Why has swelling delayed my ACL surgery?

February 26th — admin

I slid on a patch of water tearing my left ACL last week. Because there was quite a bit of swelling, my surgery has been postponed. Wouldn’t it make more sense to drain that fluid and fix that knee now while it’s newly injured? Why is it necessary to wait so long?

There is a commonly held belief that surgical repair of the ACL should be done when the knee is calm. Active inflammation leads to increased scar tissue. Doing surgery on top of an already acutely injured joint has been avoided.

Some studies have supported this thinking by their results. Some experts have advised against surgery after ACL injury for at least three weeks. Loss of motion and poor results with early surgery are the reasons given for waiting. But other studies don’t support these findings.

In a recent study of active duty military personnel with ACL injuries, two groups who had surgery were compared. The first group had surgery within 21 days. This is considered to be during the acute phase. The second group delayed surgery for at least six weeks (sometimes longer).

Patients were tested and measured before the operation and again every six months for up to three years. There was no difference in results between the two groups. The concern that motion would be less and scar tissue more in the early surgery group was unfounded.

Strength, motion, and function were equal between the two groups. Most of the patients in both groups were still making improvements during the first six months. After that, later results were about the same as what they had at the end of six months. It appears that with proper rehab after surgery, the timing of the procedure may not matter.

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 didn’t my brace protect me from re-injuring my repaired ACL?

February 18th — admin

After having an ACL repair, I did my exercises faithfully and wore my brace during activity, and I still re-injured that knee. It looks like I tore the repaired ACL. I thought the brace was supposed to protect me.

The purpose of supportive bracing after ACL reconstructive surgery is to protect the healing graft from excess strain. A functional knee brace or neoprene sleeve can also serve to keep the new tissue from stretching out too much, thus preventing joint laxity (looseness).

Many active athletes are under the mistaken belief that wearing the brace protects them no matter what they do. As you have found out, it’s still possible to re-injure the ligament. Sometimes this is just a fluke. You move the knee in just the right direction with just the right amount of torque and the healing fibers give.

In other situations, the activity is too strenuous too soon. The healing fibers cannot withstand the force or load and re-tear. And early on in the rehabilitation process, you may not have regained enough neuromuscular control or proprioceptive input (sense of joint position) to protect that knee.

Wearing a brace or protective sleeve decreases (but doesn’t eliminate) strain on the reconstructed ligament.

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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Is there a genetic link between osteoporosis and osteoarthritis?

July 3rd — admin

Is there any link between having osteoporosis and knee osteoarthritis? I’ve just been told I have osteoporosis. My mother had knee arthritis pretty bad. I don’t know if she had osteoporosis. I was wondering if there’s some kind of genetic connection.

Genetics may very well be a part of developing either osteoporosis (brittle bones) or osteoarthritis (OA). And there may be a link between osteoporosis and OA. It isn’t clear yet if there is a genetic link here.

The relationship between OA and osteoporosis may surprise you. Some studies show that women with low bone mass from osteoporosis may be less likely to have OA. But once OA is found, a higher bone mass density (no osteoporosis) means a milder case of OA. Just what all this means and what the actual connections are between OA and osteoporosis remains unclear.

One important risk factor for knee OA (such as your mother had) is a previous knee injury. Men and women are both more likely to develop knee OA after an anterior cruciate ligament (ACL) tear. And women are twice as likely to develop an ACL injury compared with men.

All in all, it looks like osteoporosis may have a protective effect. It may actually prevent OA from developing. Scientists are studying this phenomenon carefully. It’s possible they may discover something that could help prevent either or both of these conditions.

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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How does one hurt their ACL?

June 21st — admin

I hear a lot about athletes tearing their ACL, but my sister did it and she wasn’t playing sports at the time. How does one hurt their ACL?

The ACL tear is a common injury and, while it happens most often in sports, it is the result of a sudden stop and twisting motion, or if the front or side of the knee receives a sudden blow.

In sports, it’s often the result of an athlete running and coming to a quick stop and then changing direction at the same time. Pivoting on one leg, overextending the knee joint, or a hard landing from a jump can also cause the damage.

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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To test my knee, doctors plant my foot flat with my knee bent and pull on the lower leg. Why?

December 6th — admin

I have a bum knee that probably needs replacing. Over the years whenever I see a doctor they always do the same thing: plant my foot flat with my knee bent and pull on the lower leg. What kind of test is this anyway?

You may be describing the anterior drawer test. This is a test for ligament laxity or looseness. The lower leg bone (tibia) slides or glides forward underneath the thighbone (femur). A certain amount of slide or glide is normal. Too much sliding around is a sign that one of the ligaments inside the knee joint may be torn or damaged.

There is a series of tests for knee ligaments. If you’ve had the anterior drawer test, you’ve probably also been tested for side-to-side and rotational motion. All of these movements are needed for normal motion. Too much or not enough joint “play” or laxity can cause problems and put you at risk for future 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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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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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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Thigh muscle won’t contract after total knee replacement surgery

June 30th — admin

A month ago, I had a total knee replacement. I’m working very hard with my exercises, but the thigh muscle just doesn’t seem to contract when I try to straighten or lift my leg. Why is this?

Scientists refer to this as “inhibition.” The muscle along the front of your thigh is the quadriceps. The surgery disrupts this muscle and keeps it from contracting with full force. In other words, the voluntary contraction is inhibited. Pain and swelling in the joint probably add to the problem. A new study supports the use of electrical stimulation and biofeedback to get back the full power of the muscle. You may need a more complete rehab program with a physical therapist to regain this muscle function. It will prolong the life of your implant and reduce your risk of falls.

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 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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