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Causes of knee pain | Understanding symptoms | Nonsurgical treatments | Surgical options

Knee Pain

Causes of knee pain

Chronic pain

Pain is broken down into two categories: acute or chronic. If you fall down and hurt your knee or twist your knee, that is called "acute" knee pain. Chronic pain is something that occurs more gradually over time, often getting worse as weeks and months go by.

Unlike acute pain which can be linked to a specific event or time - like when you fall or twist your knee - chronic pain is more like an ache that is not linked to any event. The knee specialist will ask when and how your pain started to learn more about the potential cause of pain.

Strains & Sprains

These two terms are sometimes used together. However, technically they differ. A strain occurs when a muscle is overworked or overstretched. Sprain relates to ligaments, or tendons. For instance a strain can occur at the start up of a new exercise regime. If the body is not properly stretched, than sudden impact can tear muscles, ligaments, tendons, and soft tissues. As our body becomes accustomed to an exercise, say running, it compensates for potential injuries by strengthening muscles and ligaments. If we start a running program after living a relatively sedentary lifestyle, our body has not had a chance to compensate yet, and we are more prone to a strain.

If you are about to start up an exercise program, remember to stretch before embarking upon the new activity. That is crucial. Also try to ease into the program allowing your body to strengthen before pushing it to the limit.

Sprains relate to an over-stretched or torn ligament. Usually, the sprain is tender or swelling occurs and it can look black and blue like a bruise. This is a little more serious because this indicates a torn ligament. Tears are more severe than strains or sprains. When muscles, ligaments, or tendons are torn they are actually disrupted. The torn ends grossly disrupt the continuity of their structure.

The location of the injury should clarify any confusion over whether it is a sprain or strain. Strains occur in the muscles of the neck, back, thighs and calves. Sprains are found around joints—knees, ankles, or wrists.

Ligament Problems

An increase in interest in sports seems to have been the catalyst for more and more ligament problems every year. In fact, there are more than 50,000 hospital admissions for ligament repair. Interestingly, women are 8 times more likely to have an ACL tear than men. Some experts theorize it may relate to high heels or anatomy. The ACL (anterior cruciate ligament) and the MCL tend to be particularly susceptible to injury during sports. The cause is generally turning quickly and twisting the knee, slowing down when running, and landing from a jump. High risk sports include soccer, skiing, basketball, and tennis.

Pain from Meniscus Tears

Meniscal tears stem from sports-related injuries or even from seemingly innocuous activities such as squatting. Athletes who play football, basketball, and tennis as well as adults over the age of 40 are especially prone to meniscus tears. The type of movement that most often causes meniscal injury is one in which the foot is firmly planted on the ground while the knee is twisted. Shoes with cleats often contribute to this type of injury by anchoring the lower leg into the ground and preventing it from moving with the knee.

Fractures

A bone can break for a number of reasons. A traumatic injury such as a car accident can cause a bone to break. A "Stress" fracture occurs when a bone is used repetitively and because of compression, it breaks.

Dislocation

Sometimes, especially while doing something physically strenuous, we can throw a joint out of alignment with the bone. Although nothing breaks, the alignment is off. This is called dislocation.

Chondromalacia

Chondromalacia indicates a degenerative condition that results from chronic wear on the kneecap. Over time this cartilage may fray and soften. It is a degenerative condition, which occurs as the result of chronic wear of the kneecap against the femur. The articular cartilage gradually softens and then frays. In other circumstances, it can stem from one particular, traumatic incident. Symptoms for this condition could be pain at the front of the knee, especially when walking up and downhill, stiffness after prolonged sitting, and a grinding or clicking sensation as the knee is flexed and extended. This condition is more common in middle age. It happens mostly to women and can occur as early as the teenage years.

Arthritis

Arthritis: Osteoarthritis

This is a degenerative joint disease stemming from wear and tear on the knee usually affecting those in middle age and older. Osteoarthritis causes the cartilage to erode away. Symptoms include pain, stiffness, and swelling that at first happens once in a while but can progress to chronic pain.

