Considering Hip Surgery?

Surgery involving the hips is often necessary to restore mobility as well as alleviate pain. Hip surgery can correct a physical defect or repair damage sustained in an accident. There are several different types of hip surgery that are common today, ranging from hip repair to full hip replacement.

Some forms of hip surgery are aimed at repairing fractures somewhere on the femur. Hip pinning and hip fixation are two examples. Screws are inserted to mobilize the fracture and facilitate the healing process.

Hip fractures usually occur from a fall or from a direct blow to the side of the hip. Some medical conditions such as osteoporosis, cancer, or stress injuries can weaken the bone and make the hip more susceptible to breaking.

Hip arthroscopy may be performed before any major hip surgery. Arthroscopy is a surgical procedure that gives doctors a clear view of the inside of a joint. This helps surgeons diagnose and even treat joint problems with minimally invasive surgical techniques.

During hip arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your hip joint. The camera displays pictures on a television screen, and your surgeon uses these images to guide miniature surgical instruments.

When it comes to arthroplasty procedures for the hip, there are a few major varieties that are currently employed. These procedures can range from a partial replacement, or “hemi-arthroplasty,” to a full replacement, called a “total hip” arthroplasty.

Hip arthroscopy has emerged as an alternative to more invasive hip replacement surgeries. Hip arthroscopy has been a special focus of my practice for the past five years.

Total hip replacement may be an option if your hip pain interferes with daily activities and more conservative treatments haven’t helped. Arthritis damage is the most common reason to need hip replacement.

If you have exhausted all non-invasive treatments to alleviate your hip pain, consult with an orthopedic surgeon on procedures that may be right for you. As with any surgery, consulting an orthopedic physician experienced in hip surgery procedures will result in the most successful outcome. Physical therapy following surgery will help you return to your optimal level of functionality, and your fastest return to normal activities.

Orthopedic & Hip and Knee Reconstructive Surgery

Orthopedic Reconstructive Surgery

The most successful orthopedic reconstructive surgical outcomes combine the best of modern medicine with a compassionate and personalized approach.

Whether you’re dealing with arthritic pain or suffering from an injury, you deserve the best orthopedic care personally delivered by a skilled surgeon that you trust.

Whether searching for a solution for inflammatory arthritis or osteoarthritis; cartilage or ligament problems; revision surgery, minimally invasive surgery, partial joint replacement surgery, or total joint replacement surgery, you should select an experienced orthopedic surgeon who will work diligently and compassionately to address your needs and lead you step by step from diagnosis and treatment to rehabilitation and wellness.

Hip and Knee Reconstructive Surgery

Hip arthroscopy has emerged as an alternative to more invasive hip replacement surgeries. While technically challenging, hip arthroscopy can help to relieve the pain that results from injury or chronic conditions of the soft tissue surrounding the hip joint.

As one of the few orthopedic surgeons in Monmouth County who regularly performs hip arthroscopy, this procedure is proven to bring pain relief to patients who previously would have required more extensive procedures.  Hip arthroscopy has been a special focus of my practice for the past five years.

The knee is the largest joint in the body and one of the easiest to injure, making it the most often treated joint by orthopedic surgeons.

An orthopedist can use arthroscopy to take a direct look at the inside of your knee joint and determine what kind of repair is required. When used to treat ligament and meniscal tears and other types of serious knee injuries, arthroscopy decreases postoperative pain, risk of complications and recovery time.

You and your doctor may consider knee replacement surgery if you have a stiff, painful knee that makes it difficult to perform even the simplest of activities and other treatments are no longer working.

Minimally invasive surgery has revolutionized knee replacement surgery, requiring a much smaller incision, just 3 to 5 inches, versus the standard approach and long incision. This less invasive approaches results in less pain, decreased recovery time and better motion due to less scar tissue formation.

The vast majority of people who undergo knee joint replacement surgery enjoy dramatic improvement. Once muscle strength is restored through physical therapy, knee joint replacement patients can often return to many activities that were previously restricted due to pain and decreased range of motion.

