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Knee Surgery Teens' Knee Problems Other Questions about the Knee

Torn ACL--OK to go without surgery?

Sept 2010

I've been obsessively reading the archives to collect information on ortho surgeons, PTs, and recommendations for coping after tearing an ACL. The one thing I never saw in any of the archived material was input from anyone who tore an ACL and elected NOT to have reconstructive surgery. Can anyone speak to that? I tore my left ACL this past June, and am now taking ballet classes again, with some moderations, without pain. But I'm wondering: Am I asking for trouble, inviting further injury? Am I mad to think I can stay active without reconstruction? Can I ski moderate slopes this winter with an OTC brace? Thanks in advance for your input and personal stories. Darcy


Hi, I tore my acl and miniscus this year as well. I agonized over the same decision. I saw numerous orthopedic surgeons in consultation and each recommended different treatment strategies. I elected not to have the surgery based on functional impairment. Specifically, the knee was not showing any symptoms. Jim
I tore my ACL about 15 years ago. My doctor (who sucked, actually, so maybe this is terrible advice) suggested not to have surgery. It was only a partial tear, so if yours is total, this may not work. Nevertheless, I did not have surgery but did get a custom-made brace (extremely expensive ($3000), but I had insurance so OK). I had PT early on but just with the university athletic trainer. At any rate, I had minor pain consistently for a few months, then not much but with occasional very painful spasms for the next two years or so. Occasionaly it would just give out. After that, though, things improved and since about 3 years after the tear I now feel essentially no effects from it. It occasionally gets tired if I've run a long way or skied all day but not enough to inhibit me in those activites at all. It's totally functional and essentially pain free. Again, I don't know if my experience would apply to a total tear. Good luck.
This is not exactly what you asked, but I thought it might be helpful. I tore my ACL completely more than a year ago. I love moving: take martial arts, gymnastics (just to learn a cartwheel before I am in my 50s!) and tumbling (a lot with my 9 yr old son).

I hated the idea of surgery and tried going without it. All was fine if I moved in a straight line: walking, swimming, even running. But, once in a while, something or someone would hit me from the side (e.g., my son would tackle me), or even a strong side-ways shake on BART would happen - and I'd be in pain on the ground. I became very uncertain of moving around.

If you ACL is torn completely, then side-ways motion isn't that comfy, even with a brace. Another thing to consider: are you willing to wear the brace ALL the time?

Try going without the surgery and see how it works. You can always do it later. I am very happy that I had mine. Every time I ride on BART and it shakes me around, I still relish the feeling of strength and stability in my knee. a_a


I have one repaired and one un-repaired ACL, and I have no regrets about electing to not have the second one repaired. Both were skiing accidents--the first was in 1993 and although the repair (a patellar tendon graft) has held up well, I had complications after the surgery (broke my patella at the graft site a year later). When I tore my other ACL in 1998, I decided not to do the surgery, and that knee has held up fine. It very very occasionally ''goes out'' which can't be good for the soft tissue and joint, and may well set me up for some issues later, but it's been 12 years and I am not at all limited in my activities by either knee. I sometimes use a compression type brace when doing twisting types of activities. I ski with a custom brace on both knees (I used to ski quite aggressively even in the years after the torn and unrepaired ACL, though now not so much, but not because of any knee issues, just more cautious in my old age).

Here's the thing: you can always do the surgery later. Wait a year, or two, and if you're unhappy, then do the surgery! Good luck with your decision!


If it were me and I had a torn ACL I would get surgery. Did you tear your ACL completely or partially? Why is it that you do not want surgery? The fact that it is surgery or the cost or the recovery time layed up? If you consider how the knee is engineered, all the different parts are there for a reason. They support and depend on each other. By essentially not having a fully functioning ACL, are are, I would think, putting extra stress on the other ligaments. I would imagine, it would be more workable to not have a fully functioning ACL if you didn't do active activities, but even with that, over time as you age you may get more problems. And if you end up putting on weight, how will your knee handle it? As far as skiing goes, people with healthy knees who are middle aged often don't ski because they don't want a knee injury. I could not even imagine putting on ski boots if I had an ACL injury that wasn't addressed. If you want to ski, get the surgery. If you don't want the surgery, then don't ski and don't put stress on your knee. Good luck and good health. Anonymous
You didn't mention if you have a complete tear or partial tear.

About 5 years ago I hurt my knee during martial arts training. I didn't know how bad it was at the time, but when I was still not ready to train after a few months of rest I went to the doc, got MRI, and diagnosed with partial ACL tear. I visited an orthopedic surgeon who said he could reconstruct but since there was still some ACL left he recommended that I first try physical therapy, and only do surgical reconstruction if I was unable to get back to the activity level I wanted. I did intensive PT and have been very conscientious about keeping the surrounding muscles very strong, being careful, and knowing my limits.

Bottom line: daily life (walking around, etc.) is totally normal; I do heavy exercise and martial arts, with some extra care for the knee and not as hard as I did earlier in my life, but hard enough to be good at it and enjoy it. So yes, if you get excellent, professional PT and are very diligent, you may be able to get back to a very active life without reconstruction. But if you re-injure it or can't get back to an activity level you're happy with, you may need the surgery.

If you are already doing your favorite activites without pain, by all means do not feel pressured to have the surgery! Just be careful and hope for the best. Been there, torn that


