Author Archives: aenriquez

Managing and Restoring Mobility of a Broken Arm

By  aenriquez  published  July 5, 2018

A broken arm is a painful and unfortunate event in a patient’s life. But after that initial pain subsides, one can often be left wondering will I ever get back to normal? Will my movement be affected by the broken arm? Will I be able to work? Can I go back to playing sport? Of course, the answers to these questions is incredibly variable depending on what you have broken and how badly it has been broken.

What can you break in the arm?

A number of structures make up an “arm” and can this be broken. The arm is defined as everything between the wrist and the shoulder and includes a number of bony structures. These are:

  • The humerus bone is attached into your shoulder socket and goes all the way down to your elbow.
  • The forearm goes from the wrist to the elbow and has two bones, the radius, and the ulna. The radius is the bone you can feel on the side of your thumb, whilst the ulnar is underneath it and on the side of your little finger.

All of these structures can of course break, and break in different ways and at different points. Each individual fracture has its own specific management based on years of research.

All of these structures can of course break, and break in different ways and at different points

How do you manage a broken arm?

Whilst all break will be dealt with differently, there are some general principles that get people back to normal after a broken arm. Firstly, the break needs to heal. If the two ends of the broken bone line up perfectly and look like they will heal well then usually a sling will suffice to take the weight off the patient’s arm and ensure they are pain-free. However, in some breaks, the two bones are not properly lined up and need to be “reduced”. This can be done by pulling the bones back into position (don’t worry – anesthetic is provided) and putting a cast or splint on them to keep them in position. In some cases, surgery may be needed to fix the fracture into position.

Once this initial management has been completed the patient usually has a period of immobility where they cannot move the affected arm before rehabilitation starts. The rehab process will be specific to the break but usually involves devices to support the arm and physiotherapy to rehabilitate movement of the joints around the break. The specific exercises practiced in the physiotherapy will be determined by where the bone is broken.

If you or somebody you know has been affected by a broken arm, they may need specialist help to adequately rehabilitate mobility in their broken arm. To get specialist advice and treatment for this get in contact with a clinic providing orthopedic and physiotherapy services in the United States. It seems trivial but ensuring proper rehabilitation is often the most important part of the management of a broken arm and when done properly can allow the individual to return to work sooner with less pain and more mobility.

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Implications Of An Untreated Stress Fracture

By  aenriquez  published  June 26, 2018

If you have pain in a bone that is unrelenting and associated with exercise or work then you might have suffered a stress fracture. These injuries seem innocent enough but can have significant implications if left alone and not looked at by a professional.

What is a stress fracture?

A fracture (as many of us will know) is a broken bone. A complete fracture splits the bone into two or more pieces whilst a partial fracture doesn’t. However, a stress fracture is a broken bone caused by repetitive and repeated compressive stresses to it. It can occur from a small number of high load repeated stresses and a high number of low load stresses (ie a marine with a heavy backpack running for a few miles versus a distance runner pounding the pavement for over 100 miles a week).

What happens if you leave it untreated?

This all depends on where the fracture is and whether it is in a high or low-risk site. In the worst case scenario, the stress fracture can develop into a full fracture causing displacement of the bone, nonunion (where the bone doesn’t heal properly) or fracture propagation (where the fracture becomes bigger and bigger). These complications are likely to occur at high-risk sites. High-risk sites for a stress fracture include:

  • Any stress fractures in the spine but particular the region of the lumbar spine known as the pars interarticularis
  • Hip and thigh fractures in the femoral head
  • Knee and leg fractures of the patella or the tibia
  • Ankle and foot fractures in the:
    • Medial malleolus
    • Talus
    • Tarsal navicular
    • Base of second metatarsal

A fracture (as many of us will know) is a broken bone

Some sites have a low risk of complication and these include:

  • Second and fourth metatarsal shafts (bones in the feet)
  • Posteromedial tibial shaft (part of the lower leg bone)
  • Proximal Humerus
  • Humeral shaft (arm)
  • Ribs
  • Sacrum (bottom of the spine)

How should it be managed?

