4 COMMON ACL TEAR SYMPTOMS & WHEN TO SEEK TREATMENT

4 COMMON ACL TEAR SYMPTOMS & WHEN TO SEEK TREATMENT

ACL tears are common in physical activities that involve quick stops, changes in direction, or direct contact with the knee. Knowing the symptoms of ACL tears can help you recognize an injury and prevent it from getting worse. Explore our guide to learn how to tell if an ACL is torn and the procedures a knee specialist can perform to help you get back on your feet faster.

 

Signs & Symptoms of ACL Injuries
Individuals who suffer an ACL tear often note an audible “pop” or snapping sound as the injury happens. The onset of symptoms is immediate and usually accompanied by:

  • Decreased range of motion in the knee
  • Rapid swelling
  • Severe pain, soreness, and tenderness along the joint
  • Instability and discomfort while walking

ACL injuries usually occur during sports and fitness activities that can put stress on the knee. This includes movements like:

  • Pivoting with your foot firmly planted
  • Suddenly slowing down and changing direction
  • Stopping suddenly
  • Landing awkwardly from a jump
  • Receiving a direct blow to the knee

There are three levels of ACL injuries, which are classified by the amount of damage to the ligament (partial or complete tear). A grade 1 sprain, for example, is when the ACL is stretched but not ruptured. While a grade 3 sprain means the ACL is torn into two pieces, rendering the joint completely unstable.

 

When To Seek Treatment
If you are experiencing symptoms of an ACL tear, you should schedule an appointment with a knee specialist. They will conduct a physical exam in order to determine the extent of the injury. An X-ray may also be performed to assess if there is damage to the surrounding bone, but MRI will ultimately be the deciding factor in treatment.

Rehabilitation can be the first step in the recovery process with the goal of regaining full range of motion. You may spend several weeks working with a physical therapist who will develop a custom exercise program centered around your unique needs and symptoms.

However, ACL reconstruction surgery is often recommended if the ligament is injured or the injury is causing your knee to buckle during everyday activities. During the procedure, a surgeon will remove the damaged ligament and replace it with a new segment of tendon which recreates the ACL. This replacement tissue — called a graft — can be taken from your own patellar, hamstring, quadricep, or cadaver tendons.

The surgery is typically done using a minimally invasive, arthroscopic approach. Special surgical tools and a video camera are inserted through small incisions in the knee joint. The graft is then secured to the tibia (shin bone) and femur (thighbone) using sutures (special surgical thread) or screws depending on the type of graft. This acts as a bridge for the new ligament to grow on and reconnect the bones.

Recovery time varies based on the severity of the injury. Your doctor will recommend physical therapy in order to regain full range of motion, strength, and stability in the affected knee in the weeks and months that follow. Regular follow-up visits with your knee specialist and physical therapists are necessary to assess progress and readiness to return to your favorite activities.

Understanding the common symptoms of ACL tears can help reduce the risk of injury while playing your favorite sports. If you find yourself with pain or injury, CompOrtho offers top-level care to help you get on the road to recovery quicker. To learn more about injury prevention or make an appointment, contact us today!

What Shoes Work Best With Arthritic Knees?

What Shoes Work Best With Arthritic Knees?

WEDNESDAY, Jan. 13, 2021 (HealthDay News) — Lots of Americans suffer from painful arthritic knees, but a new study finds that wearing the right type of shoe may help ease discomfort.

Patients with knee arthritis will achieve greater pain relief by opting for sturdy and supportive shoes rather than flat flexible footwear, researchers in Australia found.

“A ‘sturdy supportive shoe’ is a shoe that gives stability to the foot, via motion control features such as arch support,” explained study author Rana Hinman, a professor of physiotherapy at the University of Melbourne. “It also has a thick, cushioned heel and a rigid sole that does not bend easily.”

In contrast, Hinman noted, “a ‘flat flexible shoe’ is more lightweight, contains no arch support or motion control features, has a low heel (i.e., flat) with minimal/no cushioning and has a flexible sole that bends easily.”

Roughly 1 in 4 adults over the age of 45 has arthritic knees, Hinman noted.

