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The treatment of meniscal tears has advanced over the years. Forty years ago it would not have been unheard of to excise in an open fashion the entire meniscus. This led to the development of arthritis earlier than was expected. With the development of knee arthroscopy and the small instruments to work inside the knee, debrided (shaving) just the tear became more common. This allowed meniscal tissue to be preserved.
As studies have shown the benefits of preserving meniscal tissue, repairing the meniscus, if possible, has become a goal. Several techniques including “outside-in”, “inside-out”, and “all inside” were developed. The term “all-inside” means the stiches are tied or the device deploys inside the knee without the need for additional incisions. This is also known as “all arthroscopic.” Regardless of the technique, the goal is to repair the meniscus in a stable manner so that early range of motion and healing are possible.
The indications for repair continue to expand with tears greater than one centimeter in the area of good blood supply and in patients less than 40 being common. Additionally, repairs at the time of ACL reconstruction, vertical tears, and acute tears also being good candidates for repair. As the technology improves the candidates for repair are expanding.
When meniscal tissue is severely lost in young patients with good alignment, intact ligaments, and no significant arthritis, meniscal transplant has been developed as an option. Taking a meniscus from a young donor and either suturing it in the knee with or without a piece of bone attached can restore needed meniscus tissue. Long term studies of meniscal transplant are on-going. Hopefully as studies are produced and technology develops, preservation of meniscal tissue will continue to advance in the hope of preserving the articular cartilage and normal biomechanics of the knee.
Knee arthroscopy (the placing of a small camera into the knee and performing surgery through small holes) is one of the most common orthopaedic procedures performed in the United States. Over 900,000 of these are performed each year, and over half are done to operate on a torn meniscus.1 The meniscus is a C-shaped cartilage structure on the inside (medial) and outside (lateral) of the knee. Acute traumatic tears of the meniscus are often caused by sporting activities or an activity where there is a sudden twisting of the knee. Hyperflexion of the knee can cause meniscal tears also. Degenerative type tears can be caused by age or untreated instability of the knee.
The meniscus serves an important function in the knee by acting as a cushion to the underlying joint cartilage called the articular cartilage. Loss of meniscus tissue through tearing or surgical removal can lead to increases in stress placed upon the articular cartilage. This can lead to arthritis. Additionally, the meniscus acts as a joint stabilizer. Loss of the meniscus can place increased stress on the major ligaments of the knee such as the anterior cruciate ligament (ACL). Therefore, preserving as much meniscus as possible is a goal for orthopaedic surgeons.
The diagnosis of a meniscal tear requires taking a history, performing a physical exam of the entire knee and surrounding structures, and performing additional diagnostic tests. As stated above, a history of a twisting injury or hyperflexion injury of the knee can lead to a meniscal tear. Common physical exam findings include swelling of the knee, joint line tenderness on the side of the tear, and pain with certain maneuvers that the physician performs such as a McMurray’s test. (The McMurray’s test is performed by taking the knee from a flexed position to an extended position while the tibia is kept internally rotated (for the lateral meniscus) or externally rotated (for medial meniscus). McMurray described a palpable click as being “positive”.2
Diagnostic tests for evaluating a torn meniscus include X-rays of the knee, MRI and knee arthroscopy. The plain X-rays do not detect the torn meniscus, but they rule out other causes of knee pain such as loose bodies and arthritis. The most common non-surgical diagnostic test for meniscal tears is the MRI. It has a high sensitivity and does not involve radiation. MRI can detect both meniscal and ligamentous tears. The “gold standard” test for diagnosing meniscal tears is actually seeing it with knee arthroscopy. This common outpatient procedure can be performed under general or spinal anesthesia.
1Kim et al: Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am. 2011 Jun 1;93(11):994-1000. 2 McMurray TP: The semilunar cartilages. Br J Surg 1942;29(116):407–414
Many athletes who play contact sports like football, can experience shoulder separation. A common misconception about a separated shoulder is that it’s an injury to the shoulder joint. A separated shoulder involves the acromioclavicular joint (known as the AC joint), which is where the collarbone meets the highest point of the shoulder blade.
A fall directly on the shoulder is the most common cause of a separated shoulder as it injures the ligaments, muscles, and tendons around the AC joint. If the movement or fall that caused the injury is bad enough, it can tear the ligaments attached to the collarbone, which is what separates the shoulder.
Symptoms of a separated shoulder include:
– Limited joint mobility
– Pain in the shoulder
– Swelling, or bruising
An X-ray usually identifies what’s wrong with the shoulder, and sometimes nonsurgical treatments like ice packs, slings, and anti-inflammatory medications can help manage the pain and help the shoulder return to its normal function. Oftentimes, however, surgery is required. Depending on the severity of the injury, the surgeon may suggest trimming the end of the collarbone so that it doesn’t rub the acromion. If the injury is more severe, the surgeon may have to reconstruct the ligaments that attach to the collarbone.
