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FAQs

 

Ankle

Q?WHAT IS AN ANKLE SCOPE?
A.

Ankle arthroscopy (or scoping) is a minimally invasive orthopedic surgical procedure that involves placing a fiber-optic camera inside the ankle  joint space through a small mini-incision (typically 5-8) in the skin. This can be done for diagnostic (to find out what the problem is) or therapeutic (to treat the problem that exists) purposes. Specially designed instruments can be placed through these and additional mini-incisions to treat joint problems. Not all problems are treatable with arthroscopy, but sports medicine specialists are trained to perform many complex procedures in this minimally invasive fashion. Most arthroscopic procedures can be performed on an outpatient basis and early recovery is often enhanced versus open surgical procedures.

Q?WHY MIGHT I NEED AN ANKLE SCOPE?
A.

An ankle scope can be performed for several indications. These include cartilage damage in the ankle from an injury, degenerative changes in the ankle (arthritis) which has produced painful spurs or loose bodies of cartilage and bone, inflamed tissues lining the joint, or in conjunction with open treatments for ankle trauma, instability, or tendon disorders.

Q?WHAT IS THE RECOVERY TIME AFTER AN ANKLE SCOPE?
A.

Recovery after ankle arthroscopy varies depending on what procedure is done, but generally the recovery is relatively rapid. For a simple clean-out of inflamed tissue, removal of loose bodies or bone spurs, or smoothing of damaged cartilage, most patients are walking without crutches in 2-4 days, back to normal day-day activities in 1-2 weeks, and back to exercise and athletic or heavy labor activities in 4-6 weeks. If a more extensive repair or reconstruction is performed, time on crutches may be longer and time to full recovery may be 2-4 months. Talk to your surgeon about your specific planned procedure for an individualized time table for recovery.

Q?WHAT IS AN ANKLE SPRAIN ?
A.

An ankle sprain is a common injury of the ankle that occurs when the foot rolls inwards or outwards relative to the leg. This results in varying degrees of stretching or tearing of the ligaments that support the ankle joint. Sometimes small pieces of bone can be avulsed with the torn ligaments but these are still usually treated as sprains rather than fractures.

Q?WHAT ARE THE SYMPTOMS OF AN ANKLE SPRAIN?
A.

Ankle sprains can occur from stepping on someone’s foot, on uneven ground, or just from losing one’s footing. The symptoms of a sprained ankle are pain, swelling, limited range of motion, difficulty walking. These symptoms can be very mild or quite severe depending on the “grade” or severity of the injury and sometimes it is difficult to bear any weight at all. Significant bruising is not uncommon, and sometimes doesn’t show up for several days after the initial injury.

Q?HOW DO I KNOW IF HAVE AN ANKLE SPRAIN OR SOMETHING WORSE?
A.

It is sometimes difficult to distinguish between a sprained ankle or other injuries of the ankle including fractures (broken bones), cartilage injuries,  unstable ligament disruptions, achilles or other tendon ruptures. If you are unable to bear weight on the injured leg, unable to move it, feel tenderness directly over the bones around the ankle, see any deformity or gaps in the ankle structure, or if your symptoms just aren’t improving, then you should see a specialist. They will likely take a history of the injury, examine the injured ankle and take an x-ray. Some injuries may require an MRI depending on what the exam and x-rays demonstrate.

Q?WHEN SHOULD I GET AN X-RAY FOR A SPRAINED ANKLE?
A.

We typically recommend x-rays for ankle sprains in situations where pain and swelling are moderate to severe and persist for several days, when you are unable to bear weight on the leg, when tenderness is present over the bones of the foot and ankle. While x-rays may not confirm the full extent of the injury, they can quickly and easily rule out a number of fractures and instabilities.

Q?WHAT ARE THE TREATMENTS FOR A SPRAINED ANKLE?
A.

Treatments for a sprained ankle vary based on the severity of the sprain, the number of times that ankle has been injured, associated injuries (cartilage injuries/tendon tears/etc), the ability to bear weight on the leg, degree of swelling, and individual patient circumstances and preferences.

For simple, low-grade, and 1st time sprains, I typically prescribe a lace-up type ankle brace for compression and support, start weight-bearing as soon as tolerated, use RICE (rest, ice, compression, elevation) immediately and then use an ankle exercise program as soon as possible to regain range-of-motion, strength, balance, and agility. Anti-inflammatory medications during this time can help with pain and swelling.

More complex or unstable injuries may require more immobilization initially (walking boot or a cast) and a longer period of protected weight-bearing (crutches). An MRI can be performed if the extent of the injury is uncertain or to rule out associated injuries.

Recurrent or highly unstable injuries may require surgical treatment to stabilize the ankle.

Q?WHEN CAN I RETURN TO MY SPORTS OR ACTIVITIES AFTER TREATMENT FOR A SPRAINED ANKLE?
A.

You can return to sports and activities after treatment for a sprained ankle once you are comfortable and physically able to perform the necessary functions of your activity. For mild sprains, athletes can return to sport during the same game or within a few days. Severe sprains may require 6-8 weeks of treatment. Before returning to sport, I recommend you have minimal swelling, full range of motion, good balance, and the ability to run /jump/cut sharply. Sometimes it is wise to use a lace-up ankle support early during your return to play to enhance stability and prevent re-injury.

Q?SHOULD I ROUTINELY TAPE MY ANKLES OR USE A BRACE FOR SPORTS AND ACTIVITIES?
A.

Typically I would not recommend routine use of ankle braces OR taping to support ankles during sports or activities. However, if you have a tendency for ankle instability and sprains or are recovering from an injury and are trying a hastened return to your sport, then taping or bracing is not a bad idea. While routine support may actually weaken your ankles and predispose you to injury while not supported, sometimes this is advisable rather than risking an injury and missing time for sport or work. The best thing to do is to rehab a sprained ankle very hard and prevent the need for extra support eventually. If you do need support, the debate between taping and bracing is controversial, but I recommend doing what is more comfortable and feasible. Taping tends to loosen up over the course of a game and re-taping may be necessary periodically. Bracing typically does not loosen up in this manner.  

Q?WHAT IS AN ACHILLES TENDON RUPTURE?
A.

The achilles tendon is the thick tendon that connects your calf muscle to your heel. It gives you the ability to walk and run and “push-off” with strength. A rupture occurs when the connection becomes disrupted and the tendon tears in it’s substance or pulls away from the heel bone. This is typically an acute or sudden event which is painful and disabling. Most patients describe the sensation of “being kicked in the heel” or feeling a loud and painful snap behind the ankle. It is usually difficult to walk after this injury. It can occur suddenly and unpredictably after a sports injury or a fall or can also occur slowly over time, usually after a period of painful thickening or swelling of the heel which eventually becomes more painful or weak when the tendon finally ruptures. It can occur in males or females of any age level, but tends to be more common in patients after their 30′s.

Q?WHAT IS THE BEST TREATMENT FOR AN ACHILLES TENDON RUPTURE?
A.

The best treatment for an achilles tendon injury varies depending on many individual factors including the degree of the tear, the length of time the tear has been present, the activity level and age of the patient, what activity goals the patient expects to return to, and other medical conditions the patient may have. These factors should be taken into account during a discussion with your treating orthopedic surgeon to determine what is the best treatment for you. The two best options for treatment are generally surgical repair or reattachment of the tendon, or non-surgical treatment in a brace, cast, or boot. Surgical options can introduce the risks of surgery, the most significant of which is wound healing problems because the blood supply to the skin over the achilles tendon is not optimal. Non-surgical treatment can result in prolonged return to full activity and strength and a slightly higher re-rupture rate. Surgical treatment is generally favored for athletes, younger patients, and more active individuals since the recovery time, return of strength, and re-rupture rates are minimized. Advancements in rehab techniques and limited immobilization after surgery along with a minimally invasive procedure has led to improved surgical outcomes.

 

ANTERIOR CRUCIATE LIGAMENT (ACL) TEARS

Q?WHAT IS THE ANTERIOR CRUCIATE LIGAMENT (ACL)?
A.

The anterior cruciate ligament is the primary stabilizing ligament of the knee. It is in the center of your knee and connects the femur (thigh) bone to the tibia (leg) bone. It provides stability to the knee in multiple planes of motion, and is important for stability with cutting, pivoting, changing directions, jumping, and landing. This is the main ligament that is injured  or torn when you hear about someone “blowing out” their knee.

Q?WHAT ARE THE SYMPTOMS OF AN ANTERIOR CRUCIATE LIGAMENT (ACL) TEAR?
A.

The most common symptoms after an ACL tear are pain, swelling, and instability. During the injury, patients often feel their knee “buckle” or “give out” and immediately hear or feel a pop followed by pain. Swelling usually builds shortly afterwards and it can be difficult to bend the knee or put weight on the leg due to the pain and swelling.  As days or weeks go by, the swelling and pain often subside and patients can walk more comfortably. Symptoms of pain, swelling, and/or instability can, however, persist with daily activities. In some cases, symptoms may only be present with attempts to run or return to athletic or high-demand activity. 

Q?HOW DO YOU DIAGNOSE AN ANTERIOR CRUCIATE LIGAMENT (ACL) TEAR?
A.

A clinical history (what happened to your knee and what symptoms you are having) and a physical examination can usually suggest that an ACL tear may be present. An MRI is usually done to confirm the diagnosis of a tear, evaluate its severity, and to evaluate for other associated damage in the knee.

Q?WILL A TORN ANTERIOR CRUCIATE (ACL) HEAL BY ITSELF?
A.

A completely ruptured/torn anterior cruciate ligament (ACL) will not heal on its own. Once ruptured, the ligament has no capacity to re-unite. It often scars to the tissue around it or to the posterior cruciate ligament behind it, but this does not produce the necessary stability that the intact ligament does. Partial tears or sprains of the ligament may have some capacity to heal with and restore necessary stability.

Q?WHAT IS THE RECOMMENDED TREATMENT FOR AN ANTERIOR CRUCIATE LIGAMENT (ACL) TEAR?
A.

Treatment for an anterior cruciate ligament (ACL) tear depends on the degree of tear, the activity level of the patient, and the underlying condition and associated injuries of the knee. In general, an untreated torn ACL is likely to lead to progressive meniscus tears, cartilage degeneration, and arthritis in the knee and persistent or intermittent instability of the knee. For a complete ACL tear in a knee with minimal arthritis and in a patient who desires to maintain some level of physical activity, arthroscopic ACL reconstruction of the ligament is recommended to restore stability and attempt to prevent further cartilage and meniscus damage and eventual arthritis. If other ligaments or meniscus tissue are also injured in the knee, arthroscopic ACL reconstruction is also recommended.  The most common reasons that surgery may not be recommended are for patients who already have significant arthritis in the knee or who participate in very limited physical activity.

Q?CAN I PLAY SPORTS AGAIN IF I DON’T HAVE MY ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTED/FIXED?
A.

This depends on the type of activities you wish to perform, associated injuries, and other individual variables. Some patients can return to mild/moderate levels of activity with minimal cutting, pivoting, or jumping without reconstructing their ACL. Most patients who try to perform these types of activities with a torn ACL will notice persistent swelling, instability, pain, or the sensation of “giving out” or “shifting.” If you had additional ligament or meniscus injuries in your knee, it is unlikely that you would be able to return to moderate/high-demand sports for a prolonged period of time. There are some patients who may be able to perform adequately without surgery, however, most of these patients will eventually sustain  other injuries to the meniscus or cartilage in the knee or develop arthritis in the future, even if they are able to perform their sport for some time. 

Q?WHAT IS INVOLVED IN ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION?
A.

