ACL

Knee Arthroscopy and Knee Arthroscopy Recovery

knee surgeryKnee arthroscopy is surgery that uses a tiny camera (arthroscope) to look inside your knee. Small cuts are made to insert the camera and small surgical tools into your knee for the procedure.

Your surgeon can use arthroscopy to feel, repair or remove damaged tissue. To do this, small surgical instruments are inserted through other incisions around your knee.

Preparation for Knee Arthroscopy:

Usually no significant pre operative testing is needed. Depending on your heath, your orthopaedic surgeon may order pre-operative tests. These may include blood counts, an EKG (electrocardiogram), and even a complete physical examination to assess your health and identify any problems that could interfere with your surgery.

Surgery for Knee Arthroscopy:

During the procedure, the orthopedic surgeon inserts the arthroscope (a small camera instrument about the size of a pencil) into your knee joint through a small incision in the knee. A sterile solution will be used to fill the knee joint and rinse away any cloudy fluid. This helps your surgeon see your knee clearly so that he may diagnose the problem and determine what treatment is needed.

Arthroscopy for the knee is most commonly used for:

  • Removal or repair of torn meniscal or articular cartilage
  • Reconstruction of a torn anterior cruciate ligament (ACL)
  • Removal of loose fragments of bone or cartilage
  • Removal of inflamed synovial tissue

After your procedure has concluded, a doctor will remove the instruments and close the incisions with a stitch.

Recovery from Knee Arthroscopy

Recovery from knee arthroscopy is much faster than traditional open knee surgery. You may have some slight swelling in the knee after surgery. Keep your leg elevated as much as possible for the first few days following surgery and ice your knee following the instructions given by your doctor. You may or may not be placed on crutches. Your surgeon will make that decision and discuss with you. Your surgeon will most likely prescribe physical therapy for 6-12 weeks, as well.

About Dr. John Xerogeanes

John Xerogeanes MD

John W. Xerogeanes, MD, Chief of Sports Medicine at Emory University, is known as Dr. “X” by his staff and patients. He is an Associate Professor of Orthopaedic Surgery at Emory University as well as an Adjunct Professor at Georgia State and Mercer University. Dr. X has been the Head Orthopaedist and Team Physician for Georgia Tech, Emory University, Agnes Scott College and the Atlanta Dream of the WNBA since 2001. He specializes in ACL and ACL revision surgery performing over 200 of these operations each year. He is board certified in orthopaedic surgery and has his sub-specialty certification in orthopaedic sports medicine.

Dr. Xerogeanes has been recognized as one of US News & World Report’s Top Doctors with a special distinction listing him among the top 1% in the nation in his specialty.

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Torn Meniscus and Torn Meniscus Surgery

Torn MeniscusWhen people talk about torn cartilage in the knee, they are usually referring to a torn meniscus. The meniscus is a rubbery, C-shaped disc that cushions your knee and acts as a shock absorber between your thighbone and shinbone. Each knee has two menisci, which help to keep your knee steady by balancing your weight across the knee.

Any person at any time can tear their meniscus, but athletes—particularly those who play contact sports—tend to be at a higher risk, the reason being that a meniscus tear is usually caused by twisting or turning quickly, often with the foot planted while the knee is bent. Players may squat and twist the knee, causing a tear.

As you get older, your meniscus gets worn which can make it tear more easily. Cartilage weakens and wears thin over time, increasing the likelihood of degenerative meniscal tears. One awkward twist when getting up from a chair may be enough to cause a tear, if the menisci have weakened with age.

Torn Meniscus Symptoms
Depending on the severity of the tear, symptoms will vary. Typically meniscal tears are categorized into three groups: minor, moderate and major tears. Generally, most people can still walk on their injured knee after a meniscal tear, but you may feel a “pop” when you tear a meniscus. Often athletes will keep playing with a tear, but over the course of two to three days the knee will likely become stiff and swollen.

Common symptoms of meniscal tears include the following:

  • Feeling a “pop” in the knee
  • Pain
  • Stiffness and swelling
  • Inability to move knee through full range of motion (such as not being able to straighten the knee)
  • Catching or locking of the knee
  • The sensation of the knee feeling “wobbly” or giving way without warning

In severe tears and those without proper treatment, a piece of meniscus may come loose and drift into the joint, causing your knee to slip, pop, or catch.

Torn Meniscus Diagnosis and Treatment
When diagnosing a meniscal tear, doctors will often perform what is known as a McMurray test. Your doctor will bend your knee, then straighten and rotate it. This puts tension on a torn meniscus. If you have a meniscal tear, this movement will cause a clicking sound. Your doctor may also order imaging tests such as an X-ray or MRI to confirm the meniscal tear.

