When is a Meniscus Tear Repairable?

When is a Meniscus Tear Repairable?

According to the American Academy of Orthopaedic Surgeons, one of the most common knee injuries is a tear in the meniscus. These rubbery pieces of cartilage act as shock absorbers in the knee to cushion and stabilize the knee joint. There are two menisci in each of your knees: one on the inside of the knee and one on the outer side.

Treatment of a meniscus tear depends on a number of factors, including the type of tear, its size and where the tear is located on the meniscus. Most meniscus tears result either from trauma or are degenerative. Traumatic tears come about from a twisting of the knee, often while engaged in sports and physical activity. Degenerative tears can occur as the body ages and tissue gradually breaks down over time.

The outer one-third of the meniscus has a rich supply of blood flow, which is important for any part of the body to heal. The inner two-thirds, however, have little to no blood flow. Nutrients from blood are necessary for the body to heal naturally, so when there are tears in the inner part of the meniscus, surgical trimming and removal of the torn piece is generally the best option.

Tears in the meniscus that are located near the outer edge of the knee are typically the result of trauma and are longitudinal – basically following parallel to the long side of the meniscus. This makes these injuries the best candidates for surgical repair.

Arthroscopic surgery for such tears can be very successful at repairing the damage. This is a minimally invasive treatment, as only a few small incisions in the knee are needed. A miniature camera is inserted in one incision, and surgical instruments are inserted in the others, allowing the surgery to all take place within the knee. The tear is closed by stitching the torn pieces together.

Recovery time from a meniscus repair is longer than for surgery where part of the meniscus is removed because the tissue must heal together, requiring 3-4 months away from sports. However, you can expect to fully return to your previous level of activity once healing is complete.

If you have sustained a knee injury or are experiencing knee pain, contact us at Missouri Orthopedics and Advanced Sports Medicine. Dr. Irvine has extensive experience in treating knee pain and injuries, and is trained in the most advanced techniques in arthroscopic surgery.

General Orthopedic Care – Caring for Broken Bones

General Orthopedic Care – Caring for Broken Bones

There are many ways a bone can be injured or broken. Car accidents, contact sports, falls, and workplace accidents are some of the most common ways bones sustain injuries. Regardless of the cause, broken bones should be treated as soon as possible to avoid complications. The best way to treat an injury to a bone is to ensure proper alignment and stabilization.

Leaving a bone break or injury untreated can result in complications including bone deformity and permanent nerve damage. An untreated break may also cause damage to surrounding muscle and ligaments. These complications occur because bone is living tissue that attempts to heal itself in stages:

  • The trauma of the break damages blood vessels within the bone resulting in bleeding inside the tissue. Within hours this blood forms a clot. The blood clot associated with a broken bone contains specialized cells known as fibroblasts.
  • In a few days, these cells begin to manufacture granulation tissue. This tissue begins to form a web of cartilage and fibrocartilage and is known as the soft callus stage. This stage may last from about four days to as long as three weeks in most cases.
  • At this point cells known as osteoblasts begin to make new bone tissue. Usually, this process begins at about two to three weeks and ends at about six to eight weeks. This is known as the hard callus stage and depending on the location and severity of the break, may continue for months.
  • The final process is remodeling. Specialized cells called osteoclasts begin to break down excess bone in the fractured area, reducing the size of the callus and replacing it with hard, compact bone tissue. As this happens, the bone returns to its original size and shape. During this time, the bone functions as well as before the break; however, the process of complete remodeling can take years to complete.

Because bone begins to heal itself almost immediately after an injury, it is vital to see a doctor as soon as possible in order to assure correct healing and avoid complications.

When you visit our office for a broken bone, an X-ray of the affected area would be done to determine the type and severity of the break. For the majority of simple fractures, the bone is able to be gently manipulated back into place. If a more complex or severe break is found, the bone may require stabilization with pins, screws, or plates. Once the bone is back to the correct alignment, immobilization with a cast, splint, or in some cases, traction is essential in order to minimize pain and allow the bone to continue to repair itself in the correct position.

Once the bone is stabilized, recovery and rehabilitation can begin. Dr. Irvine and his team will devise a plan to suit your specific needs. A proper rehabilitation program promotes blood flow to assist in healing and maintaining muscle tone, while also reducing stiffness and helping prevent blood clots.

No matter what the cause, Missouri Orthopedics & Advanced Sports Medicine is here to help. Our clinic can diagnose and treat all types of breaks to get you back to your day-to-day activities. Contact us if you suspect you may have a broken bone or other orthopedic injury. We provide prompt, professional care to minimize further damage and get you back to a healthy, active lifestyle.

