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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I’ve had surgery to repair my ACL. Why doesn’t this ligament heal itself like other tissues in the body?

January 23rd — admin

I tore my anterior cruciate ligament (ACL) and had to have surgery to reconstruct it. Why doesn’t this ligament heal itself like other tissues in the body?

Scientists studying the field of tissue engineering are very interested in knowing the answer to your question. If we can understand the normal pathways of tissue healing, then maybe we can find a way for ligaments like the ACL to repair itself.

The poor healing capacity of the ACL can be explained in part by its biology. First there is a very thin lining or sheath around the ACL. Once this sheath is disrupted, the blood supply to the ligament is decreased greatly.

Normal healing and repair depend on the formation of a hematoma. A hematoma is a collection of blood cells trapped in the tissues after trauma or injury. Somehow the presence of the hematoma sets up the right environment needed for tissue healing. Without a blood supply, there can be no hematoma formation.

The hematoma provides a base camp so-to-speak for local growth factors and chemicals to come and set up a mesh or scaffold. Cells fill in around the scaffold forming collagen and scar tissue. It looks like there’s a complex interchange between repair cells, growth chemicals, and the scaffold needed for healing. Without the hematoma to get the process started, ligaments don’t recover on their own.

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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Has anything much changed in ACL repairs over the years?

January 11th — admin

ACL repairs have been around for a long time. I had one when I was a college athlete. Now my daughter who is a collegiate basketball player is having one. Has anything much changed over the years?

Anterior cruciate ligament (ACL) repairs have indeed been around for 30 years or more. Surgeons keep finding ways to improve it. In a recent review of ACL repairs, Dr. Ben Graf from the University of Wisconsin (Madison) gave a good summary of the last 30 years.

He said the first 10 years was spent proving ACL repairs were needed. The second 10 years worked on repairing it from the inside out. And the last decade has been looking at types of grafts (hamstring versus patellar tendon grafts).

The newest change is the use of a double-bundle repair to (maybe) replace the single-bundle method. No matter what kind of graft type used, there’s still a problem with early arthritis in the grafted knee. By studying normal anatomy, scientists think this may have to do with motion that is restricted by the ACL repair.

It seems that the standard single-bundle repair doesn’t allow the normal rotation of the tibia (lower leg bone). This type of motion is needed when an athlete pivots and shifts his or her weight to move in a different direction. The double-bundle repair attaches the tendon graft in two places instead of one. The idea is to mimic the anterior and posterior (front and back) attachments of the normal ACL.

But like many new things on the horizon, this one hasn’t been fully tested and approved. The next decade may bring many innovative changes. Improved technology and new surgical instruments will bring about these changes.

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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My doctor is trying out a different way of doing my ACL surgery using a piece of my hamstring. Will this speed recovery?

December 26th — admin

I’m scheduled to have an ACL reconstruction in two weeks. The doctor is trying out a slightly different way of doing the operation. A piece of my hamstring will be used with a little piece of bone attached to give it greater stability. Will this speed up my recovery at all?

The use of multistrand hamstring tendon grafts and now hamstring tendon grafts with a bone plug to repair a ruptured anterior cruciate ligament (ACL) is gaining popularity.

Many studies have been done comparing the patellar tendon graft to the hamstring tendon graft. The results have been very favorable towards the hamstring tendon graft. Although the preparation of the graft takes longer, the stability of the knee afterwards may be worth it.

Patients have fewer problems at the donor site with the hamstring tendon graft. The patellar tendon graft is taken from the front of the knee causing painful kneeling afterwards. Sometimes the pain is severe. In most cases it never goes away.

Rehab is the same for both graft types. Recovery is not reported to be faster with one graft over another. Complications can occur with either method causing a delay in recovery. If no problems occur after the operation you should be back on your feet in two to four weeks. Full recovery and return to preinjury activities take longer (four to six months).

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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Will ACL tear jeopardize my college scholarship?

November 17th — admin

I’m entering my first practice season on a college soccer team. My entire college education depends on the athletic scholarship I’m going to school on. Lots of my teammates in high school had ACL tears and missed entire seasons of sports. How can I keep this from happening to me?

ACL injuries are common in athletes who jump, pivot, twist, or make sudden cutting movements. Girls are four to six times more likely than men to injure the ACL. Scientists aren’t sure why but they are studying this problem closely.

The latest findings suggest a problem with neuromuscular control. Any muscle weakness, loss of power, or failure to activate the muscles can lead to increased knee load. When the load is too much for the muscles, the ligaments tear or rupture.

One thing to watch for is a difference in strength from side to side. If one leg is 20 percent (or more) stronger than the other leg, there may be a neuromuscular imbalance. An athletic trainer or physical therapist can test you on a variety of hopping tasks. Any differences from side to side may help identify areas of weakness. Neuromuscular training for specific deficits is recommended.

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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To prevent an ACL injury, I’ve been doing a box heel touch exercise. What’s next?

November 15th — admin

I’m a 16-year old basketball player with lots of knee problems. I’ve been doing a program of exercises to help prevent an ACL injury. I’ve been doing a box heel touch exercise without problems. What’s the next step in the sequence of exercise?

The box heel touch is an exercise used to improve active control of the knee. The goal is to avoid letting the standing knee collapse inward while stepping down off a 12-inch box. As the athlete stands on the box with one leg, he or she lowers the other leg to touch the heel to the floor and come back up. The supporting leg must hold steady without angling in or out.

Once the athlete can do this exercise using neutral knee alignment there is a next step. Place a foam pad on top of the box. The balance pad decreases the stability of the supporting surface. The athlete must maintain balance while completing this exercise. Be sure and use a mirror to help monitor the position of the knee. Any time the knee collapses inward, correct the position before going on. Different size and density of foam pads can be used to offer more or less of a challenge.

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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