Arthritis: Rheumatoid Arthritis

Unlike osteoarthrits, this type of arthritis does not erode the cartilage slowly, rather it inflames the joint (usually many joints at one time) until the joints are ruined. Rheumatoid arthritis is most common in middle aged women, but can affect people of all ages.

Arthritis: Crystaline Arthritis

Inflammation of the joints can occur when a small granual of sodium urate (related to gout) or calcium phosphorate (related to chondrocalsinosis) gets lodged in the joint. The effect is similar to getting a piece of sand trapped in your eye. It irritates the surrounding inflammation. Middle-aged men are most prone to this sort of arthritis.

Pre-Patellar Bursitis

Between the tendon and the skin are small sacs called bursae which allow the skin to smoothly and painlessly slide over bones. When the bursae become inflamed, any knee movement can cause pain. In the knees, one function of the bursae is to allow the knee cap to move around freely without pain. Repetitive kneeling and/or direct impact on the knee can cause the bursae to swell and cause pain. Those in professions (such as masonry, house cleaning, carpet laying and other manual trades) where the knees are often bent are more likely to experience post-patellar bursitis. At other times, the condition can occur when the sacs become infected. Usually for this ailment surgery is not necessary (although may be called upon in extreme cases) and treatment includes avoiding bending of the knees and relieving pressure to the knee cap.

The Four Most Common Knee Problems

• Knee cap pain - the pain usually become most noticeable when walking up stairs, going down stairs, running or sitting.

• Pain from a torn meniscus - the meniscus is the cartilage that keeps the femur (the thigh bone) and the tibia (the shin bone) from hurting or grinding when they rub against each other. If the meniscus is torn, stretched or out of place, pain may occur when the joint is moved.

• Pain from ligament problems - there are four ligaments in the knee: the anterior cruciate ligament, the posterior cruciate ligament, the medial collateral ligament, and the lateral collateral ligament. When the ACL is torn, it is often because the leg rotates while the foot stays planted on the ground. Often times an ACL tear is accompanied by a loud popping sound from the knee and the support of the knee gives way. A posterior cruciate injury happens when the knee is forced backwards or when it receives a hard impact. A medial collateral ligament injury most commonly occurs when the knee is hit from the outside while a lateral collateral ligament injury occurs when the knee is impacted from the inside.

• Pain from tendon problems - inflamed tendons that connect the knee cap to the shin bone can cause pain.
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Understanding symptoms

What is covered in the understanding symptoms section?

Indicators of a serious problem

Misleading symptoms

How to choose a doctor

How a doctor diagnoses knee problems

What do symptoms mean? Can you self diagnose your knee problem? How can you decide if you need to see a doctor for your knee pain? Here is some helpful information.

Indicators of a serious problem

• The pain is very intense

• The pain comes on very strong and suddenly

• You hear a pop from your knee area

Misleading symptoms

Sounds:

If you hear grinding in your knee as you flex and extend the leg, you may think you have a knee problem, but in some cases that grinding sound may be normal, especially if there is not associated pain or discomfort. Noises, when accompanied by pain, should always be taken seriously.

You should have a knee specialist check them out to be sure you are not doing further damage to the knee joint. A loud "pop" for example that comes from an abrupt physical movement, during basketball or tennis, can signal a torn anterior cruciate ligament. There may also be a feeling of instability or nausea. A torn ACL is very serious and needs the attention of a knee specialist promptly.

Pain:

Some serious problems are not even painful at first. Generally speaking, the immediate onset of pain is a sign that something serious is wrong and you need to see a knee expert. But also be aware that sometimes serious problems can develop that DO NOT produce excruciating pain.

*Note:The more of these symptoms you exhibit and the more intense they are, the worse the problem could be.

