If you’re experiencing knee pain, you may have a meniscal tear. Our orthopedic experts explain what causes this injury and what you can expect during your recovery.
The meniscus is a key cartilaginous structure in the knee joint. Pain and swelling in the medial, or inside, part of the knee can unfortunately be a sign of tearing, but your treatment options will look different depending on the type of tear, the cause, and the severity. Our guide explains meniscal injuries, and what you can expect when you visit your doctor.
WHAT IS THE MENISCUS?
The meniscus is the C-shaped, rubbery cartilage in the knee that acts as a shock absorber and stabilizer for the joint, distributing the body’s weight and providing a cushion between the femur and tibia bones. The medial meniscus is located on the inner knee, while the lateral meniscus is on the outside. Medial tears are more common, but the symptoms are the same for both injuries.
Meniscal injuries can be classified according to the “zone” of the meniscus that is affected. This allows the physician to determine the amount of blood flow available to aid in the healing process. The red zone is the outer third, which has blood vessels and is more easily repaired by the body. The red-white zone has fewer blood vessels and is less quick to heal. The inner third, the white zone, has poor blood flow and is therefore more difficult to repair.
Meniscal tears also come in a variety of shapes, which may influence the course of treatment. Common shapes include bucket-handle, flap, and radial tears, or complex combinations of the three. A tears is considered “complete” if a piece of tissue has become separated from the meniscus. Degenerative tears, which are generally caused by arthritis, are more typical of older patients. Traumatic tears are common among athletes, who often twist and turn the meniscus.
SYMPTOMS AND CAUSES OF MENISCAL TEARS
The first sign of a meniscal tear may be a “pop” in the joint, and you may continue to feel a popping or clicking sensation with movement. Although you may be able to walk on the knee at first, subsequent pain and swelling can worsen in the days that follow, especially if you continue to use the leg. For a severe tear, the knee may click, lose its full range of motion, or even give way. If a part of the meniscus comes loose, the knee can slip or even lock.
Athletes and young people are especially prone to this injury due to sports trauma or hyper-flexing the joint. A forced twist, especially when the foot is planted, may cause the meniscus to tear. Older people may experience meniscal pain due to arthritis or ordinary degenerative wear to the cartilage. In these cases the pain occurs due to gradual tearing over time, and may present with no trauma to the knee.
KNEE PAIN TREATMENT AND RECOVERY
The first course of action is to follow the rules of “RICE”: rest the knee, ice the area in 20-minute sessions, compress the area, and elevate the leg to reduce swelling. In some cases, the knee may heal with this conservative treatment, but we recommend consulting an orthopedic specialist to examine the joint and monitor your recovery. Your doctor may perform a McMurray test, which includes bending, straightening, and rotating the knee in order to determine if an MRI is necessary. Orthopedic specialists usually will not recommend surgery for older patients, but physical therapy may help you find relief within five weeks.
For younger patients, arthroscopic surgery may actually be a preferred option, as this will help preserve the cartilage and prevent early onset arthritis in the joint. This type of surgery requires only two pinhole incisions. In most cases, when the tear is in the white zone, the fragment is trimmed and the remainder smoothed. Tears in the red zone are usually repaired to retain the full benefits of a complete meniscus. Surgery is often completed in 30 minutes, followed by several days of walking with the assistance of a crutch, or possibly a brace. After a few days you can expect to return to most normal activities. Full recovery, and a return to strenuous activity, can be expected after a few weeks of physical therapy.
Golfers with knee arthritis should park the golf cart and walk the links instead, researchers say.
While using a golf cart may seem the obvious choice for golfers with knee problems, a new small study finds that walking provides much greater health benefits. Moreover, it’s not associated with increased pain, inflammation or cartilage breakdown, the researchers said.
“Individuals with knee osteoarthritis are often concerned about pain and may be more likely to use a golf cart,” said lead study author Dr. Prakash Jayabalan. He’s an assistant professor of physical medicine and rehabilitation at Northwestern University Feinberg School of Medicine in Chicago.