You are a person with distinctive needs and concerns. Choose an experienced orthopedic surgeon who can answer your questions and address your medical and surgical needs as well as provide resources and support to help you maximize your everyday activities.

Types of Orthopedic Surgery

There are many types of joint reconstruction and replacement surgery. Some of the most common surgical procedures are explained here.

Total joint replacement
Total joint replacement is a surgical procedure in which certain parts of an arthritic or damaged joint, such as a knee joint, are removed and replaced with an artificial joint that moves like a healthy joint.

Total knee replacement
If you have very severe arthritis, for example, total knee replacement surgery may be an option. When knee replacement surgery is performed, the cartilage of the knee joint is replaced with an implant.

Total hip replacement
This procedure involves removing the ball and socket of a joint with arthritis and inserting a new ball and socket to allow movement at the new joint.

Total shoulder replacement
This procedure involves replacing damaged bone and cartilage with an implant to improve range of motion at the shoulder joint.

Rotator cuff repair
The rotator cuff helps keep your shoulder anchored and helps it to move. A tear in the cuff can limit your range of motion and cause pain. These tears can be repaired with surgery to relieve pain and improve strength and functioning of the shoulder.

Arthroscopic surgery
Arthroscopy is a method of viewing or performing surgery on a joint by use of an arthroscope, which consists of a very small tube, a lens, and a light source using fiber optics to visualize the surgical area. Orthopedic surgeons perform shoulder, knee and other repairs with arthroscopy. The incision made for inserting the arthroscope is very small, and fewer stitches may be required. The advantage to arthroscopy is a smaller incision heals more quickly and there is less trauma to tissue.

Spine surgery
A variety of problems may lead to spine surgery. There are a number of procedures that can be performed to improve function and remove back pain, and these procedures are done if more conservative treatment, such as medication or physical therapy, don’t work. These include such common procedures as laminectomy, diskectomy, fusion, and spinal decompressions. Kyphoplasty is a less-invasive technique for the pain of spinal fractures often caused by osteoporosis.

Ankle surgery
A variety of problems with the ankles and wrists require surgical treatment. Overuse injuries, rheumatoid arthritis, stress fractures and sprains can often be treated with surgery if more conservative treatment fails.

ACL reconstruction
The anterior cruciate ligament (ACL) is the major stabilizing ligament of the knee. When it ruptures, reconstruction can be performed in a number of ways, including state-of-the-art tendon grafts.

Partial Joint Reconstruction Is an Option for Knee, Hip and Shoulder Pain

Joints refer to the areas on our body where two or more bones meet. While we have different kinds of joints, the ones more commonly used and more easily damaged are the weight-bearing joints, such as the hips and knees. Less commonly, non-weight bearing joints, such as the shoulder, are damaged. Through overuse and aging, these joints may become weak and painful. Joint disorders such as arthritis cause pain and limit our daily activities.

Reconstructive partial joint replacement, or hemi-arthroplasty, offers relief for many people through safe and minimally invasive procedures when performed by a skilled orthopedic surgeon. Many people who have ongoing pain or loss of function in a joint may be a candidate for partial joint replacement surgery.

Hips and knees, the largest joints on the human body, bear a tremendous toll over the years from wear and tear, chronic disease such as arthritis, and traumatic injury. When joints are damaged, the resulting pain can disrupt sleep, reduce mobility, and affect all aspects of daily life.

If you suffer from hip or knee pain, rest assured you are far from being alone. Each year six million Americans seek medical help for painful knees. This translates into 2.5 percent of the U.S. population seeking orthopedic specialists for relief of knee pain. It’s estimated that about 32 million Americans visit their physician for some form of arthritis. Non-surgical intervention is the first line of treatment, with medications, therapy and injections. Surgery is reserved for those patients who do not respond to more conservative measures.

Thankfully, partial knee reconstruction and partial hip reconstruction have become very reliable procedures as orthopedic surgeons continue to revise and improve upon these minimally-invasive techniques. And, most of today’s artificial joints can be expected to last at least 15 years, and some longer than 20 years.