A torn or ruptured anterior cruciate ligament (ACL) will not heal on its own. When the ligament ruptures, it typically stretches out and frays, resembling the appearance of a horse’s tail. Because of this significant disruption, the ligament cannot simply be repaired but rather must be replaced by another tissue that replicates the ACL’s position, strength and function. This replacement tissue (graft) can be taken from your own body (autograft) or be donated from a cadaver (allograft). The torn ACL ligmanet tissue is then removed and the graft is then positioned to anatomically replicate the torn ACL which it is replacing. It can be fixed on either end to the femur (thigh) and tibia (leg) bones with a variety of fixation devices. The replacement surgery is done arthroscopically (with a small camera) and minimally invasively. It is an outpatient procedure, performed under general anesthesia and often with the addition of a regional nerve block. You will start physical therapy within a few days and generally you will use a brace for several weeks.

Q?WHAT TYPE OF GRAFT (AUTOGRAFT AND/OR ALLOGRAFT) SHOULD I CHOOSE FOR MY ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION SURGERY?
A.

There are multiple graft options for arthroscopic anterior cruciate ligament (ACL) reconstruction surgery. Each graft option has some specific pros and cons, and the best graft for you depends on numerous individual factors. What makes sense for one patient may be different from person to person. Some surgeons prefer to use one type of graft for every ACL surgery. I prefer to discuss the options with my patient and help them choose what type of graft is the best for their specific needs. Some options and implications are listed below.

 

Autograft means tissue taken from your own body. Typical autografts used for ACL reconstruction include:

  • Patellar Tendon (bone-patellar tendon-bone/PTG/BTB)
  • Hamstring Tendons (gracilis/semitendinosus, quadrupled hamstrings)
  • Quadriceps Tendon
  • Contralateral (un-injured) knee patellar, hamstring, or quadriceps tendon graft

 

The primary benefits of using autograft tissue are :

  • This type of tissue will incorporate and “heal” the fastest, potentially allowing slightly earlier return to full activity and sports than allograft tissue. Though I typically will still recommend a 6-9 month period before return to pivoting sports, sometimes accelerated returns at 4-6 months are possible with autograft tissue in specific situations.
  • Using your own tissue carries no risk of disease transmission (bacteria or viruses)
  • The overall re-rupture rate, especially for young athletes, seems to be slightly lower with autograft tissue when compared to allograft tissue, though the reasons for this are still unclear and more investigation is needed to determine if this is a true advantage (see disadvantage of allograft tissue section below).

 

The primary disadvantages of using autograft tissue are:

  • Because  we are taking additional tissue from your knee, there may be some additional discomfort and pain in the initial post-operative period (2-6 weeks)
  • Depending on which location the tissue comes from, you may experience quadriceps or hamstring weakness during the rehabilitation process. This usually normalizes after 6-12 months. Still, hurdlers and track athletes may prefer to not use hamstring grafts, while jumpers may prefer not to use patellar tendon grafts.
  • Patellar tendon grafts may be associated with higher incidence of post-operative patellar tendinitis and anterior knee pain. This graft should not be used if you already have patellar tendinitis or anterior knee pain or if you are a wrestler or have to do activities which require a great deal of jumping, kneeling or squatting.
  • Autografts require longer incisions and thus longer scars to acquire the tissue.
  • Because autografts need to first be harvested (acquired) from your knee to be used in surgery, the duration/length of surgery is increased over allograft tissue
  • If you have injured multiple ligaments and multiple grafts are required, the availability of autograft tissue is limited.

 

Allograft means tissue taken from someone else’s body (a donated cadaver tissue)

  • Patellar Tendon (bone-patellar tendon-bone/PTG/BTB)
  • Hamstring Tendons (gracilis/semitendinosus, quadrupled hamstrings)
  • Quadriceps Tendon
  • Achilles Tendon
  • Anterior or Posterior Tibialis Tendon

 

The primary advantages of using allograft tissues are:

  • Early post-operative discomfort and pain is minimized so the initial recovery and rehabilitation may progress faster.
  • Surgical incisions and thus scars can be minimized.
  • If multiple ligaments are being reconstructed, availability of graft tissue is not an issue.
  • Duration/length of surgery is decreased.

 

The primary disadvantages of using allograft tissue are:

  • Because the donated tissue comes from another person, there is a theoretical risk of bacterial or viral disease transmission. However, we only use tissues from highly accredited tissue banks that use stringent donor criteria, tissue handling and sterilizing processes. Grafts are safer today than they have ever been and risk of actual disease transmission is very low.  I would feel comfortable using cadaver tissue in my own body if I needed it.
  • Because the tissue has been stored sterilely and is not living tissue, it may take slightly longer to incorporate (“heal”) in the knee than autograft. Though return to full activity is still highly reliable, I wouldn’t recommend hastened or accelerated return to sport after allograft reconstruction. General return to sport time periods are 6-9 months for allograft reconstruction.
  • Some studies have shown a slightly higher re-rupture rate for allograft reconstructions when compared to autograft reconstructions. This was especially true in younger athletes. The problem with these studies is that many different types of allograft tissue have been studied and many different types of surgical techniques are included in these studies. This includes grafts which were irradiated, not age-matched, and often reconstructions which included older surgical techniques. There is yet to be a well-designed study comparing the newest anatomic surgical reconstruction techniques and non-irradiated age-matched cadaver grafts to the same techniques with autograft tissue. These are the grafts and techniques that I use when I do use allograft tissue, and I believe when these data become available the re-rupture rate will be nearly equal. Until we have more information, however, I lean towards autograft tissue in young athletes and cadaver (allograft) tissue once patients are in their late 20′s or 30′s or are less active. This is still a controversial and very closely evaluated topic in the world of sports medicine and orthopedic surgery.
Q?WILL I NEED A BRACE WHEN I RETURN TO SPORTS AFTER MY ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION SURGERY?
A.

This is another controversial topic for which no consensus answer exists. Use of a “sports brace” or “functional brace” following anterior cruciate ligament reconstruction (ACL) surgery has never been proven to decrease injury rate or increase performance or stability following return to sports. However, most patients polled feel better and have more confidence in their reconstructed knee while using a sports brace, at least initially. Therefore, for straight line running and low-intensity activities I do not recommend the use of a sports brace. For return to pivoting, jumping or contact sports, however, I typically recommend use of a brace for the first sports season or 6-12 months following return from the surgery. Braces are highly variable in cost, style, customization, and coverage varies amongst various insurance plans. Therefore the decision to use or not use a brace depends on many factors and should be considered on an individual basis after analysis of the risks, benefits, and feasibility of different options.

Q?WHEN CAN I PLAY SPORTS AGAIN AFTER AN ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION SURGERY?
A.

Return to sport time following anterior cruciate ligament (ACL) reconstruction surgery varies widely depending on the type of sporting activity, intensity and duration of rehab, associated injuries, and graft type. Every case will be different, but in general most athletes can return to pivoting or jumping sports in 6-9 months. Straight-line running can be started earlier, at approximately 3-4 months depending on what other injuries were present in the knee. Sports performance may not be “normal” for even longer, sometimes 12-18 months. In general , autograft reconstructions incorporate or “heal” sooner than allograft (cadaver) reconstructions. In extreme situations, accelerated rehab and autograft graft choice can lead to accelerated return at 4 months, but re-injury rate and graft laxity may be increased by early return. I recommend quadriceps and hamstring strength be 80 percent of that of the un-injured (contralateral) leg prior to return to sports. Revision reconstructions may also require longer time before return to play.

Q?CAN I RE-TEAR MY ANTERIOR CRUCIATE LIGAMENT (ACL) AFTER SURGERY?
A.

Optimal surgical technique, compliance with the specified rehabilitation protocol, and avoidance of restricted activities until the time is right can minimize the risk of re-rupture. Unfortunately, even the most expertly-reconstructed anterior cruciate ligament (ACL) reconstruction is still subject to re-tear. Though it remains controversial, some evidence suggests the re-tear rate for allograft (cadaver) tissue is slightly higher than that for autograft tissue. I use non-irradiated allograft tissue, which has been shown to have outcomes and re-tear rates comparable to autograft tissue. The rate of re-rupture may be anywhere from 5-10 percent, but it is generally thought that one is more likely to tear their ACL in the other leg than to re-tear a well-reconstructed ACL graft. The strength of tissues used for ACL graft reconstruction are mechanically stronger than the native ACL initially was.

Q?WILL I NEED A BRACE AND/OR CRUTCHES AFTER MY ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION SURGERY?
A.

I typically recommend the use of a hinged post-operative knee brace and crutches following ACL reconstruction surgery. I find that they give patients stability in the early post-operative period while pain and weakness are still present. They are also helpful to support legs temporarily weakened by regional nerve blocks which are commonly used as part of the anesthesia plan for these surgeries. Depending on the extent of your procedure and what associated injuries you had, crutches may be needed for 1-6 weeks and the brace is typically worn for approximately 6 weeks.

 

Q?WILL I NEED A “MOTION MACHINE” AFTER MY ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION SURGERY?
A.

I typically recommend the use of a CPM (continuous passive motion) machine following ACL reconstruction surgery. It is a machine that gently bends and straightens your knee at home during the days and weeks following surgery. It can help reduce the amount of scar tissue that forms and help patients regain their range of motion faster. Some insurance companies have been denying coverage for these machines and not all surgeons use them. While I don’t believe they are absolutely necessary for a successful outcome and cannot replace a good physical therapy and home exercise program, I feel strongly that they can still be beneficial and certainly don’t do any harm.

Q?WHAT ARE THE POTENTIAL COMPLICATIONS OF ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION SURGERY?
A.

Anterior cruciate ligament reconstruction surgery is generally a very safe and well-tolerated procedure. As with any surgery or injury, some level of risk remains. The most common risks of ACL surgery include re-rupture or failure of the graft, joint stiffness or loss of full range of motion,  scar tissue formation (“Cyclops” lesion), or hardware that becomes symptomatic. Infection of the surgical site or blood clots can also occur but are far more rare.  I do everything within our control to reduce the risk of these complications, but unfortunately some risks are unavoidable. Though rare, these conditions are treatable with physical therapy, medications, or occasionally additional surgical procedures.

 

Arthritis

Q?WHAT IS KNEE ARTHRITIS?
A.

Arthritis (or osteoarthritis) is a progressive condition in which the cartilage cushioning layer between moving parts of your body (joints) has started to thin or wear out. Much like the tread on a tire, the cartilage cushion can thin, wear down, and fray. As pressure is then transferred to the moving bony parts with less cushion in between, this can result in increasing pain, stiffness, inflammation, and weakness. In the knee this can be especially painful and debilitating because the knees carry much of your bodies weight throughout the day and are under significant stress during activities such as standing from a seated position, getting up from the floor, kneeling, squatting, or going up and down stairs. Symptoms of knee arthritis include pain, swelling, catching, grinding, aching and giving way. Often the knees can feel heavy or weak from fatigue of the muscles around the knee or as a result of swelling in the knee joint.

Q?WHAT ARE THE TREATMENT OPTIONS FOR KNEE ARTHRITIS?
A.
Q?HOW DO I KNOW WHEN I NEED A KNEE REPLACEMENT?
A.
Q?WHAT IS A PARTIAL KNEE REPLACEMENT? AM I A CANDIDATE FOR A PARTIAL KNEE REPLACEMENT?
A.
Q?WHEN CAN I DRIVE AFTER A KNEE REPLACEMENT?
A.

Always confirm this from your doctor as it depends on which knee you had surgery on and the specific nature and restrictions related to your particular surgery. This is also highly variable from person to person. In general, you should not drive until you are cleared to bear weight on your driving leg, you are not under the influence of pain medications or other medications, and your range of motion and reaction time is sufficient to safely allow for normal leg movements while driving. Always go to an empty parking lot and practice driving situations after being cleared by your doctor before resuming driving in public.

Q?WHAT CAUSES ARTHRITIS?
A.

