Torn ACL still causing pain two years after repair

September 7th — admin

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.

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Why does kneecap pain come and go?

August 9th — admin

I have a painful knee problem called patellofemoral pain syndrome. Sometimes it hurts like crazy. Other times I have no pain at all. Why is that?

People with patellofemoral pain syndrome (PFPS) often have knee pain and stiffness when climbing, going down stairs, or while squatting. Popping or stiffness after sitting with the knee bent is called the movie theatre sign.

Most of the symptoms of PFPS depend on the up and down movement of the kneecap and the pressure it places on the cartilage and bone underneath. Scientists aren’t sure what causes the stiffness. Symptoms go away when the person avoids any of these activities.

Changes in the joint, ligaments, and joint capsule may occur after a long period of pain. Messages of pain and stiffness may be sent to the brain sooner or more often than in the normal knee.

A recent study at the University of Illinois found that subjects with PFPS may be misinterpreting their pain as stiffness. Future treatment of PFPS may be centered on pain relief in order to decrease the sensation of stiffness.

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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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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Extension deficit common after ACL repair

July 14th — admin

My son is off to college on a basketball scholarship. Early in the season he tore his ACL and had surgery. He says he’s coming along but that he has an extension deficit. What’s that?

Simply put he’s having trouble straightening his knee all the way or with full strength. This is a common problem with ACL repairs using the patellar-tendon graft.

A small piece of tendon from below the kneecap along with a piece of bone on either sideof it can be harvested and used to replace the torn ACL. The quadriceps muscle along the front of the thigh straightens the knee. It’s attached to the patellar tendon. Removing apiece of the tendon can disrupt the way the muscle pulls.

This problem is usually taken care of with a good rehab program. The fact that your son is aware of the deficit is a good sign that his rehab team is working on it.

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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Does painful knot on knee mean tissue tear or fracture?

July 6th — admin

I was training a young horse that kept trying to push me into the fencepost. My knee got pretty banged up. Now, I have a large knot on the outside of my leg just below the knee. It especially hurts when I put weight on my leg. Could it be broken?

The lower leg is made up of two bones: the tibia (main bone) and the fibula (smaller bone along the outside). The place where these two bones meet is called the tibiofibular joint. There are strong ligaments that hold this joint together. It’s possible that you have a fracture. It could also be a tear of the soft tissues around this joint. An X-ray is needed to know for sure. The doctor will also examine your leg and test the tibiofibular joint as well as the knee joint. It’s easy to confuse a knee joint injury for a tibiofibular joint injury.

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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Knee creaks after ACL repair. Is this normal?

June 22nd — admin

I had an ACL repair done about 18 months ago. The knee works fine but it creaks and cracks a lot when I move it. Is this normal?

You may be describing what’s called crepitus. This sound or feeling occurs when the back of the kneecap grates against the bone. This finding is more common before the ACL repair is done rather than afterwards.

Any snaps, clicks, crepitus, or joint sounds should be reported to the surgeon. The same goes for locking or giving way of the knee joint. Crepitus or similar sounds could occur when the extensor mechanism of the quadriceps muscle isn’t working quite right. This can occur when scar tissue forms or if the tendon has been shortened too much.

The doctor will be able to tell the difference between sounds caused by scar tissue and those caused by cartilage rubbing against bone. There may be some treatment that can help you. It’s not a normal sound and should be taken care of before it gets worse.

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 does taping around the kneecap help reduce patellofemoral pain?

June 6th — admin

Why does taping around the kneecap help reduce patellofemoral pain? I’ve tried everything else and this is the first thing that’s worked.

Patellar (kneecap) taping has been used with good results in many patients with patellofemoral pain (PFP). Decreased pain and increased function are the two main benefits of taping.

Studies have not been able to show a difference in alignment to explain why taping works. Some doctors think taping helps with the timing of muscle contractions. Patients with PFP have been shown to have abnormal contraction of the four parts that make up the quadriceps muscle.

Other parts of rehab may be equally important in the overall results. Strengthening the quadriceps muscle will help with activities like walking down the stairs. The quadriceps power is used in this activity to keep the knee from collapsing under the load.

Flexibility is important too. Poor flexibility may add to the load on the PF joint. Flexible muscles help absorb energy during loading activities. Joint proprioception or sense of position must be retrained, too.

So if you find your results are short-lived and you have to tape for more than six weeks, reconsider some of these other elements of rehab for PFP.

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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