You really need to talk to a dr. or two about your options. As an athletic layperson who tore my ACL about 2 years ago...I totally tore it and had an allographt to reconstruct it. Some months later I was able to jog my first 1/2 marathon (after lots of PT and proper training under a coach). I skiied this past winter and it is only sometimes a little stiff. I talked with another sports instructor who left hers to nature. She said she wears a brace skiing and there is not a day that goes by that she doesn't have some pain associated with it. She made me glad that I had the surgery (with Dr. Cummins at Oakland Kaiser...great surgeon and general nice person). It depends how serious a tear you had, I suppose. My advice, get thee to an orthopedic surgeon for advice. Most docs I know would not recommend surgery if you could get by without it. cocosar
I think the point about complete vs partial tear is an important one. I read that the MRI's specificity (true positive) rate for detecting ACL tears was around 95%. However, for some reason different specialists (radiologists, orthopedic surgeons came to different conclusions). Several told me that the basis for decisions was more on PE than film, and specifically looked for laxity comparisons across knees. I took the conservative route, after having had an ACL reconstruction on my right knee 15 years ago, on my left knee. No episodes of giving out, no impairment in sports (I play tennis 3 times a week active singles), no nothing. I can't claim to understand it but I,m happy to not go through another arduous 1 year rehab!! rachaelfr
I saw this post late, but wanted to reply since what happened to me wasn't listed. I tore my ACL partially in 2001, and elected not to fix it since I was in really good shape (strong quads, glutes, hip flexors) and had minimal instability. By 2008, after two pregnancies and two children, I wasn't in as good of shape, but still cycled, snow boarded and surfed. I started having a lot of pain, mostly in the back of my knee. Long story short, that minimal instability, which got worse but never BAD, was causing my peroneal nerve (branch of the sciatica) to get dragged forward with my tibia bone, and though the nerve is intact, thankfully, it was so irritated, I had to have surgery to remove scar tissue and ''release'' it where it was stuck. I did this hoping to still avoid ACL surgery - why, I cannot answer. I think I was afraid of the long rehab, possible complications, having to choose which graft to use..... Well, after the nerve surgery, where my quads got even squishier, I finally had ACL reconstruction. If I had known then what I know now, I wouldn't have waited. Because of the nerve issues, my leg will never be perfect, but the minimal instability is gone and my quads are finally strong again. Good luck. Mary

Practicality of Knee Surgery for Mom

August 2008

Seeking advice/recommendations. Has anyone out there had knee surgery for a likely torn meniscus while parenting young toddlers? My knee is bad (no more bike riding, surfing or running) but usable. I can walk fine, climb stairs, hike a little, go to work... It's most painful when I'm not using it - sitting at a desk, driving, laying in bed, watching tv. I'm worried about two things really: screwing it up even worse then it already is because of surgery and/or, screwing it up post surgery because I didn't take care of it (lot's of physical therapy, no weight bearing..) due to the kids. Given that it's really only impacting the side of my life that would like to be more physically active, should I wait until the 3 and 4 year old are older to go under the knife? Or, is it worth doing now? I'm in moderate pain most of the time and anti inflammatories have stopped working. Physical therapy didn't help at all. I've scheduled the surgery for September but just don'! t know what to expect. I know every surgery is different, but I'm hoping to hear from other moms or dads about how they dealt with this difficult decision. Mary


Several years ago, when I was in my mid forties and had three kids between 9 and 15, my primary care doctor referred me to a highly regarded orthopedic surgeon because of chronic knee pain. Both of my knees have suffered a lot of wear and tear because of a childhood injury and an MRI showed torn meniscus. The surgeon recommended surgery to clean up the torn meniscus, but said that it could not be repaired. I scheduled the surgery, because he didn't believe that physical therapy would help. At my request, he did refer me to physical therapy before surgery, which he said might help speed my rehab, but after three weeks I felt no improvement.

At the same time, I scheduled a second opinion with Dr. James Garrick at the Center for Sports Medicine at San Francis Hospital in San Francisco. Dr. Garrick agreed that my meniscus was torn and could not be repaired, but he did not believe that just cleaning it up would have any benefit in my case, since the torn cartilage was not affecting my motion. He walked me over to the physical therapy room in the clinic, and started me on a physical therapy program. Within two weeks I was comfortable enough to enjoy a family vacation that involved extensive walking and a lot of stairs. I, of course, cancelled the surgery. It's been almost ten years, and following Dr. Garrick's advice for maintenance, I've been able to increase my activity, control further damage, and manage my knee pain with non-invasive, conservative care. My recommendation is, naturally, that you get a second opinion from Dr. Garrick or one of his colleagues in the Sports Medicine clinic. Good luck with your knees


Kaiser Orthopedic Surgeon For Knee Replacement

May 2007

I am looking for a Kaiser physician that will do knee replacements that you highly reccommend. Can anyone suggest anyone, even if it is in the greater Bay Area or Northern Cali? Or, even if you have had a Kaiser orthopedic surgeon that you are fond of that did a different surgery other than a knee replacement. Thanks. k_m


Dr. Brad Kraetzer is an Orthopedic Surgeon at Kaiser Hayward & Fremont. He is very well respected. Give him call. Good luck. anonymous
I know Brad Kraetzer at Kaiser in Fremont socially. He's a great guy. He doesn't specialize in knee replacements, but I'm sure he recommend someone. Good luck. http://www.permanente.net/homepage/doctor/bradfordkraetzer/ Anon
I had reconstructive ACL knee surgery by Dr. Craig Gyory, Orthopedic Surgeon, at Kaiser Hospital in Walnut Creek. He's very knowlegeable and has a great bedside manner. .''....skiing and running again!''

Knees making crunching sound

Jan 2007

I am turning 50 this year and have noticed that my knees now make a crunching sound going up stairs. I don't notice it as much going down stairs. It doesn't hurt at all. I haven't had any major problems or injuries with my knees. I do have some minor arthritis in my fingers, but no pain. I wonder if I should start taking supplements for joint health, but I am bewildered about what to take and where to start. My doctor didn't give me any suggestions and merely said that the sound doesn't necessarily mean arthritis. Does anyone have any experience with this and any suggestions about what works and what doesn't work (ie a waste of money)? Thanks! wanting to stay knee-healthy


My knees started making crunching sounds as well, especiallly going up and down stairs and in the A.M. I did get it checked out- arthritis and degenerative stuff from being a long-time runner. I started taking a supplement called ''Flexicose'' which is a liquid joint supplement with chondroitin, MSM, and glucosamine- the holy trio of joint supplements. I have noticed an improvement and less pain. You can buy it on-line through Flexicose website ($30 per month) but I found it on Ebay much cheaper. good luck. fellow crunchie
Hi. It's SO GOOD that you're thinking about your knees now, before there is pain. It sounds like you might have some early degenerative changes in your knees. Most docs I know are now suggesting glucosamine chondroitin (as long as you have no complicating medical issues like allergies to shellfish or diabetes); I will say that clinically I have seen people's pain significantly decrease (which is rather a moot point for you since you don't have pain). Another thing to consider is a trip to a physical therapist. Many times they can give you stretches and strengthening (for your quadriceps mostly) to help keep your patellofemoral (knee) joint more supported and healthier for the long run. Good luck. Coleen
Hi, I recently had my meniscus repaired so I've done a lot of reading about the knee lately. It seems that the only supplement that gets almost unanimous recommendation is glucosamine. It supposedly helps the various pieces of cartilage in the knee stay hydrated but it can take up to a month to start helping according to some research. There are a few choices at trader joe's. Alex
I have had the same problem--a crunching noise when walking up stairs, but no associated pain. I saw my doctor about it. After a series of x-rays that showed no arthritis, she diagnosed me with what amounts to weak quad muscles. She prescribed a series of PT appointments, which I have admittedly never had time to attend, so I can't tell you if strengthening the muscles actually works.

