Knie-artrose

Fietsen verstandig?

Feit

Bij hardlopen wordt de knie belast met 6x uw lichaamsgewicht bij elke stap

Máxima Medisch Centrum

Value-Based Health Care

ESSKA Accredited Teacher

Orthopedie Groot Eindhoven

Goede uitleg is essentieel voor juiste keuze behandeling

Meniscus-scheur

Voorste kruisbandreconstructie

Achterste kruisbandletsel

Zorg op maat

YouTube kanaal dr RPA Janssen

Internationaal wetenschappelijk onderzoek

Kruisbandoperaties knie

RPA Janssen MD PhD

Kruisbandoperaties

Waardegedreven zorg

Last van knie-artrose?

Spreekuur / Policlinique / Outpatient clinic

Nederlandse Vereniging voor Arthroscopie

Máxima Medisch Centrum

Kruisbandoperaties bij kinderen

Veel pijn bij ernstige knie-artrose?

Samen met uw arts gekozen voor een knie-operatie?

Eenzijdige knie-artrose knie en actief leven?

Máxima Medisch Centrum Eindhoven-Veldhoven

Kwaliteit van leven

Samen kiezen voor de beste behandeling

Sporten met plezier

Oplossingen voor de lange termijn

Associate Professor Knee Reconstruction

Fact

Kneecap pain is a regular occurrence in fitness knee rehabilitation

Knee osteoarthritis

Cycling wise?

Fact

When running, the knee is loaded with 6x your body weight with each step

Arthroscopic partial meniscectomy versus physical therapy for traumatic meniscal tears in a young study population: a randomised controlled trial

Abstract OBJECTIVE: To compare outcomes from...

Sabine J A van der Graaff, Susanne M Eijgenraam, Duncan E Meuffels, Eline M van Es, Jan A N Verhaar, Dirk Jan Hofstee, Kiem Gie Auw Yang, Julia C A Noorduyn, Ewoud R A van Arkel, Igor C J B van den Brand, Rob P A Janssen, Wai-Yan Liu, Sita M A Bierma-Zeinstra, Max Reijman
British Journal of Sports Medicine. E-pub ahead of print - 8 Jun 2022. http://doi.org/10.1136/bjsports-2021-105059
read more

A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis

Abstract Purpose: To evaluate the effectiveness...

T. Rietbergen, P.J. Marang-van de Mheen, J. de Graaf, R.L. Diercks, R.P.A. Janssen, H.M.J. van der Linden-van der Zwaag, M.E. van den Akker-van Marle, E.W. Steyerberg, R.G.H.H. Nelissen, L. van Bodegom-Vos (Corresponding author), P. Pander, D.J. Hofstee, R.C.I. van Geenen, K.L.M. Koenraadt, J. P.A.H. Onderwater, Y. V. Kleinlugtenbelt, T. Gosens, T.V.S. Klos, P. C. Rijk, B. DijkstraShow lessA.V.C.M. Zeegers, R.A.G. Hoogeslag, M.H.A. Huis in't Veld, A.A. Polak, N.R. Paulino Pereira, T.M.J.S. Vervest, H.C. van der Veen, N. Lopuhaä
Knee Surgery, Sports Traumatology, Arthroscopy, E-pub ahead of print - 7 Apr 2022. https://doi.org/10.1007/s00167-022-06949-w
read more

Medial Collateral ligament (MCL)

Distortion of the knee may lead to instability on the medial side of the knee. This ligament is often referred to as medial collateral ligament (MCL). MCL instability can cause limitations in activities of sports and daily life. An early diagnosis of MCL instability is important because the MCL can heal, if treated adequately. On this webpage, you will read information on the MCL, MCL lesions, treatment and rehabilitation.

Anatomy

The knee joint is the articulation between the femur and tibia. Bone is covered by cartilage to allow smooth knee motion. The inner (medial) and (outer) lateral meniscus are situated between the femur and tibia as shock absorbers (see Information Meniscus). The medial and lateral collateral ligaments as well as the cruciate ligaments provide stability of the knee joint. The medial structures of the knee (often referred to as MCL) are composed of various components that are responsible for the collateral stability of the medial side of the knee.

Medial knee injuries

A sudden sideways movement of the knee can lead to injury of the MCL. This is often caused by trauma to the knee and sports injuries. Symptoms are pain on the inside of the knee and a feeling of giving way, sometimes accompanied by hematoma. MCL lesions occur in all age groups. They are often accompanied by other knee injuries such as meniscal tears and  cruciate ligament injuries.

