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Knee injury overview

Updated: Jan 4, 2020

Knee pain is a common complaint, can effect people of all ages and can result from injuries such as torn cartilage or a ruptured ligament or from medical conditions including arthritis, gout or certain infections. If your knee has been injured, you will certainly want to relieve the pain fast. Minor knee pain may respond well to some self-care measures. Self-care methods to relieve you of the pain from structural damage to your knee can range from braces, ice packs and heat therapy to strength training, physical therapy and anti-inflammatory medications. If you have been unsuccessful at relieving your knee pain caused from the above mentioned conditions or other conditions such as a torn ACL, Torn Meniscus or even osteoarthritis, you may require surgery. It is important to check with your physician if your pain is long lasting. Your doctor will most likely take some X-ray's to determine exactly whats wrong and then figure out which remedy is best for you. If you and your doctor decide that surgery is your best option, then he will schedule your surgery date and explain everything you need to know pertaining to your upcoming surgery. The day of surgery you will meet your surgical team, one of whom will be your anesthesiologist. Your anesthesiologist will be the one who makes sure you are numb and keeps you most comfortable during the procedure.

After surgery... It is of the most importance that you get plenty of rest and stay off of your leg for a few good weeks. You will also most likely work with a trained physical therapist who will help you to heal. Though some of the movements and exercises they will ask you to do may seem impossible and perhaps even be a little painful at first, it is very important to do all of the exercises he recommends for you each day as this is the only way you will regain the strength and flexibility in that area. The physical therapist will stretch you and put you through a series of movements all designed to help you regain use of that area after surgery. The more you move the faster you will get strong again. Some people report physical therapy as being painful at first but then getting better and better with each and every visit until eventually, they are back to "like new" again. One last thing to note is to be sure to take your prescribed pain medications prior to your physical therapy sessions for the most comfort during your movements.

Types of Knee Surgeries:

There are currently a few different types of most common knee surgeries.Below are two most popular. 

Arthroscopic surgery:

One of the most common kinds of knee surgery is arthroscopy, this is a minimally invasive "keyhole" surgery used to diagnose and treat a wide range of knee problems.  where long, thin instruments are inserted into the patient's body through small incisions. This technique uses a small camera called an arthroscope, on the end of that long, thin instrument to see the area being repaired. The scope displays pictures on a monitor to help guide the surgeon's work.  Surgical devices are then inserted into the joint via a second incision. This procedure is used to repair different types of knee problems and usually leaves minimal scaring.  

Arthroscopy surgery is a good choice for the following conditions:

  • The surgery is done to remove or repair a meniscus that has been torn. The meniscus is a cartilage and its function is to cushion and stabilize the joint.

  • This surgery can also be done if reconstruction of a torn ACL is needed, ACL is Anterior Cruciate Ligament, the function of this ligament is also to help in stability of the knee joint.

  • For removing the inflamed synovial (connective) tissue.

  • To trim the damaged articular cartilage.

  • For the removal of loose fragments of bone or cartilage.

  • To treat the problems of the patella or kneecap.

  • For the treatment of knee sepsis or infection.

Knee replacement:

In case of a knee replacement operation, the damaged parts of the knee joints are removed and replaced with new parts which are mostly made of metal, ceramic or plastic. After the knee replacement surgery is complete, there are chances that the patient might feel paint in the new joint. If the patient starts therapy and executes physical activities then that can help a lot with the pain.

The knee replacement can last at least 20 years or maybe longer. Since the knee replacements do not last forever, it really depends on the age of the patient, whether to replace the knee or just manage the pain by other methods.

Types of Anesthesia:

The type of anesthesia you and your doctor choose depends on a number of factors, like what kind of surgery is being performed or if you have any allergic or adverse reactions to any medications or not. Your choice of anesthesia can affect the complications, cost and time spent during and after the surgery in the medical facility, affecting the time you have to wait to begin physical therapy.

Before choosing a type of anesthesia, it is recommended to consult your physician and your anesthesiologist.

  • One type of anesthesia is Regional Anesthesia, it is commonly used for arthroscopic surgeries. It numbs only the area of the patient’s body involved in the surgery. During the operation, you will be awake and aware of the process of surgery but won't feel anything. Regional anesthesia also includes spinal anesthesia and epidural anesthesia. Regional anesthesia can control pain very well with fewer complications compared to general anesthesia which is used to render you completely unconscious during the operation which means that you will have no knowledge of the process going on at all nor will you feel anything.  This is used during the process of a full knee replacement.

  • Another option for arthroscopic surgeries is Local anesthesia. A one-time injection is given to the patient that numbs the area around the area that is involved in the surgery. It has advantages i.e. the risk of complications are lower and it costs less too.  Also, the patient can be released from the medical facility much sooner.

Pain Management:

The pain from surgery can be made a bit more bearable if you consider a number of options that are common for the relief of pain after knee surgery. Each option has certain pros and cons to it and there can even be combination of options to choose from. Your physician and  anesthesiologist can help you with the management of pain and can work together on a plan that is best suited according to your condition, medical history and preferences. The following are some options that you may want to choose from.

  • Analgesics act solely to relive local pain.

  • Anti-inflammatory act to relive pain and reduce inflammation.

  • Peripheral nerve blocks are options that involve an injection that contains an anesthetic that is injected into certain nerves that block the pain signals between the brain and the knee.

  • Opioids are drugs that block pain signals to the brain. This drug is only given if there is severe or persistent pain and should be taken only as needed and in as low a dosage as possible as they can be very addictive.

  • Multimodal therapy is a therapy that is used for pain management right after the knee replacement surgery and usually involves opioids and one or more additional pain relief methods, in this method pain can be controlled while the dosage of opioids is limited.

The patient must consider all options in consultation with the pain management specialist. If the right method or combination of medication is used then it is possible for the patient to be discharged from the medial facility sooner, with less pain.

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