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How a doctor diagnoses knee problems

When a patient visits a knee specialist to help diagnose a knee problem, there are three parts to the examination; the medical history, the physical examination, and diagnostic imaging.

During the medical history, the knee surgeon will try to find out if you have developed your problem through heredity, through lifestyle habits or through a sudden sports injury. This will give the physician the best idea of how to find out exactly what is wrong, and then suggest proper treatment of the injury. You should indicate to your doctor if you have been using steroids since they can cause joint inflammation. Lyme Disease from the deer tick and rheumatoid arthritis can also trigger joint inflammation, for instance.

Following the medical history, your doctor will give a physical examination to see if he can hear or feel what is wrong. This portion of the exam is somewhat like a carpenter trying to find out why a hinge on a door is squeaking or is not properly aligned by opening and closing the door a few times to listen to what is going on. This will show the doctor which tests he or she should perform to find out the cause of your pain.

Next, the physician may have an MRI or x-ray image taken of your knee. An x-ray often times does not provide the clarity needed to see precisely what is wrong. In these instances, an MRI or CT-Scan is used. X-rays, for example, only show bones. MRI and CT-scans show soft tissues.
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Nonsurgical treatments

Weight Management Techniques

Overall good health

The aforementioned key to keeping a knee problem at bay is to stay relatively active and to eat right. According to the US Government, 56% of Americans are overweight. This is bad news for our knees.

Scientifically speaking, our knees form and develop in mass and strength in proportion to the amount of weight our body was designed to hold. So, if you are a small woman, your knees are meant to hold a smaller amount of weight than if you are a six-foot tall man. Although the body is very adaptable and can learn to hold different weights, a point can be reached where the body is simply not comfortable supporting the excess weight.

Let's talk BMI, or Body Mass Index. BMI is the number you come up with when you divide how much you weigh in kilograms by how tall you are in centimeters squared. The number you come up with is your BMI. A BMI between 18.5 and 25 is considered in the normal range. A BMI above 25 is considered overweight and a BMI of 30 or more is classified as obesity. To find your BMI, there are several calculators on the Internet including the BMI recommendations from the Surgeon General.

Diet

Losing weight can provide instant relief for the knees. Although we are constantly inundated with new diet fads, remember that logically, the way to lose weight is to consume fewer calories than we burn and the way to maintain weight is to burn approximately the same number of calories that we burn.

Although in reality, this method can be harder to follow than it is to understand, once we build healthy habits, this lifestyle will become easier and easier to maintain. Some diets help you to do this. Others are shams. Be cautious. Anything that seems to good to be true, probably is.

If you have arthritis, there are pain aggravators that should be avoided. For instance, paprika, pepper, tobacco, cayenne, eggplant, large amounts of potatoes and tomatoes can irritate your arthritis because these foods have alkaloids that prevent the repair of collagen and cartilage. Aspartame (found in diet sodas and artificial sweeteners) can also worsen arthritis since it causes inflammation in the joints when regularly consumed.

In study after study, it seems almost innumerable health benefits can be accumulated from eating a diet rich in fiber and complex carbohydrates found in vegetables, whole wheat and fruits. Once again, knees also benefit from this diet.

Exercise

It is also important to incorporate exercise into your routine if you have knee pain. Although it may seem like a Catch-22 (you cannot exercise because your knee hurts, and your knee hurts more because you cannot exercise) strengthening the leg muscles can be crucial in alleviating knee pain.

The more support the muscles can offer, the less stress and therefore less pain. Please refer to our online exercise library, which will show you several knee strengthening exercises. Also, if your knee hurts and you want to start up an exercise routine, why not try a stationary bike or swimming? While running or stair climbing can be taxing to the knees, the stationary bike and swimming are both excellent cardiovascular activities that only minimally put pressure on the knees.

