Michael S. Vrana, M.D.
Orthopedic Surgeon
Overview
how the knee worksYour knee is a hinge built from three bones: the femur, the tibia, and the kneecap (patella), gliding on a smooth lining of cartilage. Two C-shaped shock absorbers (the menisci) cushion the joint, and four ligaments hold it steady while it bends and pivots. It carries several times your body weight with every step, so almost everything that goes wrong falls into a few buckets: cartilage wear, a torn meniscus, a ligament injury, or a problem with the kneecap and its tendons. The sections below are grouped that way.
Arthritis & wear
cartilage problemsKnee Arthritis
Mechanical wear of the cartilage. Stiff and painful with stairs, getting up from a chair, the first steps of the morning.
Osteochondritis Dissecans
A piece of bone and cartilage loses its blood supply and can separate into the joint. Most common in active adolescents.
Ligaments
stability injuriesACL Tear
A pop on a pivot, swelling within hours, the knee gives way. The classic non-contact sports injury.
PCL Tear
A direct blow to the front of the bent knee, a dashboard injury, or a hyperextension. Often part of a multi-ligament injury.
MCL Sprain
A blow to the outside of the knee that strains the ligament on the inner side. Most heal without surgery.
LCL Sprain
A blow to the inside of the knee, or bending it too far backward, that strains the ligament on the outer side. How bad it is sets the plan.
Meniscus
the shock absorbersKneecap & tendons
the extensor mechanismPatellofemoral Pain
A vague ache behind or around the kneecap. Worse with stairs, squatting, and prolonged sitting.
Patellar Instability
The kneecap slides sideways or fully dislocates, usually from an anatomic predisposition.
Patellar Tendinopathy
Jumper's knee. Degeneration of the tendon below the kneecap from repeated loading.
Quadriceps Tendinopathy
The same degenerative process in the tendon above the kneecap.
Patellar Tendon Rupture
A sudden complete tear of the tendon below the kneecap. You can no longer straighten the leg.
Quadriceps Tendon Rupture
The same injury, one level up. Surgery is typically needed and time-sensitive.
Other soft tissue
tendons, bands, and bursaeIT Band Syndrome
Sharp outer-knee pain with running or cycling, from friction between the iliotibial band and the outer femur.
Baker's Cyst
A fluid-filled swelling behind the knee, usually a sign of something else inside the joint.
Prepatellar Bursitis
Swelling of the bursa in front of the kneecap. Common in work that involves a lot of kneeling.
Fractures around the knee
broken bonesKnee & Lower Leg Fracture
Breaks of the kneecap, shin bone, or thigh bone near the knee.
When to come in
timing and warning signsA sore knee after a hard weekend usually settles with a few days of rest, ice, and over-the-counter pain relievers. Come in sooner if the knee swelled up within hours of an injury, it locks or gives way, you cannot put weight on it, it looks deformed, or it is red, hot, and painful along with a fever.
How we treat it
non-operative first, surgery when it countsYour visit starts with a conversation and a hands-on exam. How the pain started, where it lives, and what the knee does under load tell us most of the story. We take standing X-rays in the office the same day if we need them, and order an MRI only when the answer would change the plan. Most knee pain gets better without an operation: activity changes, physical therapy to strengthen the muscles that unload the joint, bracing when it helps, and an injection when arthritis or inflammation is holding you back. Surgery enters the conversation when the problem is structural or a full course of non-operative care has not given you your life back.