How your doctor treats your meniscus tear depends on several things, such as the type of tear, where it is, and how serious it is. Your age and how active you are may also affect your treatment choices.

Common treatments include:

  • Rest
  • Ice
  • Physical therapy
  • Non-steroidal anti-inflammatory medicines (such as aspirin or ibuprofen)
  • Surgery

Surgical Treatment
Whenever possible, meniscus surgery is done using arthroscopy, rather than through a large cut in the knee. Knee arthroscopy is a commonly performed surgical procedure in which a miniature camera is inserted through a small incision to better view the knee. Your orthopaedic surgeon will then insert miniature surgical instruments through other small incisions to trim or repair the tear.

Depending on the tear, a variety of procedures can be done:

  • Meniscectomy. In this procedure, the damaged meniscal tissue is trimmed away (partial meniscectomy) or, in extreme cases, the entire meniscus will be removed (total meniscectomy). Total meniscectomy procedures are typically avoided because of the likelihood of causing osteoarthritis in the knee.
  • Meniscus repair. Some meniscal tears can be repaired by suturing (stitching) the torn pieces together.

It is preferable to preserve as much of the meniscus as possible. If the meniscus can be repaired successfully, saving the injured meniscus by doing a meniscal repair reduces the occurrence of knee joint degeneration compared with partial or total removal.

Recovery / Rehabilitation
How well the knee will heal depends on how bad the tear is. After surgery, your doctor may put your knee in a cast or brace to keep it from moving, and you may need to be on crutches for a period of time to keep weight off the knee. Your doctor will work with you on a rehabilitation program that helps you regain as much strength and flexibility as possible.

About Dr. Pombo

Mathew Pombo, MDMathew Pombo, MD, is a highly regarded orthopaedic surgeon, speaker, author and researcher who specializes in getting patients with injuries back to an active lifestyle. His professional interests include anatomic single and double bundle ACL reconstruction, rotator cuff tears, shoulder instability, meniscal/cartilage injury and repair, joint preservation in the aging athlete, and minimally invasive joint replacement surgery of the knee and shoulder. Dr. Pombo has conducted extensive scientific research, published multiple journal articles, written several book chapters, and has presented both at national and international meetings on topics related to sports medicine, concussions, and orthopaedic surgery. He is a member of several design teams for orthopaedic companies and enjoys participating in the engineering of the next generation of orthopaedic techniques and equipment. He has been instrumental in bringing awareness to Sports Related Concussions and the new Georgia “Return to Play” Act and is one of the top regarded experts in the area for the treatment of Concussions. He currently serves as the Director of the Emory Sports Concussion Program.

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Importance of Pre-Participation Sports Physicals for Student-Athletes

Children of all ages will benefit from participating in sports. Children can learn many life skills such as team work, time management, competition, conflict resolution as well help to improve social skills. While the benefits of exercising and participating in sports heavily outweigh the risks, it is very important to have every child undergo a pre – participation sports physical before beginning practice with that sport. Pre – participation exams are required for student-athletes who want to participate in middle school, high school or summer sports camps.

The pre-participation exam checks for the following:
• Identify any potential life-threatening conditions such as risk of sudden cardiac death.
• Evaluate athlete for conditions that may need treatment prior to participation.
• Identify any orthopedic conditions/concerns that may need physical therapy or other treatment prior to participation.
• Identify athletes who may be at higher risk for violence, substance abuse, STDs, depression, eating disorders, anemia, asthma, hypertension, etc.
• Evaluate history of concussion and determine if the student-athlete is still experiencing post-concussion symptoms if previously concussed.

Student athletes and their parents need to come to the physical prepared to open and honestly discuss all medical history. The doctors need all the information on the athlete’s medical history to be able to properly examine the athlete and clear him or her for participation in their sport or activity. This is not a time to try and hide past injuries or medical conditions.

Many schools perform pre- participation exams but if you would like a more thorough physical exam, visit your family’s personal physician or pediatrician. He or she may refer your child to a Sports Medicine specialists if he thinks the child needs further evaluation for orthopedic concerns or if the student has had a history of concussions.

Most student athletes are cleared for full participation in sports. Those who need more follow-up often times resume normal activities after ensuring they are cleared from all potential complications from participating in sports.

