Category Archives: Knee Treatments

After he has consulted with you and determined that knee surgery is the appropriate step to take in order to treat your knee condition or injury, Dr. Anz will discuss which surgical procedure will offer you the most optimal outcome.  Dr. Anz is skilled in arthroscopic knee surgery, and other progressive techniques of the knee. While some of the procedures might be handled arthroscopically, others will require an open approach. Each knee surgery and technique that Dr. Anz performs is different, and may require varying steps and/or stages depending on how complex the injury is. Once surgery has been completed, Dr. Anz will prescribe a thorough physical therapy recovery program so that the goal of a full recovery can be met.

FCL Reconstruction

There are four major ligaments, or “restraints” to the knee joint.  They include the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and posterior lateral complex (PLC).  The PLC is on the outer side of the knee and has three major components: the fibular collateral ligament (FCL, sometimes referred to as the LCL), the popliteus muscle and tendon, and the popliteofibular ligament.  The FCL can become damaged or torn with certain twisting injuries.  Commonly, this injury is sustained in high movement athletics such as football or soccer.  In some instances, the FCL may heal on its own after an injury; however, in certain instances, the ligament is torn to the extent that an FCL reconstruction is necessary.

By examining the knee and obtaining X-rays where the ligament is stressed, it is possible to determine which injuries will heal without surgery and which will require surgery.  If surgery is needed, Dr. Anz will perform an open FCL reconstruction, which will involve either harvesting one of a patient’s  hamstring tendons or the use of a donor tendon, which is also called an allograft.

After surgery, physical therapy is extremely important in order to obtain an optimal result.  Physical therapy begins immediately; however, knee range of motion is limited for 2 weeks.  Patients also cannot place weight on their leg for 6 weeks, as this is the amount of time which is necessary for tendon to heal to bone.  Strengthening begins at 8 weeks, and patients typically return to jogging at about 6 months depending on the extent of the injury.

For additional information on FCL knee injuries, or to learn more about FCL reconstruction surgery, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

PCL Reconstruction

The PCL (posterior cruciate ligament) is a ligament that is located inside the knee joint near the back of the knee. This particular ligament is responsible for keeping the bone in the leg from moving backward (or posterior) in relation to the bone in the thigh.  A PCL can become damaged or injured through sports or other traumatic accident such a motor vehicle collision. Some of these injuries may present themselves as mild tears, while others represent full tears.  PCL knee injuries are not as common as ACL knee injuries, however, many times it is because a PCL knee injury may simply go undiagnosed.

Mild PCL knee injuries can oftentimes heal on their own. In certain instances the ligament is torn to the extent that a PCL reconstruction may be necessary.

Dr. Anz performs PCL knee reconstructions following a thorough assessment of the knee using an MRI so that the extent of the injury, location, and pattern of injury can be determined.

Surgical reconstruction of the PCL is usually only recommended for grade III PCL tears. During a PCL reconstruction, Dr. Anz will reconstruct the ligament using a graft. This graft usually consists of donated tissue (i.e. the quadriceps) from another person (known as an allograft). Sutures will be used to complete this process and to tightly secure the ligament to as close to its native footprint as possible.

Following PCL reconstruction surgery, a brace is required for six months to prevent gravity from stretching out the reconstructed ligament.  Physical therapy is a very important part of the recovery process and is recommended in order for the patient to make a full recovery and receive optimal results.  It is recommended, that after surgery, rehabilitation begin so that patients can begin striving towards range of motion, strengthening of the knee, and full mobility. Initially, patients cannot place weight on their leg for 6 weeks.  Strengthening begins at seven weeks, and running and cutting sports are delayed for up to 24 months.

For additional information on ligament injuries of the knee, or to learn more about PCL reconstruction surgery of the knee, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

 

ACL Reconstruction

ACL knee injuries are a common occurrence among athletes.  There are four major ligaments in the knee joint that stabilize the knee.  These ligaments include the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and posterior lateral complex (PLC).  The ACL is located in the front of the knee and its purpose is to prevent the bone in the leg from moving forward relative to the bone of the thigh.  It also provides the stability that is needed to complete certain twisting or rotational movements.