Partial knee reconstruction may be possible for patients with damage to one part of the joint. The knee has three distinct compartments, which can be treated separately. Doctors refer to this limited reconstruction as a unicompartmental knee replacement. In a partial or unicompartmental knee replacement, only the diseased parts of the knee are removed and replaced; the healthy portions are left untouched. Successful partial knee replacements can delay or eliminate the need for a total knee replacement. They also allow a greater range of movement than standard total knee replacements, and they are often performed as an outpatient procedure returning the patient home on the same day.

Partial hip reconstruction is an alternative to total hip replacement, and is usually reserved for the elderly patient with a particular type of hip fracture.

Although partial shoulder joint reconstruction is less common than partial knee or partial hip replacement, it is successful in relieving joint pain and is usually used to treat osteoarthritis, and is commonly performed on an outpatient basis.

The benefits of partial joint reconstruction surgery include smaller incisions, a shorter hospital stay, less bleeding, reduced risk of infection and other complications, and faster recovery and rehabilitation.

When searching for the right orthopedic surgeon, ask friends and family for referrals and always consult an orthopedic surgeon with extensive experience performing the reconstruction your condition requires.

Partial Knee Replacement Can Help Relieve Arthritis Pain

Over the course of their lifetimes, approximately one in five Americans will develop knee arthritis. Fortunately, a wide range of nonsurgical and surgical techniques are available to address the discomfort and disability that can accompany this condition.

Partial knee replacement is a reconstructive surgical treatment option that replaces (or resurfaces) only the damaged portion of the knee, while conserving knee ligaments and unaffected cartilage. Over the past 15 years, improvements in minimally-invasive surgical techniques and instrumentation have made partial knee replacement a viable option for a growing number of patients.

Patients with unicompartmental knee arthritis have cartilage degeneration in only one section or compartment of the knee. In cases where nonsurgical techniques do not provide sufficient symptom relief, surgeons can remove damaged cartilage and bone in the diseased area only, while preserving the ligaments that help support the knee joint.

A prosthesis—which may also be called an implant—takes the place of the damaged area of the knee, leaving the other compartments intact.

During partial knee replacement, the orthopedic surgeon makes a small incision to gain access to the affected compartment of the knee and then gently moves supporting structures of the knee out of the way. Damaged cartilage and bone tissue are removed from the surfaces of the tibia and the femur in the arthritic area. The surgeon then prepares these surfaces for insertion of the prosthesis components which are specifically sized to the patient’s joint. Cement is used to secure these components. All surrounding structures and tissues are restored to their anatomic position and the incision is closed.

Partial knee replacement is usually performed as an outpatient procedure in a surgical center with no overnight stay. Most patients are able to walk with assistance, or independently, on the same day as their surgery. Typically, the patient is given a cane within a week of surgery to allow for increased independence and begins outpatient rehabilitation. Medication helps manage post-surgical pain.

Partial knee replacement usually involves minimal blood loss and a low rate of complications. Most patients can expect to be back to their daily activities within three to six weeks. Many patients find that after undergoing physical rehabilitation, they are able to return to sports such as golf or bike riding within six to ten weeks.

There are no age restrictions for partial knee replacement, but in general, partial knee replacements are typically appropriate for patients over 40 years old and less than 60 but each case is evaluated according to the needs and activity of the patient. Partial knee replacement is generally restricted to patients who are not morbidly obese. Patients with rheumatoid arthritis are not candidates for partial knee solutions since inflammatory-type arthritis typically involves the entire joint. Also patient age is typically over forty and less than 60 but each case is evaluated according to the needs and activity of the patient.

Your orthopedic surgeon will perform diagnostic tests and determine with you whether partial knee replacement is your best treatment option.

Partial knee reconstruction is widely recognized as a technically demanding surgery. Choosing an orthopedic surgeon with extensive experience with this procedure will help to ensure the best possible outcome.

Shoulder Joint Replacement Surgery

Shoulder Joint Replacement Surgery
Although shoulder joint replacement is less common than knee or hip replacement, it is just as successful in relieving joint pain.

