Ask Your Surgeon

Ligaments are tough bands of tissue that connect bones in the body.  Two of the most important ligaments in the knee are the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL).  These ligaments connect the femur and the tibia and are vital to the stability of the knee during athletic activities.

The ACL limits excessive forward movement of the tibia in relation to the femur and limits rotational movements of the knee.  ACL tears most commonly result during athletic events in which an individual experiences an injury due to a sudden stop and twisting motion in the knee, or a force or “blow” to the front of the knee.  This is often accompanied by a “pop” and painful swelling and instability in the knee.  Unfortunately return to sporting activities is most often not possible and not advised with a torn ACL due to risk of further injury to the knee and recurrent symptoms of “giving out” in the knee. 

Not all ACL tears will require surgery.  Ultimately the decision for treatment is based on a particular individual’s  level of activities and willingness to limit or avoid activities that require an intact ACL.  These activities include basketball, football, baseball, softball, racquetball and tennis, snow skiing and other sporting events that require frequent pivoting or direction changes.

If athletics are an important part of your life, or if your job requires nonsedentary work, your surgeon may recommend surgical reconstruction of the ACL.  There are several viable options for an ACL reconstruction which involve using a “graft” or substitute tissue to reconstruct the ACL.  Unfortunately, attempting to simply “suture” the torn ACL together has historically led to failure and this technique has been universally abandoned.

In general, surgery is done arthoscopically using very small incisions, specialized instruments and a fiberoptic, high definition camera.  This is usually done as an outpatient surgery, and takes between one and two hours to complete.

There are three common graft choices used when reconstructing the ACL:

  1. Patellar tendon
  2. Hamstring tendons
  3. Allograft tendons

Each of these techniques have proven to be very effective at restoring normal function to the knee and allowing return to full, unrestricted athletic participation.

After surgery the physical therapist becomes an integral part of the rehabilitation process.  Rehab begins within a few days of surgery, and most patients are allowed to bear full weight on the operative knee as soon as 1-2 weeks post op.  Additionally, your surgeon may elect to use an ACL rehabilitation brace in the post operative period.  Initial physical therapy involves regaining full range of motion in the knee, and this progresses over time to emphasizing balance, coordination and return of muscle strength and agility.

Return to work and sporting activities depends on a patient’s ability to successfully complete an appropriate rehabilitation protocol.  Most patients can expect to return to light jogging at four months post op, bicycling at four to five months, straight line running at five months, and ability to perform agility drills and light cutting activities by six months post op.  Successful return to full and unrestricted sporting activities can be expected at 7-9 months after surgery.

For most individuals who undergo reconstruction of the ACL, they can expect to achieve a reliable and stable knee that will allow them to return to preinjury sporting and work activities without limitations.

Yes, arthritis could start with aching in one joint or more than one joint. You need to see a doctor if you are having pain, swelling or stiffness in your joints that lasts longer than a few days. An evaluation with a Rheumatologist can determine if the problems are arthritis related and what can be done to start the healing process.

After total knee replacement surgery, I like for my patients to undergo an accelerated rehabilitation. This involves a close interaction of the patient with a physical therapist and the surgeon. Because there are no weight bearing or motion restrictions, the rate of progression of activities varies from patient to patient depending on several factors such as activity level, pain tolerance and motivation. I like to see my patients involved in light exercise as early as three weeks after surgery, including walking on the treadmill, stationary bicycle, and elliptical trainer.

Formal physical therapy lasts for 8-12 weeks and heavier activities such as golf and doubles tennis, could start by 12 weeks. Snow skiing would be possible by 4-6 months.

Many people have frequent episodes of low back pain, usually related to certain activities. Most often, these lower back pain complaints resolve within a few days. Stretching exercises and over-the-counter anti-inflammatories usually help. If the problem continues for two to three weeks or worsens, then it may be time to see a doctor; especially if the pain happens to travel down your leg.

Heel pain is a very common problem, and being a common problem, it has many common causes.  In fact, it has so many causes, diagnosis can sometime be challenging.  In this case, the old adage, “when you hear hooves think horses” holds true.  Most heel pain is not heel pain at all, in fact, it’s pain in your plantar fascia.  The plantar fascia is a tight band, like the string of a bow, that connects your heel to your toes along the bottom of your foot.  If it gets stiff, unlike a string, it doesn’t stretch, it tears.  Fortunately, 90% of people do better with simple treatments.

Another frequent cause of heel pain can occur on the top of the heel.  That’s where the Achilles tendon inserts.  It can hurt at the bone tendon junction or just above it in the mid-substance. These problems can be very bothersome – its hard to wear backless shoes everywhere, especially in wintertime.  Again, fortunately, most of these cases improve or resolve with specific non-operative intervention.

Lastly, some people have pain and tingling associated with heel pain, and they just can’t seem to get better.  The foot and hand are very similar, but we don’t walk on our hands, at least not anymore; many people have heard of carpal tunnel, but not as many have heard of tarsal tunnel.  Those that have heard of it, have probably had it.  Tarsal tunnel is a compression syndrome of the tibial nerve on the medial (or inside) part of the ankle.  That’s a more subtle diagnosis and requires special tests.      

If you have any symptoms of heel pain that just seem to linger or get in the way, it’s probably a good idea to see a foot and ankle specialist.  Even if it turns out to be a simple problem, there’s probably a simple solution that will make life a whole lot more enjoyable.

Carpal tunnel syndrome is a painful disorder caused by compression of a nerve in the wrist (carpal tunnel); characterized by discomfort and weakness in the hands and fingers and by sensations of tingling, burning or numbness. This syndrome has many causes including repetitive use or injury of the hand, rheumatoid arthritis, gout, pregnancy, weight gain, thyroid disorders and menopause. Repetitive motions can cause swelling and compression of the median nerve and tendons that pass through a tunnel of fibers at the base of the hand causing the symptoms listed above.

There are a number of other disorders that can cause pain, numbness, burning and weakness in the hand. These include hand/thumb arthritis, compression of nerves in the neck, elbow, forearm and other parts of the wrist. Treatment can include splinting, anti-inflammatory medications, steroid injections, physical therapy and surgical release. Sometimes people try wearing a wrist splint (available at most drugstores) to keep the wrist in a neutral position at rest. Splinting is usually tried for a period of 4-6 weeks. Some people wear their splints at night only and others wear their splints both day and night, depending upon when the symptoms are at their worst. If no relief is found at 4-6 weeks, the splints are not likely to help.

You should talk to your primary care provider or an orthopedic surgeon to make sure of the diagnosis. They can usually diagnose carpal tunnel syndrome in the office, but sometimes nerve tests may be ordered.