What is knee arthritis?

Knee arthritis is also called degenerative joint disease. It is a wear-and-tear condition that is marked by the progressive loss of articular cartilage. The articular cartilage is the slippery, white cartilage-covering on the ends of the bones; it plays an important role in joint health. With age, injury, or repetitive motion, the articular cartilage can wear. Eventually, enough cartilage can wear away, allowing the movement of bone-on-bone. The result is a painful, inflammatory process called osteoarthritis. Our experts at BICMD can diagnose your knee osteoarthritis through a virtual telemedicine encounter. BICMD physicians are the top experts in the country at diagnosing and suggesting treatment options for patients with knee osteoarthritis.

What causes arthritis in the knee?

There are different factors that can cause osteoarthritis in the knee, with the most common being wear and tear from age and repetitive motion. Other causes and risk factors include:

• Weight – Excessive weight increases pressure on the knee joint, causing early wear of the cartilage
• Heredity – Genetics plays a role in osteoarthritis and may predispose an individual to develop osteoarthritis of the knee. Inherited bone abnormalities can also increase the likelihood of knee osteoarthritis.
• Repetitive Stress Injury – Individuals who have jobs that require added force on the knee, or constant activity like kneeling, squatting or lifting heavy objects can have repeated stress injuries which increase the rate of wear on the cartilage and can cause osteoarthritis in the knee.
• Gender – Women over 55 are more likely to develop osteoarthritis of the knee than men.
• Athletics – Athletes who participate in certain types of sports put the knee at greater risk of developing osteoarthritis.
• Illness – Individuals with certain types of illness are more likely to develop knee osteoarthritis.

What are the grades of osteoarthritis in the knee?

Osteoarthritis is classified according to the amount of wear on the articular cartilage surface of the knee. Orthopedic specialists assign grades of degeneration by the following:

• Grade 1 – Softening of the articular cartilage, showing early damage
• Grade 2 – Pitting and small fissuring of the articular cartilage surface
• Grade 3 – The articular cartilage shows damage with a split or crackdown to the bone
• Grade 4 – Complete wear of the articular cartilage with the bone exposed

What are the symptoms of knee arthritis?

The symptoms of knee osteoarthritis often develop over time. Symptoms include:

• Joint stiffness and pain
• Swelling that makes it difficult to bend or straighten the knee
• Warmth, redness, and tenderness in the joint
• Pain with activity
• Pain after sitting for a period of time, often noticeable first thing in the morning
• Crepitus or a creaking, crunching, or popping sound in the joint
• Joint instability or the sensation that the knee might “give way”
• Increased pain and achiness with bad weather

How is knee arthritis diagnosed?

Arthritis in the knee can be diagnosed through x-ray. An x-ray can create a detailed picture of the bones of the knee and can help distinguish different causes of knee pain. Often an MRI will be requested which will allow the doctor to determine the amount and grade of damage to the articular cartilage. The amount of damage will help determine the best treatment for knee arthritis. An MRI will also show the other structures of the knee and if further treatments need to occur.

How is arthritis in the knee treated?

Non-surgical treatment:

The goal of knee arthritis treatment is to relieve pain and reestablish mobility. Conservative measures include weight loss, activity modification, physical therapy, over-the-counter anti-inflammatory medication and corticosteroid injections.

Surgical Treatment:

Surgery for knee osteoarthritis should only be considered when conservative treatments have failed to alleviate pain. There are different methods for treating knee osteoarthritis and should be based on the patient’s age, activity level, health and amount of degeneration of the joint. Surgical treatments often used to treat knee osteoarthritis include:

• Arthroscopy – Minimally invasive surgery using a small camera called an arthroscope, used in conjunction with specialized instruments inserted through small incisions to operate within the knee. Arthroscopy of the knee is more frequently used to treat other knee conditions, such as a torn meniscus. Treatment of osteoarthritis through arthroscopy is less common but does allow the surgeon can clean up the joint, remove bone spurs and loose particles.
• Knee Osteotomy – A procedure where one or both of the bones of the knee are reshaped to relieve pressure on the portion of the joint that is causing pain. A knee osteotomy is appropriate for younger individuals who have early-stage knee osteoarthritis.
• Knee Replacement – Also called knee arthroplasty. The orthopedic surgeon removes the damaged bone and cartilage, replacing it with a new metal and plastic joint called a prosthesis. This recreates the joint and restores function to the knee. Knee replacement is usually reserved for patients over 50 with severe osteoarthritis of the knee.

