973-898-5999

The Knee Center

at Modern Orthopaedics of NJ

Our team specializes specifically in knee conditions and procedures. Learn more about treatments offered by our Board-Certified Orthopedic doctors.

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Top Orthopedic Care in NJ

De. Peter DeNoble - Orthopedic Surgeon New Jersey

Wayne Office

2025 Hamburg Turnpike, Suite C, Wayne, NJ, 07470

Paramus Office

70 Rt 17 North, Paramus, NJ, 07652

Parsippany Office

3799 Rt. 46, Suite 207, Parsippany, NJ, 07054 - Coming Soon

Knee Conditions

Anterior Cruciate Ligament (ACL) Injury

Anterior Cruciate Ligament (ACL) Injury Treatment and Surgery in Wayne & Paramus, NJ

ACL injuries are common injuries and create instability of the knee.

The ACL (anterior cruciate ligament) is one of the most commonly injured ligaments in the body. The ACL is found within the knee joint between the thighbone (femur) and shinbone (tibia) and acts to help stabilize the knee. Injured ligaments are considered “sprains” and are graded using a severity scale where a Grade 1 Sprain is a mildly damaged ligament to a Grade 3 Sprain where the ACL is completely torn. ACL injuries are acute injuries occurring from direct contact to the knee, a rapid direction change (i.e. pivot), sudden stopping or landing incorrectly from a jump. Patients will often feel immediate pain and experience swelling over the first 24 hours after the injury. Often the initial pain and swelling will resolve if ignored, however instability to the knee is often persistent and over time this instability can cause other posttraumatic conditions like damage to the meniscus or arthritis. A thorough physical examination can often diagnose this condition, although your doctor may order an MRI to confirm the diagnosis. Treatment for ACL injury depends on the severity and the patient’s individual needs. Nonsurgical treatment with bracing and physical therapy may be used for those with low-grade injuries, older individuals or those with very low activity levels. Otherwise, ACL tears are often surgically reconstructed using either an autograft (graft created from your own tissue) or allograft (cadaver graft) (See our “Treatments” section for more information). A personalized physical therapy program will play a vital role in rehabilitation and return to normal function of the knee after ACL reconstruction surgery.

Jumper's Knee

Jumper's Knee Treatment and Surgery in Wayne & Paramus, NJ

Jumper’s knee involves inflammation of the tendon at the front of the knee that connects the patella and the tibia.

Jumper’s knee involves inflammation of the tendon at the front of the knee that connects the patella and the tibia. This issue generally develops as an overuse injury from activities that involve running, jumping, and loading the knee. Patients will feel soreness directly over the tendon and may feel pain with squatting, running, and any kind of explosive knee movements. Rest is a very important part of recovery from patellar tendonitis. Anti-inflammatory medications can be helpful for pain relief, but should not be taken long term. A focused physical therapy can be very beneficial in the rehabilitation process as well.

Patella Fracture

Patella Fracture Treatment and Surgery in Wayne & Paramus, NJ

A patella fracture is a break in the kneecap, the small bone at the front of the knee
that acts as a shield to the knee joint.

A patella fracture is a break in the kneecap, the small bone at the front of the knee that acts as a shield to the knee joint. Fractures of this nature tend to be from high-impact accidents such as motor vehicle accidents or falls directly to the knee. Patella fractures result in pain, swelling and bruising to the front of the knee, an inability to straighten the knee and difficulty walking immediately following the injury. Your doctor will perform a thorough physical exam and obtain an x-ray to confirm the diagnosis and evaluate the extent of the fracture. The type of fracture will dictate the type of treatment your doctor will implement. If the fracture is stable and the articular side of the patella (the bottom part of the kneecap that glides on femur) stays in anatomic alignment, conservative treatment by immobilizing the knee is used to allow the fracture to heal appropriately. This process takes approximately six weeks before rehabilitation therapy can begin. If a patella fracture is displaced, comminuted (in many pieces) or an open fracture, it is important to surgically realign the smooth articular surface. Surgical open reduction and internal fixation (ORIF) is performed in a hospital setting using screws and/or wires in a cerclage fashion. Once the fracture has healed, a physical therapy program will help decrease stiffness, improve motion and strengthen the muscles that surround the knee.