General arthritis or “osteoarthritis” is in general a wear and tear phenomenon. The cartilage we are born with is very durable, both cushioning and frictionless initially. On average, the lifespan of cartilage in heavy-use joints in our body is about 50 or 60 years, at which point most people will have some degree of degeneration. Persons who are genetically pre-disposed, have abnormal joint alignment, are significantly overweight, or who have had some type of trauma to the joint may notice this degeneration earlier in life, whereas a luck few may get through most of their lives without ever having symptoms. Another class of arthritis, inflammatory arthritis, is due to a variety of medical causes related to the immune system overreacting and causing joint damage. The symptoms and treatment of this type of arthritis can be different, and osteoarthritis is far more common and the typical type of arthritis. 

Q?WHAT IS ARTHRITIS?
A.

Arthritis (or osteoarthritis) is a progressive condition in which the cartilage cushioning layer between moving parts of your body (joints) has started to thin or wear out. Much like the tread on a tire, the cartilage cushion can thin, wear down, and fray. As pressure is then transferred to the moving bony parts with less cushion in between, this can result in increasing pain, stiffness, inflammation, and weakness. This can occur in one or two specific joints or be found in multiple joints at the same time.

Q?HOW CAN I PREVENT MY ARTHRITIS FROM GETTING WORSE?
A.

Unfortunately there is no absolute cure for arthritis, but there are treatments and changes in activity which can possibly help slow the progression of the cartilage damage. Keeping your weight at a healthy level, performing low-impact exercises to strengthen the muscles around the affected joint (swimming, bicycle, elliptical, low-resistance strength training), and avoiding high-impact activities (running, jumping, landing, heavy weight-training) would be a good start. Early treatment of certain ligament, bony, and meniscus or cartilage injuries can also be helpful.  Some evidence suggests that taking cartilage neutraceuticals/vitamins such as glucosamine, chondroitin, fish oils, and MSM can have long-term beneficial effects for arthritis, as can viscosupplementation or hyaluronic acid injections (Supartz/Synvisc/Orthovisc/Euflexa), but further research is necessary to determine if these products can actually slow the progression of arthritis.

Q?IS THERE A CURE FOR ARTHRITIS?
A.

Unfortunately there is no absolute cure for arthritis, but there are treatments and changes in activity which can possibly help slow the progression of the cartilage damage. (see above)

Q?HOW DO YOU DIAGNOSE ARTHRITIS?
A.

Arthritis is diagnosed from a combination of history (discussion of symptoms with your physician) and physical examination, followed by a specific series of weight-bearing x-rays. X-rays findings suggestive of osteoarthritis include narrowing of the involved joint space where the cartilage is worn away, bone spurs around the joints, and sometimes cysts or irregularities in the shape of the bones. Sometimes an MRI can provide additional detail or answer specific questions. Blood tests may help diagnose certain types of inflammatory or auto-immune arthritis, but are of little use in general degenerative or osteoarthritis.

Q?HOW/WHY DID I GET ARTHRITIS?
A.
Q?WHAT TREATMENT OPTIONS ARE THERE FOR KNEE ARTHRITIS?
A.
Q?DO GLUCOSAMINE OR JOINT SUPPLEMENTS HELP CURE ARTHRITIS?
A.

 

Cartilage

Q?MY KNEE SWELLS AND FEELS LIKE SOMETHING IS CATCHING INSIDE, WHAT DO YOU THINK IT IS?
A.

These symptoms can be from a variety of disorders in the knee joint. A full history of the problem, physical examination, and x-rays and perhaps imaging such as an MRI may be necessary to confirm the cause of your symptoms. The most common causes of these symptoms are meniscus tears, cartilage injuries, arthritis, loose bodies (small loose flecks of cartilage or bone) floating in the joint, or thickening of the inner lining of the knee which is often termed a “plica.”

Q?WHAT IS ARTICULAR CARTILAGE AND HOW IS IT DAMAGED?
A.

Cartilage, or more specifically “articular cartilage” is the surface material that covers the end of the bone in every joint in your body (a joint is where any bone contacts another). It is a very unique biologic material whose properties have been hard to duplicate using artificial substances. It is typically several millimeters thick and has several layers which contribute to its function. It is designed to provide a low-friction smooth gliding surface for joint motion while at the same time serving a cushioning function for weight-bearing for both simple low-impact activities like walking as well as high-impact activities like running and jumping.

 

Articular cartilage can be damaged in several ways. Occasionally, traumatic events during sports or falls can cause shearing, peeling, or impaction of a focal area of joint cartilage (often referred to as a CHONDRAL DEFECT). More commonly, progressive wear and tear from repeated activities can cause wearing and thinning or fraying of the cartilage surface. Genetics can also play a role and cause premature cartilage damage without any specific identifiable cause. A separate cartilage problem, osteochondritis dissecans, is occasionally seen in children and has to do with a problem with the blood supply to the cartilage surface.

 

Some people commonly say they have torn cartilage in their knee, but this is usually referring to a torn meniscus, which is a different type of cartilage. Please see the meniscus section for questions about that type of cartilage (fibrocartilage).

Q?WHAT ARE THE SYMPTOMS OF CARTILAGE DAMAGE?
A.

The symptoms of cartilage damage are very similar to the symptoms of arthritis or meniscus tears in the knee. Pain and swelling are the two most common symptoms of cartilage damage, with catching or locking possible if cartilage flaps or unstable fragments are present. Range of motion and strength may be decreased, and symptoms are often activity-related (worse with certain activities or increased levels of activity). Night pain or difficulty when in the same position for too long are also common symptoms.

Q?WHAT ARE THE TREATMENT OPTIONS FOR DAMAGED CARTILAGE?
A.

There are a wide variety of treatments for cartilage damage, and the correct treatment for you will depend on your specific situation so it is important to discuss this with your orthopedic specialist. Untreated, cartilage damage is generally progressive, and some degenerative cartilage conditions can progress no matter what is done. Therefore, treatment is generally directed to address the specific symptoms you are experiencing.

 

For isolated cartilage defects localized to one small area (often termed CHONDRAL DEFECTS), treatment options include non-operative treatments (observation, activity modification, physical therapy, medications, bracing, injections) which treat symptoms or operative solutions which attempt to repair/replace the cartilage. These treatments depend on the age of the patient, size of the lesion, location of the lesion, and activity level of the patient. Options include debridement, microfracture, cartilage plug transplant (using donor tissue or your own tissue), cartilage cell transplant (using donor cartilage or your own tissue), or artificial resurfacing. Each of these treatments has their place and you should discuss which option is best for you with your orthopedic specialist. Some investigational or cutting-edge type treatments are also available.

 

For more widespread or degenerative type cartilage damage, the same non-operative treatments can also be used to address symptoms (observation, activity modification, physical therapy, joint supplements, medications, bracing, corticosteroid injections). Viscosupplementation or gel (rooster-comb, etc) injections may also help relieve joint pain. If symptoms progress, arthroscopy with debridement or smoothing of the cartilage may be helpful. Additional surgical treatments such as partial or total joint resurfacings or replacements may be possible or necessary in certain situations.

 

Elbow

Q?WHY DOES MY CHILD’S ELBOW HURT?
A.
Q?WHAT IS LITTLE LEAGUER’S ELBOW?
A.
Q?HOW DO I PREVENT ELBOW PAIN IN MY CHILD?
A.
Q?WHAT IS TENNIS ELBOW (LATERAL EPICONDYLITIS)?
A.
Q?WHAT ARE THE SYMPTOMS OF TENNIS ELBOW (LATERAL EPICONDYLITIS)?
A.

 

General Questions

Q?IF I GO TO SEE AN ORTHOPEDIC SURGEON, WILL THEY RECOMMEND SURGERY?
A.

Orthopedic surgeons treat a variety of musculoskeletal conditions involving bones, joints, muscles, ligaments, tendon and cartilage. We can and do treat the majority of conditions successfully without surgery. When necessary, orthopedic surgeons are also trained to perform surgical procedures to correct and treat those conditions which cannot adequately be treated with non-operative treatments. Always speak to your doctor about the various treatment options that exist for a given condition, but going to see an orthopedic surgeon doesn’t necessarily mean that they will recommend surgery.

Q?WHEN SHOULD I USE ICE AND WHEN SHOULD I USE HEAT FOR INJURIES AND SPRAINS?
A.

Generally, ICE is beneficial for the first 48-72 hours after an acute injury, or after exercise for a chronic injury or pain. ICE will decrease swelling and inflammation to the injured area and decrease pain. HEAT is beneficial before exercise for a chronic pain, or before rehabbing an acute injury after the first 3-5 days. HEAT increases blood flow to the treated area which is good for healing but can increase swelling in fresh injuries.

 

Hip

Q?WHAT IS HIP ARTHRITIS?
A.
Q?WHAT IS AVASCULAR NECROSIS OF THE HIP?
A.
Q?WHAT TREATMENT OPTIONS ARE THERE FOR HIP ARTHRITIS?
A.
Q?HOW DO I KNOW WHEN I NEED A HIP REPLACEMENT?
A.
Q?WHEN CAN I DRIVE AFTER A HIP REPLACEMENT?
A.

Always confirm this from your doctor as it depends on which hip you had surgery on and the specific nature and restrictions related to your particular surgery. This is also highly variable from person to person. In general, you should not drive until you are cleared to bear weight on your driving leg, you are not under the influence of pain medications or other medications, and your range of motion and reaction time is sufficient to safely allow for normal leg movements while driving. Always go to an empty parking lot and practice driving situations after being cleared by your doctor before resuming driving in public.

Q?WHAT ARE THE TREATMENT OPTIONS FOR HIP IMPINGEMENT OR FEMORAL ACETABULAR IMPINGEMENT (FAI)?
A.
Q?WHAT IS HIP IMPINGEMENT OR FEMORAL ACETABULAR IMPINGEMENT (FAI)?
A.
Q?WHAT ARE THE SYMPTOMS OF HIP IMPINGEMENT OR FEMORAL ACETABULAR IMPINGEMENT (FAI)?
A.
Q?HOW DO YOU DIAGNOSE FEMOROACETABULAR IMPINGEMENT (FAI)?
A.
Q?WHAT IS A PINCER LESION?
A.
Q?WHAT IS A CAM LESION?
A.
Q?WHAT IS THE LABRUM OF THE HIP OR ACETABULAR LABRUM?
A.
Q?WHAT ARE THE SYMPTOMS OF A LABRUM TEAR OF THE HIP?
A.

 

Imaging

Q?WHAT IS AN X-RAY?
A.

An x-ray is an image that is used routinely to evaluate the structure and alignment of bones. High-quality x-rays can reveal fractures, arthritis, joint instability, tumors, cysts, bone spurs and many other disease conditions and are a routine part of any orthopedic evaluation. We can obtain these digital images in our office. Minimal radiation exposure is involved in obtaining x-ray images, also known as radiographs.

Q?WHAT IS AN MRI?
A.

An MRI is a series of images that provide further anatomic detail about various parts of the body.  Whereas an x-ray provides information about bones, an MRI provides extensive cross-sectional information about the soft tissues around the bones (ligaments, tendons, muscles, cartilage, meniscus, labrum, etc). It can also provide further details about bones themselves that are not visible on x-rays. Getting an MRI consists of sitting still for 30-45 minutes while a large tube obtains images using a powerful magnet. No radiation is involved in MRI imaging. The process is painless, and the noise of the machine is lessened by using headphones or listening to music.

Q?WHAT IS A CT or CAT SCAN?
A.

A CT or CAT scan is a series of images that is similar to an x-ray, except that it can provide cross-sectional anatomical information and 3D images instead of 2D images that x-rays provide. CT scans are typically ordered when detail beyond what an x-ray can provide is required to make optimal medical decisions and diagnoses. CT scans, like x-rays, also involve some radiation exposure.

 

Q?I ALREADY HAD XRAYS AND MY DOCTOR SAID THEY WERE NORMAL, WHY DO I HAVE TO REPEAT THEM? I EVEN BROUGHT THE X-RAY REPORT…
A.