If you or somebody you know suspects you might be suffering from a stress fracture then get in contact with a specialist orthopedic clinic immediately for evaluation. They will assess what the best treatment is, but the general principle is that the sooner treatment is given the better the outcome. They will decide between conservative and surgical treatment for the fracture. Usually conservative is chosen in low-risk fractures in those whose livelihood does not depend on getting better immediately. However, if an individual has a fracture in a high-risk site or their livelihood depends upon being active (ie a highly competitive athlete or a laborer on their feet all day) then it may be decided that surgery is the best option.

Conservative treatment usually consists of:

  • Pain control with medications
  • A splint that stops weight bearing on the fractured site
  • A reduction in activity until the fracture has healed
  • A slow and gradual increased in activities once the patient is pain-free
  • Exercises to help with rehab

 

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When A Full Knee Replacement is the Only Option

By  aenriquez  published  May 24, 2018

No-one wants to undergo a knee replacement operation but, if you are experiencing a huge amount of pain and movement is drastically reduced, surgery may be the only option. There are various reasons as to why you may need one, arthritis could damage the cartilage so that it has worn thin and bones grating against each other has made any movement painful. When you have the knee replaced, the remaining cartilage is often replaced by both plastic and metal parts. These parts interlock so that your knee can bend. Of course, having arthritis does not mean that surgery is essential. There are always other options to consider first such as stem cell therapy.

full knee surgery

There may be times, however, when stem cell treatments are just not suitable and of course, your medical professionals will guide you through the list of options. Certainly, knee surgery has changed dramatically over the last few years, with many advances being made and although this is offered less, there are times when there are no other options.

A partial knee replacement sounds less invasive than the full version but in truth, a partial knee replacement needs to have some very precise surgery i.e. bone being shaved back. This is a critical procedure as alignment must be perfect. If too little bone is removed, this would be as bad as removing too much. A partial knee replacement enables a quicker recovery rate, but it is not always possible.

 

The advantages of full knee surgery:

  • Increased mobility
  • Decreased pain

If you are suffering from knee pain and have been advised that surgery may be required, you may be understandably nervous. There are many benefits to having surgery but, there are always some risks. Risks are typically associated with age, although there are no actual age restrictions, however, most surgery of this type occurs between the ages of 50 to 80 years of age. Your health is a big consideration. If you are suffering from heart problems or, have a chronic health condition, surgery may not be an option.  Infections and blood clots can arise but, this is extremely rare. The benefits far outweigh the risks.

 

It is good to consider why you want treatment:

 

  • You are in severe pain
  • The knee joint is so stiff
  • Even when resting, pain is intense
  • You struggle to bend the knee joint
  • Chronic swelling does not dissipate
  • Another treatment has failed

 

A complete knee replacement today is much more efficient than ever and, also, less invasive.  Recovery time is quicker, and the success rate is very high. Once the surgery is over, there is less time spent in the hospital and you will be able to go home and really start the recovery process. To live without severe pain or stiffness is life changing. You can exercise, you can move, and you can sit in comfort. Importantly, you can get life back on track, hopefully, meeting friends and family regularly and avoiding low or fluctuating mood caused by pain and isolation.

 

If you are considering having a full knee replacement you are certainly not on your own. Many famous names are on the list and in the case of Steve Tyler from the rock band Aerosmith, it is hard to imagine that he had surgery as his movement is as good as ever.

 

Need to find out more information about your options for surgery? At the FRFX website, you can arrange an appointment with a medical professional. There really is no need to be in severe pain in modern times. Help is at hand.

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Physical Therapy and Rehabilitation

By  aenriquez  published  May 18, 2018

Physical therapy involves the use of certain maneuvers and exercises to restore your strength, activity, and motion following an injury, illness, or surgery. Physical therapists are trained professionals who identify deficiencies in the biomechanics of the body, they and teach stretches and techniques to address problems that can be managed. Physical therapists also use specialized equipment to address your condition and injury.

dealing with pain with Physical Therapy

Stretching Tight Joints and Muscles

A portion of physical therapy deals with stretching muscles and joints. Stretching is vital in maintaining good range of motion with the joints and for flexibility of muscles. If you suffer from tight muscles and/or stiff joints, normal activities can be affected. This includes climbing stairs, reaching overhead for items, and going through usual daily living. With proper stretching, these functions are preserved. After surgery, scar tissue forms and soft tissue will contract. To ensure that scar formation does not affect rehabilitation, it is important to go through regular stretching routines.