About Jeff Webb, MD

Jeff Webb, MD, is an assistant professor of orthopaedics at Emory Orthopaedics & Spine Center. Dr. Webb started practicing at Emory in 2008 after completing a Fellowship in Primary Care Sports Medicine at the American Sports Medicine Institute in Birmingham, Alabama. He is board certified in pediatrics and sports medicine. He is a team physician for the NFL’s Atlanta Falcons, and serves as the primary care sports medicine and concussion specialist for the team. He is also a consulting team physician for several Atlanta area high schools, the Atlanta Dekalb International Olympic Training Center, Emory University, Oglethorpe University, Georgia Perimeter College, and many other club sports.

Dr. Webb sees patients of all ages and abilities with musculoskeletal problems, but specializes in the care of pediatric and adolescent patients. He works hard to get players “back in the game” safely and as quickly as possible. He is currently active in the American Medical Society for Sports Medicine and American Academy of Pediatrics professional societies and has given multiple lectures at national conferences as well as contributed to sports medicine text books.

About Emory Sports Medicine

The Emory Sports Medicine Center is a leader in advanced treatments for patients with orthopedic and sports-related injuries. From surgical sports medicine expertise to innovative therapy and athletic injury rehabilitation, our sports medicine physicians and specialists provide the most comprehensive treatment for athletic injuries in Atlanta and the state of Georgia. Constantly conducting research and developing new techniques, Emory sports medicine specialists are experienced in diagnosing and treating the full spectrum of sports injuries.

Our sports medicine patients range from professional athletes to those who enjoy active lifestyles and want the best possible outcomes and recovery from sports injuries. Our doctors are the sports medicine team physicians for the Atlanta Falcons and Georgia Tech and provide services for many additional professional, collegiate and recreational teams. Appointments for surgical second opinions or acute sports injuries are available within 48 hours. Call 404-778-7777 for an appointment

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Are You a Runner Looking to Prepare for the AJC Peachtree Road Race?

The AJC Peachtree Road Race will be here before you know it! Whether you’re a beginning runner and wondering how to get started, or a seasoned pro and have been running for years, there always new things to learn about training, nutrition, attire, and even injury prevention. As a runner, training for peak performance is key.

All levels of runners are welcome to join us on Tuesday, May 14, 2013 from 12 – 1:00 p.m. for an interactive online Q & A on healthy running. The chat will span a wide array of running related topics – so join us and bring your hardest running questions! I will be available to answer questions to help you best prepare for AJC Peachtree Road Race, your first 5k or a marathon PR.

If you are interested in learning more about running benefits, prevention, and tips, register for the live chat now. Spread the word about our online runner’s chat to your fellow runners, friends and neighbors. I’ll see you on the 14th!

CHAT TRANSCRIPT

Dr. Amadeus MasonAbout Dr. Mason
Dr. R. Amadeus Mason is a board-certified physician at Emory Sports Medicine with a special interest in track and field, running injuries and exercise testing. He is the team physician for USA Track and Field and the Nike/National Scholastic Sports Foundation Track and Field and Cross Country meets, Tucker High School, and Georgia Tech Track and Field. Dr. Mason is an active member of the Atlanta running community

ACL Injuries and Young Female Athletes

Thank you for joining me for the live chat on ACL injuries last week!  We had some excellent questions. One participant asked a key question about young females and ACL injuries and I would like to expand on my response to this important subject.

There are a growing number of  female athletes who are tearing their ACLs.  In fact, young female athletes (under 20 years old) are four to eight times more likely than males to injure their ACL.  Even though extensive research has been done on the reasons why this could happen, we are not exactly sure why females tend to injure their ACL easier. Luckily, if a young woman injures her ACL  we are able to get most athletes back to their previous level of play due to advances in arthroscopic surgery and specialized physical therapy.

Full recovery may take about eight to 10 months but important to note, is in rehabilitation, experienced physical therapists are working with the athlete to help them avoid re-injury.  The physical therapists and athletic trainers are teaching young girls how to jump, how to land, how to contract muscles correctly as well as specific exercises that will help strengthen the knee.  Some of the things we are teaching young female athletes are not instinctual but will greatly help reduce the risk of future injury if implemented correctly when the athlete starts participating in their sport again.

If you have had a ACL injury please make sure to work with your physical therapist to make sure you are working some of these aspects into your recovery.  If you have not had an ACL tear but you are a young female athlete, do some research on how to avoid injuries so you can excel in your sport without injury. One recommended source is the PEP Program which seeks to prevent ACL injuries.