Treatments you can administer at home

Anti-Inflammatories

Non-Steroidal Anti-Inflammatory medication, or NSAID's, such as ibuprofen (Advil, Nuprin and Motrin IB) help reduce swelling and inflammation and can be quite helpful to a torn ligament. The ibuprofen also helps mask the pain of a knee injury. Use NSAID's cautiously, however, as taking them regularly over a long period of time can cause ulcers or other gastro-intestinal problems.

Just remember that while using NSAID's, you should also be taking other precautions to heal your pain. COX-2 inhibitors such as Celebrex by Searle and Vioxx by Merck can help lessen the stiffness brought on by arthritis pain. Vioxx can helps manage both osteoarthritis and rheumetoid arthritis pain. While they are able to help with the pain, they also might make it difficult for the body to heal ulcers, so be sure to consult with your doctor to make sure this is the right treatment for you.

Enzymes may also be useful to reduce swelling and inflammation. The FDA has labeled them GRAS (or generally regarded as safe) which means they can be used to treat knee pain with little to no side effects.

RICE — Rest, Ice, Compression, Elevation

This is an easy to remember four-step formula for treating a knee injury that is incurred from activity.

• Rest, means to keep the knee away from any stressful activity, preferably immobile initially.

• Ice means to apply ice to the knee to control swelling and inflammation. Wrap ice in a towel so that it does not agitate the skin.

• Compression will help prevent hemorrhaging or internal bleeding.

• Elevation. Elevate the leg above the heart to reduce internal bleeding.

Vitamins & Supplements

Glucosamine & chondroitin sulfate

In a study conducted on behalf of the National Institutes of Health, results published in 2008, participants with moderate-to-severe pain taking glucosamine combined with chondroitin sulfate experienced statistically significant pain relief compared to the placebo. It is important to note, that due to the small size of the subgroup the findings should be considered preliminary and need to be confirmed in further studies. For participants experiencing only mild pain, glucosamine and chondroitin sulfate together or alone did not provide statistically significant pain relief.

MSM

Methyl-Sulfonyl-Methane (MSM) is a sulfide that the body naturally produces. Those suffering from knee pain may find that it helps lessen their pain. MSM is, for the most part, safe. It increases the flow of harmful substances out of the cells and prevents pressure buildup in the cells, which causes inflammation in the joints. MSM is most widely used as an anti-inflammatory for joint and knee pain associated with arthritis.

Although the body produces MSM, additional MSM is found in other foods such as milk, meat, vegetables, fruit, and seafood. However, due to the abundance of processed foods, it can be hard to get the recommended dosage. Steamed foods, washing foods, and aging can also reduce MSM levels.

Shark cartilage

Shark cartilage has been shown to lessen the pain and stiffness in knees. This is because it contains mucopolysaccharides, powerful anti-inflammatory molecules. Shark cartilage is available in capsule form that can be taken as a dietary supplement. While it may not completely eliminate the pain, it might help.

Shark cartilage is a nontoxic, natural supplement that contains calcium, phosphorous, and complex carbohydrates. The calcium and phosphorous is easily absorbed into the body, and the complex carbohydrates have been shown to reduce inflammation.

Using shark cartilage, Dr. Joseph Orcasity, a consultant at the University of Miami Medical School, treated a dozen elderly arthritis patients with severe knee pain. He reported that after taking shark cartilage for four weeks, most patients exhibited reduced pain and swelling and increased mobility.

Gelatin

In a recent study, gelatin capsules have been shown to help reduce pain and stiffness in athletes at Ball State University. The concentration of gelatin must be much greater than what is found in a bowl full of Jell-O but it is essentially the same thing. This supplement is classified by the Food and Drug Administration as GRAS (or generally regarded as safe).

Minerals

Not only can minerals such as boron, copper, manganese, silicon, and zinc help treat osteoarthritis, they can also be beneficial to your health overall. Although many of the foods we eat contain these minerals, they can also be taken as a supplement. Some of these minerals act as anti-inflammatories and others act as antioxidants.