For more information on knee osteoarthritis and the possible treatment options you should consider, or to  have your knee condition evaluated by one of our experts, please click on “Get Started” to reach one of our orthopedic telemedicine experts.

A torn anterior cruciate ligament in the knee.  The ACL is tissue that connects the thighbone to the shinbone, at the knee. Most ACL injuries occur during certain sports such as basketball, soccer, football, skiing, and tennis.

Things you should know

coming soon...

Questions to ask your doctor

coming soon...

Common issues

coming soon...

Recommended treatment

coming soon...

What is an osteochondral defect?

Osteochondral is the medical term for the cartilage of the bone. An osteochondral defect refers to a specific area of damage on the bone’s articular cartilage that involves the damage of both the cartilage and the underlying bone. Articular cartilage is the smooth, slippery substance that coats the ends of the bones in a joint and is often compared to the rubbery substance on the end of a chicken bone. When the articular cartilage becomes damaged and that damage affects the bone beneath its protective surface, it is called an osteochondral defect. The specialists at BICMD have extensive experience and training when it comes to treating osteochondral defects of the joint. They have an excellent track-record and are able to give excellent advice and a second opinion for the best method of treating articular cartilage and bone damage.

What causes an osteochondral defect?

Although the cause of an osteochondral defect is largely unknown, the prevailing thought among orthopedic specialists is that these defects can occur from a traumatic injury. Other theories blame the lack of blood supply to the affected area, others site heredity, direct compressive trauma or repetitive strain. The causes may vary but the damaging effects of an osteochondral defect are the same.

Is an osteochondral defect the same thing as arthritis?

In both arthritis and an osteochondral defect, the articular cartilage which protects the bone is worn away, torn, or damaged. There is a distinct difference however and the treatments are significantly different as well. The differences are as follows:

• Osteochondral defect
  • Damage of the articular cartilage AND the underlying bone
  • The damaged bone can fracture or break off
  • Cartilage and bone can be repaired using special techniques
• Arthritis
  • Damage of the articular cartilage, allowing the bones to rub together
  • The bone is worn down but does not fracture or break off
  • Cartilage is not commonly repairable
  • Arthritic bone cannot be grafted

Can all joints have an osteochondral defect?

Osteochondral defects can occur in any joint in the body but are most commonly seen in the knee and the ankle. The hip and elbow are not immune to osteochondral lesions and, in rare cases, a cyst can form, causing additional bone damage by making it more vulnerable to fracture.

What are the symptoms of an osteochondral defect?

Osteochondral defects are painful. The joint involved will usually have pain that worsens with activity. Other Symptoms include:

• Swelling of the joint
• Crepitus, or a cracking or “crunching” sound when moving the joint
• Locking of the joint
• Decreased range of motion
• A limp that develops

How are osteochondral defects diagnosed?

The orthopedic specialist at BICMD prefer both an x-ray and an MRI when diagnosing an osteochondral defect. The joint in which the patient is experiencing pain may also determine which diagnostic test is needed. Most commonly, an MRI will show articular cartilage damage and the underlying bone can be evaluated. A patient’s clinical history, lifestyle and sports history will also be obtained to determine a proper diagnosis and to plan for treatment.

How are osteochondral defects treated?

Non-surgical treatment:

Patients who are not experiencing great amounts of pain and whose activities are not limited may be able to live with the symptoms of an osteochondral defect. Conservative treatments include NSAIDs (non-steroidal anti-inflammatory drugs), ice, rest, physical therapy and joint injections with steroids or platelet rich plasma.

Surgical treatment:

Patients who are experiencing pain, or worsening symptoms may require surgical intervention. Cartilage defects that are unable to heal can progress to a painful condition. Surgical treatments vary greatly and depend on the area, size of defect and the age and health of the patient. Surgical treatment can include one of the following:

• Osteochondral allograft transfer and MACI
• Chondroplasty
• Microfracture

How long is the recovery from an osteochondral defect?

