3D Animation on Torn ACL Procedures

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The anterior cruciate ligament (ACL) is one of four ligaments that are crucial to the stability of your knee. It is a strong fibrous tissue that connects the femur to the tibia. A partial or complete tear of your ACL will cause your knee to become less stable and feel as though your knee is about to give out. The following videos will describe the different options available to repair or replace your torn ACL.

Visit  our Patient Education page for the full Library of 50 specific Orthopedic Surgical Procedures in 3D Animation. Produced by an experienced team of medical writers, 3D BCMD whiteanimators, and project managers with a detailed understanding of anatomy and surgery; they take complex surgical procedures and animate the steps to tell a visually stunning story in 3D that is both educational and entertaining. Each animation is embedded with an illustrated script which can be shared, viewed or printed separately.

ACL SURGERY IN GROWING ADOLESCENT KIDS

By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • We are seeing more ACL injuries in young growing athletes than we used to several decades ago, and more young athletes choose to have early ACL surgery
  • ACL surgery in a growing athlete requires special considerations to minimize chances of injury to the growth plates
  • With proper techniques, risk to the growth plates is low and success rates for surgery are very good although results are not as good as they are for adults after ACL surgery

An ACL tear in growing athletically active kids is a challenging issue to manage from a allograft ACLsurgeon’s standpoint. It appears that the number of young people sustaining ACL tears is on the rise, and in particular we are seeing more ACL injuries in kids who are not done with their growth.

As compared to kids who are still growing, teenagers who are done growing can be treated as adults when it comes to surgical decision making. Regardless of age, the main issue with a torn ACL is that the knee is typically unstable, making some sports and daily activities difficult. A knee with a torn ACL often gives way or buckles with activities.

Some surgeons will recommend that a young patient modify activity and possibly wear a brace until growth is finished, and then go through the ACL surgery. This is theoretically possible but it’s often very difficult to successfully manage a young person’s activity level, leading to quite a bit of unhappiness. This study showed that only 6% to 52% of young athletes were able to remain physically active to their desired level when managed without surgery, whereas 80% to 100% of young athletes managed surgically were able to successfully return to their desired level of activity. The surgical option tends to be much more appealing to most kids and parents.

The surgery for a torn ACL- called “ACL reconstruction”- involves building a new ligament by drilling tunnels in the tibia and femur, and then placing a new tissue called a “graft” in those tunnels. As the graft heals and matures it functions as the new ACL. In a young growing athlete the key consideration is that the areas of the bone where growth takes place, the “growth plates”, can theoretically be damaged by the surgery. This means that there’s a chance that either the leg length or the angulation of the leg could be altered by the surgery.

Considerable research has gone into the ways to minimize risk to the growth plates during surgery. Some techniques involve modifications to the tunnel positions to avoid crossing the growth plates. Other research has studied the effects of various types of ACL grafts on growth using conventional surgery techniques.

Not surprisingly, in this relatively new area of ACL research there is some controversy. The growth plate sparing techniques may have somewhat reduced stability compared to a conventional technique. And some graft choices may have a higher risk of damage to the growth plate. For example, a patellar tendon graft with bone plugs is commonly used in adults but there appears to be a higher risk of growth disturbance if the bone plug crosses the growth plate. Hamstring tendon grafts and conventional tunnel drilling technique seem to have the best combination of stability, excellent return to sport, and low risk of injury to the growth plates.

Some recently published studies have shown excellent functional results from the surgery with low rates of bone growth issues. This study of surgery on young people with open growth plates using conventional surgical technique and hamstring grafts showed about 15% of kids with some x-ray evidence of growth issues at 4 years, but none of the issues was limiting to the young athlete. Interestingly, this study showed that during the 4 year follow up period 16% of the kids retore the ACL, and 16% tore the ACL in the other knee. Success rates are quite a bit higher in adults.

ssd.bannerThis is a controversial area with a number of important considerations when deciding treatment pathways. My advice if you’re a parent of a young growing athlete with an ACL tear is to seek the opinion of highly experienced sports medicine surgeons, or possibly a pediatric sports medicine specialist to assist you in your decision.

