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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Accurate diagnosis of hip pain can be elusive

July 28th — admin

I saw my primary care physician for hip pain that just won’t go away. Despite a huge amount of time testing me every which way, there’s no known cause for the problem. Should I insist on X-rays or an MRI?

There are many, many possible causes of hip pain. An accurate diagnosis is needed to direct treatment. But this can be elusive and take a long time to make. The physician’s examination takes into account the possible etiology or cause of the problem. Was there some trauma? The mechanism of acute hip pain caused by injury is often a twisting motion. Overuse, repetitive motion, and diseases or degenerative conditions are other potential causes of hip pain. Pain patterns associated with hip problems start with a deep aching and stiffness in the hip. True hip pain is experienced in the front of the body down into the groin area. Hip pain along the pelvic rim, down the side of the leg, or down the back of the leg is usually a sign that the cause of the pain is extraarticular (outside the hip joint). This could be coming from pinching of the soft tissues, nerve entrapment, or other extraarticular lesions. Loss of motion and/or function can help point to the specific soft tissue structures affected.

It sounds like your physician has been very thorough. Evaluation of hip pain may require imaging studies such as X-rays or MRIs. But unnecessary X-rays and other imaging studies should be avoided. Results are viewed cautiously as many changes in and around the hip may be observed but may not be the cause of the painful symptoms. The most obvious pathologies that must be treated include tumors, fractures, hematoma from bleeding after a fall, and infections.

Often in the face of an unknown cause of joint pain, a short course of physical therapy can be a diagnostic aid for the physician and helpful to the patient. As experts in human movement dysfunction, the therapist can evaluate and treat the soft tissues and postural issues that could be the underlying cause of the problem.

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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What is an “incomplete” repair of the meniscus?

July 27th — admin

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.

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What is calcific bursitis of the hip?

July 25th — admin

Have you ever heard of calcific bursitis of the hip? That’s what I have. What can you tell me about it?

Calcific bursitis occurs as a result of tiny calcium deposits in the collagen tissue around the hip. The cause is chronic inflammation of the bursae. The bursa is a normal structure. It is a thin sac of tissue that contains fluid to lubricate areas and reduce friction between muscles, tendons, and bones. The patient reports pain and/or tenderness along the side of the hip. This is the area of the greater trochanter. The greater trochanter is a large bump of bone that juts outward from the top of the femur (thigh bone). Large and important muscles connect to the greater trochanter. Sometimes these muscles are referred to as the rotator cuff of the hip. Chronic tendinitis of the hip rotator cuff can also contribute to this problem. The calcium deposits are called calcification. They can occur as long as there is inflammation of the bursae (or tendons). The deposits don’t always go away after the inflammation has been taken care of, but the symptoms improve.

Treatment can help to prevent further calcification as well as relieve pain and stiffness. Antiinflammatory drugs, cortisone injections into the bursa, and physical therapy have been shown effective. In rare cases, the inflamed bursa is surgically removed.

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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Benefits of repairing meniscus with arthroscopy

July 22nd — admin

What’s the advantage of having a meniscus repaired by arthroscopy? Are there any problems with this kind of surgery?

There are several benefits to this type of surgery. First of all, only a few small puncture holes are needed to slip the surgical tools into the joint. No large scars are needed. The back of the knee doesn’t have to be opened to tie the sutures. Healing time is shorter.

There’s less risk of damaging nerves or blood vessels with arthroscopy. The risk of infection is also less. The disadvantages may be just coming to light.

The first long-term studies are being reported. After about 10 years of using special devices that allow for an all-inside or all-arthroscopic repair, it’s clear that the repair is incomplete for many patients. A second operation may be needed to repair or remove the re-injured meniscus.

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 surgery fix trick knee?

June 27th — admin

I have a trick knee that goes out on my every now and then. It’s from a torn ACL from an old football injury. If I have it repaired surgically will that stop it from giving way?

It should but there are no guarantees. It may depend on the condition of the rest of your knee joint. Are the other ligaments okay? What about the cartilage? Are there any signs of advancing arthritis? How much strength do you have in the muscles around the knee joint? These are all important factors.

There are two popular ways to repair a torn anterior cruciate ligament (ACL). One of these methods called the bone-patellar tendon-bone graft has been shown to be 22 percent more stable. In other words, it’s less likely to give way because of joint laxity. The increased graft strength may come from the small piece of bone plug that’s used along with the tendon tissue to make the repair.

The choice of graft material must be made on a case-by-case basis. It’s an educated decision based on the condition of your joint, your activity level, your goals, and the surgeon’s level of expertise.

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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Why didn’t new treatment for torn ACL work?

May 24th — admin

I tried a new treatment for a partially torn ACL in my left knee. The doctor used radiofrequency waves to heat it up and shrink it down. It didn’t work. My joint is still too loose. What went wrong?

There are many factors that could cause a failed treatment of this type. The exact shrinkage that takes place depends on how much heat is applied and for how long. Not enough heat may not shrink the collagen fibers. Too much heat can actually kill the tissue, a condition called heat necrosis.

The extent of the damage before treatment is important, too. For example larger tears are less likely to respond to this treatment and more likely to tear again. Smaller tears may respond better but studies show long-term results (five years later) aren’t successful. The collagen shrinkage doesn’t hold, and the ligament becomes lax again.

You may be better off having a surgical repair. There’s less chance for reinjury and degenerative changes in the joint. Talk to your surgeon about treatment options at this point in your recovery.

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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Will wearing a knee brace prevent an ACL tear?

May 19th — admin

I think I might be prone to knee injuries. Would wearing a knee brace during volleyball practice help prevent an ACL tear?

Anterior Cruciate Ligament (ACL) injuries are a problem for many athletes in noncontact sports. Volleyball players are at increased risk because of the landing, turning, and pivoting required. Female athletes are up to eight times more likely to injure the ACL compared to male athletes.

Many studies have been done trying to find out the specific cause and ways to prevent ACL tears. Researchers have looked at weather conditions, playing surface, and footwear. They’ve examined hormonal differences between boys and girls. They’ve compared anatomy from head to toe as a possible reason for differences in the rates of ACL injuries between the sexes.

So far no single factor has been linked to ACL injuries. Bracing hasn’t been proven to prevent knee injuries either. Balance training and improving the joint’s sense of position seem to have the best record so far in preventing these types of knee injuries.

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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If torn ACL is not repaired, will a total knee replacement be required?

May 16th — admin

I’ve been told if I don’t have my torn ACL repaired I could end up with a total knee replacement. Is that true?

Well, there’s some truth to your statement but there are many factors in between those two points. First it depends on how severe the damage is to your anterior cruciate ligament (ACL). A minor tear can be treated with rehab. This is especially true if you’re not an athlete or exercising at intense levels.

Studies do show a tendency toward cartilage damage in unstable knees. This means the ACL is deficient and not doing its job. The joint slides around more than it should, putting stress on the meniscus and other joint cartilage. Under the increased load, wear and tear on the meniscus could end up in a tear.

Only one study has been done that shows the need for a total replacement (TKR) after ACL injury without repair. A small group of olympic athletes in the former East Germany were treated without surgery and returned to training. Doctors followed them 35 years later and found out that all of them had a torn meniscus. Half had a total knee replacement.

Long-term studies of everyday average people with an unrepaired ACL have not showed these kinds of results. They do report an increased pattern of osteoarthritis in the unstable (unrepaired) knees. The risk of a TKR is present but not a certainty.

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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My doctor examined my knee and is certain I don’t have a meniscus tear. Should I get an MRI?

March 4th — admin

My doctor examined my right knee for a meniscus tear. She seems certain that’s not the cause of my pain. Should I press for an MRI to be sure?

Damage to the meniscus is fairly easy to diagnose based on the patient’s history and a few clinical tests. The most common history is a twisting injury of the knee with the foot planted firmly on the ground. The knee is usually bent when this happens. Pain occurs along with swelling that comes and goes and a locking sensation for some patients.

Some of the tests used by doctors, therapists, and athletic trainers to test for meniscal tears have a high rate of false-positive findings. This means the test is positive for a meniscal tear when no tear is present.

No test is fool proof but joint line tenderness along the outer edge of the joint can be safely used to detect a lateral meniscus tear. Joint line tenderness for any meniscal tear is less reliable when there’s an anterior cruciate ligament (ACL) tear also present at the same time.

The most reliable test may be a new one. The Thessaly test has been shown to be 94 to 96 percent accurate with knee meniscus. The need for an expensive MRI may be replaced by this new first line screening exam.

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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