Ask the Doctors April 2005 Issue

Ask Dr. Marks: 04/05

What do I have to do to help heal a torn knee ligament? Iíve had cortisone injections and fluid drained. Do you recommend a brace?

The two most common knee ligament tears are to the medial collateral ligament and the anterior cruciate ligament (ACL), and treatment differs with each of these ligaments. The medial collateral ligament is located on the inside of the knee. It heals well by itself and rarely needs surgery. The goals of treatment are early mobilization and early function. These goals are achieved by early weight bearing and a structured physical therapy program, including range-of-motion and strengthening exercises. The patient usually uses a double upright brace for a six-week period. If returning to strenuous activity, such as sports, the patient continues to use a brace for two to three months to protect the healing ligament. The results are generally good.

ACL tears, on the other hand, are more problematic. The ACL heals poorly and usually does not heal even with bracing. The treatment depends on the expectations and the lifestyle of the patient. If movements are confined to the activities of daily living, 85 percent of patients will do well without repair. Only 15 percent of patients with ACL injuries will require surgical repair. If the patient is active in sports (running, jumping, twisting) or has an occupation that requires strenuous activity, 85 percent will have ACL symptoms serious enough to be considered for surgical repair.

If nonsurgical treatment is chosen, the type of treatment will largely depend on your symptoms. Bracing is not required, and weight bearing can be done as soon as the patient is comfortable. Aspiration of the blood within the knee is done only if it becomes uncomfortable. Cortisone injections have no place in the treatment of ACL injuries.

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Arthritis Advisor often recommends exercise for people with osteoarthritis. But canít some exercises actually cause arthritis, or make it worse?

To cause osteoarthritis, a joint motion must be repeated thousands of times over a long period of time, usually many years. Strengthening and range-of-motion exercises commonly prescribed for people with arthritis will never cause osteoarthritis. These exercises, by their design, do not place excessive stress on the joint and normally are not continued for long periods. Physical-therapy exercises, on the other hand, can cause arthritis symptoms to become worse. If the arthritis is severe, the stress of physical therapy can irritate the joint, causing increased pain. If this happens, it should be reported to your physical therapist, and the program should be modified.

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Can arthritis cause muscle soreness and weakness, or it is restricted to aching bones?

Osteoarthritis is a condition that involves the joints and has no direct effect on the muscles. However, when a joint is painful, there is a natural tendency not to use it. This lack of use can then lead to muscle atrophy and weakness, and when engaging in activities such as climbing stairs or walking uphill, a weak, overused muscle will become sore.

Muscle soreness may also be associated with joint misalignment. Muscles surrounding a joint that is out of alignment become sore because they have to work harder. In this case, physical therapy is usually prescribed to strengthen the muscles in order to lessen the discomfort of the osteoarthritis and associated muscle soreness.