One U.S. expert unconnected to the study agreed that “bum knees” will probably feel better with special footwear.

“I think it’s pretty intuitive that a structured shoe will be more stable and better for arthritis patients,” said Dr. Jeffrey Schildhorn, an orthopedic surgeon at Lenox Hill Hospital in New York City. “I’ve found that to be true in my practice and in my life. But this study is the first to really look at this in a rigorous way, and to show with good science that this isn’t just anecdotal.”

Foot support matters

As the Australian team noted, people with creaky, painful knees are often advised to wear shoes with support. But there’s also a school of thought that flat flexible shoes may deliver greater benefit because they provide more of a “barefoot” experience.

The latter theory didn’t win out in the new study. After working with 164 knee arthritis patients in the Melbourne area, Hinman’s team found that “58% of people who wore sturdy supportive shoes experienced a meaningful reduction in knee pain on walking, compared to only 40% of the people who wore flat flexible shoes.”

Study participants were 50 years old and older. Prior to the study’s launch, all had experienced near constant knee pain in the prior month (rated at a 4 or greater on a pain scale of 11), and most had worn shoes that featured a mix of sturdy and flat characteristics.

Between 2017 and 2019, half were randomly assigned to wear a flat flexible shoe for at least six hours a day over six months, while the other half was assigned stable supportive footwear. (The team did not compare shoes distributed in the study with the ones patients regularly wore.)

All footwear was commercially available. For the flat variety, the brands included: Merrell Bare Access (for men and women); Vivobarefoot Primus Lite (men and women); Vivobarefoot Mata Canvas (men); Converse Dainty Low (women); and Lacoste Marice.

Stable variety brands included ASICS Kayano (for men and women); Merrell Jungle Moc (men); Nike Air Max 90 Ultra (women); Rockport Edge Hill (men); and New Balance 624 (women).

Each patient was able to switch between two brands throughout the trial. Investigators kept track of reported knee pain levels while walking, functional ability, overall quality of life indicators and overall physical activity levels.

In the end, the team determined that while stable supportive shoes did not restore greater mobility to patients than flat flexible shoes, they did offer a leg up on knee and hip pain reduction and improved quality of life.

‘A Rolls-Royce over potholes’

As well, Hinman noted that “sturdy supportive shoes were much less likely to cause adverse effects at the knee and other joints, such as ankle/foot pain [or] knee swelling.” Moreover, people who wore flat flexible shoes reported twice as many adverse effects as people who wore sturdy supportive shoes, she said.

The upshot: “Shoes are an easy option that can help people self-manage their knee osteoarthritis pain,” Hinman said. “Patients with knee osteoarthritis should think carefully about their footwear and choose shoes that are most likely to reduce their knee pain.”

Schildhorn agreed.

“For someone with knee arthritis,” he said, “a structured shoe is almost like a Rolls-Royce going over potholes. Because the problem with an arthritic knee is that the joints aren’t aligned correctly, and aren’t nearly as supple anymore. And it has cartilage with gaps, like cobblestones, which wear away.”

A structured shoe can absorb those issues, said Schildhorn. But an unstructured shoe or a bare foot “relies on all of the joints of the body to work just as they were designed. They all have to be aligned correctly, the ligaments have to be functional, and the joints have to be supple in order to absorb loads when walking in uneven areas. Because you need your body to be able to adjust to variances.”

The U.S.-based Arthritis Foundation agrees that patients should pay attention to the style and fit of the shoes they wear. But it cites mixed findings as to best practices.

For example, foundation experts acknowledge that stable shoes and boots (without heels) can indeed be helpful for some.

However, they also highlight prior knee research indicating that some flat shoes — such as flip-flops — may trigger less knee stress than more stable shoes. Others, however, such as loosely strapped sandals and so-called “foot gloves,” may prove problematic.

But the foundation has one piece of overriding advice: Never favor style over function and comfort.

The results were published Jan. 11 in the Annals of Internal Medicine.

More information

There’s more on shoe wear and arthritis at the Arthritis Foundation.

