Knee Injuries

Microfracture of the Knee – Recovery & Outcomes

Microfracture is a simple but cost-effective procedure performed to treat smaller cartilage injuries. It is not used to address defects with damage to the underlying bone. It also cannot be used to treat widespread arthritis in a joint. But it is an excellent choice as an initial treatment of smaller articular cartilage injuries.


Recovery process

After the microfracture repair of the knee, the post-operative recovery period is fairly complication-free. After the procedure has been performed in the patella and the trochlear groove, there will likely be mild transient pain or “gritty” sensation. The pain resolves sooner but the gritty sensation typically resolves with a few weeks. Patients may notice “catching” as the ridge of the patella rides over this area during joint motion. This may be apparent during continuous passive motion machine (CPM). If it is also painful, it is best to limit weight bearing; it should resolve within 3 months. Any residual swelling and joint effusion disappears within 8 weeks after microfracture. Sometimes, there is a recurrent effusion between 6 to 8 weeks after surgery but it is usually painless and typically resolves within several weeks.



The rehabilitation process is vital to the long-term success and functional outcome of these patients. Postoperative rehabilitation programs for microfracture procedures vary greatly based on lesion size, depth, location, quality of tissue, patient age, BMI, general health, and surgical details. Thus, the appropriate rehabilitation program must be highly individualized to ensure successful outcomes. The goal of rehabilitation is to restore full function in the shortest time possible without overloading the healing articular cartilage. It is imperative to create a healing environment while avoiding deleterious forces that may overload the healing tissue.

The pain resolves sooner but the gritty sensation typically resolves with a few weeks

Paste grafting

In order for microfracture to work consistently, the healing tissue must be stimulated to form cartilage rapidly and durably. The progenitor/stem cells and bone paste can be added to a super microfracture of the lesion in a technique called Paste grafting. The healing process can be augmented by injections of growth factors and hyaluronic acid lubrication injections during the healing period.



The studies are showing mid-term and long-term success for microfracture in the knee. Multisite microfracture was seen to have poorer outcomes. This is likely because multiple cartilage injuries are indicative of a more advanced disease process. It has been found that patients younger than 45 years had significantly improved outcomes after microfracture as compared with those older than 45 years. Patient age and BMI have been found to be significant predictors of postoperative improvement after microfracture.


Overall, presence of a single cartilage lesion, lower BMI, or being a male has been found to result in greater functional improvement after microfracture. Moreover, larger defects (>3.6 and prior surgery were both independent predictors for future surgery after microfracture.

Who is considered for a Knee Replacement Surgery?

One of the most common reasons for considering a knee replacement surgery is severe osteoarthritis of the knees. Patients with knee joint damage due to trauma, people with stiff knees, rheumatoid arthritis and traumatic arthritis may also be recommended for knee replacement. However, knee replacement becomes an option only if conservative treatments have failed to provide pain relief.

Need for Knee Surgery

The recommendation for a knee replacement surgery is made only after the knee surgeon has made a physical examination of knee joints, assessed X-ray reports and other scans and talked to the patient about severity of pain, extent of damage and the mobility and stability of the joints.

Risks Involved

While modern technology and advancements in medicine have made total knee replacement surgery quite safe, there are a few risks associated with it. One risk is the formation of blood clots in the legs, which can cause pulmonary embolism. Stiffness of the joint or nerve damage are the other associated risks. Discuss these risks and any questions you may have in your mind, before you say yes to knee replacement surgery.

Knee Implant

After a knee replacement surgery, which involves implanting a prosthesis to replace the damaged part of the joint, and rehabilitation and physical therapy, you can expect significant pain relief and restoration of function and motion. You can go back to a normal life, walking and going about your day, with much ease.

If you are looking for the best knee replacement doctors, call the top knee doctor in Gilbert AZ, at OSPI Arizona at 480-899-4333.

MACI – A New Regenerative Technique for Knee Problems

MACI for Knee ProblemsCartilage regeneration has been a long debated issue for orthopedic surgeons. In the case of runner’s knee, this problem can cause a lot of irritation where the kneecap rests on the thighbone.

