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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Will repaired kneecap and PCL, now loose, ever get better?

February 8th — admin

I tripped and fell on my left knee. Besides cracking the kneecap I also tore the posterior cruciate ligament. I had surgery to repair the damage. I notice my knee is still loose. Will this ever get better?

The answer to your question may depend on what you mean by “pretty loose.” Joint laxity in the knee can be graded from one to three with a test called the drawer test. An anterior drawer test measures laxity of the anterior cruciate ligament (ACL). A posterior drawer test grades the posterior cruciate ligament (PCL).

Studies show the PCL doesn’t return to “normal” after surgery. The goal of the operation is to improve joint laxity. PCL repair usually reduces laxity by a full grade or more. Even with the best results there’s often a trace amount of laxity.

Even though your joint may be loose, the real measure of success is to compare the laxity before and after the operation. Talk to your surgeon if there doesn’t seem to be any difference. Ask if your knee is stable enough to return to normal sports and activities.

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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Can a torn PCL (posterior cruciate ligament) heal itself?

February 3rd — admin

I was in a car accident two weeks ago and slammed my right knee against the glove box. The MRI showed a partially torn ligament in my knee (the PCL). I’ve been advised to wait on having surgery since this can heal itself. Is that true?

There are two major ligaments that criss-cross inside the knee joint to give it stability. One is the anterior cruciate ligament (ACL) and the other is the posterior cruciate ligament (PCL).

ACL tears don’t regenerate tissue and heal on their own. In minor ACL injuries surgery may not be needed. Instead knee rehab is used to regain motion and strengthen the muscles around the knee. More serious injuries may need surgery to repair or reconstruct the torn ligament.

Unlike the ACL, the PCL does have the ability to heal. This has been shown with MRI studies. Healing does depend on how severe the injury is–more severe injuries may need surgery to improve laxity.

Without surgery it’s not clear yet how long the healing process takes. The PCL doesn’t return to normal but motion, strength, and control are regained.

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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No way to relieve knee pain from neuroma

November 4th — admin

Eighteen months ago, I had the anterior cruciate ligament (ACL) of my right knee repaired. The operation was done by removing a piece of tendon from my kneecap and using it to replace the torn ACL. Since that time, I’ve developed knee pain and a neuroma. What causes this?

A neuroma is a benign tumor made up of nerve cells. Benign means it’s not cancerous and not dangerous. It can be, however, quite painful. The most common cause of this type of neuroma is direct injury to the nerve. When the tendon was harvested from your knee, the nerve was most likely cut. This is a common problem with this operation. Knee pain prevents the patient from kneeling or moving around on the knees. Once it happens, there isn’t much that can be done. Prevention is now possible with an alternate method of operation. This uses the tendon from behind the knee instead of the front.

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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Still limping after an ACL repair?

September 22nd — admin

I had an ACL repair nine months ago. I don’t have any pain but I still seem to walk with a slight limp. I can’t figure this out. What could be causing it?

It takes many patients up to a year or more to return to a normal walking pattern after ACL repair. Researchers aren’t sure why there’s such a slow return. It could be patients change the way they walk early on to avoid pain. Then the pattern is hard to break.

There may be slight changes in how the knee functions as a result of the surgery. Most ACL repairs are done with donor tendon from either the patellar tendon or the hamstring tendon. Problems with the donor site can make a difference.

A recent study from Australia found slight changes in knee motion based on the type of ACL graft used. With the hamstring tendon graft the knee had less knee extension when walking. Patients with patellar tendon grafts had less knee flexion.

Check with your doctor and physical therapist for their assessments. Watching you walk, measuring your motion, and checking the internal movements of the joint may help them pinpoint the problem and a solution.

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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Method of repairing ACL may affect gymnast’s future

September 17th — admin

My 14-year old daughter is a gymnast with a bad knee. She needs an ACL repair before she can continue competing. We know there are two different ways to fix the ACL. Is one method better than the other for a gymnast?

ACL repairs are done using a tendon graft from either the patellar (knee) tendon or the hamstring tendon. Which choice is better is a topic of ongoing debate and the subject of many studies.

We do know the patellar tendon graft makes it difficult for the patient to kneel on that side. This could make a difference depending on your daughter’s event(s). Patients who hop and land on one leg have a little more trouble when the patellar tendon graft is used. This may be something to consider for many gymnastic events.

Make sure the surgeon is aware of your daughter’s plans to return to gymnastics. The type of surgery and rehab program may be based on her long-term goals to compete.

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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