Dr. Emilio López-Vidriero is a super-specialist in Knee and Sports Traumatology at the University of Ottawa, Canada. In this section you can consult the different knee injuries and their treatments, both conservative and surgical.
The knee is the most damaged joint in sports that require flexion, jumps and changes in direction, such as football, skiing, tennis, etc. errors in diagnosis are frequent given its complexity. Ideally, the lesion should be diagnosed as soon as possible so that it can be treated without surgery. If necessary, performing surgery tailored to the sport and the athlete is crucial to success.
My front knee hurts: what can it be?
Tendon lesions with or without rupture: patellar tendon, quadricipital tendon.
Patella injuries: in the cartilage, movement, direction, going up and down stairs.
Lesions of the articular interline between the femur, the tibia and the synovial covering them.
Increase in knee fluid, especially with flexion.
Anterior cruciate ligament injury in an acute phase.
Focal villonodular synovitis.
My back knee hurts: what can it be?
Tendon lesions: hamstrings, calves, goose foot, biceps, semitendinous.
Injuries in the meniscus: internal and external, especially with squatting and turning.
Baker’s cyst: accumulation of knee fluid in the back.
Sciatic syndrome: due to herniated disc in the lumbar spine, clamping of the sciatic nerve.
Posterior cruciate ligament injury in an acute phase.
Deep vein thrombosis or postphlebitic or pseudophlebitic syndrome.
Diffuse villonodular synovitis.
My inner knee hurts: what can it be?
Injury of the internal ligament (medial collateral): sprain or rupture.
Internal meniscus lesion: partial, complete, complex, suturable, extruded.
Deviation in varus: cowboy knees arched and separated, with feet together.
Internal overload: with varus knee and medial meniscal extrusion.
Cartilage lesions: chondral ulcers, dissecting osteochondritis.
Cartilage wear: osteoarthritis of the internal part.
Tendon injuries: goose foot, semitendinous, gracilis.
Saphene neuropathy and medial geniculates.
Inflammation of the synovium or membrane that lines the knee.
My external knee hurts: what can it be?
Injury of the external ligament (lateral collateral); sprain or rupture.
External meniscus lesion: more serious and worse tolerated.
Deviation in valgo: bowlegs, arched with knees together and feet apart.
Friction syndrome of the iliotibial band: typical of runners and cyclists.
Cartilage lesions: chondral ulcers, dissecting osteochondritis.
Cartilage wear: osteoarthritis of the external part.
Chronic compartment leg syndrome: typical of long-distance runners.
My knees are failing: what can it be?
Injury with instability of the anterior cruciate ligament: sprain, partial or complete.
Injury with instability of the posterior cruciate ligament: sprain, partial or complete.
Injury with instability of the medial collateral ligament: sprain, partial or complete.
Injury with instability of the lateral collateral ligament: sprain, partial or complete.
Injury with instability of several ligaments: multiligamentary.
Patellar dislocation: the anterior bone normally exits to the external side.
Tendon injury: due to pain or functional failure.
Lack of muscles: due to disuse, pain, instability.
The menisci are the shock absorbers of the knee and it is very important to preserve them. Before it was thought that they had no function and were operated by removing them completely. Now we know that removing a meniscus condemns the patient to suffer from osteoarthritis = cartilage wear very early. That is why we try to keep them even in case of injury. If they are broken and can be sewn we do it by arthroscopy. If they cannot be sewn, we try to preserve them by controlling the pain with specific infiltrations and knee pads. If you have to make a resection we try to make it minimal. If the resection is large then we replace the meniscus with another, either artificial or a transplant. The physiotherapy and retraining protocol is crucial for the success of meniscus treatment.
Anterior cruciate ligament: partial tears.
This ligament is used to control the turns. It is usually injured when landing from a jump or when the foot is blocked and the body keeps turning. Despite the current great tendency to operate, there is a great possibility that the athlete will be functional without having to operate (coper) especially in partial injuries, with the appropriate protocol of partial immobilization, specific knee brace, regenerative therapies, individualized physiotherapy and rehabilitation. In the event that the patient continues with instability or failures despite a correct conservative treatment we preserve the maximum ligament of the patient by replacing only the injured part for faster recovery and better coordination.
Anterior cruciate ligament. Complete injury.
We always try not to have to operate in the acute or recent phase of the injury. We treat all injuries with our protocol of partial immobilization, specific knee brace, regenerative therapies, individualized physical therapy and rehabilitation with a high success rate.
If there is a repairable (suturable) lesion of the meniscus or if the knee continues to fail despite the correct treatment, then the surgery we perform preserves the patient’s tissue to the maximum and is minimally invasive. We replace the ligament with a single tendon (semitendinous) to avoid further damage and speed up recovery. We use very stable fixation systems that allow the patient to walk on the same day of their operation, as well as regenerative techniques and bone preservation so that the reincorporation to sport is faster than with conventional techniques.
In patients already operated in other centers and who continue to fail we make a detailed study of the causes of the failure to solve them and achieve a high success rate.
Posterior cruciate ligament
It is a ligament with a high healing rate without surgery if adequate and individualized treatment is performed with a protocol of partial immobilization, specific knee brace, regenerative therapies, physiotherapy and rehabilitation.
The diagnosis is complex and the lesion usually goes unnoticed in non-expert hands.
If surgery is necessary, it requires high specialization since the technique is very complex and has a high risk of damaging the vessels behind the knee (popliteal artery). In expert hands the success rate is very high when working in team with surgeons, physiotherapists, rehabilitation workers, and especially the participation of the patient.
Our team is a national reference for this type of injury and we have designed our own complete treatment protocol with a high success rate.
Multi-ligament knee instability
When several ligaments of the knee fail, the patient feels unstable and the knee tends to wear the cartilage very quickly, with risk of osteoarthritis.
Diagnosis is crucial and knowing exactly and in detail what ligaments are the ones that fail is the key to success.
The surgery is very complex and has a high risk rate. That is why very experienced and expert surgeons like our team must perform it. The broken ligaments must be replaced by tendons either from the patient or from a transplant. Use the appropriate fixation systems and follow a very individualized physical therapy and retraining protocol in expert hands, like the one we have designed in our team.
Professionalism and honesty
Our commitment is to make our extensive experience and professionalism available to all our patients, offering personalized attention to achieve a complete recovery which, depending on each injury, allows our patients to return to their activities in the shortest possible amount of time.