Orthopedic specialists can obtain important information from x-ray images that are not always noted in x-ray reports or by other physicians or even radiologists. While radiology reports and other physician’s interpretations are sometimes enough to make a diagnosis, determining which treatment option is best for you often is based on details visible to the orthopedic specialist on the xray images. To optimally diagnose and treat your condition, it is imperative that we can view the actual images of your bones. Further, depending on the symptoms you are having, special radiographic views may be necessary to evaluate your condition. We are happy to interpret and use x-ray images that you have brought with you as long as they are of acceptable quality, are relatively recent and include the necessary diagnostic views.

Q?I ALREADY HAVE XRAYS, WHY DO YOU STILL NEED TO DO AN MRI?
A.

An x-ray provides an overview of bony anatomy and alignment and can provide information about a variety of injuries and conditions. Sometimes, further details are needed regarding the bones involved and an MRI can provide this information. Also, sometimes the pathology (problem) lies not within the bone but within the soft tissues around and between the bones (cartilage, ligaments, tendons, meniscus, labrum, muscles, etc) and an MRI can provide information about these structures that an x-ray cannot.

Q?I ALREADY HAVE AN MRI, WHY DO YOU NEED TO TAKE XRAYS TOO?
A.

While an MRI does provide excellent detail regarding soft tissues (cartilage, ligaments, muscles, tendons, etc), an x-ray provides very valuable additional information about the bony structures and alignment that is different than an MRI. An x-ray is a standard and invaluable part of any orthopedic examination. An x-ray is analogous to a photograph of a house whereas an MRI is more like a floor-plan or a blueprint of that house, both are important depending on the level of detail necessary.

 

Knee

Q?MY KNEE SWELLS AND FEELS LIKE SOMETHING IS CATCHING INSIDE, WHAT DO YOU THINK IT IS?
A.

These symptoms can be from a variety of disorders in the knee joint. A full history of the problem, physical examination, and x-rays and perhaps imaging such as an MRI may be necessary to confirm the cause of your symptoms. The most common causes of these symptoms are meniscus tears, cartilage injuries, arthritis, loose bodies (small loose flecks of cartilage or bone) floating in the joint, or thickening of the inner lining of the knee which is often termed a “plica.”

Q?WHEN CAN I DRIVE AFTER A KNEE REPLACEMENT SURGERY?
A.

Always confirm this from your doctor as it depends on which knee you had surgery on and the specific nature and restrictions related to your particular surgery. This is also highly variable from person to person. In general, you should not drive until you are cleared to bear weight on your driving leg, you are not under the influence of pain medications or other medications, and your range of motion and reaction time is sufficient to safely allow for normal leg movements while driving. Always go to an empty parking lot and practice driving situations after being cleared by your doctor before resuming driving in public.

Q?WHEN CAN I DRIVE AFTER A KNEE SCOPE?
A.

Always confirm this from your doctor as it depends on which knee you had surgery on and the specific nature and restrictions related to your particular surgery. This is also highly variable from person to person. In general, you should not drive until you are cleared to bear weight on your driving leg, you are not under the influence of pain medications or other medications, and your range of motion and reaction time is sufficient to safely allow for normal leg movements while driving. Always go to an empty parking lot and practice driving situations after being cleared by your doctor before resuming driving in public.

Q?WHAT IS KNEE ARTHRITIS?
A.

Arthritis (or osteoarthritis) is a progressive condition in which the cartilage cushioning layer between moving parts of your body (joints) has started to thin or wear out. Much like the tread on a tire, the cartilage cushion can thin, wear down, and fray. As pressure is then transferred to the moving bony parts with less cushion in between, this can result in increasing pain, stiffness, inflammation, and weakness. In the knee this can be especially painful and debilitating because the knees carry much of your bodies weight throughout the day and are under significant stress during activities such as standing from a seated position, getting up from the floor, kneeling, squatting, or going up and down stairs. Symptoms of knee arthritis include pain, swelling, catching, grinding, aching and giving way. Often the knees can feel heavy or weak from fatigue of the muscles around the knee or as a result of swelling in the knee joint.

Q?WHAT ARE THE TREATMENT OPTIONS FOR KNEE ARTHRITIS?
A.
Q?HOW DO I KNOW WHEN I NEED A KNEE REPLACEMENT?
A.
Q?WHAT IS A PARTIAL KNEE REPLACEMENT? AM I A CANDIDATE FOR A PARTIAL KNEE REPLACEMENT?
A.
Q?WHEN CAN I DRIVE AFTER A KNEE REPLACEMENT?
A.

Always confirm this from your doctor as it depends on which knee you had surgery on and the specific nature and restrictions related to your particular surgery. This is also highly variable from person to person. In general, you should not drive until you are cleared to bear weight on your driving leg, you are not under the influence of pain medications or other medications, and your range of motion and reaction time is sufficient to safely allow for normal leg movements while driving. Always go to an empty parking lot and practice driving situations after being cleared by your doctor before resuming driving in public.

Q?WHY DO MY KNEES SWELL?
A.

Swelling of the knee or other joints is typically from a build-up or increase of fluid inside the joint. This can occur from an injury, due to over-use, from inflammation from an allergic reaction, as a side effect of a medication, or as a result of damage to the bone, cartilage, ligaments, meniscus, tendons or other anatomical structures of the joint. It can also be a sign of medical conditions other than the knee itself. If swelling persists, you should see an orthopedic specialist for evaluation and treatment.

Q?IF MY KNEES POP, IS THAT BAD AND WILL I GET ARTHRITIS LATER?
A.

Painless popping is a natural phenomenon and should not cause arthritis in the future. Painless popping typically does not require formal evaluation. Painful popping of joints can be caused by many things, and you should seek evaluation by an orthopedic specialist to determine the cause and rule out a pre-arthritic condition.

Q?WHY DO MY KNEES POP?
A.

Popping of the knees (and other joints) can be painful or painless. Painful popping generally represents a problem and should be evaluated by an orthopedic specialist. Painless popping is typically harmless and is thought to be the result of air or nitrogen bubbles in a joint cavity moving from one part of the joint to another, or snapping of ligaments or tendons over bumps in the bones around  a joint.

Q?WHY DOES MY KNEE HURT WHEN I GO UP AND DOWN STAIRS?
A.

This is a common symptom of a variety of disorders known as “anterior knee pain,”” patellofemoral knee pain,” or “chondromalacia patella.” These disorders can involve degeneration or softening of the normally smooth cartilage on the undersurface of the kneecap (patella), increased pressure on part of the kneecap due to a muscle imbalance , or abnormal tracking of the kneecap due to muscle weakness or mechanical malalignment. You should see an orthopedic specialist to evaluate the cause of your pain and what can be done for it.

Q?WHAT EXERCISES ARE GOOD FOR KNEE PAIN?
A.

In general, because your knees bear your entire body weight on a repetitive basis it is wise to minimize the impact and trauma to the knee joints while exercising if you already have knee pain. A low-resistance strengthening program for the core, hip, thigh and lower leg muscles as well as low-impact cardiovascular exercises such as swimming, bicycling and elliptical training are generally well-tolerated and effective for patients with knee pain. Talk to your doctor about specifics for your condition. Physical therapy may also help to evaluate your condition and guide you through a rehabilitative exercise program.

Q?WHAT IS A KNEE SPRAIN?
A.

A knee sprain is a stretch or twist of the knee beyond the normal intended functional range of motion of that knee joint. One or many ligaments of the knee can be injured, as well as cartilage, tendons, muscles, and bone. The severity of the injury can be highly variable. If pain, swelling, instability, giving-way or catching persist after an knee injury, you should seek further evaluation.

 

MCL TEARS

Q?WHAT IS THE MEDIAL COLLATERAL LIGAMENT (MCL)?
A.

The medial collateral ligament (MCL) is one of the four major stabilizing ligaments in the knee. It is located on the inside or medial part of the knee (where the inside of your knee would touch the other knee if your legs were straight and together).

Q?WHAT ARE THE SYMPTOMS OF A MEDIAL COLLATERAL LIGAMENT (MCL) TEAR?
A.

Medial collateral ligament (MCL ) injuries often occur when the knee is strained or bent in an awkward position. This can be from sudden change in direction (planting or pivoting) during sporting activities, landing awkwardly, or when someone else falls onto your knee and bends it abruptly. Symptoms include pain on the inside portion of the knee near the joint line, difficulty bending or straightening the knee all the way, instability or a sense of the knee “giving out” or “giving way,” and swelling on the inside (medial) portion of the knee.

Q?HOW DO YOU DIAGNOSE A MEDIAL COLLATERAL (MCL) TEAR?
A.

A clinical history (what happened to your knee and what symptoms you are having) and a physical examination can usually suggest that a MCL tear may be present. An MRI is usually done to confirm the diagnosis of a tear, evaluate its severity, and to evaluate for other associated damage in the knee.

Q?DO I NEED AN MRI IF I HAVE A MEDIAL COLLATERAL LIGAMENT (MCL) TEAR?
A.

If history and physical exam suggest a stable, isolated, low-grade MCL tear, an MRI may not be necessary. If after examining your knee, there is any suspicion about associated other ligament, cartilage or meniscus damage, an MRI may be recommended. Also, an MRI can provide valuable information about how bad the tear is and help guide us as to how aggressive your rehab can be to minimize time to return to sports and activities.

Q?WHEN CAN I RETURN TO SPORTS AFTER TREATMENT OF MY MEDIAL COLLATERAL LIGAMENT (MCL) TEAR?
A.

Recovery times vary widely and depend on many factors such as severity of the injury, associated injuries, sport type and position, and intensity of rehab.  Generally, for most isolated and low-grade medial collateral ligament (MCL) sprains, most patients can return to normal activity in 2-4 weeks, often using a supportive brace during this time and afterwards for sporting activities. More severe injuries or those with other associated injuries can easily take 4-8 weeks for full recovery, or longer if surgery is required.

Q?HOW SHOULD MY MEDIAL COLLATERAL LIGAMENT (MCL) TEAR BE TREATED?
A.

 There are varying degrees of severity of ligament tears and they can occur in isolation or with other associated injuries in the knee. Most isolated or low-grade medial collateral ligament (MCL) injuries can be treated successfully with supportive bracing and a physical therapy program. The exception would be high-grade or unstable injuries, or those associated with other ligament, meniscal or cartilage injuries. These more severe injuries may require surgical intervention.

 

MENISCUS

Q?MY KNEE SWELLS AND FEELS LIKE SOMETHING IS CATCHING INSIDE, WHAT DO YOU THINK IT IS?
A.

These symptoms can be from a variety of disorders in the knee joint. A full history of the problem, physical examination, and x-rays and perhaps imaging such as an MRI may be necessary to confirm the cause of your symptoms. The most common causes of these symptoms are meniscus tears, cartilage injuries, arthritis, loose bodies (small loose flecks of cartilage or bone) floating in the joint, or thickening of the inner lining of the knee which is often termed a “plica.”

Q?WHAT IS THE MENISCUS?
A.

The meniscus is a shock-absorbing C-shaped disc made of collagen that sits in the knee between the femur and tibia, or joint. Each knee has two meniscus tissues, lateral and medial, which cushion the knee joint and provide stability to the knee in conjunction with other tissues and ligaments. In layman’s terms, when someone mentions “torn cartilage in my knee” they are usually referring to a torn meniscus, which is a type of cartilage tissue.

Q?WHAT IS A MENISCUS TEAR?
A.

A meniscus tear refers to a tear or damage to the shock-absorbing cushioning meniscus tissue that sits in the knee joint between the femur and tibia bones. There are many types and configurations of meniscal tears and the tear can be in either the lateral or medial meniscus. The tear can remain in a satisfactory position or the torn tissue can create a flap which displaces out of place or folds over like the corner of a bookmarked page in a book. Some tears occur during an acute injury such as a twist, fall, or slip while many tears are the result of slow unnoticed damage or degenerative changes over time and no identifiable event can be recalled. As we get older, the meniscus tissue loses some of its durability and is more susceptible to tearing.