Strengthening the Body with Exercises

Exercises are used for strengthening, which helps with rehabilitation to improve muscle function and joint stability. The goal of improving strength aids in improved range of motion and increased endurance. Post-operative exercises should be guided by the physical therapist to ensure you do not injure the surgical area. These exercises are used in back, neck, knee, and shoulder injuries.

Core Strengthening and Stability

One of the most recent physical therapy developments involve the emphasis on core stability and strengthening. The core of the body should be solid and strong. A weak core puts you at risk for injury and chronic overuse syndromes. Core strengthening emphasizes the muscles of the pelvis and back. Some exercises programs are great for core stability, especially Pilates.

Application of Ice and Heat

Ice and heat are used for cooling down and warming up joints and muscles. Warmth also increases blood flow to the injured or healing region, and ice will decrease swelling through vasoconstriction. These mechanisms are very important for the therapeutic process.

Ultrasound

Using high-frequency sound waves, ultrasound therapy is used to stimulate the deep tissues in the body. The ultrasound probe is passed over your body, and deep tissues are stimulated by the vibration of a sound wave. Ultrasound will lead to warming and increased blood flow to the afflicted body tissues.

Electrical Stimulation

Electrical stimulation is a type of therapy used to pass electric current over an affected area. Nerve condition within a region can be altered which affects muscle contractility. Blood flow to the deep tissues is increased through electrical stimulation, and patients experience diminished pain after this treatment.

Reasons for Physical Therapy

The main reasons you should have physical therapy include:

To promote healing – This is used to minimized scar tissue of the knee or shoulder following surgery, and to improve blood flow to the injured area.

To regain mobility – Physical therapy is particularly important for the knees, hips, and upper extremities. It will help prevent joint stiffening and get you moving quicker.

To enjoy a faster recovery – Rehabilitation is used to help your body recover more quickly that if you do not receive physical therapy.

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Giving Golfers a New Lease of Life

By  aenriquez  published  April 1, 2018

Golfers a New Lease of LifeGolf is played by millions of people all around the globe. For many, playing two or three rounds of golf a week is the perfect exercise, but, it does come with some health risks. The shoulder joints are particularly at risk of injury due to the full range of motion that is required.

Here are some typical shoulders injuries that golfers suffer from.

 

  • AC joint pain
  • Instability
  • Rotator cuff tears

 

Golf is unique in the way that the shoulders are expected to perform. Each shoulder has a different task to enable the full swing. As a result, there are different types of injuries to each shoulder but, one painful condition that occurs in both shoulders is a rotator cuff tear.

 

The rotator cuff is four tendons which support the upper arm and help with the rotating movement essential in golf. It does not affect every golfer in the same way. Tendonitis is where the tendons become swollen and painful and you are likely to experience the pain of this when raising your arm. In addition, bursitis is another common problem when the arm is raised.  This is where fluid builds up over the tendons below the rotator cuff. This is a very painful condition and would make playing the game an impossibility.

 

So, what can be done?

 

Well, if you are a keen golfer, and your arm hurts when you raise it, there is the potential for a rotator cuff problem. These injuries can affect all golfers but as it is a repetitive type condition then, those that play more frequently are more likely to suffer from it.

 

The arthroscopic cuff repair may provide a solution. This technique is popular as it is the least disruptive cosmetically. There is also a significant reduction in scarring compared to other invasive treatments and less chance for an infection to set in. It is also the one treatment that enables you to get back playing golf in the shortest recovery time.

 

The procedure requires a camera to be inserted into the shoulder so that the tendons can be seen properly. Then a fluid is passed in, so the medical expert can view any damage. The repair usually requires some stitches to hold the tendon in place.

 

If you are a golf enthusiast, the last thing you will want is to miss out on the game for an extended period and this treatment helps you to get back onto the course fairly quickly. Some golfers have even expressed their delight in that they can provide a better swing action thereafter. This is likely to be because their swing was originally deficient due to the early stages of the injury. In some cases, it can be of benefit to ask a golf professional to examine your swing to make sure there are no obvious biomechanical errors in the movement. This may prevent further injuries. There is a lot that can be done to avoid this type of problem in the first place and to support this, here is some additional reading, which may help in the future.

 

If you are based in or are visiting Arizona and would like to find out more about how this procedure works or even book an appointment. Then check out this link to one of Phoenix’s leading healthcare specialists. Don’t let a rotator cuff problem be your handicap.

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Benefits of Orthopedic Bracing

By  aenriquez  published  March 22, 2018

Braces and splints are useful for chronic and acute conditions alike. They can also be used for prevention of injury. There is much scientific evidence that supports the use of braces and splints.

Unloader Knee Brace

The unloader (valgus) knee brace is often used for pain reduction in people with osteoarthritis of the medial compartment of the knee. These braces are designed to apply an outside (external) force to reduce the load on the medial (central) knee compartment, which reduces pain. Improved joint proprioception also helps to relieve pain. In a study involving 120 patients with knee osteoarthritis and varus deformity, researchers found that the unloader knee brace helped relieve pain and improve functional status. The benefits of this brace were found to be greater than a hinged brace.

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Common Shoulder Injuries and Conditions

By  aenriquez  published  March 21, 2018

Whether an injury occurs from paddling a canoe, throwing a ball, or lifting boxes, it does occur. We rely on our shoulders to do a number of activities, and with use of a shoulder, injury can occur. Normally, the shoulder has a wide range of motion, more than any other joint of the body. However, because it is this flexible, it is also not very stable and prone to injury.

The shoulder is made of two main bones: the shoulder blade (scapula) and the ball of the upper arm bone (humerus/humeral head). The humeral head is round, and it fits into the scapular socket. There are several muscles and ligaments that surround the shoulder, and they are called the rotator cuff. Tendons also connect the bones to the shoulder’s surrounding muscles. Injury to any or several of these shoulder structures can produce pain and disability.

Shoulder Instability and Separation

Shoulder instability affects mostly athletes and young people, but it can occur at any age. When ligaments and muscles are stretched beyond normal limits, the shoulder becomes unstable. This condition is often part of growth and development, and shoulders can stiffen and tighten with age. For athletes, shoulder instability is caused by repetitive motions, such as pitching or throwing. These motions put tremendous force on the shoulder, and the ligaments stretch out over time.

After years of having instability, or with persistent use, shoulder separation can occur. When the ligaments that hold the clavicle to the acromion bone of the scapula tear, it is considered separately. Sprains can also occur during a fall onto an outstretched hand/arm. A sprain causes severe pain and a misshapen shoulder, which also contributes to disability and decreased shoulder mobility.

Treatment for shoulder instability and sprain can involve medications, rest, and physical therapy. A sling is often used to limit movement while the shoulder heals. With severe instability and shoulder separation, surgery is often required to remedy the problem. Your treatment plan will be determined by the orthopedic specialist, who will collaborate with other professionals to develop the best course of therapy for you.

Shoulder Dislocation

When the ligaments that hold shoulder bones together tear, and they can no longer support the joint, the shoulder is dislocated. A shoulder dislocation can occur due to a fall onto the shoulder, a fall onto an outstretched hand, or from violent twisting. The main symptom of shoulder dislocation is a pain, and the discomfort becomes worse with movement.

To treat a shoulder dislocation, you should apply ice immediately and go see a doctor. Within 15 minutes of the injury, the joint becomes sore and painful. A dislocated shoulder often can be re-set using gentle traction, where the bones are put back in place. When the shoulder moves out of socket repeatedly, it is called recurrent instability, which requires surgery for correction.

Rotator Cuff Tear

A rotator cuff is a group of four muscles that support the shoulder. They allow a person to raise and rotate the arm. These muscles are attached to bones by tendons, which allow the muscle to strategically move the arm. When the tendons tear, the upper arm bone cannot move easily in the socket, which means you cannot move it away from the body in an upward motion. As people age, and they become less active, tendons start to lose strength and degenerate. Most rotator cuff injuries occur in older adults or middle-aged individuals.

The shoulder has a poor blood supply, which makes it harder for the tendons to repair and maintain themselves. Using the arms overhead puts pressure on the rotator cuff tendons, and repetitive movement and stress can lead to shoulder impingement. When the tissue or bone in the shoulder area becomes misaligned and rubs/chafes. The rotator cuff tendons are often injured or torn when someone lifts a heavy object with an extended arm.