Rehab for knee replacement?

Jan 2007

I am getting my knee replaced by Barry McKinley (any feedback on him?). I am a single mom of a 12-year-old, and am wondering if I should check into a rehab unit/hospital for the week after I am in the hospital. Has anyone had any experience with this? I would appreciate any experience with knee replacement you might have.


At the very least, you're going to need a very good physical therapist. Deirdre McLoughlin is excellent. She's in Berkeley. 883-1126. dhtchk
Hi there- As a physical therapist I can give you some perspective- although it has been a few years since I worked in a rehab hospital- I think if you can afford the time away from home, it would be good to spend a few days-5 days? in a rehab setting- You will likely be very uncomfortable and when I used to work there, we did PT with patients at least 2x/day- this is much more than you will get at home, even with home health PT- You can then just focus on getting around, out of bed, to the toilet, walking with crutches and of course, moving your knee! Then, when the pain is better and you are more mobile, making the transition to home should be easier- WITH home PT also! Until you are ready to get out and about and start your therapy in an outpatient setting- Hope this helps! And good luck! Deirdre

Arthroscopic Knee surgery

Dec 2006

I am scheduled for arthroscopic knee surgery for torn meniscus. My doctor (Christopher Chen) said it would be under general anesthesia.
1) any information re Dr. Chen?
2) is general anesthesia typical for arthroscopic knee surgery
3) any other recommendations for ortho surgeons?
thank you!
Marcel
Primo knee surgeon is Robert Eppley, MD, - 2999 Regent St, Berkeley, 94705 - (510) 704-7760 I had my ACL replaced and it did require general anesthesia. Do be sure to get good physical therapy before as well as after your surgery - makes a huge difference. Best PT is Allan Horwitz at Berkeley PT. Phone (510) 549-BACK (2225) berkeleypt@sbcglobal.net 2041 Bancroft Way, Suite 301 Berkeley, CA 94704-1443
Good luck, Merry


I don't know anything about your surgeon, but I did just have arthroscopic surgery for a torn medial meniscus. My surgeon was Charles Strotz, M.D. from Berkeley Orthopedics (he's the ''knee guy'' there; it's all he does). He's fantastic. He also did an ACL repair on my other knee about 8 years ago, which is doing fine. He recommended general anesthesia (quicker recovery post-op) but offered spinal anesthesia (they stick a needle in your back and it numbs your legs). I opted for general, and I was able to leave the surgery center about two hours after waking up. He instilled a numbing medicine in the knee and I had no pain till the day after surgery, when it started to swell and I needed a crutch to walk. The first week it was hard to get around. Now I'm two-plus weeks post-op and walking normally, except for steps, which still bother me a bit. Both he and I are extremely happy with the result so far, and I look forward to full activity in 6-8 weeks. Good luck! Margery
Dr. Steven S. Isono is by far the best physician I have seen in my life. He is extremely approachable and kind, and a leader in the sports orthopedic surgery world (he handles Olympic atheletes and other professionals). He did knee arthroscopy for me this week. I had an ACL reconstruction years ago, and he noticed some bone growth that needed to be trimmed that was cutting into my graft. Dr. Isono is at 5915B Hollis Street in Emeryville (510-547-5633). By the way, Dr. Strotz did an MRI of my knee, and couldn't find my torn medial meniscus, which Dr. Isono spotted immediately from the same MRI Go to Dr. Isono
I have seen Dr. Steven Isono, located next door to Bucci's in Emeryville, for various problems, including my knee, for 15 years, and he is top notch in his field. Is friendly and can answer your questions; has worked with lab to design software for the knee. Dr. Isono is dr. to many professional atheletes, so you are getting state of the art care. Besides that, he is a nice guy. Even if you don't use Dr. Isono, it would be a good idea to get a second opinion. Good luck! -Anonymous

13-year-old's misaligned patella

Nov 2008

My 13 year old daughter has developed a misaligned patella and is in a lot of pain. Apparently it is a condition that happens to adolescent girls when their bones grow faster than their knee cartilage can keep up. The doctors have her on crutches for over a month and she is doing Physical Therapy. She is bummed out about it and trying to keep her spirits up and keep up with school. Are there any families out there who have been through this? Any advice how to handle it? Any girls she can connect with who have been through this? Jeanne


Unfortunately I cannot supply a peer for her to connect with. In this case I would suggest Facebook, reading, knitting, movies and other non active things to do. This is not all that uncommon.

My daughter had it, and was diagnosed during Summer Camp. I had to provide specific notes and hover over all the camp counselors to honor the doctor's recommendations regarding rest and avoiding strenuous hikes. They thought she was slacking.

We were able to get her through middle school, high school, ballet and soccer simply by having her rest whenever she felt pain. She did not need crutches, but it did curtail running. She is fine now. If you can get the inflammation down and not irritate it, usually people grow out of it. We used a lot of cold packs, alternated heat and cold. Ask about physical therapy. Especially when you walk to avoid irritating one joint you can throw off others. Follow the doctors instructions long past symptoms to give everything its due time to catch up, heal and be strong. mom


Knee Problems with a 14 Year Old

Jan 2006

My son has developed painful knees. Both knees under the knee cap have protrusions and he is now having difficulty walking. Almost always he experiences pain. Of course he carries a heavy backpack, walks up and down hills and plays basketball. I'm planning to see his doctor but wanted to know if this is a common problem among teens and what you do about it? Chuck


You may get several responses to your note, as you've described a classic growth-related problem that many kids have had.