Together the kneecap and the thighbone form a third joint known as the patellofemoral joint. It is at this junction that cartilage denegation or damage happens resulting in a sharp and sudden pain or one that is dull and chronic. The pain may affect one or both knees with symptoms including the following:

• Tenderness behind or around the kneecap.
• Pain located at the back of knee.
• Sense of cracking that the knee is giving out.
• More discomfort when treading on uneven terrain or climbing stairs.

In addition to cartilage getting damaged in this area from sports injuries, the same can also happen due to auto accidents as well as arthritis.

New Re-Generating Techniques

As the regenerative technology constantly evolves, it makes available a range of orthopedic surgery treatments for the prevention of bone, joint and muscle ailments.

A latest advancement is in the surgical methods is Matrix-Induced Autologous Chondrocyte Implantation. This invention was approved for use by FDA in 2017. It is a new cartilage regeneration procedure which allows the growth of chondrocyte cells on a biologic scaffold.
The new technology uses cells from the patient’s own cartilage to generate the scaffold and as opposed to earlier treatments, can be affixed to the cartilage.

The treatment has only recently surfaced in the US but has been operational in Europe for at least a decade with very promising results.
Basics of MACI include the following:
• In the first step of the MACI procedure, healthy chondrocytes are harvested on a sponge-like area of the bone.
• These cells are sent to the laboratory for 4-6 weeks to be cultivated over a sterile collagen membrane.
• The enriched scaffold is comparatively easier to implant and requires a minimal incision.
• The procedure is less painful with fast recovery.
• More than 6 weeks are required for the growth of the new cartilage cells.
• After the surgery, the cells grow to cover the defected area of the knee.
• The recovery period, as is true with most knee surgery procedures, is long and demands minimum movement to prevent damage to the new cartilages.
MACI appears to be an effective alternative for cartilage regeneration, compared to microfracture. If the quality of the cartilage used is good, MACI may be able to give surgeons a new technique at hand to prevent osteoarthritis.


Cartilage damage can severely paralyze knee movement. The holes caused as a result of damaged cartilages can lead up to osteoarthritis. Compared to the old surgical techniques, new innovations in technology like MACI may prove effective as a procedure that requires a minimum invasion.
MACI, with the use of high-quality cartilages and minimal incision, places an implant on the knee to enable growth of new cells. FDA approval makes the effectiveness of this treatment promising for many suffering from runner’s knee and other knee issues.

What is Osgood Schlatter Treatment?

Osgood Schlatter is a common cause of knee pain resulting from an inflammation just below the knee. The condition occurs primarily through periods of growth spurts when structures like bones, muscle, and tendons change rapidly. Depending on the severity of the condition, Osgood Schlatter treatment involves taking a few different measures.

Good osgood schlatter treatmentOsgood Schlatter symptoms

The symptoms of Osgood Schlatter typically involve pain at the tibial tuberosity or bony pit at the top of the shin.  When this part becomes inflamed or swollen, the affected area becomes more prominent than usual.

Other symptoms include experiencing tenderness and pain which is worsened during and after exercise. Some children may even experience limping after physical activity.

The severity of the symptoms can easily vary from one person to the next. Some children may only experience mild pain during specific activates while others may suffer from a constant throbbing pain. The duration of the discomfort can also vary, lasting from a few weeks to a couple of years.

Adequate rest, however, can improve these symptoms and symptoms typically disappear once the growth spurt is over.

Osgood Schlatter disease causes

While the condition does occur through an overuse of the tibial tuberosity, there are specific factors that may increase the susceptibility of sustaining this disease. These can include the following causes:

  • Age can be a notable factor in the diagnosis of Osgood Schlatter disease. In many instances, the pain experienced by boys between 13 to 15 years of age and girls between 10 -12 years old is put down as growing pains. However, it may actually be Osgood Schlatter especially if young adolescents are engaged in high impact sports or other such activities.
  • Gender seems to play a part in the occurrence of the disease. That is to say that the condition is diagnosed more in boys than girls. But with more girls getting involved in sporting activities, the gap is becoming narrower between the two.
  • Activity levels can also be a contributing factor. As the bones of young athletes grow, it may take some time for their muscles and tendons to catch up. Regular sports activity can pull on localized tendons which in turn pull on the tibial tubercle. The result of this repetitive traction can lead to inflammation in the area and cause distressing discomfort.