The recovery period for an osteochondral defect depends greatly upon the treatment. Non-surgical treatments that are effective in resolving pain can take 4-12 weeks. Larger defects that require surgery can take six months to a year to return completely to sport at pre-injury levels.

For more information about osteochondral defects or if you would like to be evaluated for your knee, ankle, elbow or shoulder pain, please click on “Get Started” to reach one of our orthopedic telemedicine experts. Our second opinions are from expert physicians who are the top in the country for treating orthopedic injuries.

Patellar tendon tears and quadriceps tendon tears occur when the quadriceps tendon contracts suddenly, with force exceeding the capacity of the tendons, often as a result of jumping during sport or falling on a flexed knee.

Things you should know

coming soon...

Questions to ask your doctor

coming soon...

Common issues

coming soon...

Recommended treatment

coming soon...

What is the difference between ACL reconstruction and ACL repair?

The terms ACL reconstruction and ACL repair sound similar, but the surgical procedure is different. Both are used to treat an ACL Tear, but they are unique in how and when they should be used. Many patients find an “all or nothing” mentality with their orthopedic surgeon where some surgeons will only repair an ACL tear and other surgeons prefer to only do an ACL reconstruction. The specialists at BICMD are experts in treating ACL Tears and will perform the necessary surgery for an ACL tear, whether that procedure is an ACL reconstruction or ACL repair. Through our telemedicine portal, you can be evaluated, and our world-class orthopedic surgeons can give you the best advice for your specific ACL tear.  In general:

• ACL Repair – When the Anterior Cruciate Ligament is repaired and not replaced. In the past, an ACL repair was only performed when the injury caused a piece of the bone and the ligament to separate from the remaining bone. The goal of this type of repair is to reattach the bone fragment to the bone. However, newer techniques and research have prompted a resurgence of ACL repair for very specific types of ACL injury, with or without a bone fracture. ACL repair is appropriate in lower-energy injuries and in some soft-tissue injuries where the ACL is pulled from the bone but is still intact structurally.
• ACL Reconstruction – The most popular and preferred treatment for an ACL Tear, replaces the torn ligament completely. ACL reconstruction is used when the ligament cannot be salvaged. ACL reconstruction for an ACL Tear is appropriate for active individuals who experience persistent knee pain and knee instability following an injury. Athletes who want to return to their active lifestyle are good candidates for an ACL reconstruction.

What is a torn ACL?

Tearing your ACL is not uncommon. In fact, a torn ACL, or anterior cruciate ligament occurs more often than any other knee injury in sports. The ACL is a ligament in the knee that connects the femur (thigh bone) to the tibia (or shin bone) and is located in the center of the knee. The ACL can be torn in sports that cause a sudden shift or change in direction. Sports that have the most ACL injuries include basketball, football, soccer, skiing and tennis.

What is the difference between an autograft and an allograft?

A graft is a portion of tissue used to repair a torn anterior cruciate ligament. There are two types of grafts, an autograft and an allograft.

ACL Autograft:

An autograft is a piece of tissue, obtained from the patient’s own body. An ACL autograft has the following advantages:

• Autografts are the preferred type of graft and the best choice for ACL reconstruction.
• Less costly to obtain than allografts.
• Quicker healing time
• Less chance of infection

ACL Allograft:

An allograft is a piece of tissue used for the ALC repair that is obtained from a donor, or cadaver. Allografts are used when the patient does not have viable tissue that is available or can be used for the graft. This can occur in athletes who have had multiple ACL or other tendon tears and reconstructions. Older individuals who are more sedentary should allow for additional healing time.

What is the best type of graft for an ACL reconstruction?

The type of autograft used for an ACL reconstruction depends greatly on what is available from the patient and the goals of recovery. The most often used autografts for ACL reconstruction are:

• Patellar tendon autograft (preferred autograft)
• Hamstring autograft
• Quadriceps tendon autograft

What happens during an ACL Reconstruction?

An ACL reconstruction is done by replacing the torn ACL with an autograft that is secured at the original attachment sites of the native ACL. During this specialized surgery, the doctor removes the torn or fragmented ACL as well as any other areas of soft tissue that are damaged. The surgeon then creates small tunnels through the bones of the femur and the tibia. The new ACL graft is threaded through the tunnels and secured with either screws or a surgical loop and button which is placed on the outside of the bone tunnels. The overall goal of ACL reconstruction is to replace the torn ligament and reestablish the stabilizing properties of the original ACL. The experts at BICMD can explain to you the nuances and details associated with ACL surgery.