Many people involved in some kind of athletic activity know the wear and constant use of your knees and joints can sometimes result in injury or pain. There are several ways to injure your knees. Knee injuries are generally caused by direct trauma and/or repetitive overuse.
Some of these different knee injuries can include damage to the articular cartilage, meniscus cartilage, collateral cartilage or cruciate cartilage. Cartilage is a thin, elastic tissue that protects the bone and makes certain that the joint surfaces can slide easily over each other. Cartilage ensures supple knee movement.
Ways to prevent injury to your knees is through strength conditioning, work and sports safety as well as proper sports techniques. If you do happen to have a slight injury you could try some conservative treatments. Active rest, the RICE treatment, or Physical Therapy. However, if you think you have an injury be sure to seek an evaluation as soon as you can.
There are also surgical treatments of knee injuries to fix the areas of your knee. AOC can help you determine if you are in need of surgery or not.
The recent injury to the knee of University of Alabama RB Jalston Fowler reminds us of how debilitating such injuries can be. Although no official report of the exact structures that have been damaged has been released, the video shows hyperextension of his knee which can damage major ligaments such as the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), side ligaments (collateral ligaments) or cause fractures to occur.
Seventy percent of non-contact injuries that result in swelling within one hour are ACL injuries. Furthermore, the C-shaped cartilages, called the menisci, can be torn during sporting injuries.
Treatment of knee injuries during football or other sports is most often treated arthroscopically– meaning via small incisions using a small camera to assist in visualizing the injured structures. Over 400,000 ACL reconstructions alone are done in the United States yearly.
According to R. Kavner’s article on collegesportsblog.dallasnews.com, Alabama coach Nick Saban announced Monday that running back Jalston Fowler will have surgery on his injured knee and is most likely going to be out for the season. Regaining muscle tone, control and joint range of motion is important if returning to sports is desired. This can take many months of hard work and dedication. AOC hopes Jalston has a good recovery and can return to the sport as soon as he is able.
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During the countdown to the 2012 London Olympics AOC is going to spotlight some USA Team members who were able to recover from an injury and fulfill their dreams of making the team. At AOC we applaud and love it when an athlete has a real COMEBACK RECOVERY and PERFORMANCE and is able to return to their passion.
The Olympics have been Katie Bell’s goal since she was younger, but injuries almost derailed that dream. At the Big Ten championships in Minnesota her freshman year, she mistimed a dive. She punctured a lung, separated chest cartilage and popped ribs out of place, though the full extent of the injury took two years to diagnose. Bell continued to battle injuries. She suffered a torn labrum in her shoulder two years ago, possibly because she was overcompensating from the previous injury.
“At that point, I didn’t even know if I was going to keep diving or not,” Bell said. “When I decided to keep diving, I set my mind on going to the Olympics. I worked so hard every year.”
To overcome her sports injury she saw many doctors, athletic trainers and a psychologist to heal her body and mind to get back to competitive diving. Last month after years of surgery, rehabilitation and hard work, Katie had a stellar COMEBACK PERFORMANCE and reached her dream of making the US Olympic Diving Team.
Keep up with Katie in this year’s London Olympics.
Knee injuries in sports are a common occurrence. One dreaded injury is a tear of the anterior cruciate ligament (ACL). Most ACL tears occur after a non-contact injury such as a wide receiver or soccer player making a sudden change in direction. The leg planted on the ground during the cutting move may experience enough force to tear the ACL. Seventy percent of acute hemarthosis (blood in the knee) after such injury is an ACL tear.
Non-surgical treatment for complete ACL tears in young, active patients has generally been met with less than satisfactory results. Loss of the ACL can result in instability or the feeling that the knee is loose. The knee wants to “give way” when a change in direction occurs. This instability can result in further damage to the knee and the C-shaped cartilages called the meniscus. Rebuilding the ACL and restoring stability to the knee can protect the meniscus from further damage.
There are over 400,000 ACL reconstructions a year in the United States. Much research has occurred and is on-going into different techniques and choices of tissue to use to rebuild the damaged ACL. Two of the more common tissue (graft) choices are hamstrings and patellar tendon. Both are usually taken (harvested) from the same knee and used in the reconstruction process. Other options include quadriceps tendon and tissue that has been donated to tissue banks (allografts). There are pros and cons to each graft choice, but analysis of multiple recent studies show little difference in long term outcomes between hamstring and patellar tendon autograft (tissue taken from the same patient.)
In part two of “ACL Injuries in Sports” we shall discuss current data on the return to sports after ACL reconstruction.
Tears of the meniscus in the knee are one of the most common causes of knee pain in active individuals. In fact, six out of ten people over the age of 65 years old have a meniscal tear. It is a mistake however to assume that all meniscus tears are the same. Continue reading →
Two of the most common causes of swelling of the knee after an injury playing sports are tears of the ACL and the important C-shaped cartilages of the knee called the meniscus. While both can cause symptoms of pain, swelling, and ‘giving way’, the treatment of these common injuries can be different and involve different lengths of recovery times. Continue reading →