Knee creaks after ACL repair. Is this normal?

June 22nd — admin

I had an ACL repair done about 18 months ago. The knee works fine but it creaks and cracks a lot when I move it. Is this normal?

You may be describing what’s called crepitus. This sound or feeling occurs when the back of the kneecap grates against the bone. This finding is more common before the ACL repair is done rather than afterwards.

Any snaps, clicks, crepitus, or joint sounds should be reported to the surgeon. The same goes for locking or giving way of the knee joint. Crepitus or similar sounds could occur when the extensor mechanism of the quadriceps muscle isn’t working quite right. This can occur when scar tissue forms or if the tendon has been shortened too much.

The doctor will be able to tell the difference between sounds caused by scar tissue and those caused by cartilage rubbing against bone. There may be some treatment that can help you. It’s not a normal sound and should be taken care of before it gets worse.

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.

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Why didn’t new treatment for torn ACL work?

May 24th — admin

I tried a new treatment for a partially torn ACL in my left knee. The doctor used radiofrequency waves to heat it up and shrink it down. It didn’t work. My joint is still too loose. What went wrong?

There are many factors that could cause a failed treatment of this type. The exact shrinkage that takes place depends on how much heat is applied and for how long. Not enough heat may not shrink the collagen fibers. Too much heat can actually kill the tissue, a condition called heat necrosis.

The extent of the damage before treatment is important, too. For example larger tears are less likely to respond to this treatment and more likely to tear again. Smaller tears may respond better but studies show long-term results (five years later) aren’t successful. The collagen shrinkage doesn’t hold, and the ligament becomes lax again.

You may be better off having a surgical repair. There’s less chance for reinjury and degenerative changes in the joint. Talk to your surgeon about treatment options at this point in your recovery.

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.

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Will wearing a knee brace prevent an ACL tear?

May 19th — admin

I think I might be prone to knee injuries. Would wearing a knee brace during volleyball practice help prevent an ACL tear?

Anterior Cruciate Ligament (ACL) injuries are a problem for many athletes in noncontact sports. Volleyball players are at increased risk because of the landing, turning, and pivoting required. Female athletes are up to eight times more likely to injure the ACL compared to male athletes.

Many studies have been done trying to find out the specific cause and ways to prevent ACL tears. Researchers have looked at weather conditions, playing surface, and footwear. They’ve examined hormonal differences between boys and girls. They’ve compared anatomy from head to toe as a possible reason for differences in the rates of ACL injuries between the sexes.

So far no single factor has been linked to ACL injuries. Bracing hasn’t been proven to prevent knee injuries either. Balance training and improving the joint’s sense of position seem to have the best record so far in preventing these types of knee injuries.

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.

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If torn ACL is not repaired, will a total knee replacement be required?

May 16th — admin

I’ve been told if I don’t have my torn ACL repaired I could end up with a total knee replacement. Is that true?

Well, there’s some truth to your statement but there are many factors in between those two points. First it depends on how severe the damage is to your anterior cruciate ligament (ACL). A minor tear can be treated with rehab. This is especially true if you’re not an athlete or exercising at intense levels.

Studies do show a tendency toward cartilage damage in unstable knees. This means the ACL is deficient and not doing its job. The joint slides around more than it should, putting stress on the meniscus and other joint cartilage. Under the increased load, wear and tear on the meniscus could end up in a tear.

Only one study has been done that shows the need for a total replacement (TKR) after ACL injury without repair. A small group of olympic athletes in the former East Germany were treated without surgery and returned to training. Doctors followed them 35 years later and found out that all of them had a torn meniscus. Half had a total knee replacement.

Long-term studies of everyday average people with an unrepaired ACL have not showed these kinds of results. They do report an increased pattern of osteoarthritis in the unstable (unrepaired) knees. The risk of a TKR is present but not a certainty.

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.

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Numbness a common result of ACL reconstruction surgery

December 3rd — admin

I’m an exercise leader at the YMCA. Six months ago, I had an ACL repair. Despite a daily workout routine, there’s still some noticeable weakness on that side. I also have a patch of numbness that really bothers me. When will these get better?

