Monday, March 6, 2017

What’s a PCL Injury and How Is It Treated?



Because ACL tears are more common, PCL tears don't get as much attention - but that doesn't mean they aren't serious. In fact, PCL tears can be just as (if not more) debilitating as ACL tears. Here's everything you need to know:

Related Knee Anatomy and Terms

The knee is made up of four ligaments that stabilize and protect the knee. The collateral ligaments (MCL and LCL) are found on the outside of the knee. And the cruciate ligaments (ACL and PCL) are found on the inside.



Illustration 1- PCL related anatomy

Cruciate Ligaments

·      Anterior cruciate ligament (ACL)
·      Posterior cruciate ligament (PCL)

The PCL is the strongest knee ligament and it’s job is to prevent the shinbone from displacing posteriorly (moving too far back).

PCL Injuries: Causes and Diagnoses

PCL injuries most commonly occur due to:

·      Car accidents
·      Sports collisions
·      A direct blow to the knee

Injuries to the PCL can be mild or severe and are classified into three grades:

·      Grade 1 refer to a slightly stretched ligament
·      Grade 2 refer to a partially torn ligament
·      Grade 3 refer to a completely torn ligament

Grades 1 and 2 sprains are treated non-operatively so long as there as no other damage to the surrounding ligaments or tendons in the knee.

Non-Operative Treatment

Commonly prescribed non-surgical treatment options are:

1.    Immobilization. A knee brace keeps the knee stable while the sprained ligament heals. After a few weeks, the knee is healthy and the patient can return to normal activities.

2.    Physical Therapy. Exercises help strengthen and stretch the ligaments and muscles of the knee so that it functions properly and is protected.

3.    NSAIDs. Anti-inflammatory medications help reduce pain and expedite the healing process.

In most cases, patients who respond well to non-operative treatment recover quickly.

Operative Treatment

When the injury is classified as Grade 3, the torn PCL can be repaired using arthroscopic surgery. During the procedure, the orthopedic surgeon detaches the damaged ligament and replaces it with a ligament graft, that’s taken from the patient's hamstrings or from those of a cadaver.  The goal of this procedure is to stabilize the knee joint and return the PCL to its normal anatomical position in the knee.



Illustration 2- Arthroscopic surgery is used to repair a torn PCL

Recovery

Patients are usually allowed to go home the same day as this surgery. After a week or two of rest, physical therapy can begin. Under the guidance of a physical therapist and the operating surgeon, patients can expect to fully recover anywhere between 8-12 months.

Contacting an Orthopedic Specialist


You now know some of the signs associated with a PCL tear. If any of them sound familiar, you should be seen by an orthopedic surgeon. At Advanced Bone & Joint in St. Peters and O'Fallon, our team of Orthopedic and Sports Medicine Specialists can create a unique plan for you based on your specific injury, lifestyle and goals. Give us a call and we’ll get you an appointment ASAP.

Did I Tear My ACL? Signs and Symptoms of an ACL Tear


For any athlete, the thought of having an ACL tear is scary as it can limit your ability to compete at a high level.  In many cases, a sudden injury to the knee may leave many athletes unsure of the severity of their injury.  But, determining if your ACL is torn is relatively easy - if you know what to look for.

The following are sure-fire signs that your ACL is torn:

1.   A loud pop. The pop occurs because the ACL is a very taught tendon and when it experiences the strain that causes it to tear, it is similar to a rope or rubber band snapping. The noise surprises patients and can even be heard by bystanders.

2.     Pain. Pain occurs immediately after the pop. The back and lateral (outside) portion of the knee are the most painful areas. Any type of bending, moving, or twisting makes the pain worse.

3.     Swelling. Because the knee joint—which holds fluid and blood—is damaged, a large amount of swelling is seen immediately after the tear.

4.     Instability. The ACL is critical for knee stability. When it’s torn, patients can bear little to no weight on the injured knee without it feeling unstable.

5.     Weakness. Instability causes weakness because the muscles aren’t able to work together to provide functional movement.

6.     Buckling. A knee that buckles (or gives out) may have a torn ACL and/or another ligament of the knee.

Diagnosing a Torn ACL

An orthopedic surgeon is the most qualified medical professional to diagnose and treat an ACL tear. Their initial evaluation will include taking a detailed history and examining the knee. They will take X-rays and an MRI to confirm their diagnosis. If it's a tear, surgery will be necessary.

Surgical Repair of a Torn ACL

Surgery involves replacing or repairing the torn ACL with tendons from the hamstring muscles or tendons from the undamaged portion of the knee, known as the patellar tendons.  These tendons are used to recreate the original ACL tendon and are often anchored to the knee to increase stability.

The out-patient procedure usually takes about 60-90 minutes. Physical Therapy is prescribed following surgery and a full recovery can be expected after about 6-8 months.

Contacting an Orthopedic Surgeon

You now know some of the signs associated with an ACL tear. If any of them sound familiar, you should be seen by an orthopedic surgeon. At Advanced Bone & Joint in St. Peters and O'Fallon, our team of Orthopedic and Sports Medicine Specialists can create a unique plan for you based on your specific injury, lifestyle and goals. Give us a call and we’ll get you an appointment ASAP.


Is There Really Such a Thing as Golfer’s Elbow?



It sounds crazy, but Golfer’s Elbow is a real injury. And, contrary to popular belief, it’s different than its well-known sibling, tennis elbow.  Here’s everything you need to know:

Causes of Golfer’s Elbow

Golfer’s elbow develops when impact swinging motions (i.e. hitting a golf ball or nail) are repeated over and over. Because the strong muscles and tendons of the forearm—that insert on the medial (middle) part of the elbow—are flexed throughout a swing, they experience a tremendous amount force upon impact. When the tendons reach the point where they are inflamed and produce pain, the condition is referred to as Golfer’s Elbow.


Illustration 1- Golfer's elbow refers to the irritation of the tendons that attach to the medial (middle) part of the elbow

It’s important to know that the term Golfer’s Elbow is a bit misleading as the condition is seen across multiple patient populations. Some of the most common are:

  • ·      Construction workers
  • ·      Carpenters
  • ·      Baseball players
  • ·      Throwing athletes
  • ·      People who work at a computer workstation


Over 200,000 cases of Golfer’s Elbow are reported annually among these (and similar) groups of people.


Illustration 2- Golfer's elbow doesn’t just affect golfers

Symptoms of Golfer’s Elbow

The most common symptoms are:

  • ·      Pain
  • ·      Tenderness
  • ·      Weakness
  • ·      Stiffness


The arms, forearms, wrist, hand, and fingers can exhibit any or any combination of these symptoms. Especially when the following movements are executed:

  • 1.     Rotating the palm downward
  • 2.     Rotating the wrist towards the body (pronation)
  • 3.     Rotating the forearm towards the body (pronation)


Symptoms are particularly problematic when these movements occur against resistance.

Golfer’s Elbow Treatments

The first (and easiest) way to treat golfer’s elbow is ice.

If ice alone isn’t enough to get the job done, rest is recommended.

If the symptoms continue to persist after adequate rest, an appointment with an orthopedic specialist should be made. Some of the treatment options they might prescribe are: 
  • 1.     Physical therapy
  • 2.     Anti-inflammatory medication
  • 3.     A steroid injection



In most cases, symptoms are relieved once these treatment measures are taken. The key is choosing the right orthopedic specialist. If you’re suffering from golfer’s elbow, please give us a call to make an appointment. We’ll get you back to work, or on the course, as soon as possible.