Q?WHAT ARE THE SYMPTOMS OF A MENISCUS TEAR?
A.

The symptoms of a meniscus tear can be quite variable in severity and type from patient to patient. This depends on other associated conditions of the knee (arthritis), the location of the tear, the type of meniscus tear, and the activity level of the patient. The most common signs and symptoms of a torn meniscus include swelling, catching or locking, “giving way” of the knee, and sharp or dull pains on either side of the knee. Sometimes the symptoms are only present while the knee is bent, and others only while standing or bearing weight. Some people have worsened pain at night. Most patients complain of pain while twisting the knee or turning from side to side.

Q?I AM NOT ATHLETE OR I DIDN’T INJURE MY KNEE, HOW DID MY MENISCUS TEAR?
A.

There are many types and configurations of meniscal tears. Some tears occur during an acute injury such as a twist, fall, or slip while most tears are actually the result of slow unnoticed damage or degenerative changes over time and no identifiable event can be recalled. As we get older, the meniscus tissue loses some of its durability and is more susceptible to tearing. I often compare meniscal tissue to the caulking that goes around your windows and doors at home. When we are young, the meniscus is rubbery and durable and cushioning like the fresh caulking. As years go by and there is normal wear and tear on the knee, the meniscus can become stiffer and less resilient, and like old caulking that starts to chip and crack and peel, the meniscus can do the same. The problem can start small and go unnoticed until a certain threshold is reached, at which point the pain and symptoms begin.

Q?HOW DO YOU DIAGNOSE A MENISCUS TEAR?
A.

Meniscus tears are diagnosed with a thorough history and physical examination by an orthopedic specialist. Certain symptoms and exam findings are highly suggestive of meniscal tears. Definitive diagnosis is typically done by obtaining an MRI, which is a imaging test that depicts the cartilage, ligaments, soft tissues, and meniscus in great detail. An MRI can confirm whether or not a meniscus tear is present, what kind of tear it is, and what the condition of the surrounding structures is. If the MRI shows that you do not have a meniscus tear, it typically will reveal what else might be causing your pain and symptoms. If you are not a candidate for an MRI due to a pacemaker or implanted metallic hardware, an arthroscopy  or “scope” can both diagnose and treat a meniscus tear and other problems.

Q?HOW ARE MENISCUS TEARS TREATED?
A.

Treatment varies widely and each individual situation is different depending on the type of meniscal tear, the symptoms caused, the patient’s age and activity level, and associated conditions in the knee. In general, if the tear is found incidentally but is causing no symptoms, treatment may not be recommended. However, in most knees without significant arthritic changes and when symptoms are present, we recommend arthroscopic treatment to remove or repair the damaged tissue. Untreated meniscal tears can cause progressive damage to the articular or joint surface cartilage which can lead to or accelerate arthritic changes of the knee joint. Treatments such as medications, physical therapy, bracing, and corticosteroid injections may provide some relief from the symptoms but don’t specifically address the tear, and progressive joint damage can continue even if symptoms are improved.

Q?WILL A TORN MENISCUS HEAL ON ITS OWN?
A.

Unfortunately most meniscus tears will not heal on their own. The meniscus is an avascular tissue (it does not have a very good blood supply) and once torn the mensical fragments are mobile and won’t stay in one place as the knee is constantly moving and bearing weight. This leads to an inability of meniscal tears to heal on their own. It is possible, however, for a torn meniscus to stop producing symptoms even though it is not truly “healed.” In young children who are still growing and have open growth plates, vascularity (blood supply) to the meniscus is better than in teens and adults and some enhanced meniscal healing potential is present.

Q?SHOULD I HAVE MY MENISCUS REPAIRED OR PARTIALLY REMOVED (PARTIAL MENISECTOMY)?
A.

 This is a common question that should be discussed with your orthopedic specialist because many variables influence whether your torn meniscus should be partially removed versus repaired. In general, it is optimal to preserve as much meniscal tissue as possible, and thus any tear that CAN be repaired probably should be. However, some tears are not possible to repair because certain zones or areas of the meniscus have no vascularity (blood supply), healing success rates decrease with increasing age, oftentimes the torn meniscal tissue is degenerated and too friable (like wet tissue paper) to repair, and certain types of tears are simply not repairable. Also, repair involves a much slower and more protected recovery process (longer time on crutches, in a brace, and out of sports), and thus many patients prefer partial removal of the torn tissue rather than repair in order to more quickly return to sports, work or other activities. You should discuss the pros and cons of partial meniscus removal (menisectomy) versus meniscal repair for your particular situation with your orthopedic specialist.

Q?CAN I PLAY SPORTS AGAIN IF I DON’T HAVE MY TORN MENISCUS REPAIRED?
A.

Treatment of meniscus tears in athletes takes many factors into consideration, including the sport(s) involved, the timing in the season, the type of symptoms and associated knee injuries. It is possible to continue playing with a torn meniscus if pain and symptoms allow it. Some tears will cause recurrent swelling, catching, locking or instability that will make continued play impossible or less effective. Other tears may cause occasional pain or swelling but can be well tolerated for continuation of sports until timing is better for surgery. In general, we recommend eventual arthroscopic treatment because untreated meniscal tears can cause progressive damage to the articular or joint surface cartilage which can lead to or accelerate arthritic changes of the knee joint. Treatments such as medications, physical therapy, bracing, and corticosteroid injections may provide some relief from the symptoms and allow continued participation in sports but don’t specifically address the tear, and progressive joint damage can continue even if symptoms are improved. Once arthroscopic treatment is initiated, playing sports again is expected and likely whether you have a partial meniscal excision or a meniscal repair, but timing of return to sports varies with each treatment and you should discuss the pros and cons and possibilities of partial excision versus repair with your orthopedic specialist.

Q?WHEN CAN I RETURN TO SPORTS/WORK/ACTIVITY AGAIN AFTER MENISCUS SURGERY?
A.

This will depend on your specific situation and sport, associated ligament and/or cartilage injuries which may be treated during your surgery, and whether your meniscus is treated with partial excision of the torn fragment versus repair of the torn fragment (meniscal repair versus menisectomy). In general, following partial menisectomy or trimming of the torn fragment, return to most sports can occur anywhere from 3-6 weeks after surgery, once swelling is gone and strength and range of motion have returned to near-normal. Following repair of a torn meniscus, extended healing time is required before return to activity, and it may take 4-6 months before full return to activity. If cartilage or ligament repair is necessary in conjunction with your meniscus surgery, full recovery to all activities may be extended to even 6-12 months. Talk to your orthopedic specialist about your particular condition and projected return to sports and other activities.

Q?WHAT IS A MENISCUS TRANSPLANT?
A.

A meniscus transplant is a complete replacement of a damaged or insufficient meniscus with a size-matched replacement from a donor or cadaver tissue. This is done in circumstances where a large portion of the meniscus has been previously removed or damaged to the extent that it no longer provides a sufficient cushioning and stabilizing effect in the knee. If an otherwise healthy knee is left without a functioning meniscus, long-term studies show that progressive articular cartilage wear and eventual arthritis are inevitable. A meniscus transplant can restore the cushioning and stability needed to prevent this progression, while eliminating pain from joint overload due to lack of meniscal tissue. Though meniscal transplant is not needed after removal of small parts of the meniscus that are commonly done, talk to your orthopedic specialist to see if this procedure is a consideration for you.

 

PATELLOFEMORAL INSTABILITY

Q?WHAT IS PATELLAR INSTABILITY OR PATELLA DISCLOCATION?
A.

A patella (kneecap) dislocation is a painful injury of the knee in which the kneecap slides out of the normal groove in the femur bone of the knee (trochlear goove or trochlea). These dislocations may pop back in to place with straightening of the knee or may have to be put back in place by a physician. During a patellar dislocation, a ligament named the medial patellofemoral ligament (MPFL) between the kneecap and femur bone can be torn or stretched. This ligament damage needs time to heal and if it doesn’t heal sufficiently or the knee is not rehabbed well, recurrent future instability can occur. When the kneecap dislocates out of its groove, the underlying cartilage of the patella or femoral trochlea can also be damaged. Patella dislocations can be very painful and debilitating. Often times, the fear or apprehension of future dislocations can hinder activity significantly.                                  

Q?WHAT IS THE TREATMENT FOR PATELLA (kneecap) DISLOCATIONS OR INSTABILITY?
A.

Treatment for initial dislocations without significant joint damage generally includes a period of icing and immobilization, with medications to reduce inflammation and pain. This is followed by bracing and physical rehabilitation to strengthen the stabilizing musculature of the hip, thigh and knee. For recurrent dislocations, highly unstable injuries, or dislocations with other injuries, surgery may be indicated. This can involve arthroscopy (knee scope) to fix injuries inside the joint and mini-open incisions to repair or reconstruct the damaged/torn/stretched tissues that previously enhanced patellar stability such as the medial patellofemoral ligament (MPFL) and associated structures.

Q?WHAT IS THE MEDIAL PATELLOFEMORAL LIGAMENT AND HOW IS IT RECONSTRUCTED?
A.

The medial patellofemoral ligament (MPFL) is a ligament that connects the patella (“kneecap”) to the femur (“thigh bone”) just above the knee. It is a restraint to the patella to slide out of place or dislocate, and can be torn or stretched if a patella (kneecap) dislocation does occur. If recurrent or persistent instability from a loose ligament is a problem, the ligament can be repaired if done soon after the injury or reconstructed (replaced) at any time. This involves using a borrowed graft from another part of the knee (autograft) or from a donated cadaver (allograft) and securing it in the proper location surgically to recreate the function of the damaged ligament. This is an outpatient surgical procedure done with the assistance of an arthroscope.

Q?HOW SOON CAN I DRIVE AFTER PATELLAR DISLOCATION SURGERY/MPFL RECONSTRUCTION SURGERY?
A.

This is highly variable and depends on the exact type of surgery you are having and which limb is having surgery. Different people also regain the strength and range of motion necessary to drive at different rates. Basic requirements for return to driving include being cleared to bear weight on your driving leg, being allowed to lift your affected foot, not being under the influence of pain medications or other medications, and having range of motion and reaction time sufficient to safely allow for normal movements while driving. Always go to an empty parking lot and practice driving situations after being cleared by your doctor before resuming driving in public. In general, patients are able to drive after 1-4 weeks (lower end of range if surgery is on non-driving leg).

Q?HOW SOON CAN I RETURN TO SPORTS OR ACTIVITIES AFTER TREATMENT FOR PATELLAR DISLOCATION OR INSTABILITY?
A.

Return to sport time following treatment for patellar dislocation depends greatly based on the severity of the injury and the type of treatment. For non-operative rehab following an injury, return to activity/sport times can be as little as 2 weeks to as much as 6 weeks depending on the severity of the injury. In the case of surgical reconstruction, every case will be different, but in general most athletes can return to sports in 4-6 months. Straight-line running can be started earlier, at approximately 3 months depending on what other injuries were present in the knee. Sports performance may not be “normal” for even longer, sometimes 6-12 months. I recommend quadriceps and hamstring strength be 80 percent of that of the un-injured (contralateral) leg prior to return to sports.

 

Physical Therapy

Q?WHY SHOULD I DO PHYSICAL THERAPY, I EXERCISE ALL THE TIME?
A.