Prepatellar (Kneecap) Bursitis

Prepatellar (Kneecap) Bursitis Treatment and Surgery in Wayne & Paramus, NJ

Prepatellar bursitis is inflammation to the bursa, a jelly-like sac that helps cushion the kneecap.

Prepatellar bursitis is inflammation to the bursa, a jelly-like sac that helps cushion the kneecap. This is most often caused by constant kneeling, often seen in patient who are plumbers, roofers, carpet layers, etc. However, repetitive direct blows to the knee (such as seen in sports like wrestling or football) can also cause prepatellar bursitis. People with rheumatoid arthritis or gout are also at risk for developing this condition. Occasionally, this condition can be caused by a bacterial infection if there is an open wound or an insect bite over the kneecap; in these cases aggressive antibacterial treatment is required. Symptoms of prepatellar bursitis include pain, swelling and redness to the front of the knee. If an infection is present, fevers and chills may accompany these symptoms. In noninfectious cases, conservative treatment with rest, ice and NSAIDs are usually all that is necessary. If infection is suspected, your doctor may aspirate the fluid to test and confirm the diagnosis where surgical drainage may be necessary to clean out the infection if antibiotics aren’t effective. Most individuals in occupations or sports that cause repetitive stress to the knees can help prevent this condition by using kneepads and practicing activity modifications when working.

Quadricep Tendon Rupture

Quadricep Tendon Rupture Treatment and Surgery in Wayne & Paramus, NJ

A tear of the quadricep tendon, the large tendon that attaches the four quadricep muscles in the thigh to the top of the kneecap.

The quadricep tendon is the large tendon that attaches the four quadricep muscles in the thigh to the top of the kneecap (patella). Quadricep tendon tears are less common than patella tendon tears, but when they do occur they are seen most often in middle-aged adults who participate in physical activity like running or jumping sports. Tendon tears are classified as either partial or complete tears. A partial tear means that there are some fibers still connected to their points of origin. A complete tear, or rupture, of the quadricep tendon is a disabling injury where the tendon is split into two pieces. These injuries are often caused by an awkward landing from a jump where a heavy load is placed on the leg with the foot planted and the knee partially bent. There are also some disease states that can weaken the patella tendon leaving it at risk for tears. Examples include tendinitis, diabetes and chronic renal failure to name a few. Steroid use like chronic corticosteroids and anabolic steroid use have also been known to weaken tendons in the body. Whatever the cause for the tear, the symptoms are generally the same. Complete tears are accompanied by a tearing or popping sensation followed by pain, bruising and swelling to the knee. An inability to straighten the knee is a hallmark symptom of this injury. Because the tendon is no longer attached to the quadricep muscles, your kneecap may migrate towards the thigh and you may feel a sizable indentation at the top of the kneecap where the tear occurred. A thorough physical exam is often all that is necessary to make this diagnosis, but your doctor may order an x-ray to observe the location of the patella or an MRI to evaluate the extent of the tear directly. Very small partial tears are good candidates for a nonsurgical treatment approach. This is accomplished by a period of immobilization to allow the tendon to heal followed by a period of physical therapy to restore strength and range of motion of the knee. If the partial tear is larger or the tendon is completely ruptured, surgery is necessary to reattach the torn tendon to the top of the kneecap (See “Quadricep Tendon Repair” under the Treatments section for more information). This is done in either an ambulatory surgical center or a hospital setting. Recovery time for this type of injury can take approximately four months and up to one year for more severe injuries.

Patella Tendon Rupture

Patella Tendon Rupture Treatment and Surgery in Wayne & Paramus, NJ

A tear of the patella tendon, the tendon that attaches to the bottom of the kneecap and helps to straighten the knee.