If nonsurgical or minimally invasive treatments are no longer helpful for relieving pain, you may want to talk with an orthopedic surgeon about shoulder joint replacement surgery.

Shoulder Anatomy
Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The shoulder is a ball-and-socket joint. The ball, or head, of your upper arm bone fits into a shallow socket in your shoulder blade. This socket is called the glenoid.

The surfaces of the bones where they touch are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily. A thin, smooth tissue called synovial membrane covers all remaining surfaces inside the shoulder joint. In a healthy shoulder, this membrane releases a small amount of fluid that lubricates the cartilage and eliminates almost any friction in your shoulder.

The muscles and tendons that surround the shoulder provide stability and support.

All of these structures allow the shoulder to rotate through a greater range of motion than any other joint in the body.

Shoulder Joint Replacement
In shoulder joint replacement surgery, the damaged parts of the shoulder are removed and replaced with artificial components, called a prosthesis. The treatment options are either replacement of just the head of the humerus bone (ball), or replacement of both the ball and the socket (glenoid).

Several conditions can cause shoulder pain and disability, and lead patients to consider shoulder joint replacement surgery.

Osteoarthritis (Degenerative Joint Disease)
This age-related “wear and tear” type of arthritis usually occurs in people over age 50 years, but occasionally in younger individuals. The cartilage that cushions the bones of the shoulder softens and wears away. The bones then rub against one another. Over time, the shoulder joint slowly becomes stiff and painful.

Rheumatoid Arthritis
This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation eventually causes cartilage loss, pain, and stiffness.

Post-traumatic Arthritis
This can follow a serious shoulder injury. Fractures of the bones that make up the shoulder or tears of the shoulder tendons or ligaments may damage the articular cartilage over time, causing shoulder pain and limiting shoulder function.

Rotator Cuff Tear Arthropathy
A patient with a very large, long-standing rotator cuff tear may develop cuff tear arthropathy. In this condition, the changes in the shoulder joint due to the rotator cuff tear may lead to arthritis and destruction of the joint cartilage.

Avascular Necrosis (Osteonecrosis)
Avascular necrosis is a painful condition that occurs when the blood supply to the bone is disrupted. Because bone cells die without a blood supply, osteonecrosis can ultimately cause destruction of the shoulder joint and lead to arthritis. Chronic steroid use, deep sea diving, severe fracture of the shoulder, sickle cell disease, and heavy alcohol use are risk factors for avascular necrosis.

Severe Fractures
A severe fracture of the shoulder is a common reason people have shoulder replacements. When the head of the upper arm bone is shattered, it may be very difficult for a doctor to put the pieces of bone back in place. In addition, the blood supply to the bone pieces can be interrupted. In this case, an orthopedic surgeon may recommend a shoulder replacement. Failed Previous Shoulder Replacement Surgery
Although uncommon, some shoulder replacements fail, most often because of implant loosening, wear, infection, and dislocation. When this occurs, a second joint replacement surgery — called a revision surgery — may be necessary.

People who benefit from surgery often have:
• Severe shoulder pain that interferes with everyday activities.
• Moderate to severe pain that prevents a good night’s sleep.
• Loss of motion and/or weakness in the shoulder.
• Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, minimally invasive surgery or physical therapy.

Orthopaedic Evaluation
An evaluation with an orthopedic surgeon consists of several components, including:
• A medical history.
• A physical examination.
• Blood tests.
• X-rays.
• Magnetic Resonance Imaging (MRI)

Your orthopedic surgeon will review the results of your evaluation with you and discuss whether shoulder joint replacement is the best method to relieve your pain and improve your function. Other treatment options — including medications, injections, physical therapy or minimally invasive surgery— will also be discussed and considered.

There are different types of shoulder replacements. Your orthopedic surgeon will evaluate your situation carefully and discuss with you which type of replacement would best meet your health needs. Do not hesitate to ask what type of implant will be used in your situation, and why that choice is right for you.