Common Sports Injuries for Teen Athletes

Common Sports Injuries for Teen Athletes

High school sports have become a popular extracurricular for many teens. They are a great way to stay in shape and help teach teamwork, leadership, and even time management when balanced with other responsibilities. Unfortunately, for many young athletes, injuries are common, ranging from acute to catastrophic. Each type of injury requires specific treatment that may cause them to miss a game, or even the entire season, but healing time is essential for a proper return to the field or court.

If you watch professional sports, you have undoubtedly witnessed any number of injuries throughout the season. Teens are injured at about the same rate as professionals, but the injuries can be much worse if not treated correctly as these young athletes are still growing. According to the American Academy of Orthopaedic Surgeons, “Growth is generally uneven: Bones grow first, which pulls at tight muscles and tendons.” This tension is a major contributing factor of injuries to muscles, tendons and growth plates that are common among young athletes.

There are a few different levels of injury that can occur in athletes. Understanding each can help the healing process and provide a realistic expectation for healing.

  • Acute Injuries: These are classified as bruises, sprains, strains and fractures. Typically, they are caused by a sudden trauma, such as a collision between players or with an obstacle. Another common acute injury is a twisted ankle, resulting in fracture or sprain.
  • Overuse Injuries: As the skill level of a sport increases, so do the practices, training and games. This can result in gradual damage over time as there is not enough recovery time in between to heal. Common overuse injuries have been seen in elbows of baseball pitchers, shoulders of swimmers, and wrist and elbow injuries in cheerleaders and gymnasts. Stress fractures also become very common, as old bone breaks down quickly with overuse and new bone does not have enough time to grow in, causing weakness.
  • Catastrophic Injuries: These types of injuries are more common with contact sports, such as hockey and football, but have been reported in many others. Catastrophic injuries include damage to the brain, spinal cord, or growth plates. Concussions, or mild traumatic brain injuries, have become a hot topic of conversation with their rise in professional football. If a concussion is suspected, the American Academy of Pediatrics and American Academy of Neurology recommend the athlete be evaluated and cleared by a doctor before they can return to normal play to avoid any permanent damage. Growth plate injuries occur to the developing cartilage at the end of long bones. These are the final portion of the bone to harden, which is why they are more susceptible to fracture. An injury to the growth plate can cause the bone growth to stop or cause a deformity of the bone.

Any injury that occurs due to sports, particularly if any symptoms or discomfort persist, should be seen by a doctor. Athletes who are pushed to work through pain, or are downplaying the severity in order to continue competing may be causing further damage that could become permanent or even result in a disability. This is where the importance of observation by both coaches and parents comes into play as pain or discomfort can be seen if their technique seems off or they have a decreased interest in practice.

Treatment will all depend on the type of injury and its severity. It could range from simple rest to therapy and even surgery. The injury should be healed completely before the athlete can return to physical activities. While it may not be easy to have to take the time off to heal, it will result in a much better outcome than what could happen if left untreated. Athletes can work to prevent these types of injuries by making sure they are properly conditioned, trained, and using proper equipment. Limiting the number of teams the athlete participates on during a given season can help prevent overuse injuries, and making sure to take breaks between seasons, as well as playing other sports throughout the year, can not only help to prevent injury, but help develop an array of athletic skills.

If you have a teen athlete who has a sports-related injury, contact us today. We will help them with the necessary treatment plan to recover and safely get back on the field.

At-home Exercises For Retired People

At-home exercises for retired people can be an efficient way to bridge the gap between health and comfort. After spending years laboring hard in the work-force, spending time commuting and sitting behind desks or working long hours on the floor it can be a blessing to be able to enjoy the comfort of one’s home. Comfort can at times get in the way of the regular exercise our bodies need in order to stay physically as well as mentally fit.

Dr. David Irvine has extensive experience treating patients who suffer from joint and tendon disease which can sometimes occur due to lack of sufficient resistance exercises. Let’s spend some time and talk about how an active retired person can remain healthy by following a few exercises at home, whether in the comfort of the living room or braving the outdoors.

How does inactivity lead to weaker joints and tendons?

Looking at the human body one might think that the parts make up the whole. However, unlike a car, the body doesn’t have components which can be treated as stand-alone parts. The knee, for example, requires adequate muscle mass in the hamstrings, gluteus muscles as well as the calves in order to protect it during exercise or even when going for a walk.

Strength is not the only factor, tendons are part of the equation as well, requiring adequate elasticity in order to allow proper movement of the knee-joint. Weak tendons can allow for unstable motions of the knee and if in turn these structures are too tight they may cause excess wear and tear of the sensitive joint surfaces.

In medicine we have learned that a sedentary lifestyle inevitably will lead to decreased muscle mass and tighter tendon structures. The main reason for this is nerve stimulation, the lack of which decreases the blood supply to these structures causing them to become less important to the body which in turn causes degeneration – or simply put, if you don’t use it, you might lose it.

