Category Archives: Knee

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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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 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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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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What are Lateral Collateral Ligament Injury Symptoms that need Surgery?

By  aenriquez  published  December 27, 2017

Knee Ligament InjuryLateral collateral ligament (LCL) injury often requires reconstructive surgery. LCL reconstruction is necessary to avoid rotational instability of the knee and cartilage damage. The extent of damage can affect the outcome of surgery. Certain symptoms exist that make surgery necessary. Our orthopedic surgeons are able to reattach the ligament with sutures or reconstruct it using donor tissue.

The lateral collateral ligament is one of the four major ligaments of the knee. The LCL is outside of the knee, and it connects the femur (thigh bone) to the fibula (lower leg bone). The LCL’s main function is to avoid varus stress across the knee (buckling outward). Together with the popliteofibular ligament, the joint capsule, and the popliteus tendon, these structures form the PLC complex, which gives you external rotational stability.

 

LCL Injury and Symptoms

Lateral collateral ligament injury symptoms vary from person-to-person. Injuries to the LCL and posterior lateral corner occur from a rotational force across the knee. A contact injury is a direct blow to the inside of the knee, whereas a non-contact injury is caused from hyperextension stress. The symptoms of LCL injury include:

  • Swelling and tenderness along the outside of the knee
  • Pain that can be mild to moderate
  • Feeling that the knee will give way under stress
  • Numbness or weakness of the foot related to the peroneal nerve, which is near the ligament stretched during injury

 

Can you Walk with a Torn LCL?

A torn lateral collateral ligament can produce severe pain and limit movement, depending on the severity of the injury. However, some people can walk following an injury or tear to the LCL. The doctor will grade the tear based on symptoms. A careful eye is needed to diagnose a posterolateral and lateral injury. The doctor will check for:

  • Ecchymosis and skin abrasions on the side of injury
  • Pain on palpation
  • Difficulty ambulating
  • Loss of normal knee movement

Diagnosis and grading of the tear are confirmed using a magnetic resonance imaging (MRI) scan. An MRI has a 90% accuracy for showing tears of the posterolateral corner and ligaments. To isolate the LCL, the doctor will apply stress during flexion and compare the knee to the other one. Signs that the knee requires surgery include a positive prone “dial” sign, problems with foot eversion and inversion, and severe tearing found during arthroscopy.

LCL Surgery for Tears and Injury

The lateral collateral ligament does not heal as well as the medial collateral ligament. For a minor tear, non-surgical treatment is used (bracing, rest, and ice). For high-grade acute tears, the ligament must be surgically reattached to the femur or fibula, depending on the situation. Surgical management includes open reconstruction using an allograft (donor material) or autograft (from the patient). The mini-open surgery involves a tiny incision and use of special tools and a camera to repair the ligament. The ends can be sewed together in certain cases where the ligament is torn into two pieces.

For a ruptured ligament, the surgeon will evaluate the situ1ation and make a surgical plan. Be sure to discuss all options with the orthopedic specialist and inquire about alternative therapies. When surgery is required, expect to have 4-12 weeks of recovery, which involves working with a physical therapist to regain strength and function of the knee.

Resources
King AH, Krych AJ, Prince MR, Pareek A, Stuart MJ, Levy BA. Surgical Outcomes of Medial Versus Lateral Multiligament-Injured, Dislocated Knees. Arthroscopy. 2016 Sep;32(9):1814-9. 
Yuuki A, Muneta T, Ohara T, Sekiya I, Koga H. Associated lateral/medial knee instability and its relevant factors in anterior cruciate ligament-injured knees. J Orthop Sci. 2016 Nov 19. pii: S0949-2658(16)30217-2. doi: 10.1016/j.jos.2016.10.009.
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Can Knee Cartilage Repair Without Surgery?

By  aenriquez  published  November 16, 2017

Knee cartilage repairCan knee cartilage repair without surgery? Cartilage is essential for the free and painless movement of any joint. A common injury to the knee is to the cartilage in the joint. Cartilage – often referred to as hyaline cartilage – in the knee is soft and spongy and has a number of functions. Firstly, it acts as a shock absorber, absorbing pressure and stopping bone on bone contact during jumping walking and running. Secondly, it maintains the synovial fluid (this is the medical term for the fluid within the joint) within the joint with the right concentrations of salts and other substances. Finally, it provides a smooth surface for joint movement to occur on. By having a smooth surface and stopping bone on bone contact (called eburnation) the joint is able to move freely and without pain. As such, when this cartilage is damaged, pain and an inability to move the joint can occur. This can come on slowly, in the case of osteoarthritis (which is due to long-term wear and tear on the joint) or suddenly, as in the case of a meniscus injury from a twisting motion in sports like Football or Tennis. Either way, the cartilage is often repaired using surgery – but this is associated with a number of risks and is not always ideal for older patients. So can knee cartilage repair without surgery?