SOURCES: Jeffrey Schildhorn, MD, orthopedic surgeon, Lenox Hill Hospital, Northwell Health, New York City; Rana Hinman, PhD, professor, department of physiotherapy, University of Melbourne, Australia; Annals of Internal Medicine, Jan. 11, 2021

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Knee Procedure Done Earlier Might Prevent Knee Replacement Later

Knee Procedure Done Earlier Might Prevent Knee Replacement Later

MONDAY, Feb. 1, 2021 (HealthDay News) — For some patients suffering from knee arthritis, a special procedure may reduce the need for a total knee replacement, Canadian researchers say.

By getting what is known as a ‘high tibial osteotomy,’ younger patients with less severe joint damage who are physically active might be able to delay the need for a knee replacement by 10 years or more, though they may have to search for a doctor who performs the surgery.

“High tibial osteotomy is a knee surgery aimed at treating patients in earlier stages of osteoarthritis by correcting the alignment of bowed legs and shifting load to less diseased parts of the knee,” explained lead researcher Trevor Birmingham, the Canada research chair of musculoskeletal rehabilitation at the University of Western Ontario.

During the procedure, the tibia (shinbone) is cut and then reshaped to relieve pressure on the knee joint.

Beyond improving pain and function, a goal of the procedure is to prevent or delay the need for total knee replacement, Birmingham said.

Although high tibial osteotomy can improve pain and function and is cost-effective, the procedure is underused in North America, Birmingham said. “Rates of high tibial osteotomy continue to decline, while rates of other knee surgeries continue to rise,” he added.

“The low rates of high tibial osteotomy are partially due to the perception that the procedure is only suitable for a very specific subset of patients with knee osteoarthritis, and that the patients will go on to require total joint replacement anyway. So why bother?” Birmingham said.

But the researchers found that among nearly 600 people in the study who had a high tibial osteotomy, 95% did not need a total knee replacement within five years, and 79% did not get a total knee replacement within 10 years.

Even patients not usually considered good candidates for high tibial osteotomy, such as women and those with later-stage disease, 70% did not need a knee replacement within 10 years, the researchers found.

“Knees treated earlier in the disease process had the highest longevity after high tibial osteotomy, with 87% not getting a total knee replacement within 10 years,” Birmingham said.

The findings from this study suggest that high tibial osteotomy has the potential to delay or prevent the need for total knee replacement, bringing the limited use of high tibial osteotomy into question, he said.

Dr. Jeffrey Schildhorn, an orthopedic surgeon at Lenox Hill Hospital in New York City, reviewed the study and said that the goal of this procedure is to realign the knee to help prevent arthritis progression in younger patients.

“The high tibial osteotomy is designed to help patients avoid the knee replacement altogether, or at the very least to get further along in life before it’s necessary,” he said. “The idea behind the operation is solid, and in the right patient, it’s absolutely the right thing to do.”

Schildhorn said the one downside of the procedure is that patients have to keep their weight off the knee for at least a month after a high tibial osteotomy, which is one reason it’s only used for patients strong enough to use crutches.

“When I treat patients, one of the things that limits me in offering certain things is what I think they can tolerate, so if I see someone who I don’t think is going to be able to get through the nuanced rehabilitation that’s going to be required, like not putting weight on it for four to six weeks and the arduous physical therapy that can be involved, I won’t offer them something like this,” Schildhorn said.

He also said that whether a patient is offered a high tibial osteotomy depends on the doctor the patient sees.

“In other words, usually the doctors who do joint replacements don’t do this, and vice versa,” Schildhorn said. “It depends on the philosophy of the surgeon; there are surgeons who are joint replacement surgeons and there are surgeons who are joint-preserving, and some crossover. But for the most part, it depends on your philosophy and how you frame your practice — there’s a lot less doctors who specialize in osteotomy than specialize in joint replacement.”

Patients need to do their homework, he noted.

“Ask your doctor, “Would this be right for me? Would this preserve my knee for longer? And do you think I’m a good candidate?'” Schildhorn said. “You have to arm people with information so they can understand the risks — basically that’s what informed consent really is.”