Treatment

A correct diagnosis is important for treatment, rehabilitation and prognosis for (sports) activities in the future. MCL lesions are categorized in 3 types: MCL grade 1 injury is characterized by merely pain on the medial side of the knee without instability. These lesions heal spontaneously with rest in 4-6 weeks. In case of MCL grade 2 injury, there is moderate instability of the medial side of the knee. MCL Grade 3 lesions show severe instability of the knee. Scientific research has demonstrated that MCL grade 2&3 injuries heal very well if diagnosed early and treated adequately with a knee brace. Treatment is depending on the time interval between the knee injury and diagnosis.

Early diagnosis

If diagnosed within 2 weeks after the knee injury, MCL grade 2&3 lesions are treated with a prescribed knee brace for 6 weeks. This brace can be provided at the Orthopaedic Center Máxima on weekdays, after referral by your general physician (huisarts). The brace needs to be worn 24 hours per day. You can walk and cycle with the brace as it allows full knee range of motion. In the shower, it needs protection by a sealing bag. After 6 weeks, the brace is removed and the knee stability examined at the outpatient orthopaedic clinic. If the MCL has healed adequately, you may return to sports activities.

Late diagnosis

If diagnosed after 2 weeks, MCL grade 2&3 lesions have a tendency to heal less. Brace treatment may be attempted within 4 weeks after the injury. Thereafter, there is a risk of chronic MCL instability.

Wearing a knee brace with sports activities may compensate chronic MCL grade 2 injuries. Chronic MCL grade 3 injuries cause limitations in activities of sports and daily life. In these cases, a surgical reconstruction is recommended to restore medial knee stability.

Anatomical medial reconstruction

Scientific research has shown that chronic MCL grade 3 injuries are best treated with an anatomical MCL medial reconstruction of the knee (technique by Prof. R. LaPrade, M.D. PhD). The two main structures of the medial side of the knee are reconstructed with autograft (if available) or allograft tissue.  The new ligaments are fixed in bone tunnels in femur and tibia. RPA Janssen, M.D. is an instructor at annual (inter)national courses to teach the latest surgical techniques of knee ligament reconstructions (see Biography).

After the operation

Hospital stay is 2-3 days. The day after surgery, the physiotherapist will give you knee instructions as well as teach you how to walk with two crutches. You need to limit weight bearing on the operated knee for 6 weeks. During this time, thromboprophylaxis is prescribed. A removable brace is provided for 6 weeks. Knee exercises are important which will be explained to you and can be done at home and at the physiotherapist’ office. You may start with physiotherapy the week after the operation. Patients from the Netherlands are referred to my practice for knee ligament reconstructions. A standardizes protocol can be downloaded for the physiotherapist close to your house (download protocol MCL reconstruction – in Dutch). A referral for your physiotherapist is provided at time of hospital discharge. It is recommended to raise the operated leg a few times a day for periods of 15 minutes to limit swelling of the leg. A hematoma may occur during the first week after the operation, this is normal and will disappear within 2 weeks. The first outpatient clinic appointment is after 2-3 weeks. The skin sutures are absorbable and will disappear automatically after a few weeks.

Work and sports

Rehabilitation time after anatomic medial reconstruction of the knee takes 6-12 months. You may resume an office job between 2 to 4 weeks after surgery. Heavy labor may be undertaken after 8-12 weeks. These are general guidelines: it may take shorter or longer depending on knee swelling and pain. Driving a car is not allowed if you walk on crutches (till first appointment). You may cycle on a home trainer after 4-6 weeks.  Jogging is usually possible after 12 weeks if swelling and pain are limited. Return to pivot sports is possible after 6 months. Recent scientific research has demonstrated that return to sports activities is related to the knee cartilage condition as well as other possible knee injuries.

Insurance reimbursement

All orthopaedic treatments at our hospital are reimbursed by Dutch insurance companies.

Complications

Complications after anatomic medial reconstruction are rare: wound disorders, infection, thrombosis, vascular or nerve injuries and arthrofibrosis (scarring of the knee). These complications occur in <1% of patients.

Please contact the hospital:

  • if there is discharge from the wound
  • if the knee becomes red and pain increases
  • in case of fever >38.5º C
  • if there is severe swelling and a painful calf.