What happens after ACL repair or reconstruction?

The rehabilitation protocol is similar in both an ACL repair and an ACL reconstruction. Patients treated for this condition can expect the following:

• Most ACL repairs and reconstructions can be done on an outpatient basis and patients can go home the same day.
• Pain medication should be taken as recommended.
• Ice, elevation and rest will be needed in the hours following surgery.
• Patients are given a rehabilitation protocol that is tailored to their specific type of ALC Surgery.
• Physical therapy is started immediately in order to reestablish range of motion.
• Strengthening exercises will begin when recommended.
• Return to fitness activities can resume in about 6 to 12 weeks.
• Full return to sport usually occurs in about 8 to 9 months.

For more information on ACL repair and ACL reconstruction, or to be evaluated for your torn ACL, please click on “Get Started” to reach one of our orthopedic telemedicine experts. Our physicians are the top orthopedic doctors in the country and are extremely skilled at diagnosing your knee injury.

What is a meniscus tear?

The meniscus are two c-shaped pieces of tough, rubbery cartilage located in the middle of the knee, between the femur (thigh bone) and the tibia (shin bone). The meniscus acts as a shock absorber and adds stabilization to the knee joint during movement. A torn meniscus is one of the most common knee injuries seen by our sports medicine specialists at BICMD. A meniscus tear can be painful and debilitating and require proper meniscus repair by a skilled and experienced orthopedic knee specialist. A second opinion is always a good idea when looking into treatment options for a torn meniscus. The experts at BICMD can evaluate your MRI and suggest the best surgical option for the best possible outcome.

What is a meniscus repair?

A meniscus repair is a surgical procedure that is needed when conservative treatments fail to alleviate pain and restore knee stability. Meniscus repair can be done arthroscopically, using a small camera and specialized instruments, inserted into the knee through small incisions, and used to operate within the knee capsule. The size, location and severity of meniscus tear will determine the procedure needed to repair or replace the meniscus. Arthroscopic meniscus surgery may include:

• Meniscus Repair:

Some meniscal tears can be repaired if they are located in the area of the knee with a rich blood supply called the “red zone.” In this outer third portion of the meniscus, a tear can be repaired using strong sutures. During a meniscus repair, the surgeon will bring the damaged tissue back together and secure it carefully, allowing the meniscus to heal.

• Meniscus Debridement:

A meniscus debridement is done arthroscopically. The goal of a meniscus debridement is to remove torn cartilage fragments while preserving as much of the meniscus as possible. The frayed meniscus is trimmed and contoured using special instruments.

• Partial Meniscectomy:

A partial meniscectomy can be done arthroscopically. It is similar to debridement, where the aim is to remove as little of the meniscal tissue as possible. During a partial meniscectomy the meniscus tear is trimmed down to remove any edges which could catch in the joint and cause further knee pain. The goal is to form a shallow depression in the meniscus, while leaving it intact when possible.

• Meniscus Transplant:

A meniscus transplant is one of the most technically involved surgeries in sports medicine and requires a surgeon who has extensive experience and skill. A meniscus transplant is performed arthroscopically and uses a donor cartilage called an allograft. Correct sizing is critical, as is the placement of the new meniscus.

What are the risks of a meniscus repair?

One of the complications of a torn meniscus can be incorrect or incomplete diagnosis. Some patients undergo surgery when a torn meniscus is not the true source of their knee pain. It is worth the extra time, energy and expense to make an informed decision about your knee surgery and the type of meniscus surgery you should have. Our experts at BICMD have a proven track record for evaluating and diagnosing knee meniscus injuries and can set you on the correct path toward the best recovery.

How long is the recovery after meniscus repair?

The time for recovery is determined largely by the type of meniscus repair surgery performed. A repair of the meniscus can take 4 weeks before weight bearing is allowed. A complete meniscus transplant can take 4 to 5 months of healing time.

For more information about meniscus repair, debridement and meniscus transplant or to receive a second opinion for your knee condition, please click on “Get Started” to reach one of our orthopedic telemedicine experts.

What is a total knee replacement?

