Questions related to the ACL
Q. I recently tore my ACL and am having it repaired surgically. My doctor gave me the options of using ligament from a cadaver or some of my own ligament from my patella or hamstring for the surgery. Which is the best treatment for me that won’t sacrifice strength or flexibility?
A. The patella tendon autograft is the most reliable procedure for ACL repair. I have had over 95% success with this graft in hundreds of aggressive athletes. The allograft (cadaver) has chance of disease transmission or stretching, but is a reasonable option for those wanting the least initial downtime from surgery and who are willing to accept these risks. Hamstring grafts take longer to heal and are more difficult to fixate to the bone, but work well when done properly. If the graft heals properly and is functioning after two years it should last indefinitely, barring any new injury. (See Anterior Cruciate Ligament (ACL))
Q. For a partial ACL tear, do I need to have a full ACL reconstruction?
A. No. Currently we are doing a type of thermal “shrinkage” of the stretched ligament, which maintains the original structure and does not require a graft or any screws. Of course there are other more traditional options that can also work, but they are more invasive and require a much longer rehabilitation period. This is a cutting edge technique that I have been doing for a few years. There is no real published data on the shrinkage procedure yet, as we need several years of follow-up for legitimacy. We will begin tabulating our data later this year. Preliminary information however is quite promising and we have done over thirty cases at this point. (See ACL Shrinkage)
Q. Do you recommend physical therapy and/or a CPM Machine after ACL reconstruction surgery?
A. I am an advocate for aggressive rehabilitation and am currently studying the benefits of a CPM (Continuous Passive Motion) machine. It has not yet been proven that CPM machines improve the outcomes of ACL surgeries. However, these machines have been shown to improve the outcomes of other surgeries, and I am hoping this is true for ACL reconstructions. (See ACL CPM Rehab Study)
Questions related to the Knee
Q. I experience pain around my kneecap whenever I play soccer. What does this mean (my X-rays are OK) and what can I do to treat it?
A. It sounds like you may be suffering from chondromalacia of the patella. Try strengthening your vastus medialis obliqus (part of the quadriceps) muscle. Some exercises for this are straight leg raises, terminal arc leg extensions, leg presses and use of a kick board in the pool. Stretching before exercise, wearing a brace during exercise and icing afterwards will also help. You might also try over-the-counter cartilage nutritional supplements: Glucosamine Sulfate/Chondroitin Sulfate. If none of these treatments helps, arthroscopic surgery might be an option. (See Patella (Knee Cap))
Q. For about six months, my knee has been hurting whenever I go running. My doctor diagnosed me with patella malalignment. What are my treatment options if I want to return to full activity?
A. First you should try stretching and taking anti-inflammatories before exercise, as well as some physical therapy. If conservative management is not effective, surgical realignment is a possibility. There are many ways to realign the patella, although I am convinced that our current arthroscopic method is as effective as traditional open techniques. The procedure is an arthroscopic medial reefing and lateral release. (See Patella (Knee Cap) AND Arthroscopic “All-Inside” Patella Realignment)
Q. I had a lateral menisectomy a long time ago and have developed pain in my knee. My doctor mentioned new treatments for articular cartilage defects; chondrocyte implantation and bone plugs. Could you give me some more information about these procedures and tell me which would be best for me.
A. There is significantly more data on the Genzyme chondrocyte implantation than the plug procedure. In brief, the plug option is reasonable for small defects, while the Genzyme procedure is recommended for larger defects. I only recommend the plug procedure for small circular defects, due to many concerns about the possible long-term consequences. (See Cartilage Transplantation)
Q. USA Weekend recently published an article that mentions polyurethane injections as a new treatment for knee arthritis. Do you do this procedure?
A. The polymer procedure is still experimental, even in Europe, and is not FDA approved. Therefore, there is little published information on this procedure at this time, and it will be some years before this procedure is available in the US. Clinical trials are not expected to begin here until next year. We hope to be one of the first centers in the country to perform this procedure.
Q. I am young and athletic, but am suffering from severe arthritic degeneration of the knee. My meniscus was removed surgically a long time ago. What can I do to reduce the pain besides having a total knee replacement?
A. Fortunately, there are several options available for patients facing knee replacements, all of which depend on the severity of your degeneration. The simplest alternative is a series of lubricant injections that are effective in some people. We have had only limited success in our patients, but since there are limited side effects it is worth a try. There are also several surgical options that are much less invasive than a total knee replacement. Meniscus transplants replace the previously removed meniscus and hopefully protect your joint from further degeneration. We can also do cartilage implantation procedure to “re-coat” the joint surface or a bony realignment to shift your weight away from the damaged areas. (See Non-Surgical Treatments AND Cartilage Transplantation AND Meniscus Transplantation (Meniscal Allografts))
Questions related to the Elbow
Q. I play outfield on my softball team and no matter how long I warm up for, after a couple of hard throws to the infield the area around my elbow is in throbbing pain. What does this mean and what can I do about it?
A. The pain you are describing could be caused by several different injuries. If it is simply tendinitis, you should get better with stretching, massage, anti-inflammatory medicine and possibly physical therapy. It could also be due to a problem within the elbow joint, in which case you might benefit from a simple arthroscopic treatment. (See Tennis Elbow)
Questions related to the Ankle
Q. I have been diagnosed with OCD in my ankle. How effective are the surgical treatments?
A. For localized arthritis of the ankle, the simplest procedure is an arthroscopic debridement to clean up the affected area. You can also have osteochondral plug or cartilage chondrocyte implantations to repair the defects. For extensive arthritis, a fusion of the ankle is the best option. Many of these procedures can be done arthroscopically. (See OCD of the Talus – Osteochondritis Dessicans (OCD))