Joint Preservation Blog

January 22, 2009

ACL Laxity and Knee Braces

acl laxity and knee braces

A doctor discusses ACL Laxity and Knee Braces. The ACL is the duct tape in the knee that holds the big thigh bone (femur) to the leg bone (tibia). It stabilizes (along with the PCL) the knee in a front-back direction. A knee brace can be used to help the ACL. An ACL knee brace allows the knee to flex and extend while holding the thigh and leg bones in alignment. However,is there a better way than wearing a knee brace all the time? Knee surgeries to replace or reconstruct the ACL should only be performed (in my opinion) if the ACL is completely gone. if the ACL is just lax, an older method of treatment is prolotherapy. This is the injection of a substance to tighten the ligament. Reeves has shown that the ligament can be tightened in this way using monthly shots for about 6 months. Newer options already being performed in the US include seeding the patient’s own adult stem cells onto the ACL ligament to repair the damage. This only works if there are ACL fibers left to seed. Eventually, this same technique may be used to inject an ACL scaffold material into the knee with adult stem cells that can create a ligament. So if you have a stretched ACL and you’re using a knee brace for ACL laxity, investigate some of the injections that can help you loose the brace!

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January 3, 2009

Knee Replacement Surgery Recovery

Knee replacement surgery recovery is hard. As a doctor, I’ve seen everything from patients who can get back on their feet in weeks, to patients with months of severe pain requiring narcotics and ultimately poor outcomes (the knee area still hurts). Why? How can you tell who will do well and who will have a prolonged Knee replacement surgery recovery? After many years of seeing these patients, I think it comes down to why the knee hurts in the first place. Too often, the knee is diagnosed as the main pain generator, but much of the pain is really coming from somewhere else. For example, recent research has shown that while we see meniscus tears on MRI, they are often not the cause of knee pain. In addition, there is a mean serious complication rate from knee replacement surgery of 20%. This gets worse as the patient gets older, with severe consequences and complications (with protracted recovery) occurring in many more patients when they are over age 80. Even if the knee is the cause of the pain, you might consider trying non-surgical options before you pull the trigger on knee replacement. Many patients can get good results from SynVisc or other artificial joint lubricants. Some of my patients try prolotherapy. Even newer techniques are now available where the patient’s own stem cells are used to heal the problems in the knee. So one way to avoid a long Knee replacement surgery recovery watching re-runs of Oprah is to avoid the knee replacement altogether.

December 14, 2008

Healing Tendon Tears

A tendon is the connection between a muscle and a bone.  It transmits force from the muscle, through a joint to allow movement.  Tendons, like any structure, can be torn or damaged.  Most tears heal, but some need help.  Surgery is an option, but should only be considered when the tendon is completely torn in half and retracted (the two ends don’t come together).  If the tear is not complete, but a partial tear, then surgery may not be needed.  Modern advances in regenerative medicine allow us to undertake healing tendon tears instead of sewing them.  This new 21st century way of healing or repairing a tear in the tendon tear has significant advantages over the older, 20th century surgical methods. 

First, if the tendon is only partially torn, the newer stem cell injection procedure often requires very minimal down time, unlike surgical approaches where the tendon is sewn.  This is because the newer stem cell procedure involves injecting those healing cells directly into the tendon under x-ray guidance.  Without a surgical incision, the area heals more quickly.  Also, the stem cells allow the tendon tear to mend fully.  For more information, see the link above. 

For scientific information on healing tendon tears with adult stem cells, see this link to the National Library of Medicine. 

Older, but still interesting ways of healing tendon tears without surgery include prolotherapy.  Another prolotherapy link here and here.  Prolotherapy is injecting the tendon with a substance to cause a brief, inflammatory healing reaction in the tedon.  This is oftern repeated several times, once every 3-6 weeks.  This works well with smaller tendon tears, in younger patients, who can remain very active.

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