Many thousands of patients have experienced an improved quality of life after shoulder joint replacement surgery. They experience less pain, improved motion and strength, and better function.

Knee Microfracture Surgery

Knee Microfracture Surgery
Microfracture surgery of the knee is an articular cartilage repair surgical technique that works by creating tiny fractures in the underlying bone. This causes new cartilage to develop from a so-called super-clot.

Microfracture surgery has gained popularity in sports in recent years; numerous professional athletes including members of the NBA (most notably Andrew Bogut, Anfernee Hardaway, Jason Kidd, Greg Oden, Allan Houston, Kenyon Martin, Tracy McGrady, Chris Webber and Amar’e Stoudemire, MLB (Jeff Clement), Matt Kemp, Derek Holland, NFL and NHL players have undergone the procedure.

The microfracture procedure uses the body’s own healing abilities and provides an enriched environment for tissue regeneration of chondral defects, which are damaged areas of articular cartilage of the knee. The surgery is quick – typically lasting between 30–90 minutes – minimally invasive, and can have a significantly shorter recovery time than an arthroplasty (knee replacement).

The Surgical Procedure: Microfracture
The microfracture procedure is done arthroscopically. An orthopedic surgeon visually assesses the defect and performs the procedure using special instruments that are inserted through three small incisions on the knee.

After assessing the cartilage damage, any unstable cartilage is removed from the exposed bone. The surrounding rim of remaining articular cartilage is also checked for loose or marginally attached cartilage. This loose cartilage is also removed so that there is a stable edge of cartilage surrounding the defect. This process of thoroughly cleaning and preparing the defect results in optimum surgical outcomes.

Multiple holes, or microfractures, are then made in the exposed bone about 3 to 4mm apart. Bone marrow cells and blood from the holes combine to form a “super clot” that completely covers the damaged area. This marrow-rich clot is the basis for the new tissue formation.

The microfracture technique produces a rough bone surface that the clot adheres to more easily. This clot eventually matures into firm repair tissue that becomes smooth and durable. Since this maturing process is gradual, it usually takes two to six months after the procedure for the patient to experience improvement in the pain and function of the knee. Improvement is likely to continue for about 2 to 3 years.

Following rehabilitation and physical therapy, which begin immediately after the microfracture procedure, most patients return to normal activities after 6 to 8 weeks. Athletes can resume sports that involve pivoting, cutting, and jumping approximately 4 to 6 months after a microfracture procedure.

What are the signs and symptoms of an articular cartilage injury that may be treated with the microfracture technique?

  • Intermittent swelling – Loose fragments floating in the knee can cause swelling to occur.
  • Pain – Pain with prolonged walking or climbing stairs.
  • Giving way – The knee may occasionally buckle or give way when weight is placed upon it.
  • Locking or catching – Loose, floating pieces of cartilage may catch in the joint as it bends, causing the knee to lock or have limited motion.
  • Noise – The knee may make noise (called crepitus) during motion, especially if the cartilage on the back of the kneecap is damaged. This noise is often described as “snap, crackle, and pop”.

Knee Injuries and Treatments

The knee is the body’s largest joint. Its complexity makes it vulnerable to a variety of injuries.

The knee is made up of the lower end of the thighbone (femur), which rotates on the upper end of the shinbone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur.

The knee contains large ligaments which connect bones and brace the joint against abnormal types of motion. The meniscus is a wedge of soft cartilage between the femur and tibia that cushions the knee and helps it absorb shocks.

Torn ligaments and cartilage are common knee injuries. Runners, cyclists, swimmers, step aerobics devotees, and football, basketball and volleyball players commonly fall victim to other knee injuries, including a variety of aches and pains related to the kneecap.

Orthopaedic surgeons use a variety of methods to treat the knee. Most treatment begins with R.I.C.E. – rest, ice, compression, and elevation.

Seek attention from an orthopedic surgeon if pain continues, especially if you:
• Hear a popping noise and feel your knee give out at the time of injury
• Have severe pain
• Cannot move the knee
• Begin limping
• Have swelling at the injury site

Many knee injuries can be successfully treated without surgery, while others require surgery to correct.