My 14 year-old son has the same symptoms as yours, and was diagnosed last spring with (don't worry!) Osgood-Schlatter disease, a growth related knee problem that has to do with the bones and tendons growing at different rates -- in the most severe cases the tendons can actually pull pieces of bone off the front of the shin right below the knee -- but its likely that your son and mine will find (as my 17 year-old daughter already has) that the condition subsides once they stop growing so fast.

Do see your doctor, to be sure nothing else is going on, but its quite likely this is not something to panic about. My kids were told not to limit their activity (both play sports) but to take care of their knees --- ice and Ibuprofen after strenuous work-outs, stopping if there is more than usual pain, etc. My daughter couldn't jog for awhile. My favorite (and the only) limitation for my son was that he is not to kneel. Fortunately he is rarely called on to do so these days. I'm less worried this time around, because my daughter has no residual pain or swelling. Heather


One more thing to add. If the knee problem is a medical condition and needs rest or moderated activity - going to the doctor gives you the chance to have a note written by the doctor. My daughter was diagnosed with Osgood- Schlatter Disease at 12 and is almost grown out of it now - no real problem for the last few years. However it is pretty clear from the literature that if pain persists the child should not be told to ''work through it.'' My daughter has been in dance most of these years, and active in various sports at school and after school. Sometimes activities at school required long walks or visits to museums where the students could not sit down for long periods. This would aggravate her knee and she would be scolded for sitting. By having the doctor's note on file and continually ''reminding'' the teachers or extra- curricular instructors we could head off some of these responses and get her support to take a break or be excused if her knees had a flare up. She only required ibuporfen occasionally, and with slight moderation of activity=basically not overdoing it - she has not been restricted or had any lasting problems. Get it checked out.

Step exercise and knees

Dec 2005

I recently purchased a set of steps and an excercise video called the ''firm''. You have to stack the steps for some exercises and the height to step on is perhaps about 15-16''.I am not very tall, 5 feet 3 inches. My husband tells me that stepping this height could damage my knees.He says that while hearts and lungs and muscles can be stregthed with exercise, knees cannot. Is this true? I must point out that my husband is not a Physician or even have a science back ground.I would love to hear from any one who has done step exercise for any length of time. Thanks


The knee joint has many many of your leg muscles connected to it, crossing over,around, thru, etc. These muscles can be strengthened,hence, yes your knees can be strengthened. You should start your exercise program with only one step. If you need several steps to do some of the exercises, try them with one step, or wait. You need to build strength on the easier level first. Try the easy level for a week or so, and then go to the next level.Don't be macho. Slowly build up to a more advanced level. If you start with the 16'' height, that may be too much and you could very definately hurt yourself. As an exercising mom studying to become a certified fitness and strength trainer, and a practicing massage therapist I have seen my fill of sport injuries from people being too zealous to start. Please be careful and enjoy. June
No matter what the fitness program is that you are starting, you need to start out slowly and work up to a greater intensity over time. It is not so much the height of the step, as the fact that your tendons, ligaments, muscles, etc. need time to accustom themselves to the work that you are asking them to do. If you rush right in to any new activity, even using a lower step, you are asking for injuries. If you have been a couch potato before this, I would suggest that you get used to the movements by beginning them on the floor, not using any step. Then, if you are doing this 3x a week, start on the lowest step in about 3 weeks. Pay attention to your form, and make sure that you wear a good supportive tennis shoe- possibly a cross-trainer shoe. If you have stiffness in your knees that won't go away after several days, you are progressing too fast (that is a different pain than an ordinary muscle soreness from training.) You can work up to using the high step, but it will take time.
Master's degree in Physical Therapy
I used The Firm's fanny lifter (the step box with the box on top) 3 times a week for 12 weeks. I did lift my fanny, but I also tore up my knee. I think the second step is way too high, and that it puts too much strain on the knee joint. It has been a few years since then, with a knee surgery, and am still in physical therapy because of it. So, I believe your husband is correct - it's too high a step. Maybe just one of them would would better than the double method? Good luck. anon
My experience with a Step class was terrible. I was relatively young (maybe 25) and pre-childbearing when I took it at Cal, and one of my knees went out and was not the same again for many years. I still get twinges, and had some problems skiing for a long time. There's something about stepping and twisting at the same time that is so much worse for you than running up and down stairs (like in the Rocky movie). So if you DO do the step thing, make sure you never turn while you're stepping or step while you're turning.

I need knee replacement surgery

Sept 2005

In the last year I have been advised by four orthopaedists that I need knee replacment surgery in both knees due to severe osteoarthritis. I am reluctant to act/frightened about this but I know it is time now because my mobiity has deteriorated to the point that it is seriously compromised. I would appreciate comments on experiences with this procedure such as whether to have both knees done at once or one knee at a time? Who is a trusted, experienced knee replacement surgeon located in Oakland, Berkeley or San Francisco? Fairly new to the East Bay area, I am grateful for all thoughtful comments. Anon


My mom had both knees done at once. My sister went up and picked her up from the hospital and stayed with her for 2 weeks. I went up and stayed with her for 1 week. After that, she was pretty much able to cope with a little help from her friends. She did get a Disabled Placard for her car so she could park closer to businesses. It worked out very well for her to do both at once. She also bought a very stylish wooden cane to use. :) Today, she is very mobile and Thank God not in the pain she used to be in. Jennie
I had an acl/mcl/patella surgery. The replacement was a cadaver, which at that time was pretty revolutionary. I was 30 at the time I did it. I could not be happier. It's now 12 years later and I am still skiing, playing tennis, running, and generally being active. I assume that the techniques now are even better than they were then. At least for me, it was great. One warning. I did a good deal of research on the doctor and I'm glad I did. Anecdotally, I was recommended one doctor who got some strong reviews but I thought he was pompous and dismissive when I met him so I went with the other guy. A few years later, the jerky doctor was on one of those tabloid news shows for being a very bad doctor. The doctor I ultimately chose is now the head of a prestigious sports medicine clinic in Colorado. Do your homework. -- tsan
Also recommended:
  • Scott Dye UCSF
  • Steve Isone Oakland
  • Douglas Lange John Muir

    ACL knee surgery - which graft?