The ACL is located in the front of the knee and can be injured during athletics, as well as everyday falls and missteps.  When the ACL is injured, some patients will hear a popping sound and will experience pain and swelling of the knee; this occurs as blood and fluid collect inside the knee joint.  Due to the limited blood supply of the ACL, most ACL injuries do not heal on their own.  Depending on the patient’s lifestyle, activity level, age, and athletic goals, some patients can be treated with rehabilitation alone. This is recommended for patients with a lower activity level.

In younger, active patients surgery may be recommended to help patients get back to their level of pre-injury activity.  Dr. Anz performs ACL reconstruction surgery using an arthroscopic approach to reconstruct the damaged ACL.  During arthroscopic knee surgery, Dr. Anz uses  small incisions on the knee to insert a camera, as well as surgical tools to evaluate the ligament and other structures inside the knee.  The torn ligament is reconstructed and secured, typically with interference screws.  In most cases, Dr. Anz will need to use a graft to reconstruct the ligament.  Grafts can be harvested from the patient (a portion of the patellar tendon or hamstring tendon) or can be acquired from a donor (cadaver).  Each case is unique, and decisions are individualized, based upon a given patient’s activity level, goals, and history.

Following ACL reconstruction surgery, Dr. Anz will construct a thorough rehabilitation program that should be fulfilled in its entirety. After surgery patients are fitted with a brace and  use crutches until their quadriceps muscle returns in strength.  Therapy and the use of functional braces will be individualized to the exact injury and patient’s needs.

Dr. Adam Anz is an orthopedic knee surgeon in Gulf Breeze, FL.  For additional information on ACL knee injuries or to schedule a consultation to discuss ACL reconstruction surgery, please call our Pensacola, FL office today.

Multi-Ligament Knee Reconstruction

Multi-ligament knee injuries are series injuries that often considered complex.  This type of injury occurs when more than one ligament are affected during injury.  There are four major ligaments that make up the knee joint. Each has their own function but together they work to stabilize the knee.  These ligaments include:

  • The anterior cruciate ligament (ACL)
  • The posterior cruciate ligament (PCL)
  • The Medial collateral ligament (MCL)
  • The Posterior lateral complex (PLC)

Multi-ligament knee injuries can occur as the result of a traumatic incident such as a collision or fall during sports, a auto mobile accident, or serious fall such as with snow skiing. Each injury is different and depending on different mechanisms, a multitude of injury patterns can be present.

In many instances where multiple ligaments are affected, a multi-ligament knee reconstruction would most likely need to take place.  An MRI will be able to detail the extent of the ligament injury.

When multiple ligaments are involved, there are occasions where one ligament can heal on its own while another is reconstructed, and there are occasions where more than one, or multiple, ligaments must be reconstructed. Reconstruction of ligaments such as the ACL and PCL requires removing the damaged ligament and reconstructing a new ligament with a graft.  This graft may be from the patient’s own tissue (known as autograft), or it could be from donated tissue from another person (known as allograft).  In some instances, it may be necessary to use multiple allografts. The goal of this surgery is to attempt to secure the ligaments back to their native position.  Dr. Anz will often perform this surgery in one operation and once the ligaments are attached back to their anatomic sites, during early post-op, one can start early range of motion to minimize the chance of the patient developing stiffness and scaring around the knee.

Following this surgical procedure, physical therapy will begin immediately; however, knee range of motion may be limited for a period of time.  Bracing and progression with therapy is individualized based upon the type of injury. Multi-ligament knee surgeries are serious procedures and a thorough, and intensive rehabilitation program will need to be followed post-op in order to obtain the most optimal results.

For additional information on multi-ligament knee injuries, or to learn more about multi-ligament knee reconstruction, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute.

 

MCL Reconstruction

The MCL (medial collateral ligament) is one of the four major restraints to the knee joint.  Along with the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and posterior lateral complex (PLC), it works to provide stability and strength to the knee joint.  The MCL is the main ligament on the inside of the knee, also known as the medial side, and is a part of the “posteromedial corner” (PMC).  This ligament can become injured with certain twisting injuries. Often, the MCL will heal on its own after injury; however, in certain instances the ligament is torn to the extent that an MCL reconstruction is necessary.