Six months after an ACL repair is about the time most people start to see a return to more normal function. Of course, this depends on the patient’s age, overall health, and physical condition.You should be seeing a gradual improvement in strength and motion. If not, you may have left out an important part of the rehab process. A physical therapist can help you sort this out. The numbness is not uncommon. Almost all patients have some amount of numbness. This is because the nerve below the kneecap isn’t in the same place for everyone. There’s great variation in the location of the branches off the main nerve. In order to complete the surgery, doctors must cut through this area. The loss of sensation is most likely going to be permanent. After 18 months, any changes in sensation are probably permanent. This damage doesn’t affect the function of your knee. It’s just annoying to many people.

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.

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No way to relieve knee pain from neuroma

November 4th — admin

Eighteen months ago, I had the anterior cruciate ligament (ACL) of my right knee repaired. The operation was done by removing a piece of tendon from my kneecap and using it to replace the torn ACL. Since that time, I’ve developed knee pain and a neuroma. What causes this?

A neuroma is a benign tumor made up of nerve cells. Benign means it’s not cancerous and not dangerous. It can be, however, quite painful. The most common cause of this type of neuroma is direct injury to the nerve. When the tendon was harvested from your knee, the nerve was most likely cut. This is a common problem with this operation. Knee pain prevents the patient from kneeling or moving around on the knees. Once it happens, there isn’t much that can be done. Prevention is now possible with an alternate method of operation. This uses the tendon from behind the knee instead of the front.

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.

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Is donor site weaker after tendon graft?

November 1st — admin

When a piece of tendon is removed and used to replace a torn tendon, is the donor site weaker?

The most common use of tendon graft is to repair the anterior cruciate ligament (ACL) in the knee. Donor tissue can come from the hamstrings tendon behind the knee or from the patellar tendon just below the kneecap.In either case, the doctor uses a special tool to harvest the tissue. This is called a tendon stripper. This device helps the doctor remove just the right amount and shape of tissue. The gap in the donor tendon is closed using absorbable stitches.The patient must be careful not to overstress this site during healing. This usually takes around six weeks. It’s about the same amount of time needed to heal the graft site. After that, strength returns to normal as the patient rehabs the knees from the original injury.

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.

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Still limping after an ACL repair?

September 22nd — admin

I had an ACL repair nine months ago. I don’t have any pain but I still seem to walk with a slight limp. I can’t figure this out. What could be causing it?

It takes many patients up to a year or more to return to a normal walking pattern after ACL repair. Researchers aren’t sure why there’s such a slow return. It could be patients change the way they walk early on to avoid pain. Then the pattern is hard to break.

There may be slight changes in how the knee functions as a result of the surgery. Most ACL repairs are done with donor tendon from either the patellar tendon or the hamstring tendon. Problems with the donor site can make a difference.

A recent study from Australia found slight changes in knee motion based on the type of ACL graft used. With the hamstring tendon graft the knee had less knee extension when walking. Patients with patellar tendon grafts had less knee flexion.

Check with your doctor and physical therapist for their assessments. Watching you walk, measuring your motion, and checking the internal movements of the joint may help them pinpoint the problem and a solution.

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.

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Method of repairing ACL may affect gymnast’s future

September 17th — admin

My 14-year old daughter is a gymnast with a bad knee. She needs an ACL repair before she can continue competing. We know there are two different ways to fix the ACL. Is one method better than the other for a gymnast?

ACL repairs are done using a tendon graft from either the patellar (knee) tendon or the hamstring tendon. Which choice is better is a topic of ongoing debate and the subject of many studies.

We do know the patellar tendon graft makes it difficult for the patient to kneel on that side. This could make a difference depending on your daughter’s event(s). Patients who hop and land on one leg have a little more trouble when the patellar tendon graft is used. This may be something to consider for many gymnastic events.

Make sure the surgeon is aware of your daughter’s plans to return to gymnastics. The type of surgery and rehab program may be based on her long-term goals to compete.

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.

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Tissue grafts often used to repair torn ACL

July 26th — admin

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.

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.

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