I’m experiencing arthritis in my ACL repair. Is this normal?

February 10th — admin

I had an ACL repair about 10 years ago. I was able to return to competitive sports but now I found out I’m starting to get arthritis in that knee. I guess I thought the knee would be better than ever. Does this happen to everyone?

Any major trauma or injury to the joints seems to be linked with osteoarthritis later on. Studies show that about 10 percent of the patients who have an anterior cruciate ligament (ACL) repair later show signs of arthritis.

At first there is a narrowing of the joint space seen only on X-ray. The patient usually doesn’t have any symptoms yet. Athletes are more likely to start seeing some changes about 10 years after the injury. The problem is delayed in less active adults until closer to age 40 or even 50.

Type of injury and type of surgical repair may make a difference. Patients who had a meniscal tear and an ACL tear at the same time had earlier onset of arthritis than patients who just had an ACL tear. There are fewer cases (four percent) of arthritis in patients who have the ACL repaired with a hamstring tendon graft. This is compared with 18 percent for patients receiving a patellar tendon graft.

So all in all, a small number of folks develop arthritis. There’s probably a combination of risk factors that result in this group having problems while others don’t seem to develop arthritis until older age.

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 a 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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About 10 years ago I had ACL surgery. Now, all of a sudden, I’m having painful grinding in the joint. What’s happening?

January 27th — admin

About 10 years ago I had an ACL repair. Everything’s been just fine and now all of a sudden, I’m having painful grinding behind my kneecap and in the joint. What’s happening?

Researchers at the Steadman-Hawkins Research Foundation in Vail, Colorado have been researching this very problem. They noticed some of their ACL patients were just fine for 10 years — a perfect outcome. Then all of a sudden, they developed arthritis.

They think the problem may be a lack of mobility between the patellar tendon and the tibia (lower leg bone). A condition referred to as patella infera may be part of the problem. With patella infera, there is a permanent shortening of the patellar ligament. The kneecap sits too low in relation to femur (thighbone). The result can be a severely limited range of motion of the knee joint.

Patella infera is a common complication of injury or surgery to the knee joint. It usually doesn’t show up until much time has passed after injury and/or surgical repair.

Treatment options include physical therapy to manually release the kneecap and/or surgery to revise the soft tissues around the knee. If the joint degeneration has gone too far for conservative care to be successful, then total knee replacement may be needed.

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 a 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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After ACL surgery, my doctor doesn’t think my motion is returning fast enough. What should I do differently?

January 25th — admin

I had an ACL repair a week ago. The doctor doesn’t think I’m getting my motion back fast enough. What should I do differently?

Motion and mobility after ACL repair is a key factor in the long-term success of the operation. Studies show that without good motion, the joint is compressed and wears out faster. Ten years down the road, the patient develops degenerative arthritis and the ACL repair looks like a failure.

Patellar mobility (kneecap motion) is a key factor in regaining overall knee motion. It is always advised to get your motion back before you start strengthening exercises.

Your physical therapist or surgeon can assess patellar motion and teach you how to manually move it side to side, up and down, and along the diagonal planes of motion. This type of motion will help prevent scarring from occurring between the patellar tendon and the tibia and between the patella and the tibia.

Without an 80 percent return of motion early on, there’s a good chance another operation will be needed to release adhesions in the joint. You should have full motion by the end of six weeks. The right rehab program must match the type of surgery you had while regaining motion. Strength training comes after joint mobility is restored.

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 a 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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Donor tissue for ACL repair – which leg?

September 9th — admin

Should I have my ACL repair done using donor tissue from the same leg or the other leg? Which is better?

There may not be an easy, straightforward answer to this question. Let’s go over some of the considerations.

If the tendon graft is taken from the same leg, then only one leg is affected. The patient can shift the weight off that leg during the early days after the surgery.

Repairing the knee with donor tissue from the other leg means both sides are affected. There have been a few cases reported of problems developing from overload of the donor side.

This is more likely during the first 24-hours when the patient is still under the influence of anesthesia and drugs to limit pain. Without complete sensation, the patient can put too much load on the donor leg. The result can be an avulsion fracture. The remaining (weakened) patellar tendon pulls away from the bone.