Exercise has multiple health benefits and is highly encouraged to speed up metabolism, strengthen muscles, lower blood pressure and burn calories, among numerous other benefits. When a particular joint or body part is injured or painful, general exercise may actually be harmful or make the symptoms worse. A physical therapist is a trained specialist who can use a physician’s diagnosis and prescription to individualize a program of stretching, strengthening, therapeutic modalities and functional exercises to help rehabilitate injuries and aches and pains. Subtle muscle imbalances or weaknesses can lead to pathologic conditions which cause pain. Such conditions require targeted therapies to correct these imbalances, with the goal of treatment being to return you to your desires general exercise routines or activities. After a surgical procedure, a therapist is of utmost importance to safely and effectively guide you and assist you through the recovery process to regain range of motion, strength, and function without jeopardizing the surgical repair.

Q?WHY SHOULD I DO PHYSICAL THERAPY, I AM ON MY FEET ALL DAY ALREADY…?
A.

Being on your feet or standing and walking throughout the day can be exhausting and seem like exercise. In reality, I typically describe this as “work” for your muscles and joints rather than exercise. Physical therapy and/or an exercise program involving targeted stretching and strengthening of specific muscles and joints will actually help the muscles in your body to endure and support the “work” of prolonged standing and walking.

 

POSTERIOR CRUCIATE LIGAMENT (PCL) TEARS

Q?WHAT IS THE POSTERIOR CRUCIATE LIGAMENT (PCL)?
A.

The posterior cruciate ligament (PCL) is one of the four major ligaments of the knee. It is located in the back (posterior) and center of the knee and is a thick two-bundle ligament which prevents posterior displacement of the tibia (leg bone) relative to the femur (thigh bone). Injuries to this ligament are less common than that of other knee ligaments, and although most injuries of the PCL can be treated without surgery, surgical reconstruction is recommended in select situations.

Q?WHAT ARE THE SYMPTOMS OF A POSTERIOR CRUCIATE LIGAMENT (PCL) TEAR?
A.

Posterior cruciate ligament (PCL) injuries can be the result of low-energy sports injuries or high-energy trauma. Symptoms of a posterior cruciate ligament (PCL) tear can include varying degrees of swelling, instability, a feeling of “giving way,” and pain in the back of the knee.

Q?HOW DO YOU DIAGNOSE A POSTERIOR CRUCIATE LIGAMENT (PCL) TEAR?
A.

A clinical history (what happened to your knee and what symptoms you are having) and a physical examination can usually suggest that a PCL tear may be present. An MRI is usually done to confirm the diagnosis of a tear, evaluate its severity, and to evaluate for other associated damage in the knee.

Q?WILL I NEED A BRACE WHEN I RETURN TO SPORTS AFTER MY POSTERIOR CRUCIATE LIGAMENT (PCL) RECONSTRUCTION SURGERY?
A.

This is another controversial topic for which no consensus answer exists. Use of a “sports brace” or “functional brace” following posterior cruciate ligament reconstruction (PCL) surgery has never been proven to decrease injury rate or increase performance or stability following return to sports. However, most patients polled feel better and have more confidence in their reconstructed knee while using a sports brace, at least initially. Therefore, for straight line running and low-intensity activities I do not recommend the use of a sports brace. For return to pivoting, jumping or contact sports, however, I typically recommend use of a brace for the first sports season or 6-12 months following return from the surgery. Braces are highly variable in cost, style, customization, and coverage varies amongst various insurance plans. Therefore the decision to use or not use a brace depends on many factors and should be considered on an individual basis after analysis of the risks, benefits, and feasibility of different options.

Q?WILL I NEED A BRACE AND/OR CRUTCHES AFTER MY POSTERIOR CRUCIATE LIGAMENT (PCL) RECONSTRUCTION SURGERY?
A.

I typically recommend the use of a hinged post-operative knee brace and crutches following PCL reconstruction surgery. I find that they give patients stability in the early post-operative period while pain and weakness are still present. They are also helpful to support legs temporarily weakened by regional nerve blocks which are commonly used as part of the anesthesia plan for these surgeries. Depending on the extent of your procedure and what associated injuries you had, crutches may be needed for 1-6 weeks and the brace is typically worn for approximately 6 weeks.

Q?WILL I NEED A “MOTION MACHINE” AFTER MY POSTERIOR CRUCIATE LIGAMENT (PCL) RECONSTRUCTION SURGERY?
A.

I sometimes recommend the use of a CPM (continuous passive motion) machine following PCL reconstruction surgery. It depends on the extent and timing of the injury, the pre-operative range of motion, and other associated injuries in the knee. It is a machine that gently bends and straightens your knee at home during the days and weeks following surgery. It can help reduce the amount of scar tissue that forms and help patients regain their range of motion faster. Some insurance companies have been denying coverage for these machines and not all surgeons use them. While I don’t believe they are absolutely necessary for a successful outcome and cannot replace a good physical therapy and home exercise program, I feel strongly that they can still be beneficial and certainly don’t do any harm.

Q?WHAT ARE THE POTENTIAL COMPLICATIONS OF POSTERIOR CRUCIATE LIGAMENT (PCL) RECONSTRUCTION SURGERY?
A.

Posterior cruciate ligament reconstruction surgery is generally a very safe and well-tolerated procedure. As with any surgery or injury, some level of risk remains. The most common risks of PCL surgery include loosening of the graft tissue, re-rupture or failure of the graft, joint stiffness or loss of full range of motion, or hardware that becomes symptomatic. Infection of the surgical site or blood clots can also occur but are far more rare.  I do everything within our control to reduce the risk of these complications, but unfortunately some risks are unavoidable. Though rare, these conditions are treatable with physical therapy, medications, or occasionally additional surgical procedures. Because of the posterior location of this ligament, nerves and blood vessels behind the knee are at increased risk of injury during the drilling and preparation involved in PCL surgery. Knowing that these anatomical risks are present, we use extreme caution during these portions of the procedure, including use of intra-operative x-ray (fluoroscopy) for precise drilling and instruments designed to protect these structures in the back of the knee.

Q?WHEN CAN I PLAY SPORTS AGAIN AFTER A POSTERIOR CRUCIATE LIGAMENT (PCL) RECONSTRUCTION SURGERY?
A.

Return to sport time following posterior  cruciate ligament (PCL) reconstruction surgery varies widely depending on the type of sporting activity, intensity and duration of rehab, associated injuries, and graft type. Every case will be different, but in general most athletes can return to pivoting or jumping sports in 6-12 months. Straight-line running can be started earlier, at approximately 3-4 months depending on what other injuries were present in the knee. Sports performance may not be “normal” for even longer, sometimes 12-18 months. In general , autograft reconstructions incorporate or “heal” sooner than allograft (cadaver) reconstructions. In extreme situations, accelerated rehab and autograft graft choice can lead to accelerated return at 5-6 months, but re-injury rate and graft laxity may be increased by early return. I recommend quadriceps and hamstring strength be 80 percent of that of the un-injured (contralateral) leg prior to return to sports. Revision reconstructions may also require longer time before return to play.

Q?CAN I PLAY SPORTS AGAIN IF I DON’T HAVE MY POSTERIOR CRUCIATE LIGAMENT (PCL) RECONSTRUCTED/FIXED?
A.

This depends on the type of activities you wish to perform, associated injuries, and other individual variables. Most patients with isolated partial or low-grade PCL ligament tears can return to full  levels of activity in a brace and after adequate rehabilitation without surgically reconstructing their PCL.  If you had additional ligament injuries, high-grade posterior cruciate ligament (PCL) tearing, or meniscus injuries in your knee, it is unlikely that you would be able to return to moderate/high-demand sports without surgical reconstruction of all or part of the injuries.

Q?WHAT TYPE OF GRAFT SHOULD I CHOOSE FOR MY POSTERIOR CRUCIATE LIGAMENT (PCL) RECONSTRUCTION?
A.

There are multiple graft options for arthroscopic posterior cruciate ligament (PCL) reconstruction surgery. Each graft option has some specific pros and cons, and the best graft for you depends on numerous individual factors. What makes sense for one patient may be different from person to person. Some surgeons prefer to use one type of graft for every PCL surgery. I prefer to discuss the options with my patient and help them choose what type of graft is the best for their specific needs. The posterior cruciate ligament (PCL) is a thick ligament and a good replacement graft should be big and bulky as well. We can use grafts taken from your own body (autograft) or grafts from donated tissue from a cadaver (allograft). Please see the section on ACL graft choices for more details about various types of graft options.

 

Shoulder

Q?WHAT IS THE RECOVERY TIME AFTER ARTHROSCOPIC LABRUM REPAIR SURGERY?
A.

Recovery from arthroscopic labrum repair surgery (SLAP repair, bankart repair, etc…) is generally very successful and generally allows a return to a very high level of function. Recovery time still varies on a number of factors, including size and location of the tear, actual surgery performed (repair of the labrum versus clean-up or debridement of the damaged tissue), previous treatments or surgeries, quality of the repaired tissue, patient healing factors (diabetes, smoking, etc…), and of course the type of activity that the patient is trying to return to. Speak to your surgeon about the specific expectations and timetable in your particular case.

In general, if the labrum is simply debrided or “cleaned-up,” the recovery time to full activity may be shorter than if repaired. Debridement cases usually require a sling for 1-2 weeks for comfort, and physical therapy for 4-6 weeks. Normal daily and routine exercise activities can usually be resumed and progressively increased at this time. Return to high level overhead activity or throwing may take longer, perhaps 2-4 moths to be at full function.

If a labrum repair is required, the recovery time can be longer since the tissues need a longer protection phase to allow full healing. Sling immobilization is usually required for the first 4 weeks. Driving is usually safe somewhere between 2-4 weeks. Running and lower extremity conditioning can usually begin around 4-6 weeks. Upper extremity therapy will be on-going and progressive after surgery and normal daily activities can usually be performed in between 8-12 weeks with some restrictions. Return to weight-lifting activities and contact sports typically is allowed at around 4-6 months. Throwing athletes can usually resume throwing at around this time frame, but return to full throwing form and speed is a gradual progression that may take 6-12 months.

Q?HOW LONG WILL IT TAKE FOR MY ADHESIVE CAPSULITIS (FROZEN SHOULDER) TO GET BETTER?
A.

Adhesive capsulitis or a “frozen shoulder” is one of the most difficult conditions that we as orthopedic surgeons, sports medicine physicians, and shoulder specialists have to see and treat because the causes are not fully known and the recovery is often a slow, long process. Typically this condition can take anywhere from 3 months to 2 years to resolve, despite many possible treatment interventions over that time period. The condition does typically resolve on its own, even without much treatment, but can take years to resolve in this setting. Treatment interventions such as medications, injections, physical therapy, home exercise and stretching programs, and surgical treatments may speed up this timeline for recovery.

Q?WHAT ARE COMMON COMPLICATIONS AFTER ROTATOR CUFF SURGERY?
A.

Arthroscopic rotator cuff surgery has evolved into a very safe and highly effective procedure. As with any surgical procedure, however, there can be some risks that are present with any surgery involving anesthesia. Anesthetic risks are rare. Your anesthesiologist will go over the risks with you on the day of surgery and discuss the best anesthesia plan with you. The healthier you are the less the risk, and the anesthesiologist and your surgeon will obtain any necessary lab tests and other tests to evaluate your heart and health prior to surgery. This is the best way to avoid complications. Infections and blood clots are also rare but potential complications from any surgical procedure, but everything possible is done to prevent these complications from occurring. Specific complications to rotator cuff surgery include swelling of the arm, hand, chest, and even legs several days after surgery. This typically resolves after a few days. Recurrent tear or persistent pain is possible but uncommon if you adhere to the recommended precautions and rehab/physical therapy schedule. If this was to occur, these conditions can be treated or will resolve with time. Stiffness after rotator cuff surgery is not uncommon, but also can be treated with additional therapy, stretching devices, additional procedures, and time. It is typically preventable by early physical therapy and a diligent home exercise program in between therapy visits.

Q?WHAT IS THE RECOVERY TIME AFTER ROTATOR CUFF SURGERY?
A.

