Naples Orthopedic Surgeon - Dr. Robert J. Zehr » ligament

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

admin — Fri, 27 Jan 2012 11:00:24 +0000

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.

My doctor is trying out a different way of doing my ACL surgery using a piece of my hamstring. Will this speed recovery?

admin — Mon, 26 Dec 2011 11:00:42 +0000

I’m scheduled to have an ACL reconstruction in two weeks. The doctor is trying out a slightly different way of doing the operation. A piece of my hamstring will be used with a little piece of bone attached to give it greater stability. Will this speed up my recovery at all?

The use of multistrand hamstring tendon grafts and now hamstring tendon grafts with a bone plug to repair a ruptured anterior cruciate ligament (ACL) is gaining popularity.

Many studies have been done comparing the patellar tendon graft to the hamstring tendon graft. The results have been very favorable towards the hamstring tendon graft. Although the preparation of the graft takes longer, the stability of the knee afterwards may be worth it.

Patients have fewer problems at the donor site with the hamstring tendon graft. The patellar tendon graft is taken from the front of the knee causing painful kneeling afterwards. Sometimes the pain is severe. In most cases it never goes away.

Rehab is the same for both graft types. Recovery is not reported to be faster with one graft over another. Complications can occur with either method causing a delay in recovery. If no problems occur after the operation you should be back on your feet in two to four weeks. Full recovery and return to preinjury activities take longer (four to six months).

Losee maneuver can detect ACL injury

admin — Wed, 24 Mar 2010 11:38:56 +0000

What is the “Losee maneuver?” I’ve heard it can be used to detect a torn anterior cruciate ligament.

Dr. Ron Losee from Ennis, Montana, was the first to describe a test for ACL instability. It was called the Losee maneuver for many years. Now it’s sometimes referred to as the “pivot-shift” test.

When the test is done, the patient is asked, “Is this how your knee feels when it gives out?” The doctor doesn’t always feel a change in the knee during the test, so the patient’s report is important.

A positive pivot-shift may be a sign that surgery is needed to repair the torn ligament. There is a device that measures laxity between the two knees (a KT-2000). The results of one test usually aren’t enough to tell which patients need an operation. Tests like the pivot-shift, along with several others, are still important.

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.

Could my knee pain be arthritis? I’m only 33!

admin — Wed, 04 Nov 2009 11:12:47 +0000

Lately I’ve had a lot of pain right behind my kneecap, especially when going down stairs. I am only 33 years old. Could I be developing arthritis already?

There are several possible causes of pain behind the knee. A recent injury can cause pain from a ligament tear. Sometimes a small structure in the knee such as a bursa or plica can become inflamed and cause pain.

You may be describing a condition called patellofemoral pain syndrome (PFPS). This occurs when the kneecap is slightly off center as it slides up and down over the joint. This kind of tracking misalignment can cause the cartilage behind the knee to become torn or frayed.

PFPS is often characterized by pain when descending stairs. There may also be pain when trying to bend at the knee in a partial squat. An orthopedic physician or physical therapist can examine you and determine the cause of your symptoms.

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.

Tear in ligament often revealed only through arthroscopic surgery

admin — Wed, 30 Sep 2009 22:53:34 +0000

I was in a car accident and broke my pelvis in two places. After the injury finally healed, I still had deep groin pain and my hip kept giving out on me. I had MRIs, X-rays, and CT scans done for my pelvis, and nothing ever showed up. Finally, I had arthroscopic surgery and the doctor found a tear in the ligamentum teres. Where is this and why doesn’t it show up on all these tests?

If you pull a chicken leg out of its socket, you’ll see a fibrous white ligament. That’s the equivalent of the ligamentum teres in the human. It helps hold the head of the femur (thigh bone) in the hip socket.

Traumatic or twisting injuries can cause this ligament to tear. Hip dislocation can stretch it to the tearing point, too.

Doctors don’t have a test to help them find this type of tear. In fact, it wasn’t until arthroscopic surgery came along that they even knew it occurs as often as it does. Now that we know it’s a problem, more studies will be done to find easier ways to diagnose it.

Where exactly is the posterior cruciate ligament (PCL)?

admin — Tue, 15 Sep 2009 16:42:56 +0000

Where exactly is the posterior cruciate ligament (PCL)? Why don’t I hear about it as much as the anterior cruciate ligament (ACL)?

The cruciate ligaments are two ligaments that cross inside the knee joint. (“Cruciate” means cross). By connecting the thighbone (femur) with the shinbone (tibia), they help stabilize the knee. The ACL is in front. It protects the tibia from going too far forward in relation to the femur. The PCL crosses behind the ACL. It’s made up of two bands that work together to stabilize the knee when the lower leg is moving backward or rotating outward.

You hear more about the ACL because ACL injuries are more common. They also tend to result in more pain and symptoms than PCL injuries. However, recent studies suggest that PCL injuries may be more common than previously thought, accounting for roughly 20 percent of all knee injuries. Researchers have recently turned more of their attention to PCL injuries, to develop more effective treatments.

Does repair of ACL guarantee problem-free future?

admin — Tue, 14 Jul 2009 13:34:14 +0000

I recently had my right ACL repaired. My orthopedist said everything looked great. If my rehab continues to go well, does this mean I won’t have problems in the future?

Unfortunately, there is no way to predict the long term outcome for you. Sometimes, people who tear a knee ligament also bruise the knee bone. This damage may or may not go away completely. Even though the ACL may have been repaired successfully, the joint may still become arthritic if the bone damage doesn’t completely resolve. This is because the initial bone bruise can cause the bone underneath the cartilage to harden. The joint loses its ability to absorb shock, so the cartilage takes the brunt of the forces on the joint. Scientists are working to figure out how to predict and prevent these kinds of problems.