Knee Arthroscopy
When necessary, an orthopedist will perform arthroscopy, a type of surgery that takes a direct look at the inside of your knee joint.

The orthopedist makes a small opening in the knee and inserts an arthroscope, a tiny tube-like tool, into the joint. The arthroscope contains a lighted video camera at one end and is wired to a monitor that the surgeon watches while moving the scope to pinpoint the injury, often repairing the injury during the same procedure.

When used to treat ligament and meniscal tears and other types of serious knee injuries, arthroscopy decreases postoperative pain, risk of complications and recovery time.

Knee Replacement Surgery
You and your doctor may consider knee replacement surgery if you have a stiff, painful knee that makes it difficult to perform even the simplest of activities and other treatments are no longer working.

Minimally invasive surgery has revolutionized knee replacement surgery, requiring a much smaller incision, just 3 to 5 inches, versus the standard approach and incision. This less invasive approaches results in less pain, decreased recovery time and better motion due to less scar tissue formation.

The vast majority of people who undergo knee joint replacement surgery enjoy dramatic improvement. Once muscle strength is restored through physical therapy, knee joint replacement patients can often return to many activities that were previously restricted due to pain and decreased range of motion.

Knee surgical procedures have undergone a dramatic evolution in the last decade. Always seek an experienced orthopedic surgeon and together, determine the best treatment for your knee injuries and chronic conditions.

Think Spring, Think Injury Avoidance

At this time of year, many individual can’t wait to leap into spring, getting back to the gym to drop some winter weight, or onto the golf course or other playing field. Proceed with caution! Sports injuries can be caused by poor training practices, improper gear and not warming up or stretching enough. People often get hurt because they are not in shape and take on too much, too soon.

The most common sports injuries are:

  • Achilles tendon injuries
  • ACL tears
  • Dislocations
  • Fractures
  • Knee injuries
  • Pain along the shin bone
  • Rotator cuff injuries
  • Sprains and strains
  • Stress fractures
  • Swollen muscles
  • Tennis elbow

If you do get injured, stop. Continuing to play or exercise can cause more harm. Treatment often begins with the RICE (Rest, Ice, Compression, and Elevation) method to relieve pain, reduce swelling, and speed healing. Other possible treatments include pain relievers, keeping the injured area from moving, rehabilitation, and sometimes surgery.

It’s important to know when to look further than your medicine cabinet to treat sports injuries. An orthopedic surgeon is a medical doctor or doctor of osteopathy with extensive training in keeping your bones, joints, ligaments, muscles, tendons, cartilage and spine in good working order. Together, all of these parts of our bodies make up our musculoskeletal system.

Orthopaedic surgeons have the greatest knowledge of and experience with the wide range of conditions and treatment options available in musculoskeletal care, many of which do not involve surgery. However, if surgery is the best option for recovery, an orthopedic surgeon is the best trained to provide that surgical treatment.

Orthopaedic surgeons use the most effective and efficient diagnostic tools and our experience in musculoskeletal treatment to determine the best care for our patients.

Initial treatment of an injury following the basic RICE formula may be all you need, but if your injury does not heal on its own and continues to be painful, swollen or stiff, you may need surgery.

Depending upon the type of injury, your age and other factors, your orthopedic surgeon may recommend minimally invasive surgery such as arthroscopy following by physical therapy to help you resume your normal activities. In other cases, more traditional surgical repair may be recommended by your orthopedic surgeon.

Sometimes preventing common sports injuries is beyond our control, but many times sports injuries are preventable. Working out regularly will help you to enjoy your sports activities safely and you’ll garner extra health benefits as well. If you feel your sports injury isn’t healing on its own, consult an experienced orthopedic surgeon to help you get well and back into the game as soon as possible.

Understanding ACL Reconstruction

In ACL reconstruction or repair, an orthopedic surgeon restores the function of the normal anterior cruciate (KROO-she-ate) ligament of the knee. This ligament is important in stabilizing the knee in athletics and day-to-day activities. The term ACL is an acronym for the anterior cruciate ligament, and easier to pronounce.