Treatment of a rotator cuff tear depends on the severity of the injury. The doctor may recommend resting the extremity, using a sling to support the arm and medications. After the initial injury, swelling and inflammation are controlled with a nonsteroidal anti-inflammatory drug.

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Common Knee Injuries

By  aenriquez  published  March 2, 2018

Knee Injuries

Many people enjoy playing sports and participating in physical activity, whether playing for fun in the backyard or competitively on a sports tea. Sports participation is beneficial to your health, but there is always the risk of injury. The knee is very vulnerable to injury in sports and everyday life. Knee injuries can occur due to poor training practices, flawed techniques, improper equipment, or accidents.

The knee is a complex joint that serves as an integral component of healthy mobility, and when one experiences an injury, he or she often requires surgery and physical therapy. Our orthopedic specialists are skilled at diagnosing and treating these common knee injuries. We assess your knee, conduct testing and imaging to confirm the problem, and develop a comprehensive treatment plan.

Sprains and Strains

The most common types of knee injuries are sprains and strains. A sprain occurs when a ligament tears or stretches beyond normal points. A ligament is a band of connective tissue that attaches bone to bone, and sprains range from minor ligament tearing to severe severing. A strain is where a muscle or tendon stretch beyond normal, and this can also be minor or severe.

Shin Splint

A shin splint is pain along the tibia (shin bone). This pain is typically at the anterior (front) region of the lower leg, but it can also occur in the knee region. Shin splints often affect runners who run on hard surfaces. Contributing factors for shin splints are poor running shoes, lack of support, failing to warm up/stretch, and having flat feet.

Fractures

The knee bones include the femur, tibia, and patella. Small cracks in any of these bones can occur from repeated stress. A stress fracture occurs from repeated impact, such as jumping or running. A patella fracture can occur from a fall onto the kneecap region. A tibia plateau fracture occurs when sudden excessive pressure collapses the top region of the tibia bone.

Dislocations

A dislocation occurs when one bone of a joint comes out of alignment. Also known as luxation, excessive stretching, falling, and twisting injuries can lead to a dislocation. Dislocated bones may be able to be realigned by a doctor, but some of these injuries require surgery. The condition involves bones of the knee being dislodged partially or completely.

Anterior Cruciate Ligament Injury

The anterior cruciate ligament (ACL) is an important knee structure. Injuries of the ACL are not just problems for athletes. A partial or complete ACL tear can occur from a quick change of direction, or from a compressive pressure of landing improperly when jumping. Damage to the ACL can cause an unstable knee.

Posterior Cruciate Ligament Injury

Posterior cruciate ligament (PCL) injury occurs when the knee is in the bent position. This type of injury results usually in only a partial tear and injury of the PCL can occur from falls or car accidents. The PCL does not have good blood flow, so tears of this type have difficulty healing.

Meniscus Tears

The meniscus is a wedge-shaped cartilage that serves as a cushion between the femur and tibia bones of the knee joint. Twisting or squatting can result in a meniscus tear, which also occurs from normal degeneration as people age.

Patellofemoral Syndrome

When the underside of the patella becomes irritated and inflamed, patellofemoral syndrome occurs. This is related to the kneecap rubbing against the femoral condyle with extension and flexion (bending) of the knee. The inflammation can result in serious pain.

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When Is Shoulder Arthroscopy A Better Option Than Open Surgery?

By  aenriquez  published  January 29, 2018

Subacromial decompression is a surgery that treats shoulder impingement syndrome and can be done through an open incision or arthroscopically.

Surgeries such as open decompression or arthroscopy have almost the same results in a reduction in pain ranging in almost 77-90 percent of the patients. The methods to be used are dictated largely by the surgeon’s preferences and the condition of the patient.

Arthroscopic Surgery for wellness

Arthroscopic surgery

A minimal two to three small cuts are made surrounding the shoulder during the surgery. An arthroscope, which is a small viewing device is inserted in the cut. The surgeon can look inside through the camera and check the biceps and joints along with the rotator cuff tendons to any issues that can otherwise be overlooked or go unnoticed in an MRI or an open procedure.

Arthroscopic surgery is generally recommended for people who are young and have a mild impingement in the shoulder. It is done to promote regaining of daily activities. Moderate shoulder impingement refers to pain which hinders daily life activities. It often occurs in individuals around the age of 25 to 40 years old.

