Telehealth Knee Injuries treated by Dr. Farr
Acute Knee Problems
Acute refers to the timing of onset: recent as opposed to longstanding (chronic). The acute problems can be subdivided into traumatic and those without trauma. Not all trauma requires an Emergency Department or Urgent Care visit, such as a deep bruise. If there is suspicion of a fracture, then in-person evaluation is appropriate. In a knee practice setting, high energy trauma (motor vehicle or fall from heights) is deferred to one of the OrthoIndy trauma specialists for emergent treatment of fractures and/or dislocations.
Lower energy trauma may be evaluated in an elective setting. While waiting, the tried and true management remains the same, PRICE: Protection, Rest, Ice, Compression, Elevation is appropriate.
Protection: If weight-bearing is painful, use 2 crutches to limit weight-bearing. If the range of motion is painful, use an over-the-counter splint.
Rest: Do not overuse the limb.
Ice: Apply only on the front of the knee to avoid nerve damage in the back of the knee. Place a towel between the ice and the skin and apply 20 minutes on and 20 to 30 minutes off to avoid frostbite.
Compression: A lightly applied compressive wrap may help limit swelling.
Elevation: Elevate the entire limb above the level of your heart to minimize swelling
Examples of Acute Low Energy Knee Injury
Squatting or twisting causing a meniscus tear
Stepping off a curb or step abruptly with a meniscal root tear
Changing direction on a fixed foot resulting in patellar instability
Landing awkwardly from a jump and tearing the ACL
Discrete tears in the vascular region of the meniscus are potentially repairable tears with poor/no vascularity are most commonly treated by trimming only the torn regions. Displaced tears often block motion and require expert Knee Telehealth Consultation with a knee replacement doctor to optimally plan management including possible referral for x-rays, MRI and possibly knee surgery.
Most first-time patellar dislocations will spontaneously reduce as the knee is brought gently into extension; the higher the energy that caused the dislocation, the more likely there is a bone and/or cartilage fracture, thus a reason for a Knee Telehealth Consultation with a possible referral for x-rays and MRI and initiation of bracing, therapy and knee replacement recovery.
The decision to proceed with knee surgery initially is based on whether or not there is bone and/or cartilage fracture. Fortunately, the need for early surgery is relatively rare. In the long-term, surgical treatment is based on the risk of future patellar instability.
The ultimate decision for ACL tear treatment is between a knee physician and the patient and is based on the probability of future instability. Even during the first ACL instability episode, the potential of an associate meniscus or articular cartilage injury is present and thus the rationale for a Knee Telehealth Consultation and possible referral for x-rays, MRI and then initiation of therapy and possible bracing.
Warning Signs of Knee Injuries
Pain Walking on Level Ground
Pain walking on level ground is associated with articular cartilage damage, meniscal cartilage chronic damage or osteoarthritis of the main bones: where the femur and tibia meet; often on the inner aspect (medial) and less commonly on the outer (lateral) aspect.
Pain Ascending or Descending Stairs
It is often associated with pain in the front of the knee with underlying problems from muscle and soft tissue imbalance in the young, to kneecap/femur (patellofemoral) osteoarthritis.
In younger age groups, the pain is most often related to muscle and soft tissue imbalance. If there are full motion and no swelling one option would be to begin conservative measures such as icing, acetaminophen or ibuprofen (if tolerated) and a gentle home exercise program that could be supplemented with physical therapy as the exercise programs often seen on the internet are not comprehensive. The key to exercises for patellofemoral imbalance pain is a program referred to as “Core to Floor”, which means starting with the core (abdominal and low back musculature) and continuing from the pelvis to hips knee and foot/ankle. It the pain and swelling are more than mild then the first step would be a Knee Telehealth Consultation and possible referral for x-rays, MRI before beginning a therapy program for your knee arthritis.