    Aug 2005

    I recently tore my ACL (anterior cruciate ligament) and my medial meniscus in my knee while playing soccer. I have decided to go ahead with the ACL reconstructive surgery, during which they will also clean up my cartilage, but am really overwhelmed by having to figure out which ACL graft to choose. I am looking for advice from anyone with experience with this surgery, either as patient, doctor, or friend, on which graft is best and why. (I am 39, very active with running, soccer, biking, hiking, etc., and have two kids, 5 and 7.) The three grafts I hear most about are patella, hamstring, and cadaver. There are advantages and disadvantages to all three, I know, but it seems that doctors specialize in only one graft and are passionate about whichever graft they perform. This makes it hard to make any kind of rational decision based on unbiased information. At this point, I am headed for a patella graft in September with Dr. Strotz but would still consider other options. This may fall under Recommendations as well but I am also interested in recommended doctors who are covered under my Healthnet HMO, preferably through Alta Bates Medical Group. Thanks! Sarah


    I had the cadaver graft in 2001. I have a friend who had the patella graft and there was additional pain due to the harvest. I had no reaction to the graft and my knee isstable now though I gave up jogging entirely; just too jarring. I did do a lot of PT and I can't say that my knee is 100% back. Would I have the surgery again? Yes, but it would have been good to know ahead that it's not necessarily a total cure. I think if I'd been in better shape before the surgery recovery might have gone more easily. Good luck! Nicole
    Sarah, Whatever you decide to do, I have used a remedy for this very successfully, and it could be worth trying: massaging arnica oil into the knee liberally several times a day. It helps to use the strongest arnica concentration you can find - arnica oil is available both in Elephant Pharmacy on Shattuck and in the Berkeley Bowl. Arnica is well known as a homeopathic medicine to help bruising (and bringing up a family of five it has been invaluable), but it seems to help all sorts of muscular/tendon injuries. When I hurt my knee severely I used the oil directly, massaging it in, and it helped the pain, and seemed to do more than that. I avoided surgery in fact - although it took six months to heal. I'm not suggesting that it would definitely achieve this for you, but it's worth a try perhaps as I think it could only help - and make things easier and less painful meanwhile. My sympathies - I do remember how knees can hurt!
    One thing you will want to discuss w/ anyone advocating patella tendon transplant is your q-angle. I had a mostly patella graft surgeon comment on my q angle and suggest hamstring, so I went to the hamstring specialist. This was in 98. I have very stable knees, no wobbles pain or gives. My scarring for the harvest is very minor (in my shin!). My hamstrings are tight, but they always have been. Rehab is important and you should stick w/ the pt exercises and remember your non injured side for strength training. I learned so much from a website called bob's acl board. I don't know if it still exists. There I also found 'same day surgery' buddies to chart progress with and compare notes and complain. The rehab is hard. Especially reestablishing a straight leg and a fully bent leg. At the time hanging a light weight on my ankle and extending my leg was one of the worst feelings I'd experienced. Child birth put that in perspective. I don't regret my surgery for a minute. I have at various times run, hiked, swum, biked, danced and rollerbladed snow shoed and cross country skied since (yoga, tai chi pilates too. (no downhill yet). I decided against getting a graft that wasn't mine because of wanting to reduce (to my mind) any possible complications. I figured I could handle muscle issues, not infections. But this was a more intuitive than scientific decision. Get an 'ice man' for recovery. It's a cooler w/a pump and bladder. it really kept pain and swelling down. Don joy makes it and get it even if it doesn't get covered by your insurance. For the number of times I used it, the price per day was low! Even as I grew stronger, after a day on my feet I raced home to that thing---and elevation. Also, even if they don't give you one, wear one of those ace-like leg stockings. I had really low swelling which I attribute to the compression, the ice-man, and perhaps a little arnica. oh, and after the surgery, be sure to get a nerve block for that leg! good luck. Jessica
    I had my ACL replaced with my hamstring tendon almost 10 years ago. I didn't have particularly good physicial therapy after the procedure and am now in PT again for both my back (related to my knee) and my knee. My issues are multiple: there is probably more meniscus damage (may need/want additional surgery), I don't have full extension/flexion AND my muscles are extremely weak from favoring my strong leg, and my ACL may be a bit loose. So, I can't totally tell how dramatic the ACL looseness is, due to the other pressing issues, but I can say that I haven't been disatisfied. This is because I think that my problems are more related to half-**ssed PT after my first surgery and my lack of motivation to work on it (and low expectations). Since I have started PT again it has made HUGE improvements and I don't notice the looseness at all anymore.

    My discussion with the surgeon who may perform the additional procedure (Dr. Eppley) of course dealt with patella or cadaver since I've used up the hamstring option. I chose cadaver if necessary since I'm not too concerned with the side effects and I don't want to ''weaken'' my body any more. Frankly, I think it's more of an equal weight to all three choices. More important is the therapy after and gaining full function of the knee and knowing how to keep your leg strong. Good luck!!!! freyja


    I had ACL surgery back in 1990 (from a skiing accident) so you are lucky you are doing it now when you will be able to walk the next day instead of being on crutches for 6 weeks. Anyway, back then, I didn't have a choice as to what they used as a replacement, which was my patella tendon. After recovery and some swelling behind my knee the first year, the graft has performed really well and my knee has been stable for 15 years now. I was back to skiing the year after the surgery and even played squash for many years afterwards too. I still run, hike, ski and ride bicycles now with ease. The only residual problems are that kneeling on that knee hurts as there is less patella tendon to protect it and can be very tender if you bang it accidentally. There is also still some numbness from the surgery - but I think they do it all arthoscopically now so this should not be a problem for you - I have two large scars from the surgery. I also get some dull aching occasionally when the weather changes. All in all, I am very happy with the result and also the ability to carry on with all the sports I enjoy. I'm afraid I can't comment on other types of replacement but would say that the patella tendon has done a good job for me. Happy with my ACL

    Orthopedic surgeon who specializes in knees

    April 2004

    I am looking for a strong recommendation for an orthopedic surgeon who specializes in knees. East Bay or San Francisco would be fine. Thank you very much.