By examining a knee and obtaining X-rays where the ligament is stressed, it is possible to determine which injuries will heal without surgery and which will require surgery. Whether the MCL tear is partial or complete, Dr. Anz will be most concerned about the overall stability of the joint. During his initial evaluation, he will also determine if the MCL was injured along with the ACL, which is commonly the case. MCL reconstruction involves harvest of one of the hamstring tendons.  This tendon is used to reconstruct the damaged MCL.

After surgery, patients will be required to undergo rehabilitation involving physical therapy in order to obtain an optimal result.  Physical therapy begins immediately; however, knee range of motion is limited for 2 weeks.  Initially, patients cannot place weight on their leg for 6 weeks, this amount of time is necessary for ligament healing.  Strengthening begins at 7 weeks, and patients typically return to jogging at 4 months and sports at 5-6 months, depending on the severity of the initial injury.

For additional information on MCL knee injuries, or to learn more about MCL reconstruction surgery using arthroscopy, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Articular Cartilage Defect Surgery

Articular cartilage is a very important component of a healthy knee joint. It covers the ends of each of the bones and is what allows for a fluid, smooth, painless motion of the knee. When an area of the cartilage becomes damaged, a patient will experience swelling and pain with activities, and over time, this process will continue to progress which eventually leads to complete loss of cartilage down to the bone.  When this happens, a diseases known as osteoarthritis becomes present. This continues to cause progressive symptoms of knee pain and stiffness.

When a patient presents with damage to the articular cartilage, or an articular cartilage defect, it is of the utmost importance to treat this appropriately in an effort to restore the damaged area and preserve the surrounding cartilage. This treatment will depend on many factors including size of the defect, depth, location, associated injuries in the knee, age, and activity goals. In many cases with a focal cartilage defect, surgery is recommended.

There are a variety of surgical procedures that can be used to treat articular cartilage damage. These include chondroplasty, Microfracture, osteochaondral autograft transfer, or osteonchondral allograft transplantation.  Listed below are some of the specific behind each technique:

  • Chrondoplasty is an arthroscopic procedure used on some patients which involves using a camera and small instruments to trim away the damaged area of cartilage to alleviate the patient’s symptoms and prevent further propagation of the defect. This procedure is typically undertaken in patients who do not have full thickness defects (down to bone).
  • Microfracture is a technique used in patients who have a full thickens loss of cartilage.  It is a technique where a small pick is used to make holes in the bony surface of the defect. This allows the flow of marrow elements and stem cells which form a clot over the defect and eventually cover the area with a fibrocartilage layer.
  • Osteochondral autograft transfer and osteonchondral allograft transplantations are two types of procedures where an autograft (taken from the patient) or allograft (taken from a donor) is used. In autograft OATs, small plugs of cartilage and bone are taken from another less important area of the patient’s knee and transferred in to fill the defect. In allograft OATs, the cartilage and bone are taken from a donor and also used to fill the defect. These procedures are done with a combination of arthroscopic and open techniques.

Physical therapy will be prescribed following surgery for an articular cartilage defect. Post-operative management varies depending on the specific type of procedure and the severity of the injury. For chondroplasty, patients are typically on crutches for a few days and allowed to weight bear as tolerated with full range of motion. For the other procedures the patient is placed into a brace and weight bearing is protected for 6-8 weeks. Motion may be initially restricted and a continuous passive motion machine (CPM) is also typically used for 6 weeks after surgery.

For additional information on osteoarthritis of the knee, or to schedule an appointment to discuss articular cartilage defect surgery or other treatments for this specific condition, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

 

Meniscus repair and Partial Meniscectomy

Meniscus is a very important part of the knee joint. It is a type of cartilage that serves as a shock absorber within the knee since very high loads are transmitted across the knee with walking, running, jumping, going up and down stairs, or participating in sports or other active extracurricular activities. The menisci are c-shaped pieces of cartilage that cover the knee and are extremely important to distribute the load across the knee and protect the articular cartilage. The menisci also serve as secondary stabilizers to the knee to assist the ligaments.

