Borchers et all studied meniscus and cartilage injuries in primary ACL and revision surgeries through the Multicenter Orthopaedic Outcomes Network and the Multicenter ACL Revision Study. This research found that meniscus injuries are the most common additional injury found in both primary procedures and revision. Having history of meniscectomy is also the most important factor associated with cartilage damage. This indicates that in the presence of a meniscus injury the best course of treatment, if possible, to to repair the meniscus injury. Roman et all reviewed a different study of 437 ACL reconstructions with 82 meniscus repairs and found that the repair had a ninety-two per cent success rate at a two year follow up. So it appears that meniscus repairs are quite successful and that this is the best way to maintain the integrity of the structures in the knee which protect from future wear and tear.
Archives: FAQs
My daughter is 16 years old and has recent torn her ACL. I have been doing research on the different graft options, and what is the best choice?
One of the most important things to consider when having an ACL reconstruction is what tissue to use as the graft. In a recent article out by Lynch et al there is some data about this from the Multicenter Orthopaedic Outcomes Network, which is a large, multi-center, collection of data from thousands of ACL reconstructions. In this article they discus the importance of choice of graft with successful outcomes. They found that the choice of graft and the patients age were the most predictive variables. Use of an allograft (donor or someone else’s tissue) had a four times greater risk of re-rupture than when an autograft (patients own tissue) was used. Re-rupture was more likely in the age group ten to nineteen and then every ten years the risk decreased slightly. The take home message is that for younger patents the best choice is autograft, with the least chance for re-tear. They did not discuss any differences between the two most common autograft choices; patella tendon and hamstring tendon, so on this point I would recommend you discuss this further with your surgeon.
If I have diabetes will a steroid injection for trigger finger be successful?
According to a study by Wojahn et al the long term success rate for a one time steroid injection for trigger finger is forty five percent. They did look at outcomes for patients with and without diabetes and they found no significant change in outcome for the group of patients with diabetes. However these authors also discussed a few other recent studies which have shown a slightly higher risk of recurrence of symptoms for patients with diabetes.
If I have been diagnosed with trigger finger, will a corticosteroid injection cure my symptoms?
According to a long term study but Wojahn et al there is good data to suggest that a single injection can improve your trigger finger symptoms. This study showed a success rate of a one time steroid shot to be forty-five percent, and if you are female this increases to nearly fifty percent. They also demonstrated that if you have symptom relief past two years then there is and eighty two percent chance that you will continue to have relief for the long term.
When would a tibiotalocalcaneal arthrodesis be appropriate?
This will be up to the individual orthopedic surgeon, however, it may be indicated in patients with severe bone loss, severe deformity and advanced arthritis affecting both the ankle and subtalar joint.
What is tibiotalocalcaneal arthrodesis?
It is a combined fusion of the ankle joint and subtalar joint.
What is a burst fracture and why does it occur?
A burst fracture is a more severe form of compression fracture that typically occurs from a high energy axial load (i.e. car accident, fall from a high height). The vertebral body can be crushed in all directions causing a bursting of fragments which can cause neurologic deficit.
I was diagnosed with a burst fracture at T11, is this common?
Yes, as far as thoracolumbar injuries, a burst fracture in this region has been shown to make up 20 per cent of all thoracolumbar injuries.
My toddler bit me yesterday on my upper arm and broke the skin. Should I seek treatment? I am embarrassed about this however I am wondering if there is a chance of infection.
There is always a high risk of infection associated with bites as mouths of mammals tend to carry a high number of bacteria. Human bites are no exception. The major concern with human bites is also the chance of infectious diseases transmitted through the bite, but if your son is a toddler this risk would be low. That being said, however, you should follow up with your physician for a thorough assessment and cleaning of your wound.
My 12 year old recently was bitten by our cat and now has a red track running up into his forearm. Should I be concerned about this? If I took him to the doctors, what could they do for him?
You should seek immediate medical attention for your son. Cat bites typically carry a higher risk of infection rate and it sounds like your son has a well-developed infection that is quickly spreading. The physician will begin him immediately on antibiotics and be able to determine how deep the infection is and if surgery is needed to better clean the wound.
Will my baby undergo imaging studies when they are born to look for developmental hip dysplasia?
Universal ultrasonography screening of newborn infants is not recommended in the current guidelines, however, performing an imaging study before they are six months old is recommended if there are significant risk factors present such as breech presentation, family history and a history of clinical instability.
What is developmental dysplasia of the hip?
In a normal hip the ball at the upper end of the thigh bone fits firmly into the socket. In babies with DDH the hip joint is not formed normally and the ball is loose in the socket so it’s easy to dislocate. The degree of hip instability will vary in children.
I have debilitating rheumatoid arthritis through my feet making walking difficult, is surgery an option for my condition?
This will be up to your supervising specialist as many individual factors need to be considered first. If surgery is appropriate they may look at options such as arthrodesis (fusion of the ankle joint) or total ankle replacement.
What is idiopathic congenital clubfoot?
Congenital means that the patient is born with it and idiopathic means it is of unknown cause. Clubfoot is known as Talipes Equinovarus – where the ankle and foot are in an atypical position (talipes) in that the foot points downward at the ankle (equinus) and the heel of the foot is turned inwards (varus).
What is the Ponseti method for treatment of clubfoot?
It is a series of gentle manipulations and casting as well as a bracing regimen that is performed for children with clubfeet usually within the first few weeks of life.
My mother suffers from severe osteoporosis and she was just diagnosed with a compression fracture at T12. Will she need to wear a brace?
Ultimately this is up to the treating physician. Recent research has demonstrated that stable benign osteoporotic compression fractures treated without a brace did not result in inferior outcomes in patient disability as compared to soft or rigid-brace treatments.
What is an osteoporotic compression fracture?
Osteoporosis is a disease in which bones become weak and become more prone to breaking. Compression fractures due to osteoporosis most often occur in the vertebrae and are caused when too much pressure is placed on a weakened vertebrae and the front of the vertebrae cracks and loses height
What is the difference between an ulnar nerve compression and carpal tunnel?
The carpal tunnel is a tunnel through your wrist whose boundaries are created by fascia, bone and tendons. Two of the major nerves to the wrist and hand run through this tunnel. The ulnar nerve runs outside of the tunnel so when the ulnar nerve is compressed it is a different diagnosis with different symptoms
My pinky finger is numb. I work as a welder and didn’t wear my gloves while grinding yesterday. Should I be concerned?
You possibly could be having ulnar nerve compression due to trauma. Vibrations from grinding can be traumatic to nerves and can cause swelling, which can then cause swelling. This swelling can cause a brief compression of the nerve as it courses through a small tunnel in your wrist. It is wise to use gloves to decrease vibration and best if you rest it all together.
I have been diagnosed with Tarsal Tunnel Syndrome will surgery be required?
Typically non-surgical treatment will be employed first. This may include anti-inflammatory medication, activity modification, night splinting, physical therapy and eliminating use of restrictive clothing or footwear. If this management fails to provide relief surgical measures may be considered.