    Recommended:
  • Robert Eppley
  • Kevin Stone
    Dr. Robert Eppley
    Dr. Steven Isono ( Emeryville)
    Dr. Warren Strudwick (Emeryville)
    All excellent knee surgeons in the area anon

    Husband needs surgery on his meniscus

    March 2004

    My husband may need surgery on his knee (meniscus). I've read the recommendations in the archives and but was wondering if anyone has any current recommendations. He's already had meniscus removed from his other knee and is really bummed about this knee. He's hoping he can still run. So, a doctor who works with athletes would be best. Thanks! shari
    Recommended:

  • Robert Eppley
  • Steve Isone (2)
  • Kevin Stone (2)
  • Cris Strotz

    Have ACL surgery the same week as childbirth?

    July 2003

    I'm planning to have knee surgery (acl replacement) as soon after I deliver my baby as possible. Ideally I would like to have the operation the same week I deliver. I would love to hear from others who've had surgery post-delivery: complications? length of time dr made you wait? advice? Thanks.


    Wow... I would be very shocked to discover any doctor would reccommend any kind of surgery so soon after a delivery, no matter how smoothly it might go, which, of course, no one can possibly predict.

    Your body has to recover from giving birth (and there may be a heck of a lot that will need drugs, time and rest), you'll be exhausted, and the baby will NEED YOU.

    I really hope that you are not feeling any kind of pressure to do this surgery while on maternity leave so as to avoid disruption to your work (the only reason I can see for even considering this).

    Maternity leave isn't about getting ''all those little things done'' as you can in order not to disrupt work, it's about you and your baby. Concerned


    Orthopedic knee doctor under HealthNet

    March 2003

    I have a knee problem and was given the following list of orthopedic doctors who will take my HealthNet ABMG insurance. I've read the archives and there are recommendations for a few of these docs, but not for knees specifically. I'd love to hear about your experiences with any of these doctors, particularly as they relate to treating knee problems. Thanks. The list: Douglas Abeles, Lamont Cardon, Michael Charles, Christopher Chen, John Debenham, Robert Eppley, Scott Hoffinger, Monica Kogan, Michael Krinsky, Mathias Masem, John Mattson, Terence McDonnell, O. Barry McKinley, and James Policy.


    I only know of Massem/Massim on your list. I was under the impression that Massim is a hand surgeon (a sub-specialty of orthopedics. An excellent orthopod who only does knees is Steven Isono (click to see review).
    One of the best orthopedic surgeons for knees around is Dr. Kevin Stone (click to see review).

    Seeking knee specialist for 12-year-old

    Feb 2003

    We are looking for an orthopaedist to perform surgery on our twelve year old daughter's knee (discoid meniscus). Has anyone had experiences with someone that they would highly recommend? Thanks, Susan

    Recommendations received:

  • Jerold Goldman
  • David Lowenberg
  • Muir Orthopaedic Specialists (2)

    Surgery for ACL?

    Jan 2003

    My friend recently tore her Anterior Cruciate Ligament (commonly known as ACL) and was begging for advice. She wants to make sure she's making the right choices, and is looking for a 2nd opinion, and advice of friends. Since I know nothing of this ailment, I thought I'd post her questions here. She wants to know anything people have to say about a) the surgery, b)other results without surgery, c) pre-op and post-op recommendations, d) recommended (or not!) doctors, and e) risks and warnings. Anon


    In 1993 I had ACL surgery on one knee, and they used a procedure that I'm not sure they still use--it was a patellar tendon graft, which required taking a piece of my patella, a piece of the patellar tendon, and a piece of the tibia and using that to replace the ACL. Unfortunately, my patella broke at the graft removal site, a complication in about 1 in 300 surgeries that used this technique (no one told me this risk beforehand, though I doubt I would have changed my mind about doing the surgery even if I had known). After so much trouble, I promised myself that if I ever tore my other ACL I wouldn't have it repaired. Well, in 2000 that happened, and I almost had the surgery, but then decided to see if I could make it through a ski season using just a brace and then reevaluate whether I thought the lack of ACL was hindering me. After a season of serious skiing (moguls and steeps) I decided I was fine. I use prescription (custom) (very expensive but covered by insurance) braces made by Townsend on both knees, and the braces do the job that the ACL used to. I think both knees work equally well (though if I hadn't had the complication, I'm sure the repaired one would work ''better''). I am able to run, bike and do whatever other sports I like to do without a problem. On one or two occasions the non-repaired ACL has ''gone out'' on me at a completely surprising moment, like taking the garbage out, or lifting something out of the trunk of a car. This is painful and sometimes leads to swelling for a few days, and may have some impact on the overall health of the joint, but on a short term basis is no big deal. The one thing to consider is that as I get older, my ability to compensate for the absence of the ACL with muscle strength will deteriorate, and I may have more problems, but right now I am happy with my knees! Tell your friend not to feel rushed about deciding about the surgery and if they do decide to do it, don't try to hurry the recovery from the surgery. June W.
    I had ACL reconstruction surgery last October. My surgeon was Cris Strotz in Berkeley, and I think he's great. The surgery was done on an out-patient basis at Alta Bates. This surgery has quite a long recovery period, and requires a big commitment to do physical therapy for many months afterwards. I have two kids, including a baby who was about 14 months old at the time of surgery. The hardest thing I found was that I couldn't pick up my baby for nearly 5 weeks (the surgeon said it would be two, so I had only planned to have help for the first two weeks, but it wasn't--and my physical therapists were very surprised he had thought it would be that quick). Even now, three months later, I find my knee swells and aches if I carry the baby for any distance. I did the surgery because I'm normally pretty active and wasn't ready to give up sports, and I also didn't want to risk having long-term knee problems (arthritis, instability). But it's a big deal and not to be taken lightly. Especially if you have kids to take care of! I did the patellar tendon graft; you'll need to figure out what kind of graft is right for you. Feel free to send an email if you want any other info. jennifer
    My husband had ACL surgery 2 years ago with Dr. Strotz at Berkeley Orthopaedic Medical Group at Alta Bates Hospital. He did and excellent job and is very conservative about recovery exercise. My husband is back to his super athletic self and feels good. In fact his ACL is now stronger than it was before. As for recovery, he was in bed for a week, with a daily visit from a nurse. It was certainly not a pleasant experience, but my understanding is that the ACL does not heal back on its own, so without the surgery the leg will never be at its full capacity again. Good luck!
    yes, I am another victum of a ski accident/ACL surgery and have LOTS of advice on the subject. Feel free to have your friend call me for advice/support. Hear, I will try to be brief..

