Answers written by: Dr. Beth Shubin Stein, Sports Medicine Surgeon
Q1. Is heat or cold therapy better to treat knee pain?
Heat is good for muscle tightness or soreness, but cold therapy is better to decrease inflammation (i.e swollen joints after exercise or after injury). It is important to consult with your physician.
Q2. Can both knees be replaced at the same time? I can’t afford to shut down work two different times. I had my left knee repaired in 1989 with a 14 hour surgery. Now they tell me it needs to be replaced. I have severe arthritis and the right knee is totally destroyed.
Yes, depending on your overall health, both knees can be replaced at the same time. There are certain risks that are increased with doing both simultaneously and your doctor can go over these with you.
Q3. Can healthy adults function without ACL repair?
Yes, healthy adults can function without an ACL assuming their sport of choice is not an ACL-dependent sport that requires a lot of cutting and pivoting. Examples of highly ACL-dependent sports include football, soccer, lacrosse, field hockey, basketball and aggressive singles tennis. Less ACL-dependent sports are activities such as running, hiking, biking and swimming. Consult with your physician before you start exercising.
Q4. I run about 6-8 miles a day and like to run 10-15 miles on the weekends. My knee is beginning to hurt. How do I know if I just need a break or if I should seek help?
If you are developing knee pain that is activity related it would be beneficial to see a specialist. Often times there are specific exercises that you can add to your workout that will help with the pain or alleviate it so that you don’t have to limit or change your activities long term.
Q5. I had a partial meniscectomy on February 14. Since then, I am in constant pain. An MRI last week revealed Grade IV chondral loss on the posterior weightbearing third of the lateral femoral condyle. Chondromalacia involving the lateral facet of the patella, subtle marrow edema in the lateral femoral condyle and proximal tibia laterally are likely stress related. I can’t seem to get any answers as to whether the pain that I have will be chronic or will go away. What can I expect in the future? I would be grateful if any of the doctors would help me to better understand the diagnosis.
You are three months out from a meniscal debridement and in continued pain. The MRI describes a knee that has a significant amount of arthritis (chondral loss is another way of saying arthritis) and though the mechanical symptoms from the meniscus tear can be treated with an arthroscopy, the arthritis cannot. Non-operative treatment for arthritis includes physical therapy for strengthening, injections (cortisone, viscosupplementation-lubricant injections and in some cases PRP-platelet rich plasma) and anti-inflammatory medications. The surgical treatment for arthritis can aim at restoring the cartilage if the defect is small and the patient is young, or it can aim at replacing the affected parts with prosthetic parts such as plastic and metal with either a partial or total knee replacement, depending on how extensive the arthritis is. Consult with your physician to help determine what is appropriate for you.
Next week, Rebekah Wallach, physical therapist, will answer your questions on exercising with lupus. Write your questions below or email socialmediacontact@hss.edu.
Dr. Beth Shubin Stein is an Associate Attending Orthopaedic Surgeon and a member of the Sports Medicine and Shoulder Service at Hospital for Special Surgery. She has developed a particular interest and expertise in arthroscopic and reconstructive surgery of the shoulder and knee. She employs the most advanced arthroscopic and minimally invasive techniques to treat patellofemoral disorders of the knee, meniscal tears, and other common knee ligament injuries such as ACL tearsm as well as sports-related injuries.
