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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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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Tibial plateau fracture may lead to total knee replacement

January 26th — admin

What is a tibial plateau fracture and what’s the final outcome with proper treatment?

The tibia is the lower leg bone between the ankle and the knee. The tibial plateau is at the top of the tibia. It’s the surface where the upper leg bone rests on the tibia. In other words, the tibial plateau is the bottom surface of the knee joint.

A fracture in this area can be treated with or without surgery. This depends on how severe it is and whether or not there is another injury with it. A torn ligament or a second fracture may also require surgery.

Over the years, studies have shown that tibial plateau fractures result in arthritis. A total knee replacement (TKR) may be needed. The final outcome isn’t as good for patients receiving a TKR without a previous fracture. The operation can be very complex.

Results are good when the doctor is aware of these problems and plans carefully.

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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Splinting, bracing, wrapping injured knees is controversial treatment

December 18th — admin

I often see people wearing braces on their knees. I hurt my knee in a skiing accident last week. Should I be wearing a brace?

The use of splints, elastic bandages, neoprene sleeves, and various braces for knee injuries is controversial. When to wear these devices and for how long are subjects of current research.

 

A proper diagnosis is the first step in knowing how to treat an injury. For example, elastic ace wraps are used for sprains to help reduce swelling in the first 24 hours. Knee support is sometimes recommended for anterior cruciate ligament injuries, especially if surgery is delayed. Talk with your doctor to find out whether extra support is necessary in your case.

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. For more information on this subject, visit www.zehrcenter.com. 

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Knee surgery vs. physical therapy for torn ACL

December 7th — admin

My skiing buddy and I both had knee injuries in competition last month. It turns out we had the same injury–a torn anterior cruciate ligament. He went on to have knee surgery. My doctor said my knee will get better with physical therapy. Shouldn’t I have the same treatment as my friend?

Not necessarily. It’s likely your friend’s ACL was severely damaged. Your doctor may have determined that your ligament was only mildly torn or stretched out. In that case, physical therapy treatments can be used to help improve your knee function.

Your doctor and physical therapist will watch to see if you get full knee motion and strength. If your pain and swelling go away and your knee feels stable and strong, you may be able to return to competition without knee surgery.

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. For more information on this subject, visit www.zehrcenter.com.

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Which knee ligament is really torn – ACL or MCL?

November 18th — admin

It has been 20 years since I was diagnosed with a partial tear of my medial collateral knee ligament. My knee gives out every once in a while, keeping me from the activities I enjoy. I just turned 63, and I like to keep active by skiing and playing golf. Should I have the ligament replaced?

It is questionable whether you merely tore your medial collateral ligament (MCL) when you were first hurt. Had you only injured the MCL, chances are it would have scarred down and not given you much trouble.

From what you describe, it is more likely that you also stretched or tore the anterior cruciate ligament (ACL). In either case, you might not be a candidate for ligament surgery given your age. Instead, a surgeon specialist will probably want to have you use a brace and do exercise treatments. If these aren’t helpful, surgery might be a last resort.

Age is one factor your surgeon will consider. So is activity. Your surgeon may treat you as he or she would a younger patient, given your level of activity.

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. For more information on this subject, visit www.zehrcenter.com.

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