The report was published Feb. 1 in the Canadian Medical Association Journal.

More information

For more on knee osteoarthritis, see the American Academy of Orthopaedic Surgeons.

SOURCES: Trevor Birmingham, Ph.D., professor and Canada research chair, musculoskeletal rehabilitation, University of Western Ontario, London, Canada; Jeffrey Schildhorn, MD, orthopedic surgeon, Lenox Hill Hospital, New York City; Canadian Medical Association Journal, Feb. 1, 2021

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Knee or Hip Replacements Cut People’s Risk for Falls: Study

Knee or Hip Replacements Cut People’s Risk for Falls: Study

MONDAY, Oct. 26, 2020 (HealthDay News) — People who have total joint replacement, or total joint arthroplasty (TJA), experience fewer falls than those who don’t undergo the surgery, a new study finds.

“Osteoarthritis (OA) is the degeneration of the cartilage in our joints over the years,” said lead author Dr. Ran Schwarzkopf, an orthopedic surgeon at NYU Langone Health in New York City. “As the wear and tear increases, patients lose their range of motion. They cannot turn their toes as easily, flex their hips or lift their legs high enough to avoid obstacles due to physical limitations as well as pain, resulting in falls and fragility fractures.”

TJA is surgery to restore function — typically by replacing a damaged joint with an artificial one.

For the study, recently published in the Journal of the American Academy of Orthopaedic Surgeons, Schwarzkopf and his team used a New York database on nearly 500,000 OA patients. Patients had either total hip or total knee replacements, and their fall rates were compared to those who didn’t have the surgeries.

“Those who had TJA fell far less than those who did not,” Schwarzkopf said in a journal news release. “From that, we concluded that TJA for patients that have OA is protective against future falls.”

TJA decreases pain, increases range of motion and agility and leads to more successful physical therapy. Mentally, patients also have less fear of falling, leading to more stability and confidence, according to the researchers.

“TJA will allow patients to go back to the daily activities they may have avoided due to pain and restricted range of motion,” Schwarzkopf said. “They are able to go back to the point in their lives when they can do activities, such as hiking, riding a bicycle or even walking their dog, without having to think about whether it will cause them physical pain or rely as heavily on ambulatory aids and caregivers.”

Not everyone needs joint replacement surgery, however. OA can be treated with anti-inflammatory drugs, walking aids and exercises to increase strength, Schwarzkopf said. Only if patients are unable to live with the symptoms is surgery recommended.

Schwarzkopf offered these safety tips to help prevent falls:

  • Cover sharp corners of tables or counters.
  • Remove loose rugs.
  • Install handrails in bathrooms and near staircases.
  • Install motion-activated night lights.
  • Encourage use of wearable or portable communication devices.

More information

For more tips on avoiding falls, visit the National Council on Aging.

SOURCE: American Academy of Orthopaedic Surgeons, news release, Oct. 16, 2020

Copyright ©2020 HealthDay. All rights reserved.
Most Knee Cracking Is Normal, Expert Says

Most Knee Cracking Is Normal, Expert Says

SUNDAY, Aug. 16, 2020 (HealthDay News) — If your knees crack when you walk or run, don’t be too worried, an expert says.

“Knee cracking could mean lots of things,” said Harshvardhan Singh, assistant professor in the department of physical therapy at the University of Alabama at Birmingham. “If it is painful, then you should see a health care provider.”

The cause can be a large kneecap that doesn’t fit well into the groove, producing cracking during activities such as running and jogging.

And if the thigh muscle is too tight, it can pull the kneecap, causing an audible crack. Degeneration of knee cartilage can, too.

“The degenerative changes can also lead to pain and/or locking of the knee joint,” Singh said in a university news release. “Typically, degenerative changes are common in older people.”

Scans have shown that the displacement of joint surfaces forming the knee can cause a chain reaction in which natural gas bubbles collapse. The result: knee cracking.

“You should not be worried if your knees crack often as long as it is not associated with pain,” Singh said.

If you have had a recent trauma to the knee and it starts to crack, you should see a doctor even in there’s no pain, he said.