For the full transcript on the chat visit - http://advancingyourhealth.org/orthopedics/past-doctor-chats/acl-injuries-chat/

About Dr. Sam Labib

Dr. Labib is an Emory Sports Medicine orthopaedic surgeon with special interest in problems and procedures of the knee, ankle, and foot. He is the head team physician for the athletic programs at Oglethorpe University, Spelman College, and Georgia Perimeter College. He is also an orthopaedic consultant to the Atlanta Faclcons, Georgia Tech and Emory University.

He has lectured both nationally and internationally at many orthopedic meetings. His research has been published in several journals, including JBJS, Arthroscopy, Foot and Ankle International and the American Journal of Orthopedics as well as numerous video presentations and book chapters. Dr Labib is Board Certified in orthopedic surgery with additional subspecialty certification in Sports Medicine Surgery.

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ACL Tear & Repair Patient Story – Freddy Assuncao, MMA Fighter

ACL tear repair surgery MMA Fighter Freddy AssunacoAnterior Cruciate Ligament tears in the knee don’t just happen to athletes playing football or soccer. Emory’s Chief of Sports Medicine, Dr. John Xerogeanes, recently repaired an ACL tear for MMA fighter, Freddy Assuncao.

Assuncao tore his ACL in training, helping one of his teammates prepare for an upcoming fight. For the repair of his potentially career-jeopardizing knee injury, Assuncao sought out renowned ACL surgeon, Dr. Xerogeanes – who is affectionately known as “Dr. X” by patients and staffers at Emory Sports Medicine – and a strong team of experts on rehabbing professional athletes from the Emory Sports Medicine Center.

Upcoming Doctor Chat: ACL Injuries

ACL Injuries Chat Sign UpDid you know that there are over 150,000 injuries to American athletes each year and female athletes are 2 to 8 times more likely to injure their ACL than their male counterparts?

Surgery is recommended for many ACL (anterior cruiciate ligament) injuries and most athletes are able to get back to their sports within 6 to 12 months. All athletes should know what they can do to prevent ACL injuries or how to take care of an ACL injury if it occurs.  Join Emory Sports Medicine surgeon, Sam Labib on Tuesday, March 26 at 12 noon for an interactive, live, web chat on ACL injuries. Dr. Labib, will be able to answer questions about  the ACL including what the ACL does, how ACL injuries occur, symptoms of an ACL injury, treatment options for ACL injuries, how to get back to your sport after an ACL injury and new research on the horizon.

Back to Life After an ACL Injury!

Prevent Joint PainACL, anterior cruciate ligament, injuries are one of the most common knee injuries among athletes. The American Orthpedic Society for Sports Medicine estimates there are over 150,000 ACL injuries each year in the US. ACL injuries can happen to everyone – from the professional athletes to the weekend warriors. The good news is that with proper treatment with an ACL specialist and adequate recovery, you can get back to the sport you love! Watch this short video of Neil, an Emory Sports Medicine patient, who has recovered from ACL surgery and is back to playing tennis and doing the things he loves to do.

About Dr. John Xerogeanes
Dr. Xerogeanes is Chief of Sports Medicine at the Emory Orthopaedic & Spine Center. Known as Dr. “X” by his staff and patients, he is an Associate Professor of Orthopaedic Surgery at Emory University as well as an Adjunct Professor at Georgia State and Mercer University. Dr. X is entering his 12th year as Head Orthopaedist and Team Physician for Georgia Tech, Emory University, Agnes Scott College and the Atlanta Dream of the WNBA. He specializes in ACL and ACL revision surgery performing over 200 of these operations each year. He is board certified in orthopaedic surgery and has his sub-specialty certification in orthopaedic sports medicine.

Dr. Xerogeanes has been recognized as one of US News & World Report’s Top Doctors with a special distinction listing him among the top 1% in the nation in his specialty. 

About Dr. Spero Karas
Dr. Karas is the Director of the Orthopaedic Sports Medicine Fellowship Program and an Associate Professor of Orthopaedic Surgery at Emory University. His specialties include sports medicine, surgery of the shoulder and knee, and arthroscopic surgery. He came to Emory in 2005, after serving as Chief of the Shoulder Service and team physician at the University of North Carolina in Chapel Hill. He is Board Certified in Orthopaedic Surgery, with a subspecialty certification in Orthopaedic Sports Medicine. He currently serves as head team physician for the Atlanta Falcons and is a consulting team physician for Emory University and Georgia Tech athletics. He cares for patients and athletes of all levels: professional, collegiate, scholastic, and recreational.

