UNDERSTANDING THE KNEE ANATOMY & FUNCTION

The knee joint, formed by the distal femur and the proximal tibia, is the largest and most complicated synovial joint in the body. Because of its unique positioning- between the body’s two longest mechanical levers- the knee is subject to a significant number of sports-related injuries. Injuries can result from acute traumatic, subacute, or chronic overload situations in the proximity of the knee. The management of each condition presents unique challenges. In this first article in a series, the anatomy and function of the knee joint are outlined...Read more

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ADVANCED SURGICAL MANAGEMENT OF KNEE OSTEOARTHRITIS

Knee arthroscopy is basically microsurgery of the knee as discussed in the articles on this website. There is quite a bit of debate as to the ideal candidate for knee arthroscopy in the early to late degenerative arthritis knee. Over the years, I have come to the conclusion that in many cases arthroscopy for the degenerative knee can be quite successful given the right parameters for treatment. In many cases an artificial knee can be avoided or delayed...Read more

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ARTHROSCOPY AND MENISCUS SURGERY

The most important substance within the knee joint is the hyaline or articular cartilage, which covers the end of the bones of the femur, tibia, and undersurface of the patella. Articular cartilage is necessary to provide smooth and fluid motion of the joint. Damage to the menisci or ligaments in the knee can cause abnormal motion in the knee and may cause abnormal wearing away of the articular cartilage. The entire joint is bathed in a thick, syrupy liquid known as synovial fluid. This fluid lubricates the joint and also provides nutrition to the articular cartilage, the menisci and the cruciate ligaments...Read more

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KNEE LIGAMENT INJURIES & KNEE RECONSTRUCTION

Most of the stability of knee is provided by soft tissue structures such as the muscles, tendons and ligaments rather than the structure of the bones which make up the joint. The ligaments guide the knee in its normal range of motion and the force for movement is provided by the muscles. Abnormal motion which results from ligament injury, especially when a meniscus is also injured, can lead to premature arthritis. Thus, as orthopaedic surgeons, it is our goal to restore as much normal function and motion to the knee as possible following ligament injury...Read more

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PLATELET-RICH PLASMA THERAPY

PRP is a concentration of blood platelets and growth factors obtained from the patient’s own blood using centrifugation techniques can be utilized immediately for clinical use. They contribute to the regulation of homeostasis and promote wound repair. In the plasma, numerous proteins are contained, such as insulin-like growth factor IGF, platelet-derived growth factor (PDGF), platelet factor interleukin (IL), platelet-derived angiogenesis factor (PDAF), epidermal growth factor (EGF), transforming growth factor (TGF), vascular endothelial growth factor (VEGF), and fibronectin (Lubkowska, 2012). Such anabolic growth factors inhibit inflammation and pain, as well as enhance the cartilage and bone matrix biosynthesis (Brandl, 2010)...Read more

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Strategies for Weight Loss and Hormonal Balance

Obesity can affect the pathogenesis of OA through biomechanical

effects as well as via increased metainflammation (metabolic inflammation). Increased obesity is associated with higher levels of joint loading and reduced levels of physical activity, which in turn reduces muscle strength. Combined, these effects can result in the structural changes of OA. Structural disease results in pain, which presents a barrier to physical activity, further reducing energy expenditure and resulting in reduced muscle mass and increased fat mass. Thus, these factors may contribute to a vicious cycle of obesity and OA...Read more

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METABOLISM, AGEING, AND ORTHOPEDICS

The body’s metabolic pathways are essential to maintaining life and homeostasis. When metabolic processes do not function correctly, the body can suffer severe consequences with various orthopedic complications, such as osteoarthritis. The following paper is a review article introducing the intricate role of various metabolic pathways and orthopedic disorders associated with weight and obesity, sarcopenia or the loss of skeletal muscle mass, dynapenia or age-associated loss of muscle strength, and Type II Diabetes Mellitus. Conservative treatment consisting of lifestyle and dietary changes is discussed as well...Read more

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CONSERVATIVE TREATMENT OF INFLAMED KNEE BURSAE

Knee Bursitis often mimics other pathologies. Most commonly affected are the pre-patellar, pes-amserine, tibial collateral ligament, and two infra-patellar bursae. Other common Bursitis conditions include Baker's cysts and post-traumatic adventitious hemorrhagic bursitis. Most of these can be treated conservatively with aspiration of fluid from the bursa, rest, ice, immobilization, and injection of corticosteroid and analgesic combination...Read more

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MANAGEMENT OF ACUTE KNEE INJURIES