Patients who experience pain from progressive knee arthritis, who have not found relief with conservative treatments may be candidates for a total knee replacement or arthroplasty. Knee replacement is a safe, effective procedure used to relieve pain, correct leg deformity, and can help patients return to their normal activities. Total knee replacement surgery is one of the most successful procedures in orthopedic medicine. In fact, in the United States alone, nearly 1-million knee replacement surgeries are performed each year. Advancements in orthopedic surgery make this procedure highly effective at improving a patient’s function. Further, advancements in telemedicine now make it possible to be evaluated by some of the best orthopedic knee surgeons in the country. Our “best in class” doctors are available to give you a second opinion and to help explain the best possible treatment options for your knee condition.

Why would I need a knee replacement?

Knee osteoarthritis is caused by damage to the articular surface of the knee. Arthritis is also the number one reason patients see a knee replacement. The pain from arthritis in the knee can be debilitating and when conservative measures fail, patients may consider a knee replacement. The types of arthritis that can cause a patient to consider a knee replacement are:

• Knee osteoarthritis – Wear and tear arthritis and the most common form of arthritis.
• Rheumatoid arthritis – An inflammatory type of arthritis and an auto-immune disorder. Rheumatoid arthritis is often inherited.
• Post-traumatic arthritis – Occurs after trauma or injury and is often sports-related. Torn ligaments, cartilage, fractures, and knee dislocations can all contribute to post-traumatic arthritis.

How is a total knee replacement surgery done?

The goal of Knee arthroplasty is to replace the damaged joint with synthetic parts. There are three basic steps in a total knee replacement:

• The bones are prepared: The damaged articular cartilage at the ends of the femur and tibia is removed, along with a small amount of bone.
• The Implants are put into position: Metal implants used to recreate the surface of the joint. The metal components are “press-fit:” or cemented onto the bone.
• The plastic spacer is placed: This medical-grade spacer is inserted between the metal components and will create a smooth gliding surface. The spacer acts as a new-age cartilage or meniscus.

How long will a knee replacement last?

This question is common, and you should understand the risks and advantages of a total knee replacement. Most people (80-90%) who have undergone total knee replacement surgery enjoy the pain-free benefits of their new knee for 25-30 years on the average. Partial knee replacements are more likely to need another operation in about 10 years, as many as 1 in 10 need additional knee surgery within that time. It is important to understand your options and a quick orthopedic telemedicine consultation by one of our experts at BICMD can save you time, money, and even further knee surgeries.

What is computer-assisted or robotic assisted total knee replacement?

The advancements in orthopedic medicine have brought about some great assistive tools for total knee replacement surgeons. These medical devices allow orthopedic surgeons a more precise fit and placement of the components in an arthroplasty. Two of these devices are:

• Computer assisted total knee replacement: This begins before the actual surgery, with an MRI or a CT scan. The surgeon designs a custom guide to position the knee implant to more exactly fit the natural joint in the correct anatomical position.
• Robot assisted total knee replacement: The use of a robotic arm takes computer-assisted knee replacement to a new level. The robot is guided by the orthopedic surgeon to precisely shape the surrounding bone before placing the implant. It is important to know that the surgeon still does the actual surgery, the technology assists the surgeon in staying within the planned boundaries that were defined when the personalized preoperative plan was created. The process decreases the margin of error and makes the placement of the new joint more precise, allowing for a more successful replacement.

How long is the recovery following a total knee replacement?

Total knee replacement is normally an in-patient procedure. Your physician will typically provide you with a complete post-operative protocol that should be followed. Knee arthroplasty patients can expect the following after surgery:

• Pain management – Medication will be prescribed to manage pain and should be taken as directed
• Blood Clot prevention – Immediately following surgery, compression boots, blood thinners or support hose will be prescribed to prevent blood clots.
• Knee exercises begin the day after surgery, usually with a CPM (continuous passive motion device.)
• Safe-motion therapy with certain restrictions may occur for the first 6 weeks.
• Physical therapy is part of the recovery process and is designed to slowly increase strength and range of motion.
• Patients can expect to return to their normal activities in 2-3 months.

For more information on total knee replacement or knee arthroscopy, or to receive a second opinion for your knee condition, please contact our experts, by clicking on “Get Started.” You will be connected to one of our orthopedic telemedicine experts through our state-of-the-art telemedicine platform.

