Knee Injuries

Cartilage Replacement Surgery – A Patient’s Succes Story


cartilage repair
Marcus Hutchinson knows all too well about surgery and physical therapy – he has had 6 surgeries on his left knee. He has also been a physical therapist for 22 years. As a teenager, Marcus was diagnosed with osteochondritis dissecans, also known as OCD, a joint condition in which a piece of cartilage, along with a layer of the bone beneath it, comes loose from the end of a bone due to trauma or lack of blood flow to this area. Osteochondritis dissecans is most commonly found in the knee and often occurs in young men.

By the time Marcus arrived at Emory Orthopaedics & Spine in Dr. Sam Labib’s clinic in 2006, his left knee had been operated on 4 different times. Dr. Labib examined Marcus and determined he had a massive osteochondral defect in his left knee that involved his entire lateral femoral condyle, a portion of the top bone of the knee joint.

Previous doctors had told Marcus that the only option he had left was total knee replacement. Dr. Labib did not recommend knee replacement because Marcus was too young to have this procedure. Typically, a joint replacement will only last about 15-20 years so if Marcus were to have the knee replaced in his 30’s, he would probably need to have another knee replacement by his 50s.-

Dr. Labib was able to offer Marcus a unique procedure called cartilage replacement surgery. Marcus had a massive fresh allograft implantation taken from a cadaver in February 2010 to treat his osteochondral defect.

There are several surgical techniques available to treat patients with OCD.

Below are three that Dr. Labib regularly performs.

• Microfracture Surgery – In microfracture surgery, small holes are drilled into the underlying bone, creating blood clots. As the blood clots heal, new repair cartilage or fibrocartilage forms.

• Autologus Osteochondral Plug Transfer – In this procedure, the patient’s own cartilage and bone are harvested from a low-stress area of the knee and implanted into the patient’s knee in the damaged area to fill the holes and defects with healthy cartilage and bone.

• Fresh Allograft Implantation – In this surgery, the cartilage and bone are taken from a fresh cadaver that has been donated for medical use. The donated tissue, also called an allograft, is thoroughly screened and matched to the patient defect to give it the best possible chance of successful healing. The surgeon prepares the patient’s knee by removing the damaged area. The allograft is then implanted and anchored to the surrounding bone.

Marcus’ surgery was performed at Emory University Orthopaedics & Spine Hospital. When asked about his experience he states, “I had such a positive experience at the hospital. Great care! Very attentive staff. Clean, professional and efficient.”

Marcus had one major goal following surgery and that was to walk and stand without pain. “I stand all day at work when seeing my patients for physical therapy. Before surgery with Dr. Labib, I had so much pain in my knee that it was affecting my job and day to day life. I feel so much more stable and pain-free now after having cartilage replacement surgery.” Marcus says he has a new perspective on what patients are experiencing after surgery and during physical therapy which has made him better at his job as a physical therapist. He is back to enjoying life with no pain and participating in low-impact activities such as swimming, cycling, and yoga.

About Dr. Sameh (Sam) A. Labib

Sam Labib, MD, is a sports medicine fellowship-trained surgeon and director of the foot and ankle service at Emory. Dr. Labib started practicing at Emory in 1999. He is an Associate Professor of Orthopedic Surgery.

Dr. Labib has a particular 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 Falcons, 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 the 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. For the past 5 years, Dr. Labib has been nominated by his peers as one of “America’s Top Doctors” as tracked by CastleConnelly.com.

Related Resources

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.

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.

Related Links

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.

Related Resources:

Understanding the Potential Benefits of Physical Therapy

National Physical Therapy MonthThe American Physical Therapy Association (APTA)’s National Physical Therapy Month (NPTM) is celebrated each October as a way to bring awareness around the potential health benefits to be sustained via physical therapy. Over 90% of back and neck problems, for example, will resolve themselves without surgery, and for some patients, there are unique benefits achieved from treatment by a physical therapist.

