The knee is a complex hinge joint made up of the thighbone (femur) and the shinbone (tibia). Another smaller bone, the fibula, runs along the side of the tibia, and the kneecap (patella) protects the joint capsule. All are surrounded by connective tissues: tendons, ligaments, and muscles. This complex structure supports the joints to provide stability. Two primary groups of fibrous ligaments stabilize the knee joint: collateral ligaments and cruciate ligaments. These tissues are composed of collagen, the most abundant protein in the body. Despite the strength of these tissues, they are quite susceptible to traumatic injury because of the movement and load they experience daily. Tiny tears often occur that can result in more serious injury or chronic inflammation resulting in arthritis.
Tendons that move the muscles and help to stabilize are comprised of similar collagenous tissue. This collagenous tissue has extremely poor blood flow, making healing slow and generally incomplete. Damaged tendons transmit pain impulses to the brain. Through a subconscious reflex, the surrounding muscles go into a painful spasm in an attempt to stabilize the joint. Often, painful knots appear in the surrounding muscles. Muscles become tight and painful as they try to compensate for the weak and damaged underlying structures. Spasm in the muscles further decreases the blood flow and nutrient supply to the tissue, contributing to increase in tissue breakdown. This chronic tension leads to deterioration of the tendon attachments and tendinosis, often resulting in chronic tendon degeneration.
Articulating surfaces between the bones are covered with a white, slippery layer called articular cartilage. The cartilage provides a smooth surface that facilitates easy movement. This is the tissue that degenerates with osteoarthritis. To further reduce friction between the articulating surfaces of the bones, the knee joint cavity is lined by a synovial membrane which produces a thick, clear fluid called synovial fluid. This fluid lubricates and nourishes the cartilage and bones inside the joint capsule.
Stem Cell Therapy and Platelet Rich Plasma Injections (PRP) accelerate regrowth of healthy tissues in the damaged area to stabilize and strengthen the joint. The ability to heal is determined by many factors, some known and some unknown. We do know that when healing is incomplete, tissue damage becomes chronic, leading to arthritis, mechanical dysfunction and harmful stress to adjoining structural areas. Treatment of small micro-tears in damaged tissue helps to restore optimal function and prevent nagging pain from becoming a major injury. Collagenous tissues found in joints has poor blood supply, causing them to heal slowly and incompletely. Orthobiologic procedures supply healing cells to enhance on a cellular level the repair of these tissues. Scientific advances in the understanding of how the body actually heals through tissue regeneration provides major advances in medical treatment. Read more
Viscosupplementation with hyaluronic acid involves the injection of a thick, gel-like substance that relieves pain by lubricating and cushioning your knee joint. Hyaluronic acid (HA) naturally occurs throughout the body and is a significant component of synovial fluid found in joints. Hyaluronic acid also has anti-inflammatory effects that further reduce pain and temporarily limit deterioration. When injected into the knee, HA allows bones to move smoothly over one another and acts as a shock absorber for joint loads. There is no evidence, however, showing that HA reverses the arthritic process or re-grows cartilage. For this reason, Dr. Minotti has developed a protocol that combines orthobiologic procedures with the use of hyaluronic acid injections. Read more about the Minotti Protocol.
If you have injured your knee, or if normal wear and tear has caused degeneration of your joint, PRP may help. It uses parts of your own blood to help repair knee damage. It may help you avoid surgery.
Common conditions of the knee
Osteoarthritis. Osteoarthritis is a degenerative joint disease that erodes the articular cartilage between the bones of the knees. It occurs most often in older people. Lack of protective cartilage results in friction that causes pain, swelling, stiffness, and restricted movement. This condition most commonly affects load bearing joints, such as hips, knees, and spine. Common causes include: overweight, excessive strain over prolonged periods of time, previous injury, growth abnormalities, and joint diseases. Some people have congenital abnormalities of the joints that cause early degeneration leading to osteoarthritis.
Meniscus & cartilage wear and tears. The two wedge-shape cartilage pieces between the thighbone and the shinbone are called menisci. Menisci stabilize the knee joint and act as shock absorbers. Meniscus tear is the most common knee injury in athletes. A sudden bend or twist in the knee causes the meniscus to tear. Elderly people are more prone to degenerative meniscal tears as the cartilage wears out and weakens with age. A torn meniscus causes pain, swelling, stiffness, and catching or locking in the knee that makes you unable to move it through its complete range of motion.
Ligament injury. Ligaments, connective tissues helping to stabilize the joint, are prone to injury during high impact and often just normal activity. Collateral ligaments are present on either side of the knee, stabilizing the knee in side-to-side motion. The collateral ligament on the inside knee is called the medial collateral ligament (MCL) and the collateral ligament on the outside is called the lateral collateral ligament (LCL). Cruciate ligaments, located inside the knee joint, control the back and forth motion of the knee. The cruciate ligament in the front of the knee is called anterior cruciate ligament (ACL) and the cruciate ligament in the back of the knee is called posterior cruciate ligament (PCL).
When ligaments are stretched, they can develop small micro-tears that are slow and difficult to heal, generally resulting in chronic conditions and arthritis. Damaged ligaments release substances that cause pain and shortening of the tissue around the joint. Because of poor blood supply, collagenous tissue, such as ligaments, generally do not heal completely. Scar tissue develops rather than healthy, functional tissue. Scar tissue is less elastic than healthy tissue, making the joint more immobile that further affects the structural integrity of the joint. Restoring movement as soon as possible encourages blood flow to the area and keeps the joint fluid from becoming thick and sticky.
Other common knee conditions
- Osgood-Schlatter disease
- Patellofemoral pain syndrome ("Runner's Knee")
- Patellar tracking Disorder
- Chondromalacia patella
- Jumper's knee
- Iliotibial (IT) band syndrome
We Can Help
To learn more about what we can do to help with your condition, call our office at 817.416.0970. We will thoroughly diagnose your condition and present you with treatment options. From there we will guide you along your road to recovery.