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Knee1 Discussion with Dr. Andree Ellermann

Knee1 : Dr. Ellermann is the author of numerous articles and the founder and organizer of a large multidisciplinary conference on sports medicine.

Knee1 : He is sought after as a clinical consultant for the orthopaedic medical industry, and was one of the first physicians to use computer-assisted navigation in ACL repair.

Knee1 : Dr. Ellermann, thank you for joining us today. Users, we welcome your questions for Dr. Ellermann!

Michael.Nickolakis : I am a 36 year old male who played many years of soccer and athletics. My right knee is bone to bone and as a result I experience pain, and cannot run at all. Can you please advise me of the latest technologies in this field. I would dearly love to run again. Thanks, Michael Nickolakis (Australia).

Dr. Ellermann : Since you are still considerably young one should try everything to preserve and repair your knee. You should have proper X-ray and MRI to evaluate the cartilage situation in all three comartments of the knee and to define the knees axis. If the axis is incorrect it might have to be corrected by a tibial or femoral osteotomy. If the knee is unstable it should be stabilized by, for example, an ACL-repair. Once these premises are fulfilled you should have cartilage treatment which could include various options depending on the nature of the cartilage defect: abrasion, microfracture, osteochondral grafting, etc. For this serious situation you absolutely need to see a knee specialist.

Amber : Hi Dr. Ellermann.....I fell on the tennis court in Jan....and just had x-rays in ER...was a pulled meniscus (probably not spelled right), but it has taken me months to get to where I am which is walking...but every now and then knee will just fold...and down I go....I have no health insurance.

Dr. Ellermann : I understood that you did not have an operation. It seems as if you have recurrent instability. This could, for example, be a so-called "bucket-handle" tear of your meniscus or a cruciate ligament lesion. I recommend an examination from an experienced knee surgeon. An MRI would be very useful as well. No doubt this problem has to be solved so to prevent further damage, especially to your knee cartilage.

jen : A month ago I was squatting during a Pilates class and have had a pain in the back of my left knee ever since. It is worse in the morning and when I extend it fully and not very severe in the evening. It had been getting better but came back after i had been crouching down to do some gardening. My knee is slightly swollen in the back but not too badly. Any idea what could be causing it? My doctor has ruled out cartilage or ligament damage.

Dr. Ellermann : Ask your doctor to check the insertion of the hamstring and biceps tendons. Furthermore ask for an ultrasound examination of the knee in order to exclude a so-called "baker cyst" which appears in the popliteal area in case of intraarticular problems. If it is a tendon problem you should get physiotherapy. If the problems persist have an MRI.

dougfelt : Have you heard about success using Synvisc on arthritic hips?

Dr. Ellermann : The therapeutic aspects are the same for almost all joints. In fact hyaluronic acid (like Synvisc) is rarely applied to the hip. One reason might be the injection itself which is much more difficult than a knee injection for example. I do have colleagues who believe in this, my personal experience is not valid enough.

hershberg : Is surgery the only solution for meniscus injury?

Dr. Ellermann : I would say "yes" for most cases. In rare situations the lesion is fresh and in an area of excellent blood supply (so called "red-red-zone"). Conservative treatment with limitation of exercise might help.

zoomnloon : I'm an avid cyclist looking at a knee replacement. Can an artificial knee stand up to 150 miles a week on a bike?

Dr. Ellermann : Current implants depend on intact capsular and ligamentous structures. Therefore the leg muscles should be strengthened after a total knee. One of the best exercises is cycling. You should absolutely be able to do 150 miles a week.

DSchamus : After leading a sedentary lifestyle, I started an exercise regimen in March. I am now walking/hiking about 15 miles per week in moderately hilly terrain; using a recumbent cycle, and bicycling. Recently I have begun to feel/hear a popping noise in my left knee. It occurs toward the end of a stride when my weight is forward of the knee and my heel is starting to lift. At present, it is not painful, but I sense I have altered my gait. Is this symptomatic of anything serious? What steps can I take to prevent this from turning into a bigger problem. Thank you.

Dr. Ellermann : If you have already altered your gait you should absolutely see a doctor for a knee, hip and spine examination. This popping noise could very well be the beginning of an intraarticular problem. In the meantime I would recommend avoiding this kind of exercise.

Knee1 : Users, we are just about out of time. Dr. Ellermann, do you have any closing thoughts about knee health for our users?

Dr. Ellermann : It seems as if the patients wait a rather long time before they ask for treatment. This could lead to severe problems over time. I strongly recommend seeking professional advice early enough. Not every consultation ends with an operation. It has been a pleasure to answer your questions!

Knee1 : Thank you, Dr. Ellermann for joining us. Users, thank you also for joining us today. Stay tuned for future discussions!