On the plus side, taking donor tissue from the other leg leaves less trauma to the reconstructed knee. Rehab can progress along much faster.

Most surgeons use donor tissue from the same side. Talk to your surgeon about his or her preferences and reasons for choosing one over the other.

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 a 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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Torn ACL still causing pain two years after repair

September 7th — admin

I tore my right ACL two years ago. It’s still not right. I have continued pain and swelling that’s keeping me from enjoying the things I like to do. Will I ever be able to ride a bike again?

Knee pain, swelling, and giving way two years after ACL repair are signs and symptoms that the joint is unstable. If you haven’t gone back to your orthopedic surgeon, now would be a good time to make an appointment.

It may be a simple case of muscular weakness or imbalance. Sometimes such problems can be taken care of with a rehab program. In other cases there may be other (unknown) damage to the joint. Perhaps there’s a torn meniscus or some osteoarthritis developing.

Worst-case scenario: the repaired ACL may have failed. Further testing is needed to find out what’s wrong. The chances are good that treatment is available that can get you back to the activities you like.

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 a 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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Does delay affect success of ACL repair?

September 2nd — admin

I tore my ACL in a water skiing accident about 27 months ago. I tried rehab but it looks like I’m going to need surgery after all. Have I missed my chance for a good result by waiting so long?

Not necessarily. It’s true that the longer a person waits, the greater the risk of the knee becoming unstable. Once the anterior cruciate ligament (ACL) is torn, there is greater strain on the other soft tissue structures in and around the knee.

Studies have shown that repair of ACL tears can be successful whether done right away or years later. If you’ve spent the last two years in rehab you may even have a better chance of good recovery. The exercises may have increased your strength. This can give you a “leg up” in recovery, so-to-speak.

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 a 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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Which leg should donor tissue come from?

August 30th — admin

Should I have my ACL repair done using donor tissue from the same leg or the other leg? Which is better?

If the tendon graft is taken from the same leg, then only one leg is affected. The patient can shift the weight off that leg during the early days after the surgery.

Repairing the knee with donor tissue from the other leg means both sides are affected. There have been a few cases reported of problems developing from overload of the donor side.

This is more likely during the first 24-hours when the patient is still under the influence of anesthesia and drugs to limit pain. Without complete sensation, the patient can put too much load on the donor leg. The result can be an avulsion fracture. The remaining (weakened) patellar tendon pulls away from the bone.

On the plus side, taking donor tissue from the other leg leaves less trauma to the reconstructed knee. Rehab can progress along much faster.

Most surgeons use donor tissue from the same side. Talk to your surgeon about his or her preferences and reasons for choosing one over the other.

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 a 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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Hamstring vs. patellar tendon graft for ACL repair

July 19th — admin

Two years ago I had a hamstring graft to repair a torn ACL. There was a lot of controversy then over whether a hamstring or patellar tendon graft was better. I’m still wondering if I made the right choice. What’s the latest thinking on this issue?

If you are satisfied with the results then you have nothing to regret or wonder about.

Researchers agree the two methods have equally good results. There may be complicationsfrom time to time. These differ between the two types of repair.

The hamstring graft is a little nicer looking cosmetically. It gives a strong graft fixation early on. The hamstring may not be able to tolerate motion right away.

The patellar graft seems to help athletes get back into high-level action more often. There are still some problems with kneeling and quadriceps muscle weakness after a patellar tendon graft.

Overall patients report satisfaction with function and results after either type of graft repair.

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 a 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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Extension deficit common after ACL repair

July 14th — admin

My son is off to college on a basketball scholarship. Early in the season he tore his ACL and had surgery. He says he’s coming along but that he has an extension deficit. What’s that?

Simply put he’s having trouble straightening his knee all the way or with full strength. This is a common problem with ACL repairs using the patellar-tendon graft.

A small piece of tendon from below the kneecap along with a piece of bone on either sideof it can be harvested and used to replace the torn ACL. The quadriceps muscle along the front of the thigh straightens the knee. It’s attached to the patellar tendon. Removing apiece of the tendon can disrupt the way the muscle pulls.

This problem is usually taken care of with a good rehab program. The fact that your son is aware of the deficit is a good sign that his rehab team is working on it.

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 a 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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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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