However, “this study has shown that golfers with knee osteoarthritis do not need to be concerned about worsening their disease through walking the course. In fact, walking provides the best health benefit,” Jayabalan said in a university news release.
More than 17 million Americans older than 50 golf regularly. Knee osteoarthritis is a leading cause of disability in this age group. The condition causes swelling, pain and difficulty moving the joint.
The study included 10 older golfers with knee osteoarthritis and five without the disease, which is usually caused by wear and tear of the joint.
On one day, the study participants played one round of golf (18 holes) walking the course. On another day, they used a golf cart to play 18 holes. On each occasion, the researchers monitored the participants’ heart rates to determine their level of exercise intensity, and took blood samples to measure markers of knee inflammation and cartilage stress.
On both occasions, the golfers had an increase in these markers, but there was no difference between use of the golf cart and walking, the findings showed.
When walking the course, the heart rates of the golfers with knee problems were in the moderate-intensity zone for more than 60 percent of the time, compared with 30 percent when using a cart.
But even using the cart, golfers met daily exercise recommendations, according to the study authors.
“Bottom line: walking the course is significantly better than using a golf cart, but using a golf cart is still better than not exercising at all,” Jayabalan concluded.
The study was presented recently at the Osteoarthritis Research Society International annual meeting in Liverpool, England. Research presented at meetings is usually considered preliminary until published in a peer-reviewed medical journal.
The Arthritis Foundation has more about osteoarthritis.
SOURCE: Northwestern University, news release, April 28, 2018
Professional athletes’ speedy recoveries from injuries have nothing to do with superhuman abilities. Instead, it’s all about proper preparation and planning.
It’s no surprise that professional athletes tend to be in much better shape than those of us who don’t play sports for a living — but what might seem more puzzling is that they also seem to recover more rapidly from injuries. Think of D’Angelo Russell, the Brooklyn Nets’ star point guard. After suffering a knee injury in November, he underwent arthroscopic knee surgery and fully recovered in just over two months, returning to the court by the middle of January.
Such a speedy recovery isn’t evidence of superior physical fitness, however, so much as a clear strategy in the wake of an injury. Professional athletes have access to some of the best orthopedic specialist available — and these doctors, trainers, and therapists help them follow strict guidelines throughout the process of rehabilitation, ensuring that they can return to action as soon as possible.
While you might not have a dedicated team of doctors at your disposal, there are many steps you can take to enjoy a similarly quick recovery. ACL tears — a rupture of the anterior cruciate ligament, one of several ligaments that stabilize the knee — are a common injury affecting star basketball players and casual gym-goers alike. Here’s what you can learn from the professional athletes’ approach to ACL rehabilitation.
1. KEEP YOUR BODY HEALTHY
In order to help your body best respond to arthroscopic surgery, you need to stay healthy and hydrated. For at least a week before your surgery, be sure to drink plenty of water and eat a nutritious, wholesome diet rich in antioxidants, both of which can boost your body’s ability to heal.
2. STRETCH AND EXERCISE BEFORE SURGERY
Staying healthy requires more than just eating right, of course. Your preparation for surgery should include regular stretches and massages, which can strength the tissues surrounding the ACL and increase their flexibility. These measures ensure that the knee joint remains relaxed and enjoys proper circulation, both of which foster optimal surgical conditions.
3. DON’T BE AFRAID TO ASK QUESTIONS
Nobody expects an injury, so when these unfortunate events happen, you might not know what to expect. Athletes have a whole team on hand — ranging from surgeons to physical therapists — to guide them through the process, and while you might not have the same resources readily available, you should do your best to stay informed. Your doctor and surgeon are there to help you, so be sure to voice your concerns and ask any questions you may have.