“Do not allow these sounds to make you feel abnormal or mentally stressed, or limit your functional activities,” Singh said. “A knee crack by itself does not indicate presence of any disease.”

It’s normal for knees to crack when you are active and it does not mean you have arthritis, he explained.

“Interestingly, in knee arthritis, knee joint becomes hypomobile and loses its movement to a certain degree, which may lead to no knee crack,” he said. “A knee crack may mean your joint is mobile and lubricated.”

A professional may be able to help quell the cracking, Singh said.

“A physical therapist may be able to help you determine if there are specific movement patterns or any biomechanical alignment which may be leading to knee crack and prescribe you certain exercises to help improve it,” he said.

More information

For more about cracking knees, visit Johns Hopkins University.

SOURCE: University of Alabama at Birmingham, news release, Aug. 10, 2020

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What Jobs Are Toughest on the Knees?

What Jobs Are Toughest on the Knees?

Joint replacements for knee osteoarthritis are becoming more common, and now researchers have identified jobs that may lead to one.

Based on a review of 71 studies that included nearly one million workers, the riskiest occupations include agriculture, construction, mining, service jobs and housekeeping. And jobs that demand excessive kneeling, squatting, standing, lifting and climbing stairs all increase your odds.

A team of researchers from the University of Sydney in Australia, and the Universities of Oxford and Southampton in the United Kingdom found that:

  • Carpenters, bricklayers and floor installers have roughly three times the risk for knee osteoarthritis, compared with sedentary workers.
  • Farm workers have 64% higher odds for the condition, slightly higher than the 63% for builders and construction workers.
  • Housekeeping also carries a risk — with unpaid houseworkers facing up to 93% increased odds for knee osteoarthritis.
  • Some jobs were kinder to the knees, however. Workers in commerce, forestry, fishing, machinists, plumbers, electricians, technicians and postal workers did not have a statistically significant risk for knee osteoarthritis, the study found.

“Knee osteoarthritis is a leading cause of loss of work and disability worldwide and can necessitate invasive surgery including total knee replacement, so preventing occupational hazards is critical,” senior study author Dr. David Hunter said in a news release from the University of Sydney, where he leads the Institute of Bone and Joint Research.

Osteoarthritis develops as cartilage deteriorates and bone comes into contact with bone, causing pain and swelling, and limiting function, which affects lifestyle. It can follow an injury, but most of the time the cause is unknown, according to a New York orthopedic surgeon.

“There is a genetic component, but there’s also a lifestyle component,” said Dr. Jeffrey Schildhorn of Lenox Hill Hospital in New York City, who reviewed the findings. One of the biggest risk factors is being overweight or obese.

“I’ve seen arthritis in every walk of life,” he said.

Osteoarthritis is a disease of aging, so it’s not surprising that more people are suffering from it and that the number of joint replacements is soaring, because people are living longer, Schildhorn said. But, he added, there is no miracle cure.

“The thing with arthritis that makes it difficult to deal with is that cartilage has no true regenerative ability,” he said, suggesting that the best way to prevent it is to eat well and watch your weight. Stretching and exercises like yoga will also help keep joints limber, Schildhorn added.

Treatment can include pain medications, and physical or behavioral therapy. But when these don’t work, a knee replacement may be in order.

“Osteoarthritis is mechanical wear and tear,” Schildhorn said. “Some people have more resilient cartilage than others.” If it is very soft and flaky, no treatment is going to work and it has nothing to do with a person’s lifestyle — or their job, he said.

But employers can help by providing physical therapy and teaching workers how to do their jobs with less stress on their knees, Schildhorn said.

The report was recently published in the journal Arthritis Care and Research.

More information

Learn more about knee osteoarthritis from the American Academy of Orthopaedic Surgeons.

SOURCES: Jeffrey Schildhorn, MD, orthopedic surgeon, Lenox Hill Hospital, New York City; University of Sydney, news release, July 8, 2020; Arthritis Care and Research, July 8, 2020

Copyright ©2020 HealthDay. All rights reserved.
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