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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Does joint injury always lead to arthritis?

October 14th — admin

I was in a car accident and crashed my left knee against the dashboard hard enough to break it. I’m only 23-years old and I know this might get arthritic later in life. What are options now to help prevent this from happening?

Good question. We don’t have studies to show the long-term results of each possible treatment option. Some may say don’t worry about it — what will be, will be. Others say don’t borrow trouble before it happens. In other words, not everyone develops arthritis in a joint after a traumatic injury. The event increases your risk but doesn’t guarantee it.

You didn’t mention what treatment you’ve had for this problem now. Sometimes even young people damage the patella enough that fracture healing isn’t possible. In those cases, the kneecap may be removed, a procedure called a patellectomy. Older folks might opt for a total knee replacement, especially if they already have arthritis in the knee. Middle-aged patients may be given the choice of just a kneecap replacement.

The biggest factor in long-term results may have to do with your knee alignment. Does the patella track up and down well during knee motion? Is it balanced and in the center? Does it tend to track more to one side or the other?

The knee joint axis is also important. Are you slightly knock-kneed or bow-legged? These positions can affect how well the knee holds up over the years.

Ask your doctor for his or her recommendations. It could be there’s nothing to be done just now. Or there may be an exercise program that could correct any weaknesses or misalignments.

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 a resurfaced patella?

January 21st — admin

What is a resurfaced patella? I see it in the surgeon’s report on my new total knee replacement. I don’t remember ever hearing about that.

When the knee joint is replaced the surgeon has two choices about the kneecap (patella). He or she can leave the patient’s patella in place or remove it and replace it with an implant. Unresurfaced or nonresurfaced means the patient’s patella is cleaned up but left alone. Any bits of uneven bone are usually smoothed over. Pits and dings in the cartilage are also evened out.

If the patella is removed and replaced, then a plastic-backed implant is used most often. Early patella replacements were made of metal but bits of metal kept breaking off causing problems.

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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Should kneecap be removed during total knee replacement?

January 18th — admin

I hear there’s a big debate over whether to leave the kneecap in or take it out during a total knee replacement. Why can’t they figure this out? It seems like a simple ‘yes’ or ‘no’ question to me.

This has been an unresolved issue ever since the total knee replacement (TKR) was first done in 1968. Today 365,000 TKRs are done each year in the United States. At first the kneecap (patella) was replaced. Early problems with fracture, loosening, and rupture of the tendon around the patella caused surgeons to rethink this decision.

Some studies were done of patients who all had a resurfaced (replaced) patella. Others reported findings on studies with patients keeping their own patellae (nonresurfaced). A single answer to which was better couldn’t be reached.

It seems there are too many factors to compare. There are many different kinds of implants to choose from. Different surgeons come to the (operating) table, so-to-speak with a wide range of experience and surgical methods.

Even the patient’s diagnosis can make a difference. Some patients have one knee replaced while others have both knees replaced. It’s not always possible to tell if the results vary because of one of these factors or because the patella was or wasn’t replaced.

There remains a need for high quality studies to be done in this area of orthopedics.

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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Ballet dancer suffers from repetitive kneecap dislocation

November 28th — admin

I am a professional ballet dancer with dislocating kneecaps. I never know when one or both of my kneecaps will pop off to the side. Although I can push them back in place, my knees are painful for at least two days afterward, and I can’t dance. I read a magazine article that suggested “conservative treatment” for this problem. What is conservative treatment, and could it help me?

Conservative treatments are those that do not involve surgery. When the knee bends and straightens, the kneecap, or patella, moves up and down in a straight track over the knee joint. If the fibers holding the patella in place are torn or damaged from injury, the patella can get pulled to the outside. If the patella moves completely off its track, it becomes dislocated.

Sometimes exercises to strengthen the muscles around the knee can help with this problem. Learning how to stand and use the leg with good alignment and proper patellar tracking may help. Sometimes a soft brace or knee support helps hold the patella in place while you retrain the muscles and change the way the patella moves.

However, when the patella dislocates over and over, conservative treatment is not likely to help. Surgery to repair the surrounding structures and realign the patella may be necessary.

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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