Chondral Defects of the Hip.

Chondral Defects of the Hip

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Chondral Defects of the Hip.

Injury Overview: 

Articular cartilage is a smooth but firm tissue that lines the joints of the body and allows for a reduction in friction. This substance covers the ends of the bones that form the hip joint (femur and acetabulum), allowing for smooth motion between the ends of the bones when the hips move. This tissue also acts as a “shock absorber” by protecting the joint during impact activities such as running and jumping.

A chondral defect is a condition of the hip that occurs when there is a defect in the articular cartilage. The defect and/or damage to the articular cartilage can result in a number of conditions leading to various symptoms. Degenerative diseases such as arthritis and osteoarthritis are the most common conditions of the hip in which articular cartilage has suffered damage. In some instances, cartilage can potentially wear down and break off or tear away from the bone. Femoroacetabular impingement (FAI), can also lead to chondral defects within the joint.

Normal wear and tear that comes with aging is a common culprit for chondral damage in the hip. Damage to the articular cartilage within the hip can also occur as a result of a direct blow to the hip joint, such as with a fall or a traumatic accident (i.e. motor vehicle accident). These defects can also result from repetitive motion, overuse, and stress from sports or other activities.

Symptoms

The most common symptom of a chondral defect is pain, which can almost feel like a “catch” within the joint.

Diagnostic Testing

Dr. Anz will review the patient’s background including a complete history and discuss any injury that may have taken place to cause damage to the hip joint. Typically an MRI is the most effective method to view the articular cartilage within the hip joint.

Treatment

Non-Surgical

In less severe cases, surgery for chondral defects can be avoided and patients are able to manage their pain with non-steroidal, anti-inflammatory medications, ice, and exercises as prescribed by a physical therapist. Injections into the hip can also help alleviate symptoms.

Surgical

Cartilage has a poor blood supply and does not have the ability to repair itself. In cases of severe chondral injury, surgery will likely be recommended with the goal of minimizing symptoms. Some procedures also have the capacity to help restore the area with scar tissue that behaves like cartilage. These surgical procedures can minimize the symptoms associated with cartilage defects and allow for a better quality of life. The exact surgical technique can vary based on the size and severity of the defect. Dr. Anz typically uses a variety of techniques:

  • Chondroplasty is an arthroscopic surgery which removes and cleans out, or debrides, any unstable pieces of cartilage or foreign bodies within the joint. When a patient is diagnosed with “loose bodies”, a chondroplasty and loose body removal is typically the procedure that is used.This usually is the first approach to treat damaged cartilage. It offers a shorter recovery time and is less invasive.
  • Microfracture is another approach that has been developed to help cartilage grow. During the procedure, tiny holes are made in the underlying bone stimulating stem cells within the marrow to approach the site of injury, creating new cartilage growth.

Post-Op

A rehabilitation and physical therapy program will be prescribed at your first post-operative visit with Dr. Anz. Initially, the therapy will focus on slowly returning motion back to the injured hip. After that is achieved, you will follow a progressive strengthening program to protect the repaired hip and avoid future damage or degenerative issues.

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For additional resources on chondral defects and chondral injuries, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

PCL Knee Injury

PCL Knee Injuries

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PCL Knee Injury

Injury Overview

The PCL, or posterior cruciate ligament, is located inside the knee joint towards the back (or posterior aspect) of the knee. It is responsible for keeping the bone in the leg from moving backward (or posterior) in relation to the bone in the thigh. It is also responsible for stabilizing the knee during rotational movements. The PCL can become injured when the knee is either hyper-extended or forced directly backwards.  Most often, this occurs in a traumatic setting such as a violent fall while skiing, during a motor vehicle accident, or through a serious impact during a sports event.

Symptoms

Knee pain, swelling, and limited mobility are the most common symptoms of a PCL injury. Many times, the symptoms can be similar to  those of an ACL knee injury, however, with a PCL tear instability symptoms will be related to the abnormal ability of the tibia to slide posteriorly in relation to the femur.

Diagnosis

Dr. Anz will perform a thorough physical examination and will palpate and manipulate the knee to assess the degree of injury.  A Posterior Drawer test and Dial Test are important physical exams when a PCL injury is suspected.  Additionally, a stress X-ray and MRI will be used to confirm the diagnosis. PCL knee injuries are graded based on the amount of abnormal movement that occurs upon examination, and injuries range from a partial tear with minimal posterior sag to a complete tear of the PCL.

Treatment

Not all PCL tears will require surgery, as certain injuries to the PCL are likely to heal with time.   Dr. Anz may recommend a non-surgical treatment that will involve a rest period, icing, quadriceps strengthening, and bracing.  Anti-inflammatory medication will help alleviate pain immediately after the injury and will allow the patient to make progress with therapy. In certain instances it may be recommended that the PCL undergo surgical reconstruction.

Surgical Treatment

Dr. Anz utilizes an arthroscopic approach to reconstruct the PCL.  In the majority of cases, a donated graft is used. If multiple ligaments are injured, a surgical reconstruction of the PCL, as well as treatment to the other damaged ligaments will be required

Post-Operative

Following a PCL knee surgery, Dr. Anz will require you to wear a brace for at least 6 months as gravity wants to pull the tibia backward and stretch the graft.  During this time, physical therapy will occur with a slow, consistent progression. Initially, the therapy will focus on returning motion back to the injured knee and surrounding muscles while protecting the healing ligament. A progressive strengthening program is very important, and eventually release to normal activities can be expected.