Vitamins

Vitamins can be helpful in alleviating pains associated with rheumatoid arthritis, an autoimmune disorder that attacks tissues in the body. The tissue degeneration causes pain in the joints. Vitamins can help the immune system eliminate these toxins in the body keeping cartilage from breaking down so rapidly.

Herbs

Taking herbs is sometimes considered archaic or analogous. However, grandmother was right. Herbs are good for your health. Certain herbs such as licorice, ginseng, cat's claw, and echinacea can help the immune system by reducing inflammation as they bolster cell membranes. Other herbs that can help alleviate pains associated with osteoarthritis or rheumatoid arthritis are Chinese skullcap, devil's claw, curcumin, yucca, ginger, and witch hazel.

Alternative Medicine

While in some cases, the treatments listed here do not change the structure of the knee, they can be a great way to manage pain — with virtually no side effects if done correctly. Some of these treatments may be more effective on some people than others. If you would like to seek alternative treatment, try to find something that works the best for you.

Acupressure

Acupressure is an ancient Chinese form of therapy where pressure is applied to the body in order to increase blood circulation and relieve pain. This unique form of massage can relax muscles and compress nerve fibers that cause pain. If you are interested in experimenting with this form of therapy, you can either find a professional acupressure therapist or simply go to the bookstore and find a book that will tell you how to try the techniques at home by yourself or by a partner.

Acupuncture

Those suffering from knee pain may find relief from visiting an acupuncture specialist. During acupuncture hair-thin needles are inserted into various parts of the body and are stimulated to alleviate pain in many forms including but not limited to nausea, dental pain, muscle pain, menstrual cramps, and pain from osteoarthritis. This 3000-year-old Chinese art gained credibility in the western world in 1997 when the National Institutes of Health declared it efficacious.

The Chinese believed that by balancing the positive and negative energy in the body, pain relief can be achieved. They found acupuncture to be an effective resource to achieve that balance. Other modern-day doctors believe that acupuncture stimulates pressure points thus releasing relaxing endorphins. Whatever the case may be, acupuncture provides relief to many people suffering from pain.

If you decide to try acupuncture, be sure to have a licensed professional administer the treatment. Also, get a physician's referral for an acupuncturist close to you. An acupuncturist should be certified by the National Commission for the Certification of Acupuncturists. You can obtain a list of certified specialists in your area by calling the American Association of Acupuncture and Oriental Medicine.

Bee Venom

Bee Venom Therapy (BVT) is a toxin that is put into a certain part of the body. The toxin is attacked by the immune system making it stronger and more prepared to deal with future toxins. The body in a way creates its own antibody against the bee venom in that area. This therapy be administered only by a practitioner licensed in it.

Hydrotherapy

Spas and whirlpools are sometimes used to improve circulation and relieve chronic pain from the back and joints. Different therapy uses different temperatures of water. Cold water reduces inflammation, cold and warm water improves circulation. Dr. Nooshin K. Darvish, a specialist in hydrotherapy, recommends that patients apply moist heat to the knee for three minutes followed by cool water for one minute. This should bring relief and stimulate circulation.

Massage

Therapy massage not only feels good, it is an effective way of relieving pain. A masseuse will increase the circulation of the body through rhythmic hand motion. In sports, massage therapy can be used to prevent strain by warming up athletes prior to a workout. The muscles can also be massaged after a workout to bring blood and oxygen into the muscles to flush out metabolic waste and increase circulation to the muscles to bring them the nutrients they need to heal after strenuous activity.

For those suffering from arthritis, massage can also be very helpful. Massage will help blood circulate in the painful area which brings essential nutrients to the muscles and joints which will help reduce inflammation and can also help break up scar tissue and adhesion which is causing pain.

Reflexology

Reflexology has been used as a method to relieve pain for thousands of years starting in ancient Egyptian culture. The premise is that by massaging the feet or hands, you can help ease pain in another part of your body. By massaging a certain part of your foot, for instance, you may be able to sooth knee pain.

Zen

Over the past few years a scientific affirmation has verified the idea of 'mind over matter'. Zen is a method employed by some to shape the mental state and in some ways actually control pain. In our frenetically paced world, all of us need focus and discipline.

Yoga and Tai Chi

Ancient Eastern exercises are have become increasingly popular in the United States over the past few decades. These exercises stress the importance not only of physical agility, but joining the mind and body to have mental control over the physical state. These exercises are not only trendy, they are useful in increasing flexibility and gaining strength, which can help prevent and alleviate pain.
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Surgical options

Sometimes, if nonsurgical treatment, rehabilitation and therapy is unsuccessful, the only way to heal a knee problem may be through surgery. If the knee is irreparably damaged or has eroded away because of arthritis, then knee surgery may be the next logical step. Statistically, 20% of knee patients will require surgery.

Remember that although surgery may be a 'scary' word, today more than ever, people are recovering from surgery and regaining peak performance.

Essentially, when surgery is done well and the recovery period is carefully and thoroughly completed, return to athletic activity is more than likely not a problem. Below are some specifics regarding knee surgery:

Knee Replacement Surgery

Quality of life is never to be underestimated and when a knee problem is so debilitating that it is impossible to enjoy hobbies that are important to you like gardening or playing with your children or grandchildren, than it is crucial to seek medical help.

Fortunately, before even considering knee replacement surgery as an option, generally physicians will try to find other ways of assuaging the pain. For instance, physical therapy, analgesics and walking aids might be the answer to many knee problems including those stemming from arthritis.

However, it is also nice to know that when other treatments prove to be futile, knee replacement surgery is an option. So prevalent is this surgery, in fact, that over 250,000 knee surgeries are performed each year in the United States alone. It is estimated that in 2040, more than 500,000 knee and hip replacement surgeries will be performed due to the influx in aging Baby Boomers. Knee replacement will help renew the ability to participate in several fun, day to day activities such as gardening, going on walks, golfing, and overall mobility. It is important to try other options before knee replacement surgery, however, since they only last for 15 to 20 years and are not easily replaced. For this reason, physicians are very selective about the types of candidates for the surgery.

So, who is a candidate?

Knee replacement is a procedure generally reserved for those who are over 60 years of age who are in relatively good health, aside obviously, from their knee pain. In fact, 72 percent of knee replacements are done on those over the age of 65. Generally, this means, they maintain a healthy weight, they do not suffer from cardiovascular problems, and they are not suffering from a terminal illness.

Active knee replacement candidates will find it comforting to know that they will be able to resume some athletics following surgery such as golf, swimming, and walking. Some knee replacement recipients have even continued to play tennis and snow ski. Unfortunately, a knee prosthesis is not quite as effective as a healthy, natural knee, however it will be a great improvement over the preoperative pain and discomfort.

Who is not a candidate?

To receive knee replacement surgery, you must be a good candidate. If not, surgery could prove counterproductive. For some, knee replacement surgery is not in their best interest. Those who are too young, with the exception of those who suffer from severe rheumatoid arthritis, should consider other types of treatment for knee pain since after 15 or 20 years, the prosthesis will need to be replaced. Unfortunately, the bone will need to be cut short to make room for a new prosthesis and function and mobility is likely to be damaged during the second operation. Those who are overweight are not good candidates as the prosthesis (just as the natural knee) is designed to carry a weight in proportion to the person’s body. Too much weight on the prosthesis can cause it to be damaged and subsequent knee surgeries will be necessary. Those with cardiovascular problems and with terminal illnesses are also not good candidates as the surgery may be too much for the body to handle. Also those with poor skin coverage over the knee are not good candidates as surgery could impair movement of the knee.

What knee replacement surgery is like?

During knee replacement surgery, you will be under general anesthesia meaning you will be asleep and without pain during the entire procedure, which usually lasts a few hours. The knee is opened up and the kneecap is moved out of the way. Doctors then, shave off the bottom of the femur and the top of the tibia and fibula bones. The prosthesis is then glued to the bones with special, surgical cement. The knee is then sutured back together and drainage tubes are used to prevent clogging.

Usually, a hospital stay for knee replacement surgery lasts between two and three days. During your time at the hospital, you may be using a Continuous Passive Motion machine and participating in physical therapy, which will help to prevent stiffness and alleviate pain. Overall, full recovery can take anywhere from two months to one year although dramatic improvements should be seen sooner than that.

The future of joint replacement surgery

Through the efforts of orthopedic surgeons working with scientists & engineers, materials and surgical techniques are improving. This innovation in the development of joint replacement will allow surgeries to last much longer than the current prototype.

Torn ACL Surgery

The Anterior Cruciate Ligament (ACL) provides stability to the knee when twisting or turning. When an athlete tears their ACL, usually it is from a sudden impact that can cause an audible pop or at least a great deal of pain.

Generally speaking, a partially torn ACL stands a chance of recovery without surgery. If the ACL is completely torn, most will need surgery to repair the ligament. Many of those with a torn ACL will need surgery to get back to activity. The procedure itself takes about one hour.

Torn ACLs are one of the most common problems associated with sports. It is important to understand your options if you have a torn ACL.

If you have a completely torn ACL, you will likely need surgery to repair this ligament. If you have a partially torn ACL, depending on the extent of the tear, some people are able to rehabilitate the knee with extensive therapy AND COMMITMENT TO EXERCISE to the point that they have use of the knee again. But you may not have the same strength in the knee joint that you had prior to your knee injury.

Generally speaking, the more you expect to play aggressive sports in the future, the more likely you will need knee surgery to repair a fully torn or partially torn ACL. If you are professional athlete, chances are you will need surgery to get back to full activity.

If you have a torn ACL, the good news is that the problem is fairly common as knee injuries go, and in the hands of a surgeon who specializes in knees, the post surgical knee can be as effective as the knee prior to injury. But most of that depends on the willingness of the athlete to invest the time to rehabilitate and strengthen the knee.

Use of the patellar tendon or hamstring to repair a torn ACL

You should be aware that repairing the torn ACL does NOT involve sewing two torn ends together. Think of your ACL as a rubber band. Once it snaps, it can not be sewn together. Instead, you have to replace the rubber band completely. And that is exactly what the knee surgeon does. They attach a new rubber band to your shin, thread it through your knee and anchor it your femur.

You should ask your physician HOW they repair the ACL. Some knee surgeons use a patellar tendon while many others use a hamstring ligament. There are pros and cons to each.

Harvesting a patellar tendon from the front of the knee makes for a more painful recovery and painful rehabilitation. However, professional athletes who are used to pain from training are more able to tolerate this approach, especially considering that the patellar tendon is viewed by some surgeons to be a higher performance replacement for the torn ligament than the hamstring. Using a hamstring ligament is less painful on rehab of the knee, and some surgeons feel that for most people, the strength of the ligament is sufficient.

Overall, most surgeons would agree that the performance of the knee after ACL replacement is directly linked to how much commitment is given to strengthening the knee with exercises. With the right knee specialist, and with specialized knee rehab, a professional athlete can regain their competitive form and play professional sports again.

Using an arthroscope (small fiber-optic TV camera), the knee surgeon can repair the knee through two tiny half-inch incisions instead of a longer incision which requires a longer recovery and causes a bigger scar. The surgeon will remove a strand from the patellar tendon or hamstring, which will ultimately become the new ACL. A hole is then drilled through the shin bone and a new ACL is threaded through. The new ligament is prepared and secured into place. Screws or staples are often used to lock the new ACL into place. About 30 minutes later, the anesthesia will wear off. Most ACL surgeries are now completed on an outpatient basis, allowing patients to recover in the comfort of home.

During the recovery process, a patient will start off by walking around. A few months later golf is acceptable. After five or six months, the patient is usually allowed to play sports without restriction.
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