I do almost all rotator cuff repair surgeries arthroscopically (using a scope through small incisions, minimally invasive).  This allows for decreased post-operative pain and earlier return to day-to-day activities than with open surgeries. Still, the rotator cuff tendon heals slowly and full recovery from surgery takes several months. Most patients need physical therapy for about 3 months after surgery.  I typically keep patients in a sling for about 4 weeks after surgery. The sling should be worn for all times except for showering, changing clothes, and for physical therapy or home exercises. Most patients can return to desk/office/computer activities in 2-4 weeks, or sooner if pain allows (everyone has a different pain threshold). I don’t recommend driving while in the sling and typically the strength you will need to drive does not return for 4-6 weeks. Many patients drive with one arm after surgery but I can’t recommend that as it can be very unsafe in case of an unpredictable event on the road. It is best to arrange for some help getting around until you can safely do so. Reaching out and over your head under your own muscle power isn’t recommended until at least 6 weeks and I don’t recommend you lift anything heavier than a glass of water at shoulder level or above for at least 3 months. Heavy labor or sports activities can take at least 3 months to start, but typically full return of normal strength and function can take 6-12 months. Of course this all varies with the size of the tear, the number of tendons involved, the other procedures performed and other individual variables. I recommend you discuss the specifics of your procedure and expected recovery with your physician.

Q?WHAT IS A ROTATOR CUFF TEAR?
A.

A rotator cuff tear is a tear of one or more of the 4 tendons of the rotator cuff (supraspinatus, infraspinatus, subscapularis, teres minor). The tear may be partial or complete, and involve any combination of these tendons. These muscles normally contract and via the tendons that connect them to the humerus (upper arm bone), allow for elevation and rotation of your arm away from your body. When a tear is present, it can result in shoulder pain (especially at night or with activities) and/or weakness with overhead activities or when reaching with your arm away from your body. The pain is generally in the deltoid muscle area, but often radiates down the arm towards the elbow or up the shoulder towards the neck or shoulder blade.

Q?WHAT ARE THE SYMPTOMS OF A ROTATOR CUFF TEAR?
A.

The most common symptoms of a rotator cuff tear are pain and weakness of the shoulder, usually worst at night or with overhead or lifting activities. The pain is typically in the deltoid region of the shoulder and can radiate down the upper arm towards the elbow. The symptoms can come on suddenly after an injury but are more commonly experienced gradually and without any specific known injury. Pain and weakness are worsened by reaching out away from your body, above your head, or behind you.

Q?HOW DO YOU DIAGNOSE A ROTATOR CUFF TEAR?
A.

A rotator cuff tear can be diagnosed using a combination of history (physician listens to the symptoms you are having), physical examination, and imaging tests (xrays and usually an MRI). The history and physical exam are important to differentiate other things which can cause pain and weakness in the shoulder area including problems from the neck, nerve injuries, and simple muscle strains or joint sprains. Xrays (images that show bones and calcifications) help identify if there is any arthritis in the joint and give the best pictures of bone spurs around the shoulder. An MRI (imaging test which shows tendons, muscles, fluid and cartilage) is typically necessary to assess the size and degree of the tear, identify how many tendons of the rotator cuff are involved, evaluate how much atrophy of the muscles is present (which helps predict treatment outcomes), and rules out other concurrent conditions which may need to be treated. The diagnosis may be made by a primary care physician or by an orthopedic surgeon, but treatment is usually best discussed with an orthopedic specialist to evaluate all the individual variables that can affect outcomes of various degrees of injury.

Q?WHAT ARE THE TREATMENT OPTIONS FOR A ROTATOR CUFF TEAR?
A.

Treatment for rotator cuff injuries varies widely depending on individual patient needs and symptoms, the degree and size of the tear, and other related conditions of the shoulder joint. The goals of treatment are to relieve pain and restore the level of function that the patient desires. Pain relief can be achieved with oral anti-inflammatory medications, pain medications or corticosteroid (steroid) injections into the shoulder. Function can often be improved with physical therapy exercises for improving range of motion and strength of the intact and unaffected muscles around the shoulder. If pain is not relieved or strength can not be restored with these options, arthroscopic surgery can be recommended to repair the torn rotator cuff tendon. In general, tears of the rotator cuff do not heal on their own and can increase in size over time. Some small or partial tears can be treated successfully with non-operative treatment while larger tears are more likely to progress or cause persistent pain and/or weakness and are more likely to need arthroscopic treatment. Still, every tear is different and I highly recommend an individualized discussion with your treating orthopedic specialist.

Q?WHEN CAN I DRIVE AFTER A SHOULDER SCOPE?
A.

Always confirm this from your doctor as it depends on the specific nature and restrictions related to your particular surgery. This is also highly variable from person to person. In general, you should not drive until you are cleared to actively lift your arm, you are not under the influence of pain medications or other medications, and your range of motion and reaction time is sufficient to safely allow for normal arm movements while driving. Always go to an empty parking lot and practice driving situations after being cleared by your doctor before resuming driving in public.

Q?WHAT IS A LABRUM TEAR OR SLAP TEAR?
A.

The labrum is a circular cartilage-like bumper that surrounds your shoulder socket and serves as the attachment point for ligaments that connect between the upper arm bone (humerus) and the flat socket (glenoid) to stabilize your shoulder. A tear of this labrum describes the bulling away of this cartilage structure from the socket (glenoid). This can result from an acute injury such as an awkward movement, sudden force, or a dislocation of the shoulder or can be from chronic and repeated use or over-use and overhead activities such as that which can occur from pitching, throwing, weight-lifting, swimming, volleyball, softball, gymnastics, cheerleading, tumbling, or various other sports or labor activities. The torn tissue itself can be out of place and thus painful because of the detachment, or the detachment can contribute to instability and pain because the ligaments which attach to the labrum are thus destabilized. A SLAP tear refers specifically to a tear of one section of the labrum, the superior labrum, which serves as the attachment point of the long head of the biceps tendon. Labrum tissue does not typically heal on its own after a tear because the tissue is poorly vascularized (does not a have a good blood supply).

Q?WHAT ARE THE SYMPTOMS OF A LABRUM TEAR OR SLAP TEAR?
A.

The symptoms of a SLAP or labrum tear can vary widely depending on the size and location of the tear, how long it has been present, associated conditions, and what activities the shoulder is doing. Small tears may have few or no symptoms, while larger ones can lead to instability and significant discomfort or limitations of activity. The most common symptoms of a labrum tear are pain, catching, popping, or the sensation of the shoulder giving out or giving way with certain activities. Pain and symptoms are typically worse when the shoulder is involved in shoulder level or overhead activities or when carrying something of weight. Pain is often worse at night but can also be present during the day and with minimal activity in some patients. Recurrent instability, dislocations, or the sensation of the shoulder “slipping out of joint” is also commonly reported in significant tears. In overhead athletes, the pain is usually aggravated by throwing or overhead activities (serving, swimming, throwing, lifting). 

Q?HOW DO YOU DIAGNOSE A SLAP or LABRUM TEAR?
A.

A SLAP or labrum tear can be diagnosed using a combination of history (physician listens to the symptoms you are having), physical examination, and imaging tests (xrays and usually an MRI). The history and physical exam are important to differentiate other things which can cause pain and weakness in the shoulder area including problems from the neck, nerve injuries, and simple muscle strains or joint sprains. Xrays (images that show bones and calcifications) help identify if there is any arthritis or small fractures in the joint which can occur with certain labrum injuries. An MRI (imaging test which shows tendons, muscles, fluid and cartilage) is typically necessary to confirm the presence, location and size of the tear. For labrum injuries, your orthopedic specialist may order an MRI Arthrogram (MRI done after a special dye is injected into your shoulder under x-ray guidance) because these injuries can be subtle and 40% of tehm can be missed on an MRI study done without contrast injection. An MRI also rules out other concurrent conditions which may need to be treated. The diagnosis may be made by a primary care physician or by an orthopedic surgeon, but treatment is usually best discussed with an orthopedic specialist to evaluate all the individual variables that can affect outcomes of various types of labrum injury.

Q?WHAT ARE THE TREATMENT OPTIONS FOR A LABRUM TEAR OR SLAP TEAR?
A.

Treatment options for labrum or SLAP tears varies widely depending on the individual activity the patient needs to return to, the severity of symptoms, the location and size of the tear, and other related conditions of the shoulder joint. The goals of treatment are to relieve pain and restore the level of function and stability that the patient desires. Pain relief can be achieved with oral anti-inflammatory medications, pain medications or corticosteroid (steroid) injections into the shoulder, or activity modifications to limit the activities which produce the pain. Function can often be improved with physical therapy exercises for improving range of motion and strengthening of the rotator cuff and scapular stabilizing muscles surrounding the shoulder. If pain is not relieved or strength, stability and function can not be restored with these options, arthroscopic surgery can be recommended to repair the torn labrum tissues. If this is done, small surgical anchors are placed in the glenoid socket, and sutures from these anchors are passed through and around the labrum to re-attach it to the glenoid socket. Multiple anchors are used depending on the size and locations of the torn labrum.  In summary, every tear is different and I highly recommend an individualized discussion with your treating orthopedic specialist to determine what course of action is best for you.

Q?WHY DOES MY SHOULDER KEEP DISLOCATING?
A.
Q?WHAT ARE THE TREATMENT OPTIONS FOR SHOUDLER DISLOCATIONS?
A.
Q?WHAT IS ADHESIVE CAPSULITIS (FROZEN SHOULDER)?
A.
Q?WHAT ARE THE TREATMENTS FOR ADHESIVE CAPSULITIS (FROZEN SHOULDER)?
A.
Q?WHAT IS SHOULDER ARTHRITIS?
A.
Q?WHAT ARE THE SYMPTOMS OF SHOULDER ARTHRITIS?
A.
Q?WHAT TREATMENT OPTIONS ARE THERE FOR SHOULDER ARTHRITIS?
A.
Q?HOW DO I KNOW WHEN I NEED A SHOULDER REPLACEMENT?
A.
Q?WHAT IS THE DIFFERENCE BETWEEN A TOTAL SHOULDER REPLACEMENT AND A PARTIAL SHOUDLER REPLACEMENT OR RESURFACING?
A.
Q?WHAT IS A REVERSE TOTAL SHOULDER REPLACEMENT?
A.

 

Sports Medicine

Q?WHAT IS AN ORTHOPEDIC SPORTS MEDICINE SPECIALIST?
A.

Orthopedic surgeons treat a variety of musculoskeletal conditions involving bones, joints, muscles, ligaments, tendon and cartilage. Sports medicine specialists have additional training in treatment of an active patient population who demands optimal recovery and early return to function. This can include treatment with medications, bracing, and physical therapy or advanced arthroscopic and open surgical treatments. Treating athletes with injuries has advanced the science and technology of healing that can then benefit all patients who suffer the same injuries that we see in athletes.

 

 

Q?I AM NOT AN ATHLETE…WHY SHOULD I SEE A SPORTS MEDICINE SPECIALIST?
A.

Sports medicine specialists are highly trained in the treatment of a variety of conditions that affect athletes AS WELL AS non-athletes. Treatment of an athletic population has refined the techniques necessary to allow for rapid healing with medications, bracing, and physical therapy as well as minimally invasive surgical procedures including arthroscopic surgery when necessary. This allows for rapid return to function for EVERYBODY, athlete or not. Sports medicine specialists typically treat orthopedic problems and fractures involving multiple body parts, including the shoulder, knee, hip, elbow, wrist and ankle.

Q?WHAT IS ARTHROSCOPY?
A.

Arthroscopy is a minimally invasive orthopedic surgical procedure that involves placing a fiber-optic camera inside a joint space through a small mini-incision (typically 5-10 mm) in the skin. This can be done for diagnostic (to find out what the problem is) or therapeutic (to treat the problem that exists) purposes. Specially designed instruments can be placed through these and additional mini-incisions to treat joint problems. Not all problems are treatable with arthroscopy, but sports medicine specialists are trained to perform many complex procedures in this minimally invasive fashion. Most arthroscopic procedures can be performed on an outpatient basis and early recovery is often enhanced versus open surgical procedures.