Osgood Schlatter treatment options

Treatment for this disease aims at reducing the associated pain and swelling. Such treatment may also demand to limit exercise and activity until the person starts to feel better.

  • Medications are usually the first line of treatment for this condition. Over the counter pain relievers like acetaminophen, ibuprofen and naproxen are all helpful. They reduce swelling and help subside the associated pain.
  • Physical therapy can be used to stretch the quadriceps which assist in reducing tension in the inflamed area.
  • Surgery may be considered as a last resort in very rare cases. Typically the condition resolves without formal treatment as symptoms usually disappear after the growth spurt is over.

However, in cases where the pain persists and does not subside even after the growth spurt, the doctor may decide to administer surgery. The surgical procedure will likely be done to remove the bony overgrowth in the area.

Overview of Common Knee Sports Injuries

In 2014, there were 10.4 million visits to a doctor’s office because of knee injuries. The knee is a complex joint with multiple components. This complexity makes it vulnerable to a variety of injuries. Knee injuries can be successfully treated using simple measures, such as physical therapy rehabilitation exercises and bracing.

Knee Components

The structures and components of the knee joint include:

  • Bones – Three bones meet to form the knee joint: femur (thighbone), tibia (shinbone), and patella (kneecap).Knee anatomy picture
  • Articular cartilage – The ends of the tibia and fibula, and back portion of the patella, are covered with a slippery articular cartilage. This allows the bones to glide smoothly across each other as you bend or extend the leg.
  • Meniscus – Two wedge-shaped pieces of cartilage that act as shock absorbers are the menisci (singular – meniscus). This tough, rubbery material stabilizes the joint.
  • Ligaments – Bones are connected to other bones via ligaments, and the knee contains four main ligament structures.
  • Tendons – These fibrous structures connect bones to muscles.

Knee Sprains and Strains

A sprain is a tear or stretch of a ligament, which holds bone to bone. A strain is injury of a tendon and/or muscle. You are at increased risk for knee injury if you have a history of strains and sprains, are overweight, or are in poor physical condition. Sprains and strains are categorized according to severity:

  • Mild – Tendon or ligament is stretched slightly, but there is no joint loosening.
  • Moderate – There are partial tears of the tendon or ligament, producing joint instability and some swelling.
  • Severe – Produces excruciating pain during movement, and the tear is complete.


The most common knee bone that is broken is the patella. Many patellar fractures are caused by high energy trauma, such as in a motor vehicle collision or a fall from a high structure. The patella is injured during sports by falling directly on it, or when there is a high impact collision with another player.


During sports play, a dislocation can occur when the bones of the knee go out of place. Dislocations are either partial or complete. The tibia and femur can be forced out of alignment, or the patella can slip out of position. A dislocation occurs as a result of sports-related contact.

Anterior Cruciate Ligament (ACL) Tears

The anterior cruciate ligament is often injured with sports play, such as football, basketball, and soccer. This ligament is torn when the athlete changes direction rapidly, or when he/she lands from a jump incorrectly. About 50% of ACL tears occur along with damage to another knee structure, such as meniscus, other ligaments, or articular cartilage.

Posterior Cruciate Ligament (PCL) Injuries

Tearing of the posterior cruciate ligament occurs from a direct blow to the front of the knee when the knee is in a bent position. PCL tears are usually partial tears and can heal without surgery.

Collateral Ligament Injuries

The collateral ligaments are torn or injured by a force that pushes the knee sideways, as with contact sports. Injury to the medial collateral ligament (MCL) often occurs from a direct blow outside of the knee, whereas the lateral collateral ligament (LCL) is injured from a blow to the inside of the knee.

Meniscal Tears

Tears to the meniscus occur when cutting, twisting, pivoting, or being tackled. These injuries also occur from arthritis or aging. A meniscal tear to a weakened meniscus can occur from an awkward twist when rising from a chair.