    I was unsure of whether or not to get the surgery and I am very glad that I did. I am active (although not nearly as active as I used to be) and any kind of sports or activites that calls for lateral movement (such as tennis, basketball, skiing, soccer...) are basically impossible to do with a torn ACL. You don't have to get it done right away (I got the surgery a year later!) I was told that many people get by without the surgery but my knee was very loose and kept giving out at the least bit of activity. The fixed ACL made my knee feel much more secure even though I am not doing alot of those lateral sports anyway. I am generally happy with the results, although I wish that I pushed myself harder with rehab! The golden rule is that the sooner you are up and about and the more rehab you do, the closer your knee will be to %100. Mine is a bit stiff probably b/c of not enough rehab. But it is better than no surgery!

    I do not think that your friend can go wrong with a doctor here in the east bay. ACL surgery is VERY common and my Orthopedic Surgeon, John Debenham, did a great job. Of course, these knee guys are a bit high on their horses & his bedside manner was not the best but I was very comfortable with his expertise. I don't think he does knees anymore but there are several orthopedic surgeons in his group that I am sure do a great job. (3010 Colby Street, Berkeley, 510-845-3856)

    Hope this helps! I know this injury must feel overwhelming for your friend and recovery is tough! But with orthoscopic surgery these days the procedure is much less of a big deal (only a small incision, a few hours and it's done!). And it seems that everyone knows someone who had this done and everyone LOVES to tell their knee story! stacey


    I highly recommend Dr. Charles Strotz for ACL surgery. I spent over 10 years with a torn ACL, and had to be careful with whatever I did. Before having a child I decided to have surgery, so that I could keep up with a toddler, and now I am very glad I did. Dr. Strotz used to work out of Tang center at UCB (if your friend is a student), and he also is part of a practice in Berkeley. He is a renowned ''knee guy.'' He doesn't press surgery, but will look at MRI's and tell you your options in a clear and kind way. anon
    I tore my ACL about 15 years ago. At the time, the sports med MD I saw recommended keeping the rest of the supporting structures and muscles strong and avoiding surgery. He said people who have surgery tend to develop arthritis in that knee more than those who don't and that there are more professional basketball players playing without ACL's than with reconstructed ACL's. I've found that if I truly maintain the strength of those muscles and wear a brace in sporting situations where there are lots of unknowns (first time on a particular single-track, etc.), there's no problem. However, since I've stopped exercising, my knee becomes less reliable the weaker the muscles get and even when I'm fit,the knee will occasionally fail on plant-and-twist moves (e.g. kickboxing). I tend to believe, however, that even with surgery, you'd face these issues. I recommend avoiding surgery and dedicated cycling. Cara
    I am a physical therapist working in Oakland. We treat patients with ACL surgery all of the time. I would recommend Dr. Steven Isono or Dr. Warren Strudwick for the surgery. Dr. Eppley is good too. You can expect 4-6 months of rehab after the surgery to get back to full function depending on your level of activity. It is usually a very sucessful surgery with good end results. Going into the surgery with good quadricep strength and full range of motion is a plus. Good Luck dawn
    I had my acl surgically reconstructed in 1998. It has not given me a speck of trouble since I completed rehab. There was a website called ''Bob's ACL board'' back then and I believe it stil exists. I learned a ton on the board and also made two surgery buddies. We emailed eachother daily during the first days post surgery and weekly for a bit until we bid adieu. It was a great help. i saw two surgeons. One specialized in patella ligament grafts, but said I should probably have a hamstring graft. The other only does hamstring grafts. I went with the latter. You want someone who does scads of your type of surgery. It's out patient surgery. I had general anesthesia. I was my own donor. W/ hamstring graft you lose 20% of your hamstring and get 110% performance on your 'new' acl. It's arthroscopic surgery and my scars are virtually invisible today. The rehab is really hard. I distinctly remember lying face down on my bed w/ a light weight on my angle and my leg hanging off just above the knee. I cried as I waited for my leg to straighten. It was incredible. Child birth put that in perspective! There's a device called an ice- man that was my main pain medication. It's a pump you fill w/ ice water that is circulated through a plastic bladder that you wrap around your knee. It was heaven. I teach and many nights post surgery I couldn't wait to get home and put my leg up and turn on the ice man. I also wore a full length stocking/ace bandage thing on my leg and took arnica and had very little post surgery swelling. If I could turn back time I'd have avoided the sierra concrete or just fallen on my butt instead of struggling for control. but since I tore my acl, I'm so glad I had the surgery. I worked very hard at rehab, stretching weight training and cycling. Cycling is your friend. Find a great surgeon. Learn which graft procedure is right for you. Rehab rehab rehab. You'll be glad you did. Jessica W.

    Runner's Knee

    Sept 2005

    Runners: I need your advice, help, support. For the past two years, when I run more than 9 mile training distances or in half marathons or longer race, a tightness/pain begins in my right knee. It hurts enough that I start to grimace on downhills when I used to fly. I've tried cross training, twice a day stretches of all varieties, weights/resistance, frequent purchases of new running shoes. My doc says it may be the IT ban and gave me stretches. He's now referring me to a sport's medicine specialist. When I stop running, the pain disappears. I run trails and roads and the pain begins the same, usually mile 8/9 and on the downhill or flat only. On the uphill, I fly by people but then they fly by me on the downhill. And particularly galling is that I've been ending races with a lot of energy in me because I have been going slow to protect my knee. I just turned 40 and want to run into old age. A Paula Radcliffe Wannabe


    Have your body alignment checked, with particular attention to pronation. Consider Dr. Dave Hannaford in Marin Cty and San Francisco; he is the former personal podiatrist of Alberto Salazar.

