Tuesday, February 28, 2017

Does a Torn Meniscus Always Require Surgery?



“I tore my meniscus so I am probably going to need surgery”—it’s a common thought.  But, it’s also a misconception.

Non-operative treatment of meniscus tears exists and can be effective. An orthopedic surgeon’s treatment recommendation depends on a variety of factors.

How to Determine if a Torn Meniscus Can Be Treated Without Surgery

There are three things to look for:

1.     Blood supply. The meniscus is classified into two zones, the red zone and white zone.  A torn meniscus that has sufficient blood supply (red zone) can often heal without surgery. But, a torn meniscus with a poor blood supply (white zone) often requires surgical repair.
2.     Knee stability. If there is no ligament damage and the knee is stable, the tear can often heal and normal function can be maintained.
3.     Symptoms. Patients who suffer a tear but experience little to no symptoms should be treated non-operatively.

Once an orthopedic surgeon has made their diagnosis, a treatment plan can be put into place.

Non-Operative Treatment of a Torn Meniscus

The first step in treatment is to reduce pain and swelling and this only takes a few days. Then, physical therapy is prescribed with the goal being to strengthen the ligaments and muscles of the knee so the joint maintains stability and function. Depending on the severity of injury and symptoms, therapy can be short (2-3 weeks) or long-term (6-8 months).


Surgical Procedures for Meniscus Tears

As mentioned above, the meniscus is divided into the red zone and the white zone.  The type of procedure recommended is based on where the tear has occurred.

A Tear in the Red Zone
The Red Zone is the outer edge of the meniscus that does have some blood supply. Due to this blood supply, the healing potential is usually much greater and the cartilage can become strong and healthy again.

The most common procedure to treat the Red Zone tears is a Meniscus Repair. This procedure involves using a small puncture to access the meniscus. Once the incision is made, a small camera (arthroscope) is inserted into the knee and small surgical tools are used to stitch the meniscus back to its original position.

A Tear in the White Zone
The White Zone is the inner 2/3 of the meniscus that is avascular, meaning it has no direct blood supply. For this reason, tears in this area not stitched back together because they will not heal.

If surgery is needed for a tear in the White Zone, a procedure known as an Arthroscopic Meniscectomy is performed. This procedure involves using a small puncture to access the meniscus. Once the incision is made, a small camera (arthroscope) is inserted into the knee and the torn portions of the meniscus are trimmed. These torn pieces of meniscus have exposed nerve endings and will often cause the pain and inflammation associated with a meniscus tear.


 How to Determine If the Meniscus Has Healed

The meniscus has healed if the knee is stable and 
· No symptoms are present
· An MRI is negative
· An orthopedic surgeon’s physical exam is negative

Once cleared, patients can return to normal activities, including sports.

Contacting an Orthopedic Surgeon


Sometimes, surgery isn't needed, but the only one who can tell is an orthopedic surgeon. Please give us a call to schedule an appointment. One of our specialists will provide you with everything you need to know.

At Advanced Bone and Joint our Orthopedic and Sports Medicine physicians are experts in treating injuries of the bones, joints and soft tissue - including the meniscus.  Contact us today to learn more!


Friday, February 10, 2017

The 3 Most Common Symptoms of a Torn Ankle Ligament (And What You Can Do About Them)


Almost all of us at some point in our lives have missed a stair, slipped on ice or just rolled our ankle and felt the pain of a sprained ankle.  When the ankle is over rotated, the ligaments of the ankle can become stretched which is what causes the pain and swelling associated with an ankle sprain.  However, many people are unsure of the severity of the sprain and if their has been damage to the ligament.  Therefore, it is very important to understand that a sprained ligament and a torn ligament are not the same thing.

Sprained ligaments are ligaments that have been abnormally stretched. Ankle sprains classified as mild to moderate indicate sprained ligaments.

Torn ligaments are those that have been partially or fully torn. It’s confusing, but ankle sprains that are classified as moderate to severe indicate that ligaments have been torn—a serious injury.

The three most common signs of torn ligaments are:

1.     Pain. The first symptom is pain immediately following the injury. The amount of pain alone is not always enough to diagnose a tear, but it’s a clear-cut sign that a tear might have occurred. If a person has experienced an ankle injury in the past, they can compare pain levels to get a feel for how severe their current injury is.

2.     Swelling and bruising. Because the foot and ankle bear most of the body’s weight, swelling and bruising always occur following an injury. The degree to which swelling and bruising occur depends on the individual and severity of the injury.

3.     Instability. A surefire way to tell if a ligament has been torn is to assess the degree of instability. Severe lack of stability, balance, and ability to bear weight are often signs that a ligament has been torn.

If you have any of the symptoms above, it is best to seek the expertise of an orthopedic specialist to determine the severity of the injury develop an appropriate treatment plan.   In most cases, these injuries can be managed with rest and the use of a temporary brace.  When these injuries are not treated properly, they can lead to further damage to the ligament and possibly require surgical correction.


At Advanced Bone and Joint, Dr. Anthony Lombardo leads our Foot and Ankle Team.  Dr. Lombardo is board certified by the American Board of Podiatric Surgery and is a fellow of the American College of Foot and Ankle Surgeons. He has over 20 years of experience in treating all forms of foot and ankle conditions and has offices in both St. Peters and O'Fallon.

What Are Vertebral Compression Fractures and How Are They Treated?


As we age, back pain can be attributed to many different causes.  One of the most common, and painful, is what are known as “vertebral compression fractures”.    Although the cause for these compression fractures is not limited to aging, it is most common in those 60 and over.  These fractures occur as the vertebrae weaken over time through osteoporosis or other bone related conditions.

When the vertebrae are weakened, even the act of sneezing and coughing can be enough to create small hairline fractures in the spinal column.  Because these compression fractures will typically occur on the front side of the vertebra, it can cause you to lose height and/or develop a hunched back, otherwise known as kyphosis.  As the vertebrae become weaker they are no longer able to provide a normal level of stability to the spine and this can eventually lead to the collapse of one or more vertebrae.   

In many cases, the symptoms begin as a simple backache, however, the pain can become more severe and limit the ability to carry out normal daily activities such as cooking or showering.  Initially your health care provider may have you try more conservative treatment such as rest, pain medication, or bracing.  Often times these treatments do not provide pain control, allow for return of normal function, or are associated with significant side effects (nausea, vomiting, grogginess, increased risk of falling).  Left to heal on their own, most people will experience a moderate level of pain or discomfort for several months.

Kyphoplasty - a simple, minimally invasive surgical option - can be considered if the conservative care is not relieving the pain.   This 30-60 minute procedure works to stabilize the fracture and reduce pain.  A small needle is advanced into the fracture, guided by x-ray.  Medical cement is then injected and once this hardens it keeps the fractured bones from shifting and causing pain.  No incision is necessary and most often pain relief is immediate.  The procedure can be completed in ambulatory or outpatient setting without need for general anesthesia or admission to the hospital.

I have completed hundreds of these procedures with excellent results.  I also work with each patient to decide on what treatments are best for them.  Every patient and fracture is unique and it should be handled that way. 

If interested in further discussing non-surgical back care, please contact me for an appointment at 636.441.3444.


Pain Management Physician