One exciting new prospect is regenerative medicine. This stem cell therapy could cause cartilage regeneration. By taking knee cartilage regeneration supplements, patients avoid length and risky surgeries that can actually make the situation worse! There are a number of examples of regenerative medicine for knee cartilage including platelet-rich plasma therapy (whereby somebodies blood without the red blood cells) is given, Bone marrow-derived stem cell injections (as the name suggests, stem cells are taken from bone marrow), Amniotic derived stem cell injections (here stem cells are taken from the amniotic fluid that a baby is surrounded by in the mother’s womb). In platelet-rich plasma therapy, for example, all that is needed is a sample of the patients’ blood. After the platelets are sported out the doctor injects the liquid into the patient painful joint. This is much simpler than a lengthy surgical procedure where patients often have to stay in the hospital to recover. These therapies have been shown to be beneficial in smaller studies for a number of years now. Currently, larger scale studies are underway with promising results. In the future perhaps surgeries to repair cartilage (commonly in the knee but also the elbow, shoulder and other joints) may be a thing of the past!

As we have seen there are options for knee cartilage repair that do NOT involve risky surgery. Regenerative medicine could be the breakthrough many doctors have been waiting for as it is associated with so few risks and has so many benefits.

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Being Managed by One of The Best for a Bicycle Knee Injury

By  aenriquez  published  November 13, 2017

Bicycle Knee InjurykneeOne of the worst orthopedic pathologies one can experience includes a bicycle knee injury. The reason for this is because not only are there three potential bones that can fracture, but numerous another anatomy such as ligaments, tendons, muscles, and soft tissue can be damaged as well. What makes a bicycle knee injury such a potentially problematic trauma is that due to the velocity that an affected individual falls at, this can result in high impact injuries that can involve lots of tissue loss.

Patients who experience severe injuries due to the trauma may end up receiving orthopedic and reconstructive surgeries for the bone and tissue damage sustained. Fractures may include those of the femur (upper leg), patella (knee cap), and/or the tibia and even then fibula (lower leg bones).

Ligament injuries may include those of the collateral ligaments that stabilize the sides of the knee, or the cruciate ligaments which are the support structures inside the knee. If these cruciate ligaments are torn then surgical interventions include either repairing the injured anatomy or replacement of these ligaments with either a donor ligament from the upper leg (graft) or with a synthetic graft if a donor ligament is not appropriate enough.

In order to have the best possible outcomes following such an injury, one will need to be managed by one of the best orthopedic surgeons who specialize in managing such injuries.

One Of The Best  

One of the best orthopedic surgeons specializing in the management of knee injuries is Dr. Sumit Dewanjee, MD, who is based at FXRX in Phoenix, AZ.

Dr. Dewanjee is a Board Certified and Fellowship Trained Orthopedic Surgeon with specialty training in knee surgery to manage injuries, diseases, and disorders affecting this particular joint. The therapies that he is highly competent in performing include the following:

  • Arthroscopy of the knee which entails making small surgical incisions and using small instruments to visualize the inside of the knee and manage any possible problems. Major pathologies such as the mentioned cruciate ligament tears are managed via arthroscopic surgery to improve the recovery time of the patient, as well as to help reduce the risk of any possible complications. Other pathologies such as a tear in the meniscus (cartilage) of the knee are managed this way, too.
  • Partial and total knee replacement surgery which is performed on damaged and severely degenerated knee joints where conservative therapies are no longer helpful or effective.
  • Regeneration of cartilage is performed when there are isolated areas of the knee where the cartilage has worn down, but the patient is not yet a candidate for a total or partial knee replacement. Here, certain procedures, which can only be performed by specialized surgeons such as Dr. Dewanjee, are done which help to stimulate the growth of the missing cartilage in the area where it is needed.
  • Treating arthritis of the knee can be performed by injecting certain medication in the knee joint. The administration of a hyaluronic acid, which is a synthetic type of synovial fluid that is normally found in the knee joints, can only be performed by specialist orthopedic surgeons.
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What are Some Torn Ligament in Knee Symptoms?