The knee needs the meniscus in order to function. If a meniscus sustains a significant tear, it loses its ability to function. Over time this will lead to degradation and wear of the articular cartilage, called arthritis.  This eventually can lead to osteoarthritis and bring a myriad of unwanted symptoms.

The symptoms of a meniscus tear include pain on the inside or outside of the knee, a feeling of instability, locking, catching, and tenderness. An MRI will be used to confirm a meniscus injury. If the meniscus shows a small tear, the patient may be able to heal without surgery by way of physical therapy. For larger tears, those that have failed non-operative management, and those with frank mechanical symptoms surgery is typically recommended.

A meniscectomy will be performed on the knee if the meniscus has a small symptomatic tear, one that is shredded beyond repair, or a tear in the inner third of the meniscus. This procedure essentially removes the area of the tear, and removes the damaged section. This is called a partial meniscectomy. Dr. Anz will take great care to only remove the damaged part of the tear and leave as much of the healthy meniscus as possible.

For tears that occur in the outer two thirds of the meniscus, or for larger tears that can be fixed, an attempt is made to repair the meniscus and preserve as much of the native meniscus as possible. This is performed with a combination arthroscopic and open procedure. Strong stitches are placed through the tear to bring the tissue back together and complete the repair.

After a meniscal repair, the knee must be protected to allow the meniscus to heal. For a partial meniscectomy procedure, the patient is allowed to weight-bear as tolerated. Physical therapy is started immediately to regain motion and strength. Weight bearing is protected on crutches for two weeks followed by full weight bearing in the brace, which is worn for a total of six weeks.

To learn more about mensical injuries of the knee, or for additional information on meniscus repairs or meniscus surgery of the knee, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

 

Revision ACL Reconstruction

The ACL is a ligament located in the front of the knee.  It provides stability to the knee with rotational movements or twisting. The main function of this ligament is to prevent the bone in the leg from moving forward relative to the bone of the thigh.

The ACL is the most commonly torn ligament in the knee and in many cases is associated with athletic participation. When an individual tears their ACL, at the time the injury occurs, patients will hear a pop and will immediately feel pain and have swelling in the knee joint. In most cases, because the ACL typically does not heal on its own, ACL reconstruction surgery is performed to restore function to the knee. While the procedure is very successful, some patients will have a re-tear of the ACL and tear the reconstructed graft.

While the exact cause for a re-tear is not always fully understood it can be due to many circumstances. Some patients simply return to sports too soon, or did not take the necessary time to rehab the injury.  Some will experience a new trauma (such as a fall or another sports related injury). Unfortunately, some patients will have a graft or fixation from the original surgery that failed. One a re-tear occurs, the knee once again is left unstable and must be carefully addressed to restore function to the knee.

In these cases, an ACL revision surgery will probably need to take place. This procedure is more difficult to perform because of the fact that at least one surgery has already failed and that the devices used to fix the first ACL are still in place in the knee.

Dr. Anz will assess the knee carefully and will order new X-rays and most likely an MRI to help understand why the initial surgery failed and check to see if there are any anatomical or other factors that put the patient at risk for tears or other predisposed risks.  In certain cases a revision ACL reconstruction can be performed immediately using either a graft from the patient (patellar tendon, hamstrings) or a donated graft. This will all depend on the circumstances stemming from the first surgery (i.e. what graft was used, how it was placed, etc.).  Dr. Anz may decide to perform the revision surgery in stages, especially if the quality of the bone in not strong enough or good from the first surgery.   These stages will include a bone grafting procedure to fill the areas with new bone, followed by a revision ACL reconstruction with a graft 4-6 months later.

Patients will be prescribed a very strict and thorough rehabilitation program following revision ACL surgery. After surgery patients will be placed into a brace and will typically use crutches for 2 weeks.  Even after therapy has concluded, Dr. Anz may recommend that a patient use a functional type brace once they return to activities for the first year.

The results of ACL reconstruction are highly successful in terms of restoring function and allowing patients to return to their activities. In cases of a revision reconstruction, the results are also very successful but less so than a primary surgery due to the complexity of the injury and procedure.

For additional information on revision ACL reconstruction surgery, or to learn more about common knee injuries involving one or more ligaments within the knee, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute.