Knee Injuries & Knee Surgery

Dr. O'Donnell treats the knee injuries that stop athletes and the wear that stops everyone else: ACL and MCL tears, meniscus tears, cartilage injuries, patellar instability, patellofemoral pain, quadriceps and patellar tendon ruptures, tibial plateau fractures and knee arthritis. His patients include University of Miami athletes, weekend soccer and basketball players, and adults in Coral Gables and Miami whose knee swells after a walk or gives way on stairs.

The first visit sorts the knee by mechanism and findings. A pop with rapid swelling after a pivot is an ACL tear until proven otherwise; a knee that locks has a displaced meniscus fragment; a knee that cannot straighten against gravity after a fall has a torn extensor tendon. Exam tests such as the Lachman, pivot shift and McMurray, weight-bearing X-rays and, when the result would change treatment, an MRI settle the diagnosis. Most knees are rehabilitated first: degenerative meniscus tears, patellofemoral pain, MCL tears, early arthritis and first-time kneecap dislocations do well with a structured program and, where needed, an ultrasound-guided injection. When surgery is the right choice, Dr. O'Donnell works arthroscopically wherever possible: ACL reconstruction, usually with a quadriceps tendon autograft for athletes, meniscus repair in preference to removal whenever the tissue can heal, cartilage restoration for focal defects, and MPFL reconstruction for recurrent patellar dislocation. Tendon ruptures and displaced fractures are repaired within days. Bone-on-bone arthritis is treated with partial or total knee replacement.

Every patient rehabilitates on Dr. O'Donnell's written protocols, which advance brace, weight bearing, running and return to sport on strength and hop criteria. Arthroscopic procedures are outpatient at Bayside Surgery Center; patients outside South Florida can upload imaging through mymedicalimages.com and arrange telemedicine consults and post-operative visits.

When to see a specialist

A knee that is sore after a long run or a hard match usually settles within a week or two. The following signs point to a structural injury and should be examined the same week:

• A pop at the moment of injury followed by swelling within a few hours
• The knee locking, so it cannot fully straighten, or catching with a sharp pain
• Giving way, buckling or a feeling the knee will not hold when cutting, landing or descending stairs
• Inability to straighten the knee against gravity or lift the heel off a bed after a fall, or a visible gap above or below the kneecap
• The kneecap visibly out of place, or a feeling it slipped and went back
• Inability to bear weight after an injury, or a knee that is hot, red and swollen without an injury, which needs same-day assessment

How Dr. O'Donnell decides between rehab and surgery

The deciding question is whether the injured tissue can heal in place and whether the patient needs the function it provides. An ACL tear does not heal, so reconstruction is recommended for anyone returning to cutting and pivoting sport, and for anyone with recurrent instability or a repairable meniscus tear; a patient who will stay with straight-ahead activities can be treated with rehabilitation alone. Reconstruction is scheduled 2 to 6 weeks after injury, once swelling has settled and motion is back, because operating on an inflamed knee produces stiffness.

A meniscus tear is decided on the tear, not the symptoms alone: a tear in the vascular outer zone in a younger patient is repaired, a degenerative tear without locking gets 6 to 12 weeks of therapy that matches surgery in trials, and a locked knee is treated promptly. Arthritis is managed with load changes, strengthening, bracing and injections for as long as they work; replacement is offered when the X-ray shows bone on bone and the knee limits walking, work or sleep. Arthroscopy has almost no role in an arthritic knee.