Knee brace or immobilizer after ACL repair?

August 3rd — admin

What is the difference between a knee immobilizer and a knee brace used for patients after an ACL repair?

Sometimes the term “immobilizer” and brace are used interchangeably. It may be necessary to know exactly what type of device is being called an immobilizer or a brace. A true immobilizer keeps the joint from moving at all.

An immobilizer may be used after ACL repair to keep the knee fully extended for the first few weeks after surgery. Some doctors think this kind of immobilization is needed to prevent loss of knee extension. The immobilizer can be removed and usually is taken off during physical therapy every day.

Braces usually have a metal hinge joint that allows the knee to bend and straighten. It keeps the joint stable and protects the healing ligament from too much strain or load during activity. In some braces, the joint can be set to allow some, but not all motion.

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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Surgery on torn ACL may be needed to protect the joint

July 29th — admin

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.

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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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Doctor exam as good as MRI in diagnosing ACL injury?

July 8th — admin

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.

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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Arthroscopic exam finds torn ACL that MRI missed

July 2nd — admin

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.

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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The best way to rehab a knee after ACL reconstruction surgery

May 21st — admin

What’s the best way to rehab my knee after an ACL reconstruction?

Most doctors will send you to a physical therapist who can guide you through this process. Exercises at the beginning of rehab are different from what your knee can handle later. The goal is to get as much motion back as possible without damaging the knee any further.

The healing graft is under increased strain when the knee is in the fully extended position. Closed kinetic chain exercises with the foot on the floor or other surface strain the ACL less when the hip is bent. An example of this activity would be the mini-squats often prescribed in the early phase of rehab.

High demand exercises such as the lunge can be done when the squat is deemed safe to do after ACL repair. Then comes the step-up, step-down, and sit to stand exercises. These can all done on one leg. Each one puts about the same amount of strain on the healing graft.

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 a return to sports six months after ACL reconstruction possible?

May 18th — admin

I’m scheduled to have an ACL reconstruction in two weeks. The doctor thinks I can get back to playing sports within six months. Will I have my full function by then?

There are many parts to recovery after ACL reconstruction. Rehab can move forward quickly if there aren’t any complications and the joint is mechanically stable. Your doctor and your physical therapist will help you know when the time is right to start each phase of your rehab program.

Studies show the joint’s sense of position, called proprioception, comes back slowly over the first nine to 12 months. Most rehab programs focus on balance and proprioception during this time. Strength training and flexibility are also important.

Agility training to restore functional stability comes in later phases of rehab. You probably won’t be 100 percent at six months but if all goes well, you’ll be safe to resume sports. Follow your doctor’s advice carefully for the best long-term results.

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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The best way to prevent ACL injuries

May 14th — admin

What’s the best way to prevent ACL injuries?

The jury is still out on this one. We can give you the results so far. Studies show balance and strength training are important. Flexibility is also a key feature in prevention programs. Training in all three of these areas is advised for the ankle, knee, and hip.

Single-leg balance drills have been shown to decrease knee injuries in female athletes. Forward and backward motion of the joint is improved with these exercises. Side-to-side motion is not as likely to change.

The results of studies so far suggest preseason training works well for athletes at risk for ACL injury. This includes female athletes with increased forward joint motion of the tibia (lower leg) against the femur (upper leg). Team training is good, but preventing injury works best by looking at each player’s needs and providing individual training.

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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Losee maneuver can detect ACL injury

March 24th — admin

What is the “Losee maneuver?” I’ve heard it can be used to detect a torn anterior cruciate ligament.

Dr. Ron Losee from Ennis, Montana, was the first to describe a test for ACL instability. It was called the Losee maneuver for many years. Now it’s sometimes referred to as the “pivot-shift” test.

When the test is done, the patient is asked, “Is this how your knee feels when it gives out?” The doctor doesn’t always feel a change in the knee during the test, so the patient’s report is important.

A positive pivot-shift may be a sign that surgery is needed to repair the torn ligament. There is a device that measures laxity between the two knees (a KT-2000). The results of one test usually aren’t enough to tell which patients need an operation. Tests like the pivot-shift, along with several others, are still important.

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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KT-1000 an accurate test for torn ACL

March 19th — admin

I’m scheduled to have a special test for my knee. It’s called a KT-1000. What is this exactly?

The KT-1000 arthrometer is a small device that’s strapped to the leg during knee examination. It’s used when the doctor thinks there may be a tear in the anterior cruciate ligament (ACL).

The examiner pulls on the uninjured knee and the gauge on the KT-1000 shows how many millimeters of motion occur between the lower leg bone (tibia) and the upper leg (femur). This motion is called a drawer sign. The reading is compared between the injured knee and the normal knee.

If there’s more than three millimeters difference between the knees, the ACL is torn. It’s considered more accurate than an MRI.

If you’d like to see a photo of this tool go to:
http://www.medmetric.com/kt1.htm or

http://www.ismoc.net/procedures/kt1000.html.

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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