Joint Preservation Blog

December 15, 2008

torn shoulder ligaments cures

There are many ligaments that help to support the shoulder.  The shoulder ligaments are the duct tape that hold the bones together.  These include the coraco-acromial ligaments (the duct tape that holds the collar bone to the front of the shoulder blade).  Other ligaments include the joint capsule of the AC joint (duct tape that holds the AC joint together) and the shoulder joint capsule (the duct tape that holds the shoulder ball in the socket).  An injury that stretches these ligaments can cause instability, meaning that the duct tape can be stretched an lose it’s ability to hold these shoulder bones together as they move and as you use the shoulder.  This can cause many problems, including early arthritis and pain.  Torn shoulder ligament cures have traditionally been surgical.  However, newer non-surgical torn shoulder ligament cures are now available. 

Surgery for this area usually means sewing the torn ligament together or back to it’s attachment to the bone.  While for a complete tear of one of these ligaments this may the only way to get the two ends back together, for partial tears, this is an older method of repair that may have more problems than benefits.  For example, sewing a partially torn ligament often over tightens the ligament.  In addition, this surgical approach carries more risk of infection.  Newer treatments are all injection based.  This means that stem cells can be injected into the ligament to help it mend, rather than needing surgery.  The newer stem cell based treatments (links above) also mean much less down-time and immobilization for the patient. 

As an example, a patient with an AC joint injury often has chronic and painful popping and cracking in this joint between the front of the should blade and the collar bone.  The shoulder muscles underneath can become sore.  The surgical option is to sew a cadaver ligament or synthetic material around the injured ligaments to try and stabilize the joint.  However, there is huge down-time, with the patient being unable to use the area for months.  In addition, over tightening is common, and this leads to more arthritis.  The newer technique of injecting stem cells into the ligament requires no or little down-time and likely results in a more physiologic repair (without the over tightening) because the goal with this procedure is to get the ligament to heal back to it’s pre-injured state (or as close to it as possible).

mri knee anterior and posterior ligament tears

MRI knee anterior and posterior ligament tears. The knee has ligaments in the font and back (ACL and PCL) that keep the knee stable in a front-back direction. These ligaments can be seen on MRI and will usually have bright areas in them under certain special MRI sequences if they are partially torn or stretched. These areas are called “high signal intensity” in medical radiology jargon. If the ligament tears are complete (broken in half), then surgery is needed to reconnect those ligaments. However, if the ligaments are only partially torn or stretched, newer techniques to treat these ligaments without surgery are available. Surgery to treat an ACL/PCL partial ligament tear may cause more problems than it’s worth, in that sewing these ligaments may result in ligaments that are too tight. Ligaments that are too tight can rapidly increase the wear and tear forces on the knee. This can lead to further degeneration of the cartilage and arthritis. However, leaving the ligaments stretched out and too loose may result in the same fate, as the extra motion of the knee joint will lead to extra wear and tear as well.

While surgical repair may well lead to more arthritis down the line, non-surgical repair has advanced greatly in the past few years. The ability to inject the patent’s own stem cells into the partially torn ligaments without surgery may be able to heal these tears without over tightening the ligaments. Research in the arena of using adult stem cells (not from embryos, but from the patient) has blossomed. This technique (see the first link in the above paragraph) allows for much less downtime than surgery and also allows the patient to remain active while the ligaments are healing. In addition, it’s believed that this more physiologic repair reduces the risk of over tightening the ligament.

For more information on these ligaments, see below:

The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) are the primary restraints to front and back motion of the tibia on the femur. The femur (thigh bone) sits on top of the tibia (shin bone), and the knee joint allows movement of the mid leg. Without ligaments to stabilize the knee joint, the joint would be unstable and prone to excessive wear and tear and loose much of it’s bio mechanical advantage. The ACL and PCL prevents the tibia from sliding too far in the font-back direction. The ACL and PCL also contribute stability to other movements at the joint including rotation at the knee joint. The other major ligaments of the knee are the medial and lateral collateral ligaments (MCL and LCL, respectively).

What happens when there is an ACL or PCL injury?
When an ACL injury occurs, the knee becomes unstable. The ACL injury is a concern because this instability can make pivoting movements difficult, and it may make the knee more likely to developing arthritis and cartilage injury.

Why are ACL and PCL tears a big problem with daily activities?

When the knee is unstable, patients complain of a feeling that the knee will ‘give out’ from under them. When this “giving way” is because of an ACL injury, the knee joint is sliding around too much. This can be a problem because each occurrence of instability (the ‘giving way’ feeling) can lead to damage to the knee cartilage. Therefore an ACL or PCL injury can make a patient more likely to develop knee arthritis and meniscus tears.

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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