OSTEOARTHRITIS & YOUR KNEES

More than 27 million Americans have OA and the knee is one of the most commonly affected joints. There are many treatment options available including several non-pharmaceutical and non-surgical choices.

WHAT IS OA OF THE KNEE?

Osteoarthritis is commonly known as “wear-and-tear arthritis,” but did you know that young people get it, too? Osteoarthritis, or OA, is the most common type of arthritis; it happens when the body’s natural cushioning—cartilage—wears away between joints. Think of cartilage as a shock absorber for your knees; less cushion results in bone rubbing against bone, and that can cause stiffness, pain, swelling decreased mobility and bone spurs. OA typically develops slowly and becomes worse over time. There is no cure for OA, but there are many treatments available that can ease the pain and help people to retain or regain their mobility.

WHAT CAUSES OA?

The ability of cartilage to heal decreases as people age, but the causes of knee OA vary. It can be hereditary or can be the result of injury, infection, overuse or excess weight.

In osteoarthritis, the cartilage in the knee joint gradually wears away. As it does the protective spaces between the bones decrease resulting in bone rubbing on bone, producing painful bone spurs.
  • Obesity is the No. 1 driver of knee OA and the No. 1 cause of disability in the U.S.
  • Weak muscles around the knee can cause OA
  • Every extra pound of weight adds 3 to 4 pounds of extra weight to the knees; extra weight increases pressure on knees
  • Genetic mutations can make a person more likely to develop knee OA; abnormalities of bones surrounding the knee joint can also cause OA
  • Women ages 55 and older are more likely to develop knee OA
  • Athletes who play soccer, tennis or run long-distance may be at higher risk
  • Activities that cause a lot of stress on the joint—kneeling, squatting, lifting heavy weights of 55 pounds or more—can cause OA of the knee due to repetitive stress
  • Those with rheumatoid arthritis or metabolic disorders are at higher risk to develop knee OA

WHO GETS KNEE OA?

  • More than 27 million Americans have OA; the knee is one of the most commonly affected joints with more than 11 million people diagonosed in the U.S.
  • Chances of developing OA increase after age 45 and according to the Centers for Disease Control, the average onset of knee OA is 55 years old.
  • More than 40 percent of knee replacements happen over the age of 65, so many people have to find other forms of conservative, non-invasive and non-addicting methods to control pain and maintain an active lifestyle.
  • Women aged 55 and older are more likely than men to develop knee OA.

WHAT ARE MY OPTIONS IF I HAVE KNEE OA?

There are many options available for those with knee OA, including several that are non-pharmaceutical and non-surgical choices. You’ll want to talk with your health care provider about the treatment or combination of treatments that’s best for you; here are some you may want to explore and consider:

MOTION IS MEDICINE

  • Activities; walking, strength training, swimming, biking, yoga, tai chi and other low-impact activities may help with pain and function of the knee
  • Lighten up; a 2007 review found that overweight people who lost a moderate amount of weight had reduced pain and disability from knee OA
  • Braces, sleeves other devices can help reduce pain and stiffness, take weight load off the affected joint and improve confidence and function for those with knee OA
  • Transcutaneous electrical nerve stimulation, or TENS uses electrodes to send a mild current to the affected joint, which can help alleviate pain
  • Acupuncture, balneotherapy (soaking in warm mineral springs) or heat or cold therapy may help ease joint pain for some people with knee OA
  • Medications can include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs, prescription medications, corticosteroid or hyaluronic acid injections and more
  • Glucosamine and chondroitin sulfate, some studies have shown, can reduce pain and improve physical function; natural supplements, including avocado, soybean, capsaicin and turmeric, may have anti-inflammatory benefits for some people
  • Joint replacement or joint-preserving surgery may be an effective option for some people

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HOW CAN DONJOY HELP?