Physical therapy is a form of treatment—practiced by a licensed physical therapist under the referral of a physician. The purpose of physical therapy is to improve and/or restore mobility in patients for whom it is limited due to a medical condition, surgical procedure, accident or fall, neurological disease or other medical condition that has limited a patient’s functional mobility.  Often the injury limits the performance of everyday tasks.

Physical therapy programs at Emory Healthcare are available to support every type of mobility and functionality issue patients may experience. Whether a patient’s functional mobility issues relate to a neurological occurrence like a stroke, or an athletic injury like a torn ACL, our physical therapists available on both an inpatient and outpatient basis are here to help.

For more information on our physical therapy programs, including information on our department of Rehabilitation Medicine, please visit the links below.

Related Resources:

Takeaways from Running Injury Live Chat

Dr. Amadeus MasonOn Tuesday, Dr. Amadeus Mason of Emory Sports Medicine, held a live chat that answered your questions about preventing running injuries. Dr. Mason provided some great answers to some very interesting questions; from how to prevent running injuries to the ideal length of time one should consider when training for a 5k and other long distance races.  Dr. Mason also provided participants with resources on things like: knee pain and strengthening and IT Band Syndrome.

The following is a recap of the live chat, or you can check out the transcript from Dr. Mason’s Preventing Running Injuries chat.

Q. Is it better to stretch before a run? After a run? Or Both?

A. For runners stretching for flexibility, it’s better to stretch after their run, because muscles are looser and more receptive to the stretch at that time. Dr. Mason also noted that while stretching before a run doesn’t hurt, runners should keep in mind that it’s best to spend at least ¼ of the time you spend running on stretching. As an example, Dr. Mason suggests if a runner trains for an hour, it’s best to stretch for at least 15 minutes.

Q. How does a runner prevent shin splints from reoccurring and preventing the pain’s longevity?

A. Runners experiencing recurrent shin splints, or moderate to severe pain in the shin that lasts for a long period of time, should see a specialist. Make sure not to train too much, too quickly, that’s one of the most common causes of shin splints, according to Dr. Mason. If shin splints occur, it’s recommended that a runner modifies their training regimen to accommodate for pain relief. Females, who experience shin splints on a fairly regular or recurrent basis, should contact their Physician.  Continuous shin pain is a possible indication that there’s some sort of hormonal imbalance or insufficient caloric intake from a female runner’s diet.

For more information on preventing running injuries, check out Dr. Mason’s chat transcript. You can also download the resources he shared in the chat by using the links below.

Related Resources

At-Home Workouts Ease Osteoarthritis Pain

Osteoarthritis at home workoutsIf you have osteoarthritis, you already know that exercise can help reduce pain and improve mobility. But did you know that working out at home with a DVD may bring even more relief?

According to a study presented at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), 107 people with osteoarthritis in the knee were randomized to either a DVD-based exercise group or a control group. The DVD group received a DVD-based exercise program along with verbal and hands-on exercise instructions for the first four to eight weeks. Participants in the DVD group reportedly exercised 5.3, 5.0, and 3.8 times per week at three-, six-, and 12-month intervals and had significantly greater improvement in pain and physical function than those in the control group.

While exercise did not make a significant difference in the progression of osteoarthritis, the reduction of pain and mobility among the DVD group speaks to the benefits of adding a video-based home exercise program to an existing exercise regimen.

When you exercise regularly, you strengthen the muscles around the arthritic joint, which helps decrease the pain of osteoarthritis and improve function. We suggest you do whatever keeps you on track to exercise regularly, whether it’s a video-based exercise program or exercising with a friend. But first, we recommend that you have an exercise program designed specifically for you by a physical therapist who understands osteoarthritis, to avoid injuries from overdoing it or doing the wrong exercises. The physical therapists here at the Emory Orthopaedics & Spine Center have the experience and the expertise to develop an exercise plan that meets your unique needs and helps bring relief from osteoarthritis pain.

Do you have osteoarthritis? Has a regular home-based exercise program helped ease your pain? We welcome your questions and feedback in the comments section below.

Related Resources:

Why Are Women Over 50 More Likely to Suffer From Knee Pain?