By  aenriquez  published  October 27, 2017

There are four ligaments in the knee out of which the lateral collateral ligament is crucial for providing stability. Injury to this ligament is a very common occurrence that can affect optimal knee functioning. As such, it becomes important for athletes and others to be aware of some notable torn ligament in knee symptoms.

What happens in an LCL injury?

The lateral collateral ligament or LCL runs along the outside of the knee joint. Any partial or complete tear of the ligament can seriously impair movement and result in disability in more severe cases.

Depending on the nature of the injury, LCL injuries can be graded into the following categories:

Grade I injuries: Only a minimal amount of fibers get torn resulting in some pain and the individual can still utilize full functioning of the knee.

Grade II injuries: These injuries involve a greater amount of fiber tearing and impair knee function more severely.

Grade III injuries: These serious injuries result in rupturing all the fibers in the knee. The knee becomes severely destabilized and knee mobility/ function is significantly reduced. Grade III injuries may also lead to other complications in the knee area.

torn ligament in knee symptoms to check

Symptoms of an LCL injury

The symptoms of a torn ligament in the knee can range from being very mild to extremely severe. Symptoms are dictated by the severity of the sprain or if the ligament gets torn completely. While mild sprains may not present any noticeable symptoms, partial or complete tears can result in the following:

  • Swelling of the knee
  • Stiffness of knee joint
  • Soreness or pain on the outside of the knee
  • Instability of knee joint
  • Reduced mobility in the area

Swollen knee treatment

Occasionally an LCL injury may happen due to strenuous activity when a lot of pressure is placed on this ligament. Possible scenarios could be a sudden shift in movement putting too much weight on the knee or extending it too far.

In the case of minor injuries, the individual may still be able to pursue regular activity but may experience some stiffness and swelling in the knee. Since both grade I and grade II injuries to the LCL do not involve complete ligament tearing, they may be treated successfully using non-operative techniques.

Typical treatment options will include rest, compression, and cryotherapy with the aim of minimizing the pain and the associated swelling. Injury recovery accessories like a knee brace may be recommended.

Other options include taking pain relievers, keeping the knee elevated and limiting physical activity until the associated discomfort goes away.

Therapy will also involve a range of motion exercises to prevent joint stiffness and to keep the ligaments mobile. For such minor injuries, complete recovery time may take up to six weeks.

Severe LCL injuries, on the other hand, result in a complete tear and require surgical intervention to reconstruct the damaged ligament.

However, surgery is not usually recommended for treating LCL injuries in isolation. The LCL in these cases is often injured along with other ligaments in the knee to necessitate a surgical procedure.

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Effectiveness of Platelet Rich Plasma in treating Knee Injuries

By  admin6  published  October 25, 2017

Platelet rich plasma therapy has been shown to be highly effective in healing painful knee injuries, using a person’s own blood!

What is Platelet Rich Plasma (PRP) Therapy?

Platelet rich plasma is derived from the patient’s own blood and injected into the knee.

Platelets are blood cells that are best known as clotting cells. But they also contain a number of proteins called growth factors. These growth factors can support healing.

In the PRP therapy, the person’s own blood is used to separate the blood cells from plasma. The plasma now contains a high concentration of platelets. This platelet rich plasma is injected into damaged tissues.

Research has shown that PRP or platelet-rich plasma can help with knee injuries and pain, especially those cases that have failed to achieve relief with other treatments.

Platelet-rich plasma has been used to treat the following –

  • Joint instability
  • Joint pain
  • Knee, shoulder, elbow, and other joint injuries
  • Osteoarthritis
  • Carpal tunnel syndrome
  • Sprains and strains

Effectiveness of PRP Therapy

A study in 2009 showed significant improvements in pain, 6 months after the treatment, among 100 people with degenerative cartilage lesions in their knees.

A 2013 study followed 78 patients with osteoarthritis in both knees. Patients who received PRP injections experienced great pain reduction as compared with a group that received placebo injections. Most people obtained relief within a few weeks.

Most studies found few or no side effects. PRP has been shown to be a safe, non-invasive alternative to knee surgery. Since it uses the person’s own blood, no adverse reaction is likely.

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