in a short term rehab, although some patients do this at home. Life expectancy varies with usage, but usually greater than 10 years unless you fall and shatter the replacement. A good operation, but don't do it until you have no options including narcotics, physical therapy etc.

Knee Injury
Question: My son was in a recent auto accident and x-rays have been taken twice to make sure there were no broken bones or fractures. However, there is a large round spot below his knee about the size of a saucer that is soft and swollen. The pediatrician said it was full of blood and other body fluids and would go away, and if it didn't go away it could be drained. We would like to get a second opinion. Is this serious and could it cause any type of permanent damage? Is it something to be worried about? My son is 16 years old, 6'4" and is a large boy. His leg is very tender now and he said it hurts a lot. All the pediatrician said to do was take it easy and try not to walk to much. It has been getting a little larger and more swollen.

Answer: It sounds like he is having inflammation of the pre-patellar bursa. This is a "sac" like structure just below the knee. It can often be inflamed as the result of direct trauma and tends to become swollen. The usual treatment if this persists is injection with local steroid solutions to decrease the swelling and inflammation. Treatment with non-steroidal anti-inflammatory drugs is also usually helpful.

Knee Pain
Question: I have had some chronic pain in my right knee right below the patella. It hurts when I squat or even walk stairs. What could this be?

Answer: I can’t really say without examining them. Common causes would be chrondomalacia patella (damaged or inflamed cartilage behind the patella), tendonitis, or a Bakers Cyst (a congenital cyst behind the knee).

Knee Problem
Question: I have constant pain in both knees that gets worse as the day goes on. The pain is centralized right below the patella and is on the inside part of the knee. I am 27 and am active on a daily basis. When I bend the knees I feel a lot of popping and also can feel loose tissue in the knee. Is there anything I can do as far as relieving the pain at home?

Answer: Try two weeks of non-steroidal antiinflammatories. These are drugs like motrin-ib, aleve, etc. In general, doubling the over the counter dosage will give you prescription dosages. The potential toxicity is mainly in the stomach. Stop them with any indication of prolonged dyspepsia or heartburn. Also, stop any non-necessary weight bearing.

Knee Problem
Question: I have been experiencing very loud cracking of the knees every time I get up from a sitting position or move my knees up and down. This also happens when I ride a bicycle. Although this is not painful, I am concerned. This has been going on for about 8 to 10 years. I am a 59 years old male and 25 pounds overweight. I have never had any knee damage.

Answer: As most professional athletes will tell you, the wheels are the first to go. Degenerative arthritis is usually first seen in the late 40s or early 50s in the absence of any preceding trauma. Popping and cracking may be a problem, and it may not. If there is no pain, joint swelling or instability of the knee it probably merely represents the first signs of osteoarthritis of the knee. If the knee is painful, swollen, locks or gives way it will need to be examined to ensure that there has not been damage to the ligaments or meniscus of the knee which can require surgery.

Cortisone Shot
Question: I am scheduled to receive a cortisone shot in my knee due to an injury from an auto accident that is still painful to touch. Would you, please, supply me with some information on the benefits/risks of such an injection?

Answer: The risk of one shot is limited to local reactions, infections etc. Multiple shots could have the same systemic effects as steroids; that is, rapid aging manifested by hardening of the arteries, diabetes mellitus, cataracts, etc. Usually a steroid injection is limited to 2-3 at max.

Question: My wife is scheduled to have surgery on both knees to release the patella as they are being pulled to the outside of the knee. My questions are: Is it customary to do both legs at the same time? My wife’s surgeon said that he doesn't like to use the arthroscopic technique for this surgery. Should I be concerned about this? I thought that arthroscopic surgery was the best way to go for knees. The surgeon likes to do this surgery in his clinic. Wouldn't the day surgery suite at our local hospital be better? My wife has had some problems with (excuse spelling) anesthesia in the past. My last question: Generally speaking how long would she have to recover before returning to work that required getting up and down from he desk quite a bit?

Answer: These are excellent questions that you should ask her surgeon. One should never undertake surgery without a clear understanding of risk /benefit and approach. If a surgeon is unwilling to discuss these areas-find another surgeon.

Menisci Information
Question: What exactly is the meniscus in my knee, and can I pass a military physical with one broken?

Answer: The menisci are in the knee and each knee has two-the medial(inside)and lateral(outside). They act as spacers and shock absorbers in the knee; but, are commonly injured in any twisting motion or sports injury. The medial is more likely to be torn;but, both are susceptible. This may or may not be seen on a military physical depending on how much pain is present. But, would usually need to be repaired before acceptance into the military if found on a physical.

Torn Meniscus
Question: How long does it take to heal and what type of tape job can you use to still be able to play football with this type of injury.

Answer: Once torn, it will not heal without some sort of surgery. Usually this is arthoscopic and will take 2-4 weeks to be functional depending on the amount of tissue that needs to be removed (complete or partial). I wouldn't recommend further play with a torn meniscus if you value your future career.

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