 

Surgery

Q?WHAT ARE COMMON COMPLICATIONS AFTER ROTATOR CUFF SURGERY?
A.

Arthroscopic rotator cuff surgery has evolved into a very safe and highly effective procedure. As with any surgical procedure, however, there can be some risks that are present with any surgery involving anesthesia. Anesthetic risks are rare. Your anesthesiologist will go over the risks with you on the day of surgery and discuss the best anesthesia plan with you. The healthier you are the less the risk, and the anesthesiologist and your surgeon will obtain any necessary lab tests and other tests to evaluate your heart and health prior to surgery. This is the best way to avoid complications. Infections and blood clots are also rare but potential complications from any surgical procedure, but everything possible is done to prevent these complications from occurring. Specific complications to rotator cuff surgery include swelling of the arm, hand, chest, and even legs several days after surgery. This typically resolves after a few days. Recurrent tear or persistent pain is possible but uncommon if you adhere to the recommended precautions and rehab/physical therapy schedule. If this was to occur, these conditions can be treated or will resolve with time. Stiffness after rotator cuff surgery is not uncommon, but also can be treated with additional therapy, stretching devices, additional procedures, and time. It is typically preventable by early physical therapy and a diligent home exercise program in between therapy visits.

Q?WHAT IS THE RECOVERY TIME AFTER ROTATOR CUFF SURGERY?
A.

I do almost all rotator cuff repair surgeries arthroscopically (using a scope through small incisions, minimally invasive).  This allows for decreased post-operative pain and earlier return to day-to-day activities than with open surgeries. Still, the rotator cuff tendon heals slowly and full recovery from surgery takes several months. Most patients need physical therapy for about 3 months after surgery.  I typically keep patients in a sling for about 4 weeks after surgery. The sling should be worn for all times except for showering, changing clothes, and for physical therapy or home exercises. Most patients can return to desk/office/computer activities in 2-4 weeks, or sooner if pain allows (everyone has a different pain threshold). I don’t recommend driving while in the sling and typically the strength you will need to drive does not return for 4-6 weeks. Many patients drive with one arm after surgery but I can’t recommend that as it can be very unsafe in case of an unpredictable event on the road. It is best to arrange for some help getting around until you can safely do so. Reaching out and over your head under your own muscle power isn’t recommended until at least 6 weeks and I don’t recommend you lift anything heavier than a glass of water at shoulder level or above for at least 3 months. Heavy labor or sports activities can take at least 3 months to start, but typically full return of normal strength and function can take 6-12 months. Of course this all varies with the size of the tear, the number of tendons involved, the other procedures performed and other individual variables. I recommend you discuss the specifics of your procedure and expected recovery with your physician.

Q?WHAT IS AN ANKLE SCOPE?
A.

Ankle arthroscopy (or scoping) is a minimally invasive orthopedic surgical procedure that involves placing a fiber-optic camera inside the ankle  joint space through a small mini-incision (typically 5-8) in the skin. This can be done for diagnostic (to find out what the problem is) or therapeutic (to treat the problem that exists) purposes. Specially designed instruments can be placed through these and additional mini-incisions to treat joint problems. Not all problems are treatable with arthroscopy, but sports medicine specialists are trained to perform many complex procedures in this minimally invasive fashion. Most arthroscopic procedures can be performed on an outpatient basis and early recovery is often enhanced versus open surgical procedures.

Q?WHAT IS THE RECOVERY TIME AFTER AN ANKLE SCOPE?
A.

Recovery after ankle arthroscopy varies depending on what procedure is done, but generally the recovery is relatively rapid. For a simple clean-out of inflamed tissue, removal of loose bodies or bone spurs, or smoothing of damaged cartilage, most patients are walking without crutches in 2-4 days, back to normal day-day activities in 1-2 weeks, and back to exercise and athletic or heavy labor activities in 4-6 weeks. If a more extensive repair or reconstruction is performed, time on crutches may be longer and time to full recovery may be 2-4 months. Talk to your surgeon about your specific planned procedure for an individualized time table for recovery.

Q?WHAT IS ARTHROSCOPY?
A.

Arthroscopy is a minimally invasive orthopedic surgical procedure that involves placing a fiber-optic camera inside a joint space through a small mini-incision (typically 5-10 mm) in the skin. This can be done for diagnostic (to find out what the problem is) or therapeutic (to treat the problem that exists) purposes. Specially designed instruments can be placed through these and additional mini-incisions to treat joint problems. Not all problems are treatable with arthroscopy, but sports medicine specialists are trained to perform many complex procedures in this minimally invasive fashion. Most arthroscopic procedures can be performed on an outpatient basis and early recovery is often enhanced versus open surgical procedures.

Q?SHOULD I GET A REGIONAL NERVE BLOCK FOR MY SURGERY?
A.

Talk to your doctor before surgery to discuss this in detail based on the particular type of procedure you are having. If the procedure is considered painful and local anesthetic alone may not be effective then you may benefit from a regional nerve block. They are especially helpful for patients who have low pain thresholds, other risk factors for general anesthesia, or wish to minimize narcotic pain medications. If it is appropriate for you and your type of procedure, your anesthesiologist will speak to you in detail about the benefits and potential risks of nerve block procedures on the day of your surgery. It is your decision whether or not you would like to receive a nerve block after this discussion. Pain relief is often not complete even with a nerve block, but any reduction in pain for the first 12-48 hours after surgery is beneficial and can reduce the amount of medications you will need to take and the overall severity of the pain you feel.

Q?WHAT IS A REGIONAL NERVE BLOCK?
A.

A regional nerve block is a small procedure that a trained anesthesiologist performs before or after your surgical procedure that is designed to anesthetize nerves that go to your arm or leg. This helps optimize pain control during and for 1-2 days after your surgery. Individual nerves are targeted depending on what type of surgery is to be performed and where your incision will be. These can be done in addition to or instead of general anesthesia depending on the type and duration of your surgery and your overall medical condition. For many orthopedic procedures, I recommend these nerve blocks as a way to control pain without the unwanted side effects of narcotic pain medications, though these can still be used while a nerve block is in place. Your anesthesiologist will place numbing medicine around the desired nerve/nerves via a small needle or a catheter (small plastic tube) which can be left in place for a few days, much like an epidural that women receive during labor. Medications can then be infused as needed through the tube via a small pump with a button that you can control as needed.

Q?HOW DO I MINIMIZE SCAR FORMATION AFTER SURGERY?
A.

Although I attempt to close all incisions as cosmetically as possible, every individual heals differently and scar formation of some type is inevitable. Some are thicker or darker than others. To minimize scar formation, adhere to all post-operative instructions regarding your dressings and bandages. Once the incision is adequately healed, perform routine scar massage to soften the scar tissue. Avoid sun exposure to the affected area as sunlight can darken your scar (apply sunscreen and cover the affected area with clothing when possible). Topical scar treatments include cocoa butter, vitamin E lotion, Mederma, Bio-Oil and many others which are available over the counter without a prescription.

Q?WHEN CAN I GO BACK TO WORK AFTER MY SURGERY?
A.

You should discuss this in detail with your doctor. This varies widely depending on the nature of your surgery, the severity of your condition, individual variability in recovery times, and your individual job requirements. In general, seated and desk-duties can be resumed sooner than labor-intensive or standing positions. You should also not be under the adverse influence of pain medications and other medications that can affect your ability to do your job safely and effectively. You will also need to be cleared to drive or be able to arrange transportation if you cannot drive yourself. In summary, you can expect to return to work once you can safely and comfortably resume your individual job responsibilities.

Q?HOW MUCH PAIN WILL I BE IN AFTER MY SURGERY?
A.

Pain is a very subjective thing and varies widely from person to person. This will also depend heavily on what type of surgery you are having. It is important to ask your surgeon directly what to expect after surgery as it depends on the exact type and severity of the procedure you will be having.

Q?WHEN CAN I DRIVE AFTER A HIP REPLACEMENT?
A.

Always confirm this from your doctor as it depends on which hip you had surgery on and the specific nature and restrictions related to your particular surgery. This is also highly variable from person to person. In general, you should not drive until you are cleared to bear weight on your driving leg, you are not under the influence of pain medications or other medications, and your range of motion and reaction time is sufficient to safely allow for normal leg movements while driving. Always go to an empty parking lot and practice driving situations after being cleared by your doctor before resuming driving in public.

 

Q?WHEN CAN I DRIVE AFTER SURGERY?
A.

This is highly variable and depends on the type of surgery you are having and which limb is having surgery. Different people also regain the strength and range of motion necessary to drive at different rates. Basic requirements for return to driving include being cleared to bear weight on your driving leg, being allowed to lift your affected arm, not being under the influence of pain medications or other medications, and having range of motion and reaction time sufficient to safely allow for normal movements while driving. Always go to an empty parking lot and practice driving situations after being cleared by your doctor before resuming driving in public.

Q?WHEN CAN I DRIVE AFTER A KNEE REPLACEMENT SURGERY?
A.

Always confirm this from your doctor as it depends on which knee you had surgery on and the specific nature and restrictions related to your particular surgery. This is also highly variable from person to person. In general, you should not drive until you are cleared to bear weight on your driving leg, you are not under the influence of pain medications or other medications, and your range of motion and reaction time is sufficient to safely allow for normal leg movements while driving. Always go to an empty parking lot and practice driving situations after being cleared by your doctor before resuming driving in public.

Q?WHEN CAN I DRIVE AFTER A SHOULDER SCOPE?
A.

Always confirm this from your doctor as it depends on the specific nature and restrictions related to your particular surgery. This is also highly variable from person to person. In general, you should not drive until you are cleared to actively lift your arm, you are not under the influence of pain medications or other medications, and your range of motion and reaction time is sufficient to safely allow for normal arm movements while driving. Always go to an empty parking lot and practice driving situations after being cleared by your doctor before resuming driving in public.

Q?WHEN CAN I DRIVE AFTER A KNEE SCOPE?
A.

Always confirm this from your doctor as it depends on which knee you had surgery on and the specific nature and restrictions related to your particular surgery. This is also highly variable from person to person. In general, you should not drive until you are cleared to bear weight on your driving leg, you are not under the influence of pain medications or other medications, and your range of motion and reaction time is sufficient to safely allow for normal leg movements while driving. Always go to an empty parking lot and practice driving situations after being cleared by your doctor before resuming driving in public.

Q?IF I GO TO SEE AN ORTHOPEDIC SURGEON, WILL THEY RECOMMEND SURGERY?
A.

Orthopedic surgeons treat a variety of musculoskeletal conditions involving bones, joints, muscles, ligaments, tendon and cartilage. We can and do treat the majority of conditions successfully without surgery. When necessary, orthopedic surgeons are also trained to perform surgical procedures to correct and treat those conditions which cannot adequately be treated with non-operative treatments. Always speak to your doctor about the various treatment options that exist for a given condition, but going to see an orthopedic surgeon doesn’t necessarily mean that they will recommend surgery.

Q?HOW DO I KNOW WHEN I NEED A KNEE REPLACEMENT?
A.
Q?WHAT IS A PARTIAL KNEE REPLACEMENT? AM I A CANDIDATE FOR A PARTIAL KNEE REPLACEMENT?
A.
Q?WHEN CAN I DRIVE AFTER A KNEE REPLACEMENT?
A.

Always confirm this from your doctor as it depends on which knee you had surgery on and the specific nature and restrictions related to your particular surgery. This is also highly variable from person to person. In general, you should not drive until you are cleared to bear weight on your driving leg, you are not under the influence of pain medications or other medications, and your range of motion and reaction time is sufficient to safely allow for normal leg movements while driving. Always go to an empty parking lot and practice driving situations after being cleared by your doctor before resuming driving in public.