    The doctor will take a movie of you while running and analyze it to see if there are some problems. Mine was fixed by a simple shoe insert, and the recognition that it's better for me to run with the left foot pointed 15-20 degrees to the left.

    Try this simple experiment: Stand with both feet pointed straight ahead. Then bend at the knees and watch the direction that your knees move. If one moves at an angle, you may have an alignment problem. In my case the left knee moves toward the right knee and eventually touches it unless I orient the left foot at an angle or slightly lift the inside of my left foot.

    I had run for many years with only a mysterious tiredness after 20 miles or so. But then I started to run trails, and one day after a down-hill on Ring Mtn in Corte Madera I began to have the same symptoms that you describe. For a while, I had to descend stairs one at a time. After seeing the Dr., getting a left shoe insert and learning to let my left foot go to the left slightly while running, there was very gradual improvement. After 3 years I have almost full strength back in the left knee.

    If you have further questions, you may email me. Bill


    Housewife's Knee

    July 2003

    Much to my horror, my mother recently pointed out to me that I have ''housewife's knee'', or basically calloused areas on my knees. I knew they were there of course, but hearing that horrible name put to it has me obsessing a bit. The callous on my right knee is pretty bad, but both my knees are dark and it looks horrible in my opinion. I have tried using pumice and lotion to no avail. Can anyone give me advice on how to get rid of these? Unfortunatley, I have two small children (THAT is not the unfortunate part by the way!) and spend time on my knees; I am unable to squat due to bad knees, so I'm not sure what my other options might be. Thanks for any advice you might give. Hilary


    Get knee pads! Callouses will (slowly) go away if you stop causing them. There are thick, flexible, foam kneepads available at many nurseries and garden supply stores. There are also heavy solid ones at places that provide supplies for masons, plumbers, tilers, etc, who spend a lot of time on their knees (like Truitt and White Lumber in Berkeley). Find a pair that's comfortable for you that you'll use regularly. There are also ''kneeling stools'' at many nurseries, etc. that turned one way are a thick foam cushioned ground-level pad with arms to help you stand back up, and turned the other way are little seats on legs.

    These items will help your bad knees also. Other things can help bad knees also- strengthening leg muscles, back adjustments from a chiroprator (knee pain can come from the lower back and pelvis being out of alignment), and operations if it's bad enough.

    Don't rub yourself raw with pumice stones in your panic. The lotions that rub away the top layer of callous on hands and feet are useful if used regularly. There is also a prescription cream that is good called Lac-Hydrin 12%. Had Callouses


    Have you tried a gardeners knee pads, they are soft and squishy. I bought one and use it when I am on the floor because me knees end up killing me. As far as the callouses go here is a website with advice. http://www.healthcaremanual.com/skinhair/cornscalluses/cornscallu ses-home.htm Hope it helps. Pat

    Knee problems during pregnancy

    March 2003

    Hi everyone, sometime in my 9th month of pregnancy, i developed a knee and heel problem which has not gone away for 3 months now. i was wondering if anyone has ideas about what the problem may be or who they might refer me to. we are part of the kaiser health care system, so any orthopedist recommendation would be appreciated. basically, the symptoms are: a short ligament or muscle right below and slightly to the outside of center of the kneecap gives me a sharp pain when i bend it more than 90 degrees or apply pressure. the pain lessens only slightly if i do warmups. on the heel, the pain is similar. mainly i feel the pull or tug on the inside of the left heel and a bit along the bottom. please send any advice, as it's the only thing keeping me from exercising. thanks! cma


    Hi, During pregnancy so many stresses are put on our body, especially the legs because they carry ALL the weight, and what is more we are off of our ''normal'' balance with a big round tummy full of baby. So it is very common to develop foot and leg pain. Your heel pain may typically be plantar fasciatis which is essentially a tightening of the tissue from the heel to the arch of the foot.It can be painful on the center of the heel or sides of the heel.

    Knee pain can be a problem either at the knee joint where the hip muscles attach to the bone or can be a problem anywhere in between the knee and hip. It is most likely overuse of one or more muscles (called ''compensation'' ) while other relating muscles are essentially taking a vacation. A typical example would be if someone has pain on the outside of the knee (bicyclists often do) the weak muscle would be the inner quad muscle and the overcompensating muscle would be the outer quad muscle.

    I would suggest two possibilities for you....a chirpractor who works with feet...I know a good one, Dr. Bruce Rizzo at Back In Action Chiropractic Center at MLK and Dwight wayin Bkly. 843-2584.Bruce is really great and has helped me tremendously with plantar fasciatis.

    Possibliity number two....I am a massage therapist and I use a technique called Neuromuscular Reprogramming (NMR). In this technique I use a process called muscle testing (movement against resistance) to find out which muscle is overcompensating for the ''vacationing'' muscles. Then I do a release of the over comp. muscle and retest. This process of test,release, retest signals the motor control center of the brain that a change is about to happen and the brain signals the muscle to let go of that way of holding and ''reprograms '' itself to find a new way to move. This technique is very affective (or is it effective?). I also suggest exercises to strengthen and stretch the appropriate muscles. I work a lot with chronic aches and pain, auto accidents, repetitive stress and other injuries as well as life's general tension and stress.

    You may already know chiropractors or massage therapists that you are comfortable seeing. My suggestion would be to see someone consistantly till you feel better. That could be weekly, every other week etc., but it's not likely (but not impossible) that 1 session will give you a quick fix. Good luck with whatever you decide,
    June Kamerling, Nationally Certified Massage Therapist


    I also had significant knee and ankle problems during and immediately after pregnancy. My knees were numb and hurt, and my ankles ached when I moved them. My mother, who is a physical therapist, advised me to wait until I had lost all my weight, and then see what happened. She was right - by the time I had lost all the additional weight, I was fine. She said our joints get more fatigued more easily with the sudden weight gain, and that some swelling inside (due to that wonderful water retention) can also cause pain and numbness. Hopefully, yours will ease then also. If not, you should probably have someone check it out. Kelly
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