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

Multiligament Knee Injury

Multi-Ligament Knee Injuries

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Multiligament Knee Injury

Injury Overview

The knee is stabilized and is able to function properly because of four major ligaments which allow the knee to perform movements such as walking, pivoting, running, and cutting.  These ligaments can be inside the knee joint (intra-articular) or on the outside of the knee joint (extra-articular).  The Anterior Cruciate Ligament (ACL) and the Posterior Cruciate Ligament (PCL) are intra-articular and called “cruciate ligaments” because they cross over each other inside the knee joint. The Medial Collateral Ligament (MCL) and the Posterolateral Complex (PLC) are extra-articular and provide side-to-side stability.

All four ligaments work together during walking and sporting activities.  Each ligament has specific functions and functions which overlap with other structures. When any of these ligaments are stressed beyond its normal strength, a tear can occur.  In serious accidents, damage to more than one ligament is possible.  This is referred to as a multi-ligament knee injury and requires appropriate medical attention.

Symptoms

Multi-ligament knee injuries present acute symptoms that are often more intense than typical isolated ligament tears. Immediate pain, bruising, swelling, and difficulty moving the knee will be present.  Nearby blood vessels and nerves may also be affected causing numbness, tingling, a cooling sensation, and overall weakness. Multi-ligament knee injuries are serious and require immediate medical evaluation.

Diagnosis

A thorough examination, X-rays, and  an MRI are necessary when more than one ligament is suspected to be injured.  If a dislocation has also occurred, reduction (placing it back into its proper position) and stabilization are necessary as soon as is safely possible. In many cases, dislocations are reduced on a playing field or in an emergency room upon arrival.  Sometimes, special studies to evaluate blood vessels are necessary, and in cases of vascular injury, a consultation with a vascular surgeon will be necessary.

Treatment

In the majority of cases that involve multi-ligament knee injury, a surgery will be needed. This is considered a complex knee surgery and may involve more than one technique.  Surgery may be delayed to allow  swelling to decrease. Depending on which ligaments are injured, Dr. Anz will focus on restoring stability to the knee by performing a repair or reconstruction of all torn ligaments. A graft from either the patient or a donor will often be needed. Sutures, anchors, and screws  are used to reattach the injured ligaments or correctly position and secure grafts.

Post-Operative

Dr. Anz will prescribe a thorough and attentive rehabilitation program following a multi-ligament knee surgery. Restrictions regarding motion and weight bearing are important and tailored to an individual’s unique injury.  It is important for patients to achieve full knee extension as soon as possible.  This often involves an early focus on the quadriceps muscle.  Dr. Anz will work as a team with the patient and therapist to ensure that a full recovery can be reached and individualize the rehabilitation process.

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

Knee Pain

FCL/LCL Knee Injuries

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Knee Pain

Injury Overview

There are four major restraints to the knee joint, including 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), the popliteus muscle and tendon, and the popliteofibular ligament.  The FCL may also be referred to as the lateral collateral ligament (LCL) because of its location on the outside of the knee.  It is attached to the femur (the bone in the thigh) and the fibula (one of the two bones in the lower leg).  The FCL and entire PLC helps stabilize the knee during rotation and side-to-side motion.  These structures can become damaged/torn with certain twisting injuries.

In some instances, the FCL may heal on its own after injury; however, in certain instances, the ligament is torn to the extent that an FCL repair or reconstruction is necessary.  When the FCL is injured, other ligaments are often injured as well. This is referred to as a multi-ligament knee injury and typically requires a large amount of impact or force, such as high-impact sporting collision, fall, or a traumatic accident.

Symptoms

Injuries to the FCL/LCL can occur in a variety of situations.  A direct hit to the inside portion of an athlete’s knee or impact with a twisting motion may cause an injury to the FCL and other structures of the knee.  Initially after a FCL/LCL injury, there will be significant swelling and bruising on the outside (lateral side) of the knee.  Bruising and swelling will often be accompanied by pain and instability.  Fluid in the knee joint (a knee effusion) and a catching sensation may also be present.

Diagnosis

Dr. Anz will conduct a thorough physical examination of the knee evaluating the location of pain, range of motion of the knee, status of strength and sensation, as well knee stability. He will perform a series of tests to evaluate all of the ligaments of the knee and determine if there is abnormal gapping of the knee during the exam.  Stress X-rays are necessary to determine the degree of injury.   Depending on the nature of the injury as well as results of the examination and X-rays, the most appropriate intervention will be prescribed.  This may include non-operative or operative measures.  Dr. Anz may also include an MRI as part of the evaluation to help determine exactly which structures are injured and to assess the structures that surround the initial injury.

Treatment

Isolated FCL injuries can often be treated with non-surgical measures such as an extended rest period, icing, anti-inflammatory medications, and bracing of the injured knee. Physical therapy may also be recommended to help regain mobility and function, as well as overall strength back to the knee joint.

Surgical Treatment

For FCL injuries that are more severe, Dr. Anz may recommend a surgery to repair or reconstruct the FCL. Due to the location of the FCL, a repair or reconstruction cannot be performed arthroscopically, so an open approach to the surgery is necessary.    In some instances, structures other than the FCL may also require repair or reconstruction.

Post-Operative

Dr. Anz will prescribe a complete rehabilitation program following FCL knee surgery. The outcomes of reconstructions and repairs often yield very good results.  It’s important for patients to fulfill their physical therapy program completely, and those who do, are usually able to demonstrate excellent return of stability following the rehab process.  Most patients can usually return to full function within 6-12 months after surgery depending on the nature of the injury.

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For additional information regarding FCL knee injuries, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute.