About 10 years ago I had ACL surgery. Now, all of a sudden, I’m having painful grinding in the joint. What’s happening?

January 27th — admin

About 10 years ago I had an ACL repair. Everything’s been just fine and now all of a sudden, I’m having painful grinding behind my kneecap and in the joint. What’s happening?

Researchers at the Steadman-Hawkins Research Foundation in Vail, Colorado have been researching this very problem. They noticed some of their ACL patients were just fine for 10 years — a perfect outcome. Then all of a sudden, they developed arthritis.

They think the problem may be a lack of mobility between the patellar tendon and the tibia (lower leg bone). A condition referred to as patella infera may be part of the problem. With patella infera, there is a permanent shortening of the patellar ligament. The kneecap sits too low in relation to femur (thighbone). The result can be a severely limited range of motion of the knee joint.

Patella infera is a common complication of injury or surgery to the knee joint. It usually doesn’t show up until much time has passed after injury and/or surgical repair.

Treatment options include physical therapy to manually release the kneecap and/or surgery to revise the soft tissues around the knee. If the joint degeneration has gone too far for conservative care to be successful, then total knee replacement may be needed.

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’s a lateral overhang of the kneecap? X-rays show that my daughter needs surgery for kneecap overhang problems.

December 20th — admin

What’s a lateral overhang of the kneecap? X-rays show that my daughter needs surgery for kneecap overhang problems.

The kneecap or patella sits over the knee joint and moves up and down along a track of cartilage. Connective tissue on each side called the retinaculum help hold it in place and guide it up and down in the track.

Patellar instability occurs when one side of the retinaculum is tighter or looser than the other. The kneecap can move out of the track and sublux or even dislocate. When this happens over and over the patella doesn’t always go back to the middle. One edge hangs over the side (as seen on X-ray).

Conservative care with physical therapy, exercises, and bracing or taping is the usual treatment. If these measures don’t help after three months then surgery to rebalance the retinaculum may be considered.

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’s a bucket handle tear? That’s the kind of meniscal tear I have.

December 12th — admin

What’s a bucket handle tear? That’s the kind of meniscal tear I have.

The knee joint has two horseshoe or C-shaped pieces of hard cartilage called the menisci. There’s a medial (inside edge) and lateral (outside edge) meniscus. Both menisci are attached to the bone.

The medial meniscus is also attached to the joint capsule and one of the ligaments. These extra attachments make it less mobile but also more likely to tear under force. In fact the medial meniscus is torn twice as often as the lateral.

When the meniscus is torn and the tear goes the length of the cartilage it’s called a bucket handle tear. If you could touch the torn meniscus, it’s possible to lift the torn section up like a bucket handle.

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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Ligament damage during total knee replacement uncommon

November 1st — admin

My father had a total knee replacement that had some problems. During the operation one of his ligaments was damaged that was fine before the operation. Does this happen very often? Is it an indication that the surgeon wasn’t being careful?

Studies of hundreds of knee replacements show this can and does happen … even in patients with no risk factors or deformities. Ligament damage isn’t rare but it’s uncommon. It can happen to anyone but it does tend to occur in patients who are very overweight.

The surgeon usually repairs the surgically torn ligament. The surgeon may use an implant that is designed for use with a torn or absent ligament. Rotating-hinge knees are favored when the patient has severe joint instability. The doctor’s task is to balance the ligaments, stabilize the joint, and restore 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 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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Which knee implant is better – plastic or metal?

September 21st — admin

I’m used to walking three to four miles a day even with my painful, arthritic knees. If I have a new joint put in should I go with the plastic or metal implant? Which one holds up best for walkers like me?

Good question…and one that is highly debated in the literature. After decades of using the metal-backed implants surgeons are trying the new all-poly (molded plastic) implants.

They say the metal backed implants can get worn unevenly causing the bone to deteriorate. The implant can loosen, too. On the other hand there’s concern that the polypropylene type won’t hold up under daily use by active adults.

Researchers at the Lenox Hill Hospital in New York City report results of the all-poly implant for a group of active, younger (less than 60 years old) adults. A majority of the patients said that walking distance was unlimited. A smaller number reported walking limited to 10 blocks or less.

Many of these active adults were also involved in swimming, tennis, and golf.

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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After using an ice pack on my knee, the joint feels really frozen. Is there any actual change in the temperature inside the joint? Or is it just the skin that gets cold?

April 12th — admin

After using an ice pack on my knee, the joint feels really frozen. Is there any actual change in the temperature inside the joint? Or is it just the skin that gets cold?

Today’s technology has brought us new temperature measuring systems. These tools allow scientists to measure and graph temperatures inside the knee joint. This is helpful because keeping a cool joint can help prevent painful swelling after surgery.

A recent study from Spain measured the temperature inside the knee joint. Measurements were taken during and after arthroscopic surgery. A temperature probe in the joint fluid took the joint temperature every 30 seconds during the operation.

They found the temperature inside the joint was lowered by four degrees after using a saline solution to flush the joint out. The saline solution was kept at room temperature. Other studies also show that the normal temperature inside the knee joint is lower than normal body temperature.

Normal core body temperature is between 97 and 99 degrees F for most people. Internal knee temperature is between 90 and 95 degrees. The difference is most likely due to a fact lack of blood supply to the cartilage in the normal knee. 

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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Unicompartmental knee arthroplasty not always the answer

August 19th — admin

I had a unicompartmental knee joint replacement last year. That means they only replaced the inside half of my left knee. I thought it was going to be the answer to all my problems. Instead I ended up with more problems. Would it have been better to have a total knee replacement?

Many studies support the use of the unicompartmental knee arthroplasty (UKA). It’s been shown to have a faster rehab time, give better function, and cost less than a total knee replacement.

Failure in a small number of cases does occur. There are several reasons why this can happen. Sometimes the arthritis continues to get worse. The bone around the implant wears away and the implant loosens.

In other patients the hip, knee, and ankle don’t line up as well as they used to. Finally, overcorrecting a deformity at the time of surgery can cause too much load on the knee joint. The wear and tear on bone and ligaments can lead to failure of the implant.

It may still be possible to salvage your “new” knee. Sometimes surgery to revise the implant is the answer. In other cases, replacing the unicompartmental implant with a total knee replacement is the next step. Be sure and ask your doctor what are your options. Perhaps get a second opinion from another surgeon.

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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Football injury could result in bruised bone.

September 3rd — admin
One of the ligaments inside my knee was injured in a recent football game. I’m wondering about the knee bones. My biology teacher said ligaments are attached to bones. Do the bones get hurt, too?

 
Good job thinking it through! In fact, bones are often bruised when the ligaments that attach to them get torn. These “bruises” can’t be seen on an X-ray. They can be seen with MRI scans. A bone bruise is like a small fracture of the bone. Most bruises will go away completely. But it’s still unclear what the bone injury will mean in the long term.

Scientists are concerned that the initial bone injury eventually causes the bone to become less resilient–less “bouncy.” With the shock absorbers down, the cartilage that covers the knee joint ends up taking more force. This can take a toll on the joint surfaces, and may lead to arthritic changes in the knee joint.

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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