Naples Orthopedic Surgeon - Dr. Robert J. Zehr » Knees

Surgery on torn ACL may be needed to protect the joint

admin — Thu, 29 Jul 2010 14:00:42 +0000

My 21-year old daughter hurt her knee when she slipped and fell on some ice. The doctor says the ACL is torn and she needs surgery to protect the joint. Protect it from what?

There are some studies that show patients are at greater risk for knee re-injury after anterior cruciate ligament (ACL) tears if the damage isn’t repaired. The most common injuries later are meniscus and joint cartilage tears.

If the joint cartilage is damaged, the bone underneath is unprotected. Wear and tear can cause damage to the bone. Painful arthritis can develop much later.

A recent study of over 6,000 adults confirmed these beliefs. Patients who didn’t have an ACL repair and opted for conservative care were twice as likely to injure the meniscus later and 30 percent more likely to damage the joint cartilage.

For more information on this subject, call The Zehr Center for Orthopaedics at 239-596-0100 or visit www.zehrcenter.com.The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

Tissue grafts often used to repair torn ACL

admin — Mon, 26 Jul 2010 14:00:19 +0000

I’m going to have an ACL repair using my own patellar tendon as the graft. What can you tell me about this kind of graft?

There are many different kinds of tissue grafts that can be used to repair a torn or ruptured anterior cruciate ligament (ACL). The bone-patellar tendon-bone (BPTB) is called the “gold standard.” It’s used the most with the best results.

The graft is made up of the middle third of the patellar tendon and a piece of bone on either end. The bone is taken at one end from the kneecap and at the other end from the lower leg bone (tibia).

This graft works well because the patellar tendon has a high strength and stiffness. The bone plugs make it possible to get a good solid hold with screws to keep it in place. The graft seems to take hold quickly.

There are a few problems with the BPTB. Some patients have pain and swelling where the graft is taken from. It can be very difficult to kneel. Other patients report numbness, most likely caused by damage to a branch of the saphenous nerve. Loss of quadriceps muscle strength and even fracture of the patella are also possible problems.

Do you need resurfacing before knee joint replacement?

admin — Wed, 21 Jul 2010 14:10:59 +0000

What is selective resurfacing? I know it has something to do with knee joint replacements.

The knee joint consists of three parts: the knee cap (patella), the femur (thigh bone), and the tibia (lower leg bone). A knee joint replacement is done when arthritic changes cause pain, swelling, and loss of knee function.

Arthritic changes occur inside the knee joint as well as behind the patella. The patella may need to be resurfaced for a successful joint replacement. This means a metal or plastic backing is added to the patella. This helps it ride smoothly over the other parts of the implant when the knee moves.

Not every patient needs patellar resurfacing. Doctors decide whether or not to do this when they look at the back of the patella during the operation. The doctor looks at the shape of the patella and the condition of the cartilage when making this decision.

Selective resurfacing refers to the fact that not all patients have the patella resurfaced, only those who need it based on the surgeon’s exam.

Scar tissue needs to be desensitized

admin — Fri, 16 Jul 2010 14:00:13 +0000

I have a knee joint replacement that is fully healed but the scar is still tender. It keeps me from kneeling down to get things. Is there any way to overcome this problem? Perhaps some kind of cream to toughen up the scar?

Actually, there is a series of desensitization activities you can perform to help with this problem. A physical or occupational therapist can get you set up with a home program to do this on your own.

The therapist will show you how to massage the scar using vitamin E oil. Then you will be rubbing different things across and along the scar. At first even soft materials can seem painful. Firm pressure will help to start. Over time lighter contact is possible. You’ll also be able to change from soft to firm to rough materials. Each one will be used with firm pressure gradually applying light pressure.

A clean roller like what you see on a bottle of deodorant will also be used to help desensitize the area. The roller is pressed across and along the scar tissue just like the other materials. You can expect to be given a packet of items to use daily (or more often as your schedule allows). It usually only takes a few days to a few weeks to desensitize painful scar tissue.

Will arthroscopic surgery solve problems with knee arthritis?

admin — Tue, 13 Jul 2010 14:00:11 +0000

I have some mild, but painful arthritis in my left knee. I’m thinking about having arthroscopic surgery done. The doctor wants to take a look inside and smooth out any rough edges. Will that take care of the problem?

Short-term results (six months to two years) after arthroscopic surgery for mild to moderate arthritis are good. Reports show at least 75 percent (three-fourths) of all patients get better. The have less pain and more function.

After three years, only half the patients stay pain free. Those with rough cartilage behind the knee cap (a condition called chondromalacia) often have return of painful symptoms. Patients who are overweight have pain much more often than patients of normal weight.

Patients with mild degenerative changes but no arthritis who aren’t overweight have the best results with arthroscopic surgery.