In ACL reconstruction or repair, an orthopedic surgeon restores the function of the normal anterior cruciate (KROO-she-ate) ligament of the knee. This ligament is important in stabilizing the knee in athletics and day-to-day activities. The term ACL is an acronym for the anterior cruciate ligament, and easier to pronounce.

Anterior (front) view of arthritic adult knee from below hip to lower leg showing the bones of leg ghosted within the skin including the femur, patella, tibia and fibula. Osteophytes (bumps) and torn articular surfaces and indicative of osteoarthritis of the knee.

Ligaments are strong bands of tissue that connect one bone to another. The ACL, one of two ligaments that cross in the middle of the knee, connects the thighbone (femur) to the shinbone (tibia) and helps stabilize the knee joint.

ACL injury most commonly occurs during sports that involve sudden stops and changes in direction — such as basketball, soccer, football and volleyball. ACL injuries typically occur in non-contact events on the sporting field. They can also be the result of workplace injuries and traumas such as motor vehicle accidents.

In the past, a torn ACL would mean the end of high level athletic activity for a prolonged period of time and possibly permanently. Today’s minimally invasive arthroscopic reconstruction followed by aggressive rehabilitation can restore the knee’s stability and function.

Not everyone who tears an ACL requires reconstruction. Sedentary people who forgo sports that involve a lot of quick stops and changes in direction usually recover well with conservative treatments and physical therapy. Bracing is also an option.

An orthopedic surgeon may recommend ACL reconstruction if:

  • You are an athlete and want to continue in your sport, especially if the sport involves jumping, cutting or pivoting
  • More than one ligament or the cartilage in your knee is injured
  • You are young and active
  • The injury is causing instability in your knee during activities of daily life, such as stair climbing

What to Expect During ACL Surgery

ACL reconstruction is performed on an outpatient basis under anesthesia. The ACL is replaced with a piece of tendon from another part of the leg or from a tissue bank.

Orthopedic surgeons use an arthroscope, a small fiber-optic viewing instrument made up of a tiny lens, a light source and video camera, to perform ACL repair.

The orthopedic surgeon creates a tiny 5mm puncture in the joint space of the knee – about 1/4 of an inch – called a portal. Additional small punctures are made for the insertion of surgical instruments. These punctures result in tiny scars, which become unnoticeable, providing direct access to most areas of the knee joint.

The orthopedic surgeon views the procedure on a large screen monitor as the graft is positioned and then secured with screws or other fixation devices.

In an acute injury, surgery is usually delayed until muscle strength and knee mobility has been improved with physical therapy. People who go into surgery with a stiff, swollen knee often have problems regaining full range of motion after surgery.

What to Expect After ACL Repair

The patient returns home on the day of surgery and immediately begins the rehab process. Before going home, patients practice walking with crutches. To reduce swelling and pain in the days immediately following surgery, the R.I.C.E. model of self-care is followed at home:

  • Rest. Use crutches to avoid weight bearing on the knee.
  • Ice. Applying ice for 20 minutes every two hours when awake will help reduce swelling and ease pain.
  • Compression. An elastic bandage or compression wrap keeps the knee immobile and supported.
  • Elevate. Elevating the leg to heart level reduces swelling and pain.

The orthopedic surgeon will also prescribe medication to help manage pain. Physical therapy strengthens the muscles around the knee and improves flexibility. Most patients can expect a return to full function within 6 to 9 months. Athletes can often return to their sports after 6 to 12 months.

Choosing an Orthopedic Surgeon for ACL Repair

To ensure the best possible outcome, it is important to choose a surgeon experienced performing minimally invasive ACL repair.

Good communications between patient and surgeon is critical. You should be comfortable asking your doctor questions, sharing your concerns, and feel that your surgeon takes the time to respond fully and completely. Together, you and your orthopedic surgeon can create the best plan of care to help return you to normal activities as soon as possible following ACL repair.