If you have mild to severe knee OA and experience intermittent to chronic knee pain, or if you are not a candidate for surgery, ask your doctor about the science of bracing. DonJoy pioneered the concept of functional knee bracing more than 30 years ago and offers the most advanced technologies available.

Most importantly, they can help people return or continue to live an active lifestyle. No one person with knee OA is treated the same, so it’s important to look at all of the available solutions to find what is right for you. Some people may need a lot of off-loading capabilities, while others need just a slight push and comfort that surrounds the muscles around the knee.

Meniscal Tear: Is Physical Therapy a Good Option?

Authored by Dennis Carter, PT, MPT, physical therapist and clinic director at ATI Naperville South

meniscalA meniscal tear in the knee is an injury to the cartilage that absorbs weight through the joint. Tears can occur as a result of sudden trauma such as twisting, or over extending the knee. Tears can also develop due to degenerative changes over time. Meniscal tears can limit a person’s ability in squatting, twisting, athletics, or performing activities at work and at home. A recent article in The New England Journal of Medicine supports that there is a high percentage of successful outcomes for patients seeking physical therapy as their first choice of care for a torn meniscus in the knee. This is a welcome statement to those who may have been recently given the diagnosis of a meniscal tear, and are weighing options for a plan of care.

Many times when patients are given a diagnosis, they form the opinion that they are set on a defined path without options.  A diagnosis of a “tear in the knee” is often associated with it getting “fixed”, which can be upsetting and discouraging when patients consider their future activity level.

Growing evidence supports physical therapy as a viable alternative to early surgical intervention. Physical therapy can provide treatments that reduce the pain and inflammation associated with the acute nature of a tear. Modalities such as electrical stimulation, compression, and ice are frequently used to reduce acute swelling and pain. Manual care provided by a Physical Therapist can help to restore range of motion, improve joint mechanics, decrease swelling, and increase muscle flexibility. Specifically prescribed therapeutic exercises can address deficiencies in strength and muscle control that may have resulted from, or even contributed to events leading to the tear.

Physical therapy has been a successful option for many. More research is needed to identify what factors determine the characteristics that will identify who will be successful with either treatment option. Deciding if it is right for you should be done as part of a team. The decision should be made with your doctor and therapist based on several factors: the mechanism of injury, history of progressive symptoms, a thorough clinical examination, diagnostic studies (x-rays, MRI), and your goals/aspirations for future activity level. The decision is not simply black and white and often comes down to individuality.

When the conservative approach of therapy is chosen, patients should be well educated in the nature of the injury, the avoidance of activities that could negatively impact their progress, and the expected progressions they will encounter. Treatment will focus on progressive strengthening, range of motion, flexibility, balance, gait training, and functional activities. Considerations are also given to address individual deficiencies that may have contributed to the nature of the injury: weakness of hip and thigh muscles, foot mechanics such as over pronation (flat feet), inflexibility of the calf and hamstring muscles.

ATI 300x250Whenever affected by any health issue or concern, awareness of options is prudent. Meniscal tears are no different. Custom treatments in physical therapy and dedication to prescribed home program allow many people to return to a high functional level following a meniscal tear in the knee. Please be sure to discuss details of your injury and all options with your doctor. If you have more questions please reach out to one of your local physical therapists who can help to answer your questions.

Preventing ACL Injuries

Dr. Adam Yanke, MOR sports medicine physician, recently sat down to discuss a study that showed athletes with fatigue are at higher risk for anterior cruciate ligament (ACL) injuries. One of the ACL injury prevention programs that Yanke recommends for young athletes is Knees For Life (Kneesforlife.org), which offers a downloadable brochure and an opportunity to obtain complimentary gym bag tags featuring warm up exercises and other prevention strategies.

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