When is it not recommended?

It is generally not recommended for people who experience the following:

  • Existing shoulder problem
  • Have a large tear in the rotator cuff which is medically proven as unrepairable. Patients who have such significant injuries can only be treated with open surgeries.
  • Individuals with a flat acromion or tissue inflammation like tendonitis in the rotator cuff, which is not due to shoulder impingement but rather the cause.

Open Surgery

This procedure involves a large incision of about 4-6 cm. It is necessary for patients who have a large rotator cuff tear. In many cases, surgeons recommend open surgeries compared to other options as it allows them access to a large area of injury. On the other hand, however, a large incision increases the chance of infection. Patients who undergo open surgery may have to spend 1-2 nights in the hospital for recovery.

Open Surgery vs Arthroscopic

Open surgeries are for external rotation while arthroscopic procedures are linked with less motion. Open surgery can be performed faster, while arthroscopic procedures require a detail-oriented set of skills.

Many surgeons are comfortable with open surgeries for the latter can be a difficult procedure.  Recovery time varies for both, and in general, takes 3-6 months to fully recover. People may be able to use the affected arm by two weeks of the surgery.

It is reported that people who go through arthroscopic surgery recover faster, and experience less pain during the recovery period. The recovery process involves stretching and exercise that prevents swelling and stiffness. In both cases, a therapist would likely be involved to assist the patient with exercises that promote healing and recovery.

Risks

There are potential risks of both types of surgeries, including:

  • Chronic shoulder pain and stiffness
  • Damage to the nerves or blood vessels
  • Infection  (less risk in arthroscopic compared to open surgery)

 

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Can You 3D Print Knee Cartilage?

By  aenriquez  published  January 8, 2018

Young or old, you’ve probably felt a nagging pain in your knee at some point.  In fact, some studies suggest that knee pain has increased up to 65% in the over the past few decades. But for some that pain becomes constant and unbearable. That can be for a number of reasons including:

Printing 3D Cartilage for Knee Surgeries

  • Osteoarthritis (often referred to as degenerative or “wear and tear” arthritis
  • Damage to the meniscus or cartilage (this can also be caused by osteoarthritis)
  • Gout
  • Tendonitis
  • Bursitis
  • Torn ligament or tendon

 

For many of these conditions, there are clear treatment plans that pave a way to recovery. However, cartilage damage (the regions of cartilage in the knee are known as menisci) has previously been tricky to treat. But now revolutionary technologies and surgeries could provide hope to those suffering in silence.

 

What do the menisci do?

 

The menisci sit on the bones of your knee and act as cushions. They absorb shocks and make sure the bones of your knee don’t bump and rub against each other. However, unlike most tissues they don’t have a blood supply and as such can’t get the nutrients they need to repair themselves. Damage often occurs in young people with sports injuries. You may hear doctors talk of the “unhappy triad” where athletes tear their ACL, MCL and damage their medial meniscus. This is what happened to Judy Hobson who talked to the DailyMail about her road to recovery

 

“I had to give up sport altogether. I could barely walk a couple of hundred yards and was starting to limp. I was miserable because it was such a huge part of my life. I even thought about having my leg amputated and being fitted with an artificial limb”

 

A 3D printing breakthrough

 

New hope could be on the horizon as researchers at the University of Alberta are working on 3D printing knee cartilage needed for transplant surgery. They have been able to print a 3D leaf made of natural proteins. One of the engineers, Stella Matthews, said

 

“It is the first step towards tissue engineering,”

 

Next, they will try to print cartilage shaped for the individual that surgeons can transplant into the patient’s knee.

 

What can be done at the moment?

 

Whilst these results are highly exciting, they aren’t available for the patient right now. However, patients can still have a meniscus replacement surgery. This is what Judy Hobson had done. Again talking to the Daily Mail she said

 

“After nine months, I could walk more than a mile pain-free – now it’s five or six miles and I’ve also started to play a little volleyball again. I’m so grateful to the person who donated the meniscus.”

 

Specialist clinics across the United States offer the procedure. Ricky Valadez, who had the procedure and talked to Fox32 about it said

 

“The best thing, in the long run, is I’m going to be able to have the opportunity to do whatever I want and not be held back,”.

 

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