Tag Archives: sports medicine

AOC PATTON BLOG Articles

Knee Arthroscopy and Meniscal Tears – Part Two

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.

AOC PATTON BLOG Articles

Knee Arthroscopy and Meniscal Tears – Part One

 

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

Dr. Christopher Patton inducted as an Honorary member of the Cottage Hill Christian Academy Athletic Hall of Fame

Dr. Christopher Patton was inducted into the Cottage Hill Christian Academy Athletic Hall of Fame as an Honorary member. Dr. Patton is part of the inaugural class of inductees. He has served as the only team doctor in CHCA history and has been a great supporter of Warrior athletes, spending all home games and several road games on the sideline. Jimmy Messer, Head of School CHCA says, “Dr. Patton is very deserving of his induction to our inaugural class. We are fortunate to have someone of his expertise and love for high school athletics as a part of our team.”

Shoulder Separation

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.

For more information, call 251-410-3600.

AOC, comebacks start here.

Labrum Tear

Labrum Tear: Solutions and Treatment

The football season is in full swing, and while each snap of the ball is thrilling for fans, for the athletes on the field, one wrong hit can lead to serious shoulder injuries, such as a torn labrum.

The shoulder is made up of three bones: the shoulder blade (scapula), the upper arm bone (humerus), and the collarbone (clavicle). On the outer edge of the glenoid (the shallow socket in which the upper arm bone rests in the shoulder blade) is the labrum, a soft tissue that helps stabilize the joint, makes the socket deeper, and allows a variety of movements.

A labrum can be torn in a number of ways; from falling on an outstretched arm, a direct hit to the shoulder, a forceful pull on the arm, or a forceful movement when the arm is above the shoulder level. Athletes who partake in repetitive overhead arm movements, such as quarterbacks and receivers, are especially at risk of a torn labrum.

Symptoms of a torn labrum typically include:

  • A sharp popping in or locking of the shoulder
  • Pain during shoulder movement
  • Difficulty lifting objects, especially when lifting overhead
  • Shoulder strength decrease
  • Diminished range of motion

If surgery is required, it will be done with arthroscopy, which means the surgeon inserts a small camera into the shoulder joint through a small incision. The camera, called an arthroscope, provides pictures on a screen to help the surgeon guide and maneuver small surgical instruments to fix the tear.

For more information, call 251-410-3600. Comebacks start here.

Meniscus Repair

Meniscus Repair

Meniscus Repair

Athletes are at risk for a number of knee injuries. A common knee injury experienced by many players—especially those participating in contact sports—is meniscus tears. Meniscus are the pieces of cartilage situated between the thighbone and shinbone that cushion the joints, provide stability, and act as shock absorbers.

There are multiple ways the meniscus can tear, the most frequent being bucket handle, flap, and radial. A common reason for a meniscus tear is a sudden twist of the knee, but it can also happen as cartilage weakens with age.

Common symptoms of a meniscus tear include:

– Pain
– Swelling
– Stiffness
– Inability to move the knee
– Locking of the knee

While many with a meniscus tear can still walk on their knee—or even keep playing sports—over a period of a few days, the knee will get more stiff and swollen. And if not treated properly, pieces of the cartilage can even get loose and move into the joint, causing further discomfort and problems. Many times, meniscus repair requires a surgical procedure known as knee arthroscopy. Arthroscopy is a common procedure done through a small incision in which a small camera is inserted into the knee joint. This allows the orthopedic surgeon the information needed to repair or removed the damaged cartilage, which is done with other small surgical tools being inserted through other small incisions around the knee.

For more information, call 251-410-3600.

AOC, comebacks start here!

ACL Reconstruction Surgery

ACL Reconstruction Surgery

ACL Reconstruction Surgery

The anterior cruciate ligament, better known as the ACL, is one of four ligaments that hold the knee together. The ACL is also one of the most easily—and commonly—injured parts of the knee, especially for athletes. This type of injury frequently occurs in athletes who participate in high impact sports like football, basketball, hockey, and soccer. But, it can also happen even without impact from another player.

Symptoms of an ACL tear include:

  • Pain

  • Swelling

  • Instability of the knee

  • Loss of full range of motion

Approximately 200,000 ACL injuries occur every year in the United States, and on average, about half of those require ACL reconstruction surgery because once torn, ACLs generally cannot be repaired.

ACL reconstruction surgery is performed through a small incision in the front of the knee, it includes removing the torn ligament and replacing it with a new tendon, which can be taken from another part of the knee. It’s an outpatient procedure, so patients get to go home in the same day.

For more information, call 251-410-3600.

AOC, comebacks start here.

 

Playing Injured: Not a Tough Call

Playing Injured: Not a Tough Call

Playing Injured: Not a Tough Call

Did you know that many NFL players risk their health by playing through injuries? Tough or not, their desire to stay on the field is so strong that it can sometimes overshadow their pain. The nature of this sport fosters high pain tolerance and quick recovery, but athletes shouldn’t always “suck it up,” as it increases their chances of re-injury or re-aggravation.

With playoffs approaching, it is important to look out for these four common football-related injuries and encourage players to seek proper treatment:

ACL/MCL/PCL/LCL tears – anterior cruciate, medial collateral, posterior cruciate and lateral collateral ligaments are all located in the knee. Each serves a different purpose to the function of the knee. Depending on the area of impact, front, rear or side, these ligaments can be damaged or torn. These tears are dangerous because of their high pain level and long-term healing time. Tears can also affect a player’s long-term ability to play.

Concussions – Even though players wear helmets, concussions can still occur. Concussions are the result of a traumatic hit to the head and can have serious effects on the player. When in doubt, players should take the bench and seek medical attention.

Shoulder injuries – While shoulder pads are designed to absorb the shock of tackles, injury can still occur. Common shoulder injuries are: shoulder separation/ dislocation and shoulder tendonitis. If a player takes a direct blow below the shoulder, it can cause separation of the acromioclavicular joint. A shoulder dislocation occurs when the head of the humerus detaches from the scapula. Shoulder tendonitis occurs due to overuse from throwing.

Ankle/Foot injuries – The most common sports injury is a sprained ankle. Ankle sprains and strains are caused by soft tissue damage from pivoting, changing direction or applying pressure to the joint.

Reality check: the longer an injury is played on, the longer it takes to retrain the muscle. If you’re injured while playing a sport, please make an appointment with one of our sports medicine orthopedics – Call: 251-410-3600 

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What You Need to Know About Knee Injuries

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.

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Injury Analysis: University of Alabama RB Jalston Fowler

 

Portrait of a pretty young girl enjoying a swim on a hot day looking at you

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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