The orthopedic surgeon is really the best one to advise your mother and answer your questions. He or she has the benefit of knowing your mother’s history and the results of the physical exam. Looking at the joint and leg alignment helps guide the decision. Seeing X-rays of the joint space is also very helpful.

At age 66 your mother is still fairly “young” by today’s longevity standards. If she has severe enough joint damage, then total joint replacement may be the best option. But these days, the goal is to preserve the natural joint for as long as possible.

It sounds like she’s planning to have an arthroscopic debridement. This is a minimally invasive operation. The surgeon makes two or three puncture holes and inserts a long, thin needle (the arthroscope) with a tiny TV camera on the end into the joint. This tool gives a view inside the joint. Tools used to remove loose cartilage or to repair any damaged cartilage are passed through the scope.

Most patients are up and going two or three days later. They wear a knee immobilizer and put partial weight on the leg until they feel up to full weight-bearing. Range of motion exercises are prescribed. Most pain relief occurs within the first six months. Some patients report continued improvement for up to two years after the operation.

It’s a good treatment option for patients with mild osteoarthritis. The ease of recovery makes it worth a try before going to major surgery like a joint replacement.

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 health care provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

You’re not alone in your questions. We know that osteonecrosis is the death of bone tissue. But spontaneous osteonecrosis (SON) is sudden, unexpected, and without known cause.

Some recent reports point to a possible increase in this condition in adults over age 60. At first doctors thought it was linked with arthroscopic surgery to remove a torn meniscus. But then five new cases were reported in patients who had meniscus degeneration but no surgery.

It appears that age-related wear and tear on the meniscus may be the start of the problem. But there are still many questions about what’s going on. For example, in one study of five patients, symptoms of knee pain were identified as medial meniscal degeneration.

At the time of the diagnosis, there were no changes in the bone seen on an MRI. The patients were all treated with physical therapy, exercise, and noninflammatory drugs. Two months later the symptoms increased. A second MRI showed osteonecrosis of the knee.

What happened in those two months between MRIs? Doctors just aren’t sure yet but further studies may offer some insight into SON.

Treatment depends somewhat on your goals. If you are planning to return to competitive sports, then analgesics to control the pain and rehab may be your best options. However, you should be aware that without the meniscus, your knees are at increased risk for damage and changes from arthritis.

If possible, the meniscus is repaired rather than removed. Most patients are encouraged to put aside strenuous, high-impact activities to protect their joints.

For some younger patients, meniscal transplantation may be the answer. Cartilage freshly donated or stored in a frozen state may be used. The knee must be stable and in good alignment. There can’t be any bone spurs.

A surgeon will conduct a physical exam. How you stand and walk is evaluated. Knee joint motion and alignment are important. Too much angle at the knee may keep you from being a good candidate for this surgery.

This treatment option is only considered for younger patients (less than 40 years old). The down side is that long-term studies haven’t been done to show results 10, 20, or more years ater.

Talk with your doctor about what’s best for you given your age, activity level, and sporting goals.

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.

Orthopedic surgeons see all kinds of injuries in the athletic population. One of the less common but very challenging areas of injury to evaluate is the hip. Hip pain can be coming from the hip itself, of course. But it could also originate in the spine or knee.The medical diagnosis is based on an understanding of what happened, how it happened, clinical presentation (signs and symptoms), and the results of specific tests. It’s really a differential diagnosis meaning the physician sorts through all the possible problems that could be present. Using the information collected so far, the doctor rules out those that don’t fit the description. Then further tests are done until the final diagnosis is made.Some of the most common choices in the differential diagnosis include: hip pointer, greater trochanter bursitis, iliotibial band syndrome, snapping hip syndrome, tendon tears, and meralgia paresthetica. Let’s take a closer look at each of these conditions.Athletes who collide with others or who take the force of a helmeted head into the lateral hip can end up with a hip pointer. This injury or contusion is visible as blood under the skin leaves a large bruise. It is treated with a leave it alone approach. Ice, rest, and compression help the body complete its natural course of healing.Bursitis is best treated by finding out what is causing the friction in the first place and dealing with that problem. It could be tight, inflexible muscles, tendons, or fascia. Stretching, strengthening, and manual therapy under the supervision of a physical therapist may be advised. Or it could be a postural or alignment problem such as a leg length difference, unsupported flat feet, or even broken down running shoes.Sometimes a tendon (e.g., the iliotibial band along the outside of the leg) snaps over the bone underneath. This condition is called iliotibial (IT) band syndrome or snapping hip syndrome. The IT band can be so tight that movement causes a pop that can be seen and heard. The athlete is taught how to avoid those movements and how to stretch the involved soft tissues. In chronic cases that don’t respond to physical therapy, surgery to release or lengthen the tight tissue may be needed.That brings us to lateral hip pain caused by tendon tears. The tendons involved most often are from the buttock muscles (gluteus medius and gluteus minimus). Because of the way these muscles attach to the greater trochanter (part of the femur or thigh bone), tendinitis of the gluteal muscles can look just like bursitis or iliotibial band syndrome.And finally, meralgia paresthetica must be considered whenever there is numbness along the front and side of the thigh. Meralgia paresthetica is caused by entrapment of the lateral femoral cutaneous nerve. This nerve can get pinched or compressed by tight clothing, after surgery to remove bone from the pelvic crest, a large belly associated with obesity, or in association with diabetes.There are some more serious types of problems that can affect the hip. Bone fractures, infections, and tumors head the list and are part of the differential diagnosis. Fortunately, these are rare and not easily overlooked when present.Once the physician diagnoses the problem, then an injury-specific treatment plan can be determined and carried out. With the exception of the more serious problems, most of these hip conditions are considered self-limiting meaning they will eventually go away in time. Treatment is first with conservative (nonoperative) approaches. The most common plan of care is for oral anti-inflammatory drugs, rest, and physical therapy. The therapist will work on correcting postural issues or malalignment, stretching and/or strengthening, and modification of aggravating activities or movements.Of course, fractures, infections, and tumors are dealt with in a different way. Treatment is also injury-specific but may include surgery, immobilization, antibiotics, and so on. You are on the right track to see an orthopedic surgeon and get a diagnosis. The rest will fall into place from there.

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.

Many studies have repeatedly shown that final knee motion after replacement depends on preoperative motion. It’s also true that patients with the greatest loss of motion have better results than patients with minimal loss of motion.

Recently a group of researchers in England and Canada got together to review the results of total knee replacements. They were especially interested to see what factors predict final motion measurements.

They found that age, gender, and body weight didn’t seem to make much difference. Likewise the type of implant was no longer such a big factor. The amount of knee flexion before replacement was still pretty important.

It’s likely you’ll notice some difference with the new implant. Let us know how you compare them!

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.

There may not be an easy, straightforward answer to this question. Let’s go over some of the considerations.

If the tendon graft is taken from the same leg, then only one leg is affected. The patient can shift the weight off that leg during the early days after the surgery.

Repairing the knee with donor tissue from the other leg means both sides are affected. There have been a few cases reported of problems developing from overload of the donor side.

This is more likely during the first 24-hours when the patient is still under the influence of anesthesia and drugs to limit pain. Without complete sensation, the patient can put too much load on the donor leg. The result can be an avulsion fracture. The remaining (weakened) patellar tendon pulls away from the bone.

On the plus side, taking donor tissue from the other leg leaves less trauma to the reconstructed knee. Rehab can progress along much faster.

Most surgeons use donor tissue from the same side. Talk to your surgeon about his or her preferences and reasons for choosing one over the other.

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.

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.

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.

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.

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.