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.

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.

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.

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.

There are many, many possible causes of hip pain. An accurate diagnosis is needed to direct treatment. But this can be elusive and take a long time to make. The physician’s examination takes into account the possible etiology or cause of the problem. Was there some trauma? The mechanism of acute hip pain caused by injury is often a twisting motion. Overuse, repetitive motion, and diseases or degenerative conditions are other potential causes of hip pain. Pain patterns associated with hip problems start with a deep aching and stiffness in the hip. True hip pain is experienced in the front of the body down into the groin area. Hip pain along the pelvic rim, down the side of the leg, or down the back of the leg is usually a sign that the cause of the pain is extraarticular (outside the hip joint). This could be coming from pinching of the soft tissues, nerve entrapment, or other extraarticular lesions. Loss of motion and/or function can help point to the specific soft tissue structures affected.

It sounds like your physician has been very thorough. Evaluation of hip pain may require imaging studies such as X-rays or MRIs. But unnecessary X-rays and other imaging studies should be avoided. Results are viewed cautiously as many changes in and around the hip may be observed but may not be the cause of the painful symptoms. The most obvious pathologies that must be treated include tumors, fractures, hematoma from bleeding after a fall, and infections.

Often in the face of an unknown cause of joint pain, a short course of physical therapy can be a diagnostic aid for the physician and helpful to the patient. As experts in human movement dysfunction, the therapist can evaluate and treat the soft tissues and postural issues that could be the underlying cause of the problem.

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.

It’s not uncommon to have strength differences from side-to-side after a hip fracture. A strength-training program may help. But even more importantly, a balance-training program is needed. Many times, strength-training is done in the seated position. This does not challenge the balance system, which is what is needed to improve balance. Improving balance also improves mobility and prevents falls that can lead to life-threatening or disabling fractures.

You can do some simple things to begin challenging and improving your balance. Stand on one foot and practice standing balance. At first you may need to hold on to a chair or countertop to avoid losing your balance and falling. Keep your pelvis level (don’t let one side drop down). Doing balance exercises in front of a mirror can help. Gradually increase the length of time you can stand on one leg without putting the foot down. You can do these standing balance exercises when you are standing in line at the store, while on the phone, or even while brushing your teeth.

Combining balance activities with strength training is important. For example, while balancing on one leg, swing your free leg out to the side and back to midline. Do this 10 to 12 times before switching to the other side. This exercise targets the hip and buttock muscles for good pelvic stability needed for balance. Your public library may have some good videos (or DVDs) with a home-based exercise program to improve balance.

If you need more specific help, see a physical therapist. The therapist can assess your individual needs and show you a home program tailored to your needs. With occasional visits, the therapist can progress you through the program safely and effectively.

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.

Making the proper diagnosis is key. They are frequently overlooked. Ninety percent of the time, conservative treatment rather than surgery is adequate. Conservative treatment includes ice initially, then the use of heat. Immobilization for three to four weeks is usually necessary. Physical therapy for strengthening of the muscles around the shoulder blade is often prescribed. Repeat imaging such as computed tomography is used to monitor the healing progress of the fracture.

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 older adults who survive a hip fracture are left with problems they didn’t have before the fracture. For example, they may have to use a walker or cane to get around. Walking and managing stairs can be major disabilities now. Dressing and undressing can be difficult. And some patients are unable to get back to their regular community or social activities. Recovery can take up to two years.  

Most patients receive physical therapy while in the hospital. But PT after discharge isn’t always ordered or provided. Yet studies show that patients with this injury who have PT after going home are less likely to be rehospitalized. They are also less likely to die from complications of this condition.

The therapist will help the patient regain motion, balance, and strength needed to resume normal activities of daily living. These skills are also needed to get back to regular social activities. Breathing exercises and aerobic conditioning may help prevent problems such as pneumonia that can cause rehospitalization and even death.

Most states in the U.S. now have consumer access or direct access to PTs. This means you can contact the therapist directly without requiring a physician’s referral. The therapist’s evaluation will include screening for conditions that require medical attention.

After a few weeks of PT, many patients can be set up on a supervised home program they can follow on their own. The therapist will also help identify safety concerns in the home environment. Anything you can do to make sure safety feature are installed (e.g., lighting, tub bars) will go a long way to prevent future falls and subsequent fractures. 

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.

Astronauts are subject to many possible problems due to travel in a gravity free environment. Muscles start to waste away. Bones get brittle and the heart and lungs start to get deconditioned.

Exercise in space has not been able to help staff keep muscle strength and mass. Treadmills with bungee cords have been tried but the harness is uncomfortable. A lower body negative pressure chamber has been devised to help with this problem.

The chamber is a rectangle-shaped box that forms a vacuum around the lower body. It’s sealed at the waist. A special saddle helps the legs stay relaxed while supported. Pressure can be lowered to reduce the force on the joints equal to 20 percent of the person’s body weight.

Using this idea might be helpful with patients who need to get up and moving but can’t put weight on their leg. This could apply to patients with hip and knee surgeries, amputations, and even strokes. It’s not available for commercial use yet. It’s still being tested for patient use.

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.

It might be time for a follow-up visit with your doctor or therapist. Tests of motion, strength, balance, and coordination can guide you. Patients exercising on their own can still show major weakness even years after a total knee replacement. This can put you at risk for falls and other injuries.

Every person is different and has his or her own unique needs for rehab after joint replacement. A closer look at what you’re doing and how you doing can lead to an answer to your question.

It’s likely that some form of exercise will be advised. Regular exercise and physical activity has been shown to keep joints healthy, even joints already affected by arthritis. Make it worth your while to exercise. Find out what’s best for you in this phase of 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.