Are you having back pain with any of the following?
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
The knee, the largest joint in the body, consists of three bones – the thighbone (femur), the shinbone (tibia) and the knee cap (patella). The bones of the knee joint are held together and supported by muscles, tendons, and strong bands of tissue called ligaments. Four ligaments help to stabilize the knee joint, and injuries to these ligaments are a common cause of knee problems.
The anterior cruciate and posterior cruciate ligaments criss-cross in the middle of the knee to allow you to pivot your knee and move it back and forth. The medial and lateral collateral ligaments, located on the inside and outside of the knee, provide stability so that you can move your knee sideways.
Injuries to ligaments are called sprains. We classify sprains by their level of severity:
We usually recommend that you try conservative treatments first, especially if you have a grade 1 or 2 strain. Rest, ice, and physical therapy are often successful although more severe injuries may require surgery. We will discuss treatment options with you.
There are a number of risk factors and activities that increase your risk of damaging your ligaments. You can injure just one ligament or several at the same time. Knee ligament injuries are often caused by:
Anterior cruciate ligament (ACL) injuries involve sudden stopping or slowing of movement. Most injuries do not involve a direct impact or trauma but are due to a sudden stop or change of direction while running or playing basketball, volleyball, football, tennis, or soccer. About half of ACL injuries are associated with damage to the meniscus cartilage, the articular cartilage that lines the bones, and/or other ligaments.
Medial collateral ligament (MCL) injuries occur when the knee suffers a direct hit, pushing it toward the other knee.
Posterior cruciate ligament (PCL) injuries are caused by a powerful impact to the knee; for example, a car collision that forces the bent knee up against the dashboard or a hard fall on a bent knee while running. A twisting injury with the leg overstretched can also injure the PCL.
Lateral collateral ligament injuries may occur if the knee is pushed outward.
Although knee injuries can involve different structures in the knee joint, there are a number of symptoms that are common to all knee injuries. These include:
People who injure their ACL usually know exactly when they did it. You may feel or hear a “popping” sensation at the time of the injury. You typically have significant pain and swelling.
For the medial collateral ligament injury, the pain is usually located on the inside of the knee. In the case of the lateral collateral ligament injury, people with this injury report pain on the outside of the knee.
In order to diagnose the cause of your knee pain, we rely on the results of a physical examination and what you tell us about your symptoms.
We will ask you about your symptoms and about how the injury occurred. Our questions usually include:
We will ask you about your symptoms and how the injury occurred. We will perform a physical exam of your knee to look for swelling, redness, or any asymmetry compared to the other knee. We will also move your knee in certain ways to test the stability of the ligaments and the integrity of the meniscus cartilage. It is important to tell us if you have pain or discomfort during the exam.
Depending on the results of this exam, we may order X-rays or other imaging studies to check for any evidence of arthritis or fracture of the bones.
If we suspect a torn ligament, we may look inside your knee with a tiny camera to see if you have injuries to other parts of your knee. This outpatient procedure is called knee arthroscopy.
We will give you an anesthetic prior to the procedure, which can be general or local anesthesia with sedation. We insert a miniature camera into your knee through a small incision and can even repair the knee using appropriate instruments.
If your knee is stable and your tear is not severe, we will usually recommend trying a combination of nonsurgical treatments first to reduce your pain and strengthen the muscles in your leg. These may include:
Partial tears usually take around 3 months to heal using these methods.
We do not recommend surgery for all types of ligament tears. The decision to proceed or not to proceed with surgery depends on the severity of your tear and your lifestyle. We will consider a number of factors when discussing surgical options with you:
Ligament surgery is successful in most cases. However, some patients do not get back sufficient function to continue participating in activities that stress the knee.
If you have a serious, or complete, tear to your anterior cruciate ligament, surgery is usually an option. ACL surgery is usually an outpatient surgery and you should be able to go home the same day. During this procedure, we replace the anterior cruciate ligament with a graft of tissue. We either use tissue from one of your own tendons, from your knee or hamstring, or a graft from a donor.
We insert a miniature camera and tiny surgical instruments into your knee through small incisions and remove the injured ACL. We drill bone tunnels above and below the knee joint. and insert the replacement graft. We then secure the graft with screws or sutures before closing the incisions.
As with any surgical procedure, there is a risk of complications. However the risks are very low. Potential complications include:
Physical therapy is an essential component of preparing for your surgery and recovering afterwards.
Prior to surgery, our physical therapists will work with you, for at least a month before your surgery, to improve your leg strength and range of movement. The stronger your legs are the more successful your surgery is likely to be.
After surgery, it can take up to 6 months or longer of strengthening and stabilization exercises to regain balance, strength, and control of the knee. We supervise your exercises during the first few weeks after surgery, but we will expect you to continue them at home. People who commit to following the exercise program are more likely to recover full use of their knee.
Although it is not always possible to avoid injuring your knee and specifically your ligaments, there are a number of things you can do to reduce your risk of developing knee problems. It is also important to follow these guidelines to protect your knee if you have had surgery to repair a damaged or torn ligament:
If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.
If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.
We will ask you to come in 30 minutes before your appointment so that we can X-ray your knee. During your office visit, we will review your X-rays, discuss your medical and family history and I will examine your knee. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options and develop a treatment plan that is right for you.
If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.
For general medical advice, our Appointment and Advice line is available 24 hours a day, 7 days a week.
If you have urgent concerns or issues while my office is closed, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.
If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.
Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.
Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.
We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.
If refills are needed in the future, you can:
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.
If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.
I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.
If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.
As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available at any time that is most convenient for you. From my home page you can:
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.