What is a unicompartmental arthroplasty?

Unicompartmental arthroplasty is also called a partial knee replacement. It is a surgical procedure that replaces only a portion of the knee that is affected by knee osteoarthritis. Unicompartmental arthroplasty is used to relieve the symptoms of arthritis when occurring in just one compartment of the knee. In a “normal” arthroplasty, or a total knee replacement, the damaged bone and cartilage is resurfaced and replaced with metal and plastic components. In a unicompartmental knee replacement only a portion of the knee is resurfaced and replaced. Not everyone needs a total knee replacement, and a few select patients are excellent candidates for unicompartmental arthroplasty. If you would like to be evaluated for the best type of knee replacement for your knee condition, we can help! Our “best in class” surgical experts, through our telemedicine platform, can diagnose your knee condition and offer personalized surgical options for the best possible outcome.

Who should have a partial knee replacement?

The choice between a partial knee replacement or complete knee replacement depends primarily on the condition of the knee joint. The knee has three main compartments where osteoarthritis may be present; these are called the medial, lateral and patellofemoral compartments. The medial compartment refers to the inside of the joint, toward the center of the body. The lateral compartment refers to the outside of the joint. The patellofemoral compartment is the area between the kneecap and the femur (thigh bone). Osteoarthritis can form in any of these compartments but is more frequently found in the medial portion of the knee. Partial knee replacement is an alternative treatment for a total knee replacement in patients who have osteoarthritis in one compartment of the knee. Patients who have osteoarthritis in two or more of the compartments are better candidates for a total knee replacement.

How is unicompartmental arthroplasty, or partial knee replacement surgery performed?

The surgical procedure for a unicompartmental arthroplasty is very similar to a total knee arthroplasty. The goal is also similar: replace the damaged portion of the knee with new, synthetic components. The surgery is done in the following steps:

• Patient is placed under anesthesia, either general or regional.
• The surgeon makes a small incision over the knee.
• The entire knee is examined for damage and the surgeon removes the damaged bone and tissue.
• A pre-sized prosthetic component is placed over the repaired portions of the knee and secured with bone cement.
• A spacer is inserted between the two metal components to create a smooth gliding surface.
• The surgeon checks the components for correct motion of the knee.
• The knee is sutured closed.

What are the advantages and disadvantages of a unicompartmental arthroplasty?

Advantages:

• Quicker recovery with less pain
• Less blood loss
• Many patients are able to walk without a cane or walker earlier than a total knee replacement.
• The return to “normal” activities is less limited. Patients are able to continue with activities that have lower impact like swimming, tennis, golf and biking.

Disadvantages:

• Knee osteoarthritis can still develop in the other compartments of the knee, prompting additional surgery.
• Slightly less predictable pain relief

How long will a unicompartmental arthroplasty last?

When done properly and in patients who meet the criteria for unicompartmental arthroplasty, the long-term outcome is good. Studies show the majority (90%) of partial knee replacements last 10 years or longer. Patient enjoy the same durability as a total knee replacement with the benefit of quicker recovery and the sensation of a “normal” knee, rather than a replacement.

How long is the recovery after a partial knee replacement?

The recovery after a unicompartmental arthroplasty is quicker than a complete knee replacement recovery. Physician post-operative protocols should be followed carefully for the best possible outcome. In general, healthy, active patients undergoing a partial knee replacement can often resume regular activity in about 6 to 8 weeks.

For more information on unicompartmental arthroplasty or a partial knee replacement, or to find out if you are a candidate for this specialized surgical procedure and to receive a second opinion for your knee condition, please contact our experts, by clicking on “Get Started.” You will be connected to one of our orthopedic telemedicine experts through our state-of-the-art telemedicine platform.

This list contains some of our most commonly seen conditions, but it is by no means exhaustive. Our knee doctors handle the same wide variety of conditions that an in-person physician would.

No one should have to live with knee pain. Today’s advancements in orthopedic care have made it possible for many to live a pain-free life while maintaining full function.  A consultation with one of our knee experts is the first step on your path to recovery. Let us discuss the options that will work for you and your specific issue.  Our physicians are committed to helping you feel better.

Click on “Get Started” to reach one of our orthopedic telemedicine experts.