Dr. Karas was recognized as one of America’s “Top Orthopaedic Doctors” in Men’s Health Magazine April 2007 and “Top Sports Medicine Specialists for Women” in Women’s Health Magazine. Atlanta Magazine has named him “Atlanta’s Most Trusted Sports Medicine Specialist” for the past three years. Dr. Karas is an internationally recognized expert in the field of shoulder, knee, and sports medicine.

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Robert Griffin III: On the Road to ACL Injury Recovery

Dr. John Xerogeanes Emory Sports Medicine

Emory’s Chief of Sports Medicine, Dr. John Xerogeanes (Dr. X), recently spoke with the team from USA Today about the significance of NFL Washington Redskins’ quarterback, Robert Griffin III’s knee injury and the surgery to repair it.

Check out the video below via USA Today to see what Dr. X believes Robert Griffin III’s biggest recovery challenges will be and more on ACL injuries:

About John Xerogeanes, MD

John Xerogeanes MD
Dr. Xerogeanes is Chief of Sports Medicine at the Emory Orthopaedic & Spine Center. Known as Dr. “X” by his staff and patients, he is an Associate Professor of Orthopaedic Surgery at Emory University as well as an Adjunct Professor at Georgia State and Mercer University. Dr. Xerogeanes is entering his 11th year as Head Orthopaedist and Team Physician for Georgia Tech, Emory University, Agnes Scott College and the Atlanta Dream of the WNBA. Dr. X specializes in the care of the knee and shoulder for both male and female athletes of every age. He is board certified in orthopaedic surgery and has his sub-specialty certification in orthopaedic sports medicine.

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Returning to Competition after an ACL Injury and Surgery

ACL Rehab ProgramBecause our sports medicine specialists have created a new program dedicated entirely to ACL injuries and your successful recovery from them, we’ve been sharing blog posts that correspond with the stages of the program. In first post, we helped you identify goals and prepare for ACL surgery after an injury and also introduced you to the concept of prehabilitation, which is equally as important as rehabilitating after surgery. For more on that topic, check out part I of our ACL injury blog series. After helping you prepare for surgery, we then moved on to identifying your post-ACL surgery recovery goals week-by-week in part II of our series. Today, we’ll be covering the last stage of the program and the portion that’s probably most important to those who consider themselves athletes: Returning to Play.

The goals and exercises outlined below will guide you from 3 months until 8 months post surgery. It is vital to faithfully adhere to the following program to avoid re-injury to the ACL reconstruction. Having a physical therapist or certified athletic trainer to help hide you through this program is often helpful. If you’ve had ACL surgery, but are still in the early stages of rehabilitation, check out part I and part II of our ACL injury blog series before moving forward.

Months 3-4: Jogging Phase

During months 3 and 4 of your recovery after ACL surgery you will work on improving functional strength with forwards and backwards movement, increasing your cardiovascular fitness and starting a jogging progression, core strengthening and overall lower extremity flexibility. Tip: when performing exercises such as Schlopy Mini Jumps, use a mirror for feedback. Your hips should stay even and knees should not buckle in, you should flex at your knees not your hips.

Months 4-5: Agility Phase

Building agility in months 4 and 5 of your recovery is a key step in returning to play. During months 4-5, focus on your strength, cardio, flexibility, core, and agility workouts. From the exercises outlined by the program, lower extremity strength should all be done on same day and make sure you get 48 hours rest between strength exercises. Cardiovascular exercises should be done 3-5 times per week.

Months 5-6: Return to Drills Phase

Throughout months 5-6 you will continue to work on improving strength and balance and start getting back to your game. You can add the BOSU ball with your strengthening exercises and start sport specific drills and start to be a part of your team.

Months 6-7: Return to Practice Phase

During months 6-7 of your post-ACL surgery recovery, you can start practicing your sport with your team. You can get physical in practice but only progress to play when you are fully confident. You will need both the physical strength and mental confidence before you start to compete and play.

Months 7-8: Return to Competition Phase

Congratulations! Once you’ve made it this far through the ACL surgery and rehabilitation program, you are ready to return to competition!  Make sure you are in the best shape possible to return both physically and mentally. Your ACL strength and flexibility will only improve as long as you continue to challenge yourself and continue your strengthening.

Remember you won’t be 100 percent, fully recovered until 12 to 18 months. Professional athletes take one year to return to high level competition. Be patient!

If you’ve injured your ACL, whether or not you’ve had surgery yet, check out our ACL rehabilitation program website. All of the phases listed above are outlined on the site with detailed instructions, exercises and tips for making your recovery after ACL surgery as effective as possible.

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