The treatment of knee injuries is based upon the structure that is damaged, as well as the severity of the injury. Rest, ice, compression, and elevation (RICE) therapy is a standard component of treatment during the acute, initial phase of of injury. Exercise, which should be tailored to the individual needs of the patient, protects the supporting structures around the injury and maintains mobility. Patients with injury requiring further diagnostic procedures or more technical treatment should be referred to an orthopedic specialist...Read more

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ASPIRATION OF THE KNEE JOINT & SYNOVIAL FLUID ANALYSIS

Because the knee is the largest synovial cavity in the body, it is the easiest to aspirate. The aspiration of fluid from a tense knee effusion not only relieves pain, but also can render valuable diagnostic information. Additionally, aspiration can drain an infected joint, as well as permit instillation of medication, such as a corticosteroid agent, into the synovial cavity...Read more

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KNEE & RUNNING: PLICA SYNDROME | LOOSE BODIES

The synovium is a dynamic secretary membrane that produces nutrients for the knee. It also provides cells that pick up wear and tear products and protects the joint from infection. Five percent of the population have extraneous extra synovial membranes within the knee joint cavity. With the repetitive bending of the knee in running or direct external trauma such as a fall onto the bent knee, these congenital extra membranes can become inflamed and thickened. Often, a snapping sensation develops with pain and tenderness over the front of the knee...Read more

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KNEE & RUNNING: TENDON INJURIES | BURSITIS

Tendons connect muscles to bones. There are numerous tendons about the knee (Lui, 2010). In the back of the knees, these tendons are commonly referred to as “the hamstrings”. There are four inner hamstrings that pull (flex) backwards and internally rotate the tibia (the large inner bone below the knee joint)...Read more

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KNEE & RUNNING: MENISCUS & LIGAMENT INJURIES

The most important structure in the knee is called articular (hyaline) cartilage which is the spongy lining surface covering the articulating (opposing) surfaces of the femur, patella, and tibia. Articular cartilage receives nutrients by the pumping action of the knee. If we lost this spongy material, it may be replaced by another less resistant variety called fibrocartilage. More commonly, the articular cartilage is not replaced and eventually bone opposes bone, forming arthritis...Read more

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KNEE & RUNNING: CHONDROMALACIA

The term “runner’s knee” refers to pain about the knee caused by running. The most common problem is “kneecap pain”. Medically this is referred to as “chondromalacie patellae” or soft cartilage of the kneecap.

Once the diagnosis of chondromalacae patellae is made, then rest, ice after running, anti-inflammatory medication, and a gentle quadricep exercise program is recommended...Read more

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KNEE & RUNNING: SPINE

The spine is comprised of vertebrae, rectangular bones that help provide stability to the axial skeleton. Between the vertebrae are the intervertebral discs, which are somewhat ovoid, softer, and essentially act as cushions between the vertebrae. They provide for shock absorption as well as provide stability...Read more

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THE SHOULDER

The shoulder is a fascinating joint. Several muscles traverse the shoulder joint. These include the deltoid muscle, which is the large superficial, fleshy muscle best noted on the lateral, or outside, aspect of the shoulder, etc. In order for the shoulder to function normally, the bony architecture and the shoulder muscles must work in concert to produce a normal painless range of motion at the shoulder. There are many shoulder conditions that can disrupt this delicate balance and control...Read more

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HAND METACARPAL FRACTURES

The hand is a wonderfully complex structure that is both an intricate mechanical manipulator and one of the body’s most delicate and discriminating sensory organs. From the standpoint of function, the hand and fingers are the most important components of the upper-limb complex. Because of its potential to perform a variety of tasks and its functional relationship to the rest of the body, however, the hand is particularly vulnerable to injury...Read more

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COMMON ANKLE INJURIES IN SPORTS

Ankle injuries have been considered relatively minor in comparison with other types of injury that commonly occur in sport, and there seems to be a somewhat casual attitude toward the treatment of these injuries. Yet studies show that the average period of disability associated with an ankle sprain is from four to 26 weeks, and up to 40% of patients experience symptoms for up to four years. In view of the increasing importance of sports in the United States, these “minor” injuries deserve more careful attention...Read more

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COMMON FOOT INJURIES IN SPORTS

The foot is wonderfully complex. It is the base of support when we are standing, walking, and running, and it is the mechanism that transfers the mechanical power of the legs to the ground for locomotion. The foot can be rigid when transferring lower-limb power to the ground, and it can be flexible when responding to changing surface characteristics.

Because of the foot’s complexity, anyone dealing with foot problems must have an intimate understanding of both its anatomy and its biomechanics...Read more