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

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.

Will ACL tear jeopardize my college scholarship?

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.

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

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.

Donor tissue for ACL repair – which leg?

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.

Torn ACL still causing pain two years after repair

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.

Does delay affect success of ACL repair?

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.

Which leg should donor tissue come from?

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.

What are closed-kinetic chain exercises?

Since I hurt my ACL, I’ve been reading a lot about doing closed-kinetic chain exercises after knee injury. What kind of exercises are these anyway?

Closed-kinetic chain exercises are done with the foot or feet planted firmly on the ground or some other surface. This type of exercise is preferred because it helps reproduce normal, everyday movements.

Squatting, stepping, and stair climbing are examples of closed-kinetic chain activities. The exercises are functional but also reduce the strain and shear force on the ACL. In fact, they also decrease the compressive force on the patella (kneecap), too.

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.

Do-it-yourself-rehab after ACL repair

I have heard that it’s possible to do my own rehab after an ACL repair. Is this true? It would sure save me time and money driving into town to go to rehab.

A few studies have been done showing how rehab can be done at home. Most researchers advised patients to have some supervision by a physical therapist. They reported a need for quality education before and after the operation.

Patients at home need good handouts with detailed instructions about the exercises. Patients must be motivated to do their own program for it to work. Not all patient types have been studied. Most studies have included athletes. A recent study from Canada only included athletes with chronic ACL tears. Anyone with a recent injury wasn’t included.

Talk to your surgeon about your options. There may be a way to work out a program with some supervision that cuts down the number of trips you make. It’s important to follow some kind of rehab program to prevent joint problems later.

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.

What is an “incomplete” repair of the meniscus?

Three years after a meniscal repair I started having painful clicking in my knee again. The doctor says the repair was “incomplete.” What does that mean? I may have to have another operation to repair the problem.

Incomplete healing of a torn mensicus is usually found by having a second arthroscopy.

The surgeon makes one or more puncture holes in the skin and inserts a long, thin needle called a cannula into the joint.

Tiny tools can be passed through the cannula including a miniature TV camera to take a look inside the joint. What the surgeon sees as an incomplete healing of meniscal tears is a cleft or gap at the site of the tear. It may go down 10 to 50 percent of the thickness of the meniscus.

A gap of more than 50 percent is a nonhealed repair. A second operation is often needed in such cases.

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.