Doctor exam as good as MRI in diagnosing ACL injury?

admin — Thu, 08 Jul 2010 14:30:45 +0000

My 17-year old son tore his ACL playing soccer. The doctor told us it was torn before the MRI confirmed it. Why did we need the expensive MRI test if the doctor already knew what was wrong?

Magnetic resonance imaging (MRI) has become the standard test for knee injuries. But you’re right about the expense. One study stated that MRI is equal in cost to a doctor’s exam only if the cost of the MRI is less than $250.00. MRIs can cost much more than that.

The pendulum is now swinging back the other way. Studies show a doctor’s exam is just as good as an MRI . . . most of the time. This assumes the doctor is well-trained in evaluating knee injuries.

An MRI does offer some information to help the doctor direct treatment. The MRI can show where the cartilage (meniscus) or ligament (ACL) is torn and how large the tear is. This helps in deciding between rehab and surgery. This information can be very helpful with elite athletes trying to get back on the field.

Arthroscopic exam finds torn ACL that MRI missed

admin — Fri, 02 Jul 2010 14:37:11 +0000

I had a bike accident and went to the emergency department for an exam. The doctor didn’t find anything wrong with the knee on the MRI, so I went home. Two weeks later I still had swelling and pain so I saw an orthopedic surgeon. I had an arthroscopic exam that showed a torn ACL. How is that possible?

You probably had what’s called a false-negative. In other words, the MRI didn’t show anything wrong when there really was something torn. There are several things that could cause this.

First, the level of MRI technology makes a difference. Low field scanners are used in the doctor’s office for a quick look. They are less expensive and immediately available, but not as accurate as the more traditional MRI equipment.

A false-positive can also occur if the patient moves during the MRI. It’s possible to strain a ligament and then later re-injure the knee causing a tear to occur. In such a case, the MRI taken at the time of the first injury would be negative. A true positive might be found if a second MRI instead of arthroscopy was done after the second injury.

In your case you went from an MRI to arthroscopy. This is the normal sequence of tests when trying to diagnose an injury.

Obesity a factor in failed knee replacements

admin — Tue, 29 Jun 2010 11:50:16 +0000

My brother-in-law is very overweight. His knees are bad but he refuses to lose weight. He says he’ll just have them replaced when they wear out. Is it really that simple?

The rising cost of health care has taken “simple” out of almost every picture today. Obesity is linked with degenerative disease of the hips and knees. A high body weight is also linked to a poor result after the joints are replaced.

A recent study at The Good Samaritan Hospital in Baltimore, Maryland compared total knee replacements (TKRs) in obese and nonobese adults. The patients all got the same joint implant (one that has been used successfully for many years).

Results were reviewed after five years. Being overweight had a negative impact on the success rate of TKRs. More implants failed in the obese group than in the nonobese group. Obese patients with failed implants had lower satisfaction rates.

There are improved medical treatments for obesity today. Encourage your brother-in-law to see his doctor and find out what are his options. He may be able to at least improve his health before his knees wear out and he faces the risks of surgery.

Exercising on your own after total knee replacement surgery

admin — Thu, 24 Jun 2010 12:31:41 +0000

I had a total knee replacement six months ago. After physical therapy in the hospital, I had more therapy at home. Now I’m doing my own exercises everyday. How long should I keep this up?

It might be time for a follow-up visit with your doctor or therapist. Tests of motion, strength, balance, and coordination can guide you. Patients exercising on their own can still show major weakness even years after a total knee replacement. This can put you at risk for falls and other injuries.

Every person is different and has his or her own unique needs for rehab after joint replacement. A closer look at what you’re doing and how you doing can lead to an answer to your question.

It’s likely that some form of exercise will be advised. Regular exercise and physical activity has been shown to keep joints healthy, even joints already affected by arthritis. Make it worth your while to exercise. Find out what’s best for you in this phase of your recovery.

Source of knee pain best discovered by MRI

admin — Mon, 21 Jun 2010 11:42:36 +0000

I am only 48 years old, but I have severe knee pain from years of running marathons and participating in triathlons. The first doctor I saw took an X-ray and said there’s some narrowing of the joint space, but nothing to worry about. Would an MRI (magnetic resonance imaging) show anything else the X-ray didn’t show?

For years doctors have used X-rays to help diagnose osteoarthritis (OA). Recently, researchers have started to call this practice into question. An X-ray reading of the joint may not be valid in predicting pain and function. In other words, the joint looks fine but the pain is very limiting all the same.

More and more doctors are using MRIs to find OA. MRIs can image cartilage and soft tissues. The more the doctor knows about the soft tissues involved, the more direct and specific treatment can be.

Ask your doctor about having an MRI. You may be a good candidate.