4. FORMULATE AND WRITE DOWN THE RULES
When it comes to recovery, you can’t break the rules. A rehabilitation plan isn’t something you can come up with on the fly, so be sure to consult with your doctor, therapist, and surgeon to formulate a concrete plan centered around defined protocols and regular benchmarks to help you stay motivated and focused.
5. STAY STOCKED UP ON SUPPLIES
Proper recovery requires keeping plenty of tools on hand, such as ice packs and non-steroidal anti-inflammatories. You may struggle to get out of the house while you recover from the procedure, so ensure that you have an ample supply of everything you might need before you undergo surgery.
6. MAINTAIN A POSITIVE MOOD
As a minimally invasive procedure, arthroscopic surgery is designed to shorten recovery timelines, but you’ll still need to spend some time resting immediately after surgery. Since you won’t be able to participate in many of your daily activities, try to have some projects at the ready to keep you happy and occupied. Maintaining a positive mood will help boost your morale, and ultimately assist in recovery.
If you’re considering arthroscopic surgery for an ACL tear, CompOrtho is ready to help. Our team of specialists has decades of combined experience in treating knee injuries, providing every patient with the care and attention they need from the initial diagnosis to the final follow-up. Call us today to schedule a consultation!
“The traumatic injuries are something that you can’t avoid in the nature of sports,” said Michael Hughes, Clinic Coordinator and lead Physical Therapist at Agape Physical Therapy of Gates. “A lot of kids will come from the winter and start their spring season, and they don’t have a good strengthening regimen when starting their specific sport. It can lead to some injuries if they don’t have the proper muscle training.”
Orthopedic surgeons at Strong Memorial Hospital are seeing similar trends. According to a hospital spokesperson, orthopedic sports medicine surgeon Mike Maloney, M.D., confirms that he’s seeing the same rate of increase in his practice. We’re told Maloney specializes in treating elite student athletes and says the following factors are causing the alarming increase in this injury:
• The increasing level of intensity in scholastic sports
• More kids specializing in one sport and doing year-round training in that sport
• Lack of emphasis on proper nutrition
• Lack of focus on preventive care – teaching kids how to get conditioned to be strong, and how to move to help prevent injury.
Jeff Bobzin can’t preach it enough to the youth soccer players he coaches in Gates.
“We encourage kids to drink a lot of water, eat right and exercise,” Bobzin said.
Boys between ages 10-14 make up more than half of the reported injuries in the study. Therapists at Agape say its important for parents and kids to map out a training plan to prevent serious body injuries.
Ski season is in full swing — but an injury can put you out of commission until next year’s first snowfall. Here’s how to stay safe on the slopes all winter long.
While many people huddle inside during the winter months, away from “bomb cyclones” and blizzards, a select few know that the best way to beat wintry weather is to embrace it — on the ski slopes, that is!
As any seasoned skier will tell you, however, their beloved sport does come with the risk of injury. Fortunately, taking some simple precautions before you hit the slopes can help you stay in peak condition regardless of how many tumbles you take.
We’ve outlined some of the most common injuries that afflict skiers, and what you can do to prevent them.
A number of injuries can affect the medial collateral ligament (MCL), but the most common by far is an MCL tears. In skiing, MCL tears most often occur when the skier falls while attempting to slow or stop in a snowplow position, in which the tips of the skis are pointed toward each other. To avoid injury in this position, make sure to always keep your weight balanced. In addition, sticking to runs with which you’re comfortable can reduce the need to enter the snowplow position at all.
A variety of falls on the slopes can result in a tear of the anterior cruciante ligament (ACL). It most commonly happens after a forward fall, during which the inner edge of the front of the ski becomes embedded in the snow, trapping the leg in the process. It can also occur when the top of the back of the boot pushes the tibia (the weight-bearing bone in the leg) forward, away from the femur. On other occasions, it arises when the skier leans back on the skis, loses balance, and falls backward. Strengthening the hamstrings, wearing proper bindings, and using shorter skis can all reduce the risk of sustaining an ACL tear.