Combining daily indoor activities with exercise

You likely have common daily routines at home which may offer some relaxation such as listening to podcasts, reading a magazine or watching entertainment/news on TV. Combining exercise with such activities is the most efficient way to get mental as well as physical stimulation.

  • Stand at the kitchen counter with you feet close together, flex your calves and raise your heels off the floor and lower your weight down to a count of 5 seconds.
  • When seated on that comfy couch raise one leg at a time up to the level of your pelvis and lower it down and repeat with the other leg.
  • When listening to your favorite podcast or news source stand with your feet at arm’s-length away from the wall and gently lower your weight into the wall, performing a standing push-up.
  • Don’t forget that cleaning your home manually is an exercise by itself. A good rubdown of the counters and that circular polishing motion of the interior mirrors will definitely get your heart pumping and provide a wonderful upper body resistance exercise.
  • A couple of inexpensive 10-lb dumbbells should be used to perform biceps curls by standing erect with arms at your sides while flexing the biceps and bringing the weights to your shoulder.
  • A variation of the above exercise is to then go from the flexed biceps position directly into an overhead press by pushing the dumbbells over your head and straightening the arms as if reaching for the stars.

Exercising the body in your outdoor space

  • Gardening is one of the most meditative and laborious activities you can do in your outdoor space. Aerating the lawn, plucking weeds, planting flours and vegetables serve as wonderful exercises.
  • If you have room for potted plants consider adding them to your garden, besides requiring watering such plants need to be regularly re-potted – this is less of a chore and more of an exercise – said the optimistic doctor.
  • Consider waking up early and performing a Tai chi routine before you start your day either out on your patio, in front of some beautiful plants or under the shade of your tree.
  • Don’t let those stairs stop you, if you have stairs leading up to the house then turn on some music and go up and down them daily to provide stronger quads and calves.

Limitations to exercise

At our practice we often encounter patients who have given up exercising either because they are unable to get to a nearby gym or are limited by aches and pains.

The former is easily remedied by performing some simple home exercises as outlined above. Get creative and use common household items to perform resistance exercises.

The latter is a common concern. Patients often associate pain with causing damage. This isn’t always the case but it certainly is worth investigating. If you are trying to be more active but constantly experience pain in a specific part of your body please don’t ignore it. Dr. Irvine’s experience with muscles, ligaments and joint pains allows him to differentiate between benign pains which can be overcome with changes to your exercise routine while identifying more serious disease processes which may require proper intervention such as advanced arthritis, frayed tendons, inflamed joint surfaces etc.

We hope that you gained some useful tips from this article regarding home exercises. If you are experiencing aches or pains while doing them please contact us so that we can guide your exercise better.

Advancements in Knee Arthoscopy

Crystal Ball Technology

Advancements in Knee Arthoscopy, Missouri Orthopedics and Advanced Sports Medicine

Most of us are familiar with arthroscopic surgery. This procedure uses tiny cameras and tools to explore and/or repair joints. The word root “arthro-“ actually means joint. Therefore, virtually any joint in the body, such as hip, elbow and knee, can be helped with the use of arthroscopy. The knee is probably the one most people think of when they hear “arthroscopy”, and an estimated one million people in the U.S. are expected to have the procedure performed this year alone.

Synovial fluid is located in each of our joints. This fluid has been used in the past to determine causes or severity of conditions involving those joints. A small sample is taken of the fluid and sent to a lab for analysis. It can be used to test for several disorders, but for our purposes, let’s concentrate on inflammation and degenerative diseases. Typical testing checks the physical appearance of the fluid, including color and clarity. The chemical composition is analyzed. Synovial fluid is comprised of glucose, protein and uric acid. Fluctuations in any of one of these components will signify certain issues are present. For example, lower than expected glucose levels would indicate problems with inflammation or infection.

Researchers have now discovered that these same synovial fluid biomarkers can be an indicator for predicting postoperative outcomes. There are several factors, such as age and duration of symptoms, which were included, along with the biomarker data, to help determine potential results. In other words, physicians would be able to tell how a person will respond after surgery and how successful the procedure will be for each patient.

Much of the terminology and chemical names are meaningless to a non-scientist, but one of the items looked at was T-cell response. T-cells may sound familiar to most as they are mentioned frequently in regards to cancer. They are part of the immune response system, and in cases of infection and inflammation, they are stimulated to respond in an effort to slow down or stop certain processes.

In the near future, surgeons may be able to provide patients with a fairly accurate prognosis regarding their recovery time and expectations after surgery using this technology, much like a prognostic crystal ball.

If you or someone you know is experiencing knee pain or discomfort, please contact us to set up a consultation.