Tendon Tears

The patellar and quadriceps tendons can be torn or stretched easily during sports activities. These occur from falls, landing awkwardly from a jump, or from a direct force to the front aspect of the knee.

OSPI offers the top sports medicine specialists in Arizona serving Gilbert, Chandler, Mesa, Queen Creek and Maricopa AZ. All types of tendon and ligament injuries are treated with regenerative medicine procedures, bracing, physical therapy and operative procedures when necessary.

Most insurance is accepted, and the Board Certified orthopedic surgeons in Gilbert are experts at getting athletes back to activity quickly, call today!


Overview of Knee Collateral Ligament Injuries and Treatment

The lateral collateral ligament (LCL) and medial collateral ligament (MCL) are important for avoiding rotational instability of the knee joint, as well as preventing cartilage damage. A collateral ligament injury often requires reconstruction using the patient’s own tissue or donor tissue.

What is the purpose of the collateral ligaments?

The LCL is on the outer portion of the knee, and it connects the thigh bone (femur) to the leg bone (fibula). This

[ File # csp11032144, License # 2179054 ] Licensed through in accordance with the End User License Agreement ( (c) Can Stock Photo Inc. / pixologic

ligament’s purpose is to avoid stress across the knee where it buckles outward. Along with other ligaments, the LCL forms a complex that provides external rotation stability. The MCL connects the thigh bone (femur) to the shin bone (tibia). It keeps the knee from buckling inward.

What are the symptoms of lateral collateral ligament injuries?

Injury to the LCL can lead to buckling of the knee. A direct blow on the inside of the knee can cause hyperextension stress on the LCL. This ligament often is torn along with the anterior cruciate ligament, which occurs from high-force sporting injuries. Symptoms include instability of the knee joint, mild knee pain, tenderness and swelling on the outer region of the knee, as well as weakness and/or numbness of the foot.

What are the symptoms of medial collateral ligament injuries?

With MCL injuries, you can have pain, tenderness, and swelling. Several hours after the initial injury, the pain may increase. You may also notice some bruising on the inner aspect of the knee.

How are collateral ligament injuries diagnosed?

The doctor diagnoses collateral ligament injuries based on symptoms, history of injury, physical examination, and magnetic resonance imaging (MRI) scans. X-rays can be normal, but MRI has a 90% accuracy rate for showing ligament tears. Ligament injuries are graded using a scale as follows:

  • Grade 1 injuries – Mild and usually gets better within 1-3 weeks. Only requires non-surgical treatment and use of crutches for a short while.
  • Grade 2 injuries – Moderate and usually gets better in 4-6 weeks. May require wearing a hinged knee brace and limited weight-bearing.
  • Grade 3 injuries – Severe and require wearing a hinged brace for several months. Weight-bearing is limited for 4-6 weeks. Often requires surgery.

What is the treatment for collateral ligament injuries?canstockphoto7107950

The LCL does not heal as well as the MCL. For minor tears, the doctor will recommend rest for a few weeks, use of ice to decrease swelling, elevation of the leg, and a compression bandage (ACE wrap). Physical therapy is used to restore strength and range of knee motion.

For high-grade tears, surgery is necessary. The doctor will reattach the ligament using large stitches or a suture anchor. If the ligament is torn into two pieces, the pieces can be sewed together. When a graft is used, the new structure is attached to replace the torn ligament.

How common are collateral ligament injuries?

According to statistics, the incidence of acute knee injury in the U.S. is 300 cases per 100,000 persons per year. Collateral ligament injuries make up 25% of all acute knee emergency room visits. These injuries are more common in adults aged 20 to 34 years. The NCAA reports 2 collateral injuries per 1,000 player exposures in a year.

OSPI has been the top sports medicine orthopedic doctors in the East Valley for years, with sports medicine physicians providing comprehensive operative and nonoperative care for all types of knee injuries. Call us today!


National Collegiate Athletic Association. NCAA Injury Surveillance System. 1999-2000.

Yawn BP, Amadio P, Harmsen WS, et al. Isolated acute knee injuries in the general population. J Trauma. 2000 Apr. 48(4):716-23.