Like torn ligaments, fractures are most commonly caused by falls while skiing. The wrist and ankles are particularly susceptible to breaks. To help avoid broken bones, always wear adequate protective gear and practice proper techniques for falling. Increasing cardiovascular endurance and developing the surrounding muscles can also be beneficial.
Most shoulder dislocations happen when skiers fall, either directly onto the shoulder or onto an outstretched hand or arm. This injury results in heavy, immediate pain, significantly restricts the shoulder’s range of motion, and can leave it misshapen. Since dislocations are caused by sudden trauma, they can be difficult to anticipate, but strengthening the rotator cuff muscles, especially if you have previously dislocated your shoulder, can lower the risk of a dislocation. As with other common skiing injuries, employing proper form will also minimize the possibility of a dislocation.
Aside from protecting the spinal cord, the spine ensures the strength and stability of the back. It is made up of various bony segments called vertebrae separated by pieces of fibrocartilaginous tissue called intervertebral discs, any of which can be injured while skiing. Some ways to avoid spinal injuries include using spine protectors, sticking to trails on which you are comfortable, using proper equipment, and learning the technique for “safe” falls.
While some ski injuries are immediately apparent, others can be more subtle, slowly progressing with time. Fortunately, the talented team of specialists at New York Bone and Joint has extensive experience working in sports medicine and can quickly diagnose and treat any of these common problems. If you think you may have suffered an injury during your latest trip to the mountain, call us today to schedule a consultation, or if the injury has been recent, stop in to our Orthopedic Urgent Care!
Cortisone shots can potentially provide long-lasting relief from pain and inflammation in the joints.
Many injections can greatly reduce pain and inflammation caused by musculoskeletal injuries or chronic conditions such as arthritis, significantly shortening recovery timelines and providing lasting relief. One shot we particularly recommend to patients entails an injection of cortisone into a damaged joint. We’ll tell you what you need to know about this tried-and-true treatment for pain and inflammation in the joints.
What Is a Cortisone Shot?
A cortisone shot is an injection composed of a corticosteroid medication and a local anesthetic. Used to relieve pain and inflammation, it’s most commonly injected into a joint, often in the shoulder, hip, or knee. These shots are often one option in a comprehensive treatment plan for chronic inflammatory conditions such as arthritis, tendinitis, or rotator cuff impingements or tears.
How Long Does a Cortisone Shot Last?
A cortisone shot’s effectiveness depends on the severity of the patient’s condition. In most cases, pain and inflammation will marginally increase for about 48 hours following the injection, and will decrease precipitously thereafter. In some cases, a single injection can provide relief for as long as several months.
Generally, cortisone shots should only be given two times per joint per year. Repeated cortisone injections can damage the cartilage in the joint.
What Are the Side Effects of a Cortisone Shot?
Cortisone shots are typically safe in moderation, but since they infrequently lead to serious complications, they should be taken under a doctor’s supervision. Be sure to let your doctor know if you suffer from diabetes or other any other conditions affecting your blood sugar levels, as well as any medications that you are currently taking.
Most cortisone shots have some minor side effects, including a temporary uptick in pain and inflammation in and around the joint, and a thinning and lightening of the skin around the site of the injection. In some cases, however, they can result in a sudden spike in blood sugar if you’re diabetic and have poorly controlled blood sugar levels. .
What If the Cortisone Shot Doesn’t Work?
Cortisone shots provide a source of temporary relief from inflammation and pain. They will not solve the underlying problem, and pain may gradually return as the shot’s effectiveness subsides. As a result, cortisone shots should be administered as part of a more comprehensive treatment plan that may include physical therapy or surgery.
Fortunately, our team of orthopedic specialists at Comprehensive Orthopaedics has several years of experience in treating joint problems. Regardless of your specific condition, we’ll work with you to develop a personalized treatment plan that provides lasting relief from your symptoms.