The patella tendon is a large tendon that attaches to the bottom of the kneecap (patella) and the top of the shinbone (tibia); it works with the muscles and other tendons in the front of the thigh to straighten your leg. Tendon tears can either be a partial tear or a complete tear. A partial tear means that there are some fibers that are still connected to their points of origin. A complete tear, or rupture, of the patella tendon is a disabling injury where the tendon is split into two pieces. These injuries often require a very strong force to tear this large tendon. Some examples are direct falls to the front of the knee or landing with a very bent knee from a jump. There are also some disease states that can weaken the patella tendon, leaving it at risk for tears such as tendinitis, diabetes and chronic renal failure to name a few. Steroid use like chronic corticosteroids and anabolic steroid use have also been known to weaken tendons in the body. Whatever the cause for the tear, the symptoms are the same. Complete tears are accompanied with a tearing or popping sensation followed by pain, bruising and swelling to the front of the knee. An inability to straighten the knee is a hallmark symptom of this injury. Because the tendon is no longer anchored to the shinbone, your kneecap may migrate towards the thigh and you may feel a sizable indentation at the bottom of the kneecap where the tear occurred. A thorough physical exam is often all that is necessary to make this diagnosis, however your doctor may order an x-ray to observe the location of the patella or an MRI to evaluate the extent of the tear directly. Very small partial tears are good candidates for a nonsurgical treatment approach. This is accomplished by a period of immobilization to allow the tendon to heal followed by a period of physical therapy to restore strength and range of motion of the knee. If the partial tear is larger or the tendon is completely ruptured, surgery is necessary to reattach the torn tendon to the kneecap (See “Patella Tendon Repair” under the Treatments section for more information). This is done in either an ambulatory surgical center or a hospital setting. Recovery time for this type of injury can take six months or more for severe tendon injuries.

Knee Arthritis

Knee Arthritis Treatment and Surgery in Wayne & Paramus, NJ

Knee arthritis is a common condition where the protective cartilage in the knee joint is worn down and the protective space between the bones decreases.

Knee arthritis is a common condition where the protective cartilage in the knee joint is worn down and the protective space between the bones decreases. This results in bone rubbing on bone, producing irritation and painful bone spurs. The most common type of arthritis is osteoarthritis, caused by chronic wear and tear of the joint. Rheumatoid arthritis is an autoimmune disease where the immune system attacks normal tissue and often effects multiple joints in the body. Posttraumatic arthritis develops after an injury to the knee where change to the joint surface can have long term arthritic effects. Symptoms of knee arthritis include pain and swelling to the knee joint, stiffness, weakness, and a grinding or locking sensation. This diagnosis is often made in our office with a thorough physical exam and x-rays. There is no cure for arthritis and therefore treatment is centered around symptom relief often in the form of lifestyle modifications, physical therapy, NSAIDs, braces and/or cortisone injections. In cases of rheumatoid arthritis, immunosuppressant medication may be prescribed. We also offer hyaluronic acid injections (i.e. Synvisc, Orthovisc) to help alleviate knee arthritis symptoms; these injections are a viscous gelatinous substance that helps increase lubrication in the joint. If conservative treatment does not help and daily living is affected, a partial or total knee replacement (arthroplasty) may be indicated. Please see our “Treatments” section for more information on knee arthroplasty.

Baker’s Cyst

Baker’s Cyst Treatment and Surgery in Wayne & Paramus, NJ

A Baker’s cyst is a swelling at the back of the knee caused by outpouching of the normal synovial fluid found in the knee joint.

A Baker’s cyst, also known as a popliteal cyst, is a swelling at the back of the knee caused by outpouching of the normal synovial fluid found in the knee joint. They are usually visible as a soft bulge behind the knee and are more prominent when standing. Normally, these cysts do not cause symptoms and are nontender. However, knee stiffness or pain can occur especially when the knee is in full extension. Knee arthritis is the most common cause of Baker’s cysts, but these cysts can also occur when associated with injury to the knee such as meniscal tears. These cysts usually do not need any formal treatment, especially if they do not cause any discomfort. If the cyst is associated with pain and discomfort, your doctor may perform an ultrasound-guided aspiration to drain the cyst. Sometimes just draining the cyst is not a definitive treatment, and these cysts can recur. In these cases, a more formal surgical approach may be indicated to completely resolve the source of the cyst (i.e. knee arthroscopy, please see “Knee Arthroscopy” under our Treatments section for more information on this). It is not uncommon for a Baker’s cyst to rupture on its own, leaving a painless bruising under the skin usually seen down at the level of the ankle.

 

Collateral Ligament Injuries

Collateral Ligament Injuries - Treatment and Surgery in Wayne & Paramus, NJ

The collateral ligaments of the knee are the MCL (medial collateral ligament) and the LCL (lateral collateral ligament).

The collateral ligaments of the knee are the MCL (medial collateral ligament) and the LCL (lateral collateral ligament). These ligaments are found on the sides of you knee joint — the MCL connects the thighbone (femur) to the shinbone (tibia) whereas the LCL connects the thighbone (femur) to a smaller bone in the lower leg (fibula). These ligaments together control sideways motion and brace the knee against unusual movement. Injuries to these ligaments are graded where a Grade 1 Sprain is a mild injury and a Grade 3 Sprain is a complete tear. These injuries are often caused by unusual sideways force to the knee. The MCL is more commonly injured than the LCL, usually from blows to the outside of the knee forcing the knee inwards. Pain, swelling and instability are the predominant symptoms associated with these injuries. A thorough physical exam will help make this diagnosis, but an MRI may be obtained to visualize the extent of the injury. MCL injuries rarely require surgery and are often treated with rest, ice, NSAIDs, bracing and physical therapy. If the collateral ligaments are torn in a way that does not promote healing or in conjunction with other ligamentous injuries, reconstructive surgery may be indicated. Progressive rehabilitative therapy will be an important part of the recovery process.

Meniscus Tear

Meniscus Tear - Treatment and Surgery in Wayne & Paramus, NJ

Injury to the meniscus, which is a wedge-shaped cartilage disc in the knee that cushions and absorbs shock.

The meniscus is a wedge-shaped cartilage disc in the knee that cushions and absorbs shock between the femur (thighbone) and tibia (shinbone). Meniscus tears can occur acutely from direct contact or a twisting injury, or they can occur due to degenerative changes over time. Symptoms include pain, swelling, stiffness, a catching or locking sensation, weakness, or a “giving way” sensation. Your doctor can often make this diagnosis in the office but may order some advanced imaging such as an MRI to visualize the location and extent of the tear. Conservative treatment typically consists of the RICE protocol (rest, ice, compression, elevation), NSAIDs and/or physical therapy. If your symptoms persist or the knee is unstable, surgical intervention to either debride or repair the affected meniscus may be necessary. See our “Treatments” section for more information.

Patellofemoral Syndrome

Patellofemoral Syndrome - Treatment and Surgery in Wayne & Paramus, NJ

Patellofemoral syndrome, aka “runner’s knee”, is a painful condition affecting the front of the knee.

Patellofemoral syndrome, aka “runner’s knee”, is a painful condition to the front portion of the knee. Often this condition occurs in young adults who participate in regular activity like sports or running, but pain to the anterior portion of the knee can occur in older individuals and nonathletes as well. Usually this is caused by overuse of the knee and/or problems with the alignment of the kneecap. Pain to the front of the knee is often the most common symptom. Pain with this condition often occurs during activity, especially activity involving repeatedly bending the knee or after prolonged sitting. Your doctor will do a thorough exam to determine if this diagnosis is due to overuse or kneecap malalignment. Conservative treatment is recommended as first-line therapy. This includes the RICE protocol (rest, ice, elevation, compression), NSAIDS, and lifestyle medications and physical therapy. Sometimes arthroscopic surgery may be needed to in cases where the kneecap is misaligned. Prevention is key to avoid patellofemoral syndrome — wearing appropriate footwear when participating in activity, stretching before and after exercise, and maintaining a normal body weight to avoid stress to the knees are all effective preventative measures.

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