Knee Pain in womenIf you have knee pain, you know how debilitating it can be. And if you’re a woman, you have an even greater chance of developing knee pain after you reach 50. In a recent “Health Minute” spot, CNN’s Elizabeth Cohen spoke with Emory orthopedic physician Dr. Ken Mautner about knee pain in women over 50.

According to Dr. Mautner, knee pain in younger women tends to come from tendonitis or irritation issues around the knee. However, as women age, earlier knee injuries may lead to arthritis. The American College of Rheumatology reports that nearly two-thirds of women ages 50 and older have some degree of knee pain, and that pain is often due to osteoarthritis. And, Dr. Mautner says, women are more at risk for arthritis than men.

“We think that estrogen may have some protective effect on the cartilage of the knee,” Dr. Mautner says. That translates to a greater chance of experiencing knee pain after menopause.

Overuse injuries can cause knee pain, as can weight. If you have knee pain, your first step is to see your primary doctor to start determining the cause. He or she may then send you to a specialist. Treatment options may be as simple as taking acetaminophen or anti-inflammatory medications or using exercise as medicine, to strengthen the stabilizing muscles around the knee. Physical therapy may also be an option. When working out, avoid high-impact exercises that can further injure the knee. Low-impact exercises, like swimming, are a good alternative.

To watch Cohen’s “Health Minute,” visit: http://www.cnn.com/video/#/video/health/2012/01/26/hm-womens-knees.cnn

Are you over 50 and suffering from knee pain? Would you like to learn more about knee pain treatment at Emory? We welcome your questions and feedback in the comments section below.

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.

Related Resources:

 

Defining Post-Op Goals After ACL Surgery

ACL post operative goals

It is estimated that there are approximately 80,000 anterior cruciate ligament (ACL) tears in the U.S. each year. Not surprisingly, 70% of those injuries take place while the person injured is participating in athletic activity. Because ACL tears are so common and can put a hindrance on an athlete pursuing his or her career or passion, our Emory Sports Medicine team has put together an ACL program specifically for people seeking guidance in their treatment and recovery from ACL injuries and tears.

In our last blog post on ACL injuries, we got you familiar with the idea of prehabilitation, or care and steps to take before surgery for an ACL-tear. which is part one of the ACL program at Emory. In this post, we’ll cover some of the details and goals of your post-op recovery from ACL surgery, including what you should expect to see week by week:

ACL Surgery Post-Op Weeks 1-3

Goals: The goals in the first three weeks of your recovery from ACL surgery are fairly straight forward, to get patients back on their feet (off crutches), reduce swelling in the joint by faithfully icing (20 min every 2-4 hrs), and to increase the knee’s range of motion and focusing on getting extension back. For specific measurements you should track and exercises to consider, check out the materials on our website.

ACL Surgery Post-Op Weeks 4-6

Goals: Consistently reducing swelling in the knee and continuing to work on increasing the knee’s range of motion are the core goals of ACL surgery recovery weeks 4-6. At this point in your surgical recovery, your knee should be able to be straight or equal to other knee. Your knee joint should be cooing and not warm to touch. Those 4-6 weeks out from surgery should focus on being able to walk without limping and strengthening quadricep muscles.

ACL Surgery Post-Op Weeks 7-12

Goals: 2-3 months after ACL surgery, swelling should be controlled and there should be minimal effusion in the knee joint. Range of motion should be nearly full or equal to the other side full extension and knee flexion should be to 120 degrees. Knee joint should be cool and normal temperature, compared to other side. By this point, patients should have achieved good quadriceps tone with their vastus medialis oblique (VMO) firing effectively. Patients should also seek to establish normal gait pattern and be able to walk without limping at this point.

Does your recovery timeline after ACL surgery match up with what you see here? If so, or if not, please feel free to share your story with us and with our readers.

Emory Sports Medicine’s ACL injury program specializes in providing care ranging from the prehabilitation stage to getting you back in the game. So, in our next ACL injury post, we’ll share with you specific exercises you can use and steps you can take (including video